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In a limb with a normal circulation the toes and sole of the foot, stay pink, even when the limb is raised by 90 degrees. In an ischaemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause pallor. (This part of the test checks for elevation pallor.) A vascular angle of less than 20 degrees indicates severe ischaemia. [1] [2]
The reversed blood pools in the low third of legs and feet. [17] Unlike in the arterial ultrasound study, when the sonographer studies venous insufficiency, the vein wall itself has no relevance and attention is focused on the direction of blood flow. The objective of the examination is to see how the veins drain.
An ABPI between and including 0.90 and 1.29 considered normal (free from significant PAD), while a lesser than 0.9 indicates arterial disease. [14] An ABPI value of 1.3 or greater is also considered abnormal, and suggests calcification of the walls of the arteries and incompressible vessels, reflecting severe peripheral vascular disease.
In normal patients, the feet quickly turn pink. If, more slowly, they turn red like a cooked lobster, suspect ischemia. Brodie-Trendelenburg test (assessment of valvular competence if varicose veins are present): One leg at a time. With the patient supine, empty the superficial veins by 'milking' the leg in the distal to proximal direction.
Unlike arterial ultrasonography, venous ultrasonography is carried out with the probe in a transversal position, (perpendicular to the vein axis), displaying cross-sections of the veins. [4] All collateral veins are better detected this way, including perforator veins , but of most importance is the detection of venous thrombosis .
Ultrasonography of chronic venous insufficiency of the legs; Duplex evaluation is usually done prior to any invasive testing or surgical procedure. [8] Ultrasound duplex scanning can provide additional information that may guide therapeutic decisions. The location and severity of arterial narrowings and occlusions can be identified.
Peripheral arterial disease is more common in these populations: [42] [50] All people who have leg symptoms with exertion (suggestive of claudication) or ischemic rest pain; All people aged 65 years and over, regardless of risk factor status; All people between 50 and 69 who have a cardiovascular risk factor (particularly diabetes or smoking)
A venous ulcer tends to occur on the medial side of the leg, typically around the medial malleolus in the 'gaiter area' whereas arterial ulcer tends to occur on lateral side of the leg and over bony prominences. A venous ulcer is typically shallow with irregular sloping edges whereas an arterial ulcer can be deep and has a 'punched out' appearance.