26. The arterial and venous circulation

Narrowing, dilation, traumatic injury and abnormal interconnections in the peripheral vascular system (arteries and veins) can cause symptoms of ischaemia, aneurysm, bleeding or arteriovenous fistula. Circulation problems can occur anywhere in the body, but they frequently manifest in the lower extremities. Initial examination comprises inspection, palpation and auscultation, if necessary supplemented with a capillary refill test. We also discuss examination for some peripheral circulation disorders: chronic venous insufficiency, venous thrombosis, peripheral arterial disease, acute arterial occlusion, deep vein thrombosis, compartment syndrome, blue toe syndrome and diabetic foot. Arterial Doppler ultrasound to determine the ankle brachial index and Allen’s test are discussed under ‘Examination on indication’.