Study of arteries

The examination of arteries allows to detect signs of partial occlusion as a result of the development of atherosclerosis or their embolism. Peripheral arterial circulation disorders are usually more severe in the elderly due to the deterioration of collateral blood flow.

Demand, collection of anamnesis

The survey reveals the presence of intermittent claudication, which is the first symptom of chronic arterial insufficiency of the legs. The patient observes during walking the appearance of pain or cramps in the calves, passing at rest. The gradual decrease in the length of the path that the patient can pass without the appearance of pain reflects the progression of the disease. These disorders occur with lesions of the femoral or internal iliac arteries. Pain can also arise at rest, with a particularly advanced process. In this case, the patient is forced to lower his leg: in this position, the circulatory conditions improve, perfusion increases, although a slight increase in venous pressure may cause local edema.

[1], [2], [3], [4]

Inspection

When examining, you can identify signs of arterial insufficiency. In acute development, the limb becomes cold, pale, later cyanotic. Gangrene may develop , requiring the supervision of a surgeon. Long-term ischemia leads to a disorder of sensitivity and trophic disorders; a violation of the growth of nails, hair, atrophy, thinning of the skin and subcutaneous fat. Characteristic changes in the form of the limb when changing its position: when climbing up, it becomes pale, cyanotic, when lowering down there is reactive hyperemia with purple-cyanotic skin color.

Raynaud's disease often occurs in young women and is a consequence of insufficient arterial blood supply to the fingers. Such patients note increased sensitivity to cold, cold water, there is whitening and numbness of the fingers (primarily IV and V) due to spasm of the arteries and transient disruption of the arterial blood supply of tissues. Upon examination, the fingers become white, cold to the touch, insensitive. After this, cyanosis and painful reddening of the fingers arise as a result of increased blood flow in connection with the restoration of arterial patency. Similar disorders of blood flow associated with the defeat of small arteries of the limbs, are often found in inflammatory lesions of connective tissue, for example, in systemic scleroderma and systemic lupus erythematosus.

Apparent pulsation of arteries, for example, carotid, is detected with aortic valve failure, and sometimes with severe sclerotic changes of this vessel in elderly women.

If there is a suspicion of peripheral circulatory insufficiency, a detailed feeling of the vessels, on both sides, is advisable. The posterior tibial artery is probed behind the medial condyle; the dorsal artery of the foot - near the tendon, going to the big toe. With intermittent claudication and other manifestations of insufficiency of the blood supply to the feet, the pulsation of these arteries can be dramatically weakened and even absent. When you feel the ischemic limb, in particular with the acute development of ischemia, accompanied by pain and impaired pulsation, pay attention to the decrease in skin temperature, especially in the distal areas.

Auscultation of vessels is carried out at points corresponding to their projection on the surface of the body. The appearance of systolic noise is very characteristic for the development of arterial stenosis, with complete occlusion of the vessel the noise may disappear. Systolic murmurs over the carotid arteries are often noted. Of great practical importance is the detection of noise over the renal arteries, which may indicate their stenosis (the cause of hypertension).