Pemeriksaan Status Vaskular
Pemeriksaan Status Vaskular
VASKULAR
Diagnosis
• Anamnesis
• Pemeriksaan Fisik
Pemeriksaan penunjang
• Korelasi dengan anamnesis & pem fisik
• Menilai proses lebih lanjut
Anamnesis
Keluhan Utama
• Alasan utama pasien berobat
• Nyeri, luka, kelemahan, neurosensori, diskolorasi
Neurosensori
• Dingin, hangat, kesemutan
Luka
• Ulkus
• Pembengkakan
Rutherford’s
Rutherford’s Vascular
Vascular Surgery,
Surgery, 7th
7th ed.
ed. 2010.
2010. Saunders
Saunders Elsevier.
Elsevier. London.
London. Chapter
Chapter 13.
13. Vol
Vol 11
Anamnesis
Karakteristik Pasien
• Usia, jenis kelamin
• Kebiasaan
Rutherford’s
Rutherford’s Vascular
Vascular Surgery,
Surgery, 7th
7th ed.
ed. 2010.
2010. Saunders
Saunders Elsevier.
Elsevier. London.
London. Chapter
Chapter 13.
13. Vol
Vol 11
Pemeriksaan Fisik
Primer - Sekunder Survei
• Status Generalis : A, B, C
• Status lokalis
Inspeksi
• Perubahan kulit, atropi, sianosis
• Edema, ulkus, tanda inflamasi
Palpasi
• Suhu, sensasi, pulsasi
• Dibandingkan ekstremitas lain
Rutherford’s
Rutherford’s Vascular
Vascular Surgery,
Surgery, 7th
7th ed.
ed. 2010.
2010. Saunders
Saunders Elsevier.
Elsevier. London.
London. Chapter
Chapter 13.
13. Vol
Vol 11
Pemeriksaan Pada Penyakit Arteri
Acute Arterial Occlusion
6P :
Pain
Pallor
Pulselessness
Paresthesias
Paralysis
Poikilothermia
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Arteri
Chronic Obstructive Arterial
Disease
Claudicatio
Rest Pain
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Arteri
Lower Extremity Claudicatio
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Arteri
Upper Extremity Claudicatio
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Arteri
Rest Pain
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Peripheral Arterial Diseases
2017 Guidelines on the Diagnosis and Treatment
of Peripheral Arterial Diseases
Peripheral Arterial Disease
Perifer : tidak memperdarahi jantung atau otak
Organ lain, Extremitas
Arteri : Pembuluh darah arteri
PAD : Biasanya disebabkan oleh sumbatan (baik
organik maupun fungsional)
Peripheral Arterial Disease
ORGANIK PAD FUNGSIONAL PAD
Peripheral Arterial Disease
Peripheral Arterial Disease
Endarterectomy or bypass at
the femoral level combined
with endovascular therapy of
iliac arteries
Peripheral Arterial Disease
CHRONIC LIMB-THREATENING ISCHEMIA
Peripheral Arterial Disease
Assessment klinis kemampuan berjalan harus tersedia dan pemeriksaan
klinis juga meliputi pemeriksaan neuropati
Pemeriksaan Pada Penyakit Arteri
Inspeksi
•• PAOD
PAOD :: atrofi
atrofi otot,
otot, bulu
bulu tidak
tidak tumbuh,
tumbuh, penebalan
penebalan kuku
kuku
•• Perubahan
Perubahan warna
warna kulit,
kulit, kulit
kulit rapuh,
rapuh, edema,
edema, ulkus,
ulkus, luka
luka
Palpasi
•• Deskripsi
Deskripsi :: normal,
normal, berkurang,
berkurang, absen
absen
Auskultasi
•• Bruit
Bruit :: aliran
aliran turbulen
turbulen
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pulse Examination
Avoid using the thumb
Scale from 0 to 4
More practical
Absent
Decreased
Normal
Comparing contralateral
Assess
Neck
Upper and lower extremities
abdominal aortic pulse
Auscultation
Although typically nothing is heard on auscultation but
Bruit
Bruit, which is indicative of turbulent blood flow, is a
marker of underlying pathology
Difficult to quantify the degree of stenosis
Arteriovenous fistula
Palmar Circulation
Radialand ulnar arteries merge form palmar arch
10% congenitally incomplete
Incomplete or occlusion palmar arch Allen test
Used before
dialysis access surgery
placement radial artery catheter
Allen Test
the Allen test
Pressure applied occlude radial and ulnar artery
Patient open and close hand several times palmar
aspect blanches and pale
Release pressure over radial or ulnar, normal skin
color return within seconds
Persistent blanching or slowly resolving pallor
suggests incomplete arch or occlusion radial or
ulnar.
Ankle Pressure Measurement
Measured with blood pressure cuff and handheld
continuous-wave Doppler.
Cuff is placed above the ankle, Inflated above
systolic pressure, slowly deflated, Doppler probe
is held over posterior tibial artery, or dorsalis
pedis.
Pressure > 60 mm Hg is required to heal
ulceration in non diabetics.
Pressure > 80 mm Hg or greater is required
healing in diabetic patients.
Ankle-Brachial Index (ABI)
Simplest noninvasive method.
Brachial pressure is used as a surrogate for central
aortic pressure.
Brachial pressure is generally accurate unless there
is occlusive disease of the vessels supplying the
upper extremity.
For this reason, pressure is measured in both upper
extremities, and the higher of the two is used.
ABI
Normal value ABI 0.9 to 1.29
Intermittent claudication ABI 0.5 to 0.9
Pain at rest ABI below 0.4
Impending gangrene ABI below 0.3
Sensitivity of ABI in detecting PAD ranges from 80% to
95%
Specificity ranges from 95% to 100%
Cara Mengukur ABI
Pemeriksaan Pada Penyakit Vena
Trombosis Vena
Upper
Upper Extremity
Extremity Venous
Venous Thrombosis
Thrombosis Lower
Lower Extremity
Extremity Venous
Venous Thrombosis
Thrombosis
•• Dapat
Dapat mengenai
mengenai VV Subclavia/Axilla
Subclavia/Axilla •• Bengkak,
Bengkak, tidak
tidak nyaman
nyaman sisisisi sakit
sakit
•• Onset
Onset akut
akut •• Onset
Onset akut
akut
•• Bengkak
Bengkak pada
pada lengan
lengan •• Gejala
Gejala <<
<< elevasi
elevasi tungkai
tungkai
•• Gejala
Gejala >>
>> aktifitas
aktifitas •• Gejala
Gejala >>
>> aktifitas
aktifitas // posisi
posisi statis
statis
•• Berkaitan
Berkaitan erat
erat dengan
dengan kateterisasi
kateterisasi V
V •• Riwayat
Riwayat pembedahan,
pembedahan, trauma,
trauma,
Subclavia
Subclavia bepergian,
bepergian, imobilisasi
imobilisasi lama
lama
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Vena
Bengkak
Onset : akut/kronis
Ekstremitas : uni / bilateral
Progresifitas : tetap / makin bertambah
Etiologi : vena , limfe, sistemik
Vena
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Vena
Limfedema Primer
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Vena
Limfedema Sekunder
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Vena
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Homans sign calf pain with passive
dorsiflexion of the foot.
Varises
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pemeriksaan Pada Penyakit Vena
Ulkus
• Ulkus kronis
• iskemia arteri
• stasis vena
• neuropati
Rutherford’s Vascular Surgery, 7th ed. 2010. Saunders Elsevier. London. Chapter 13. Vol 1
Pengenalan USG Doppler
Christian Doppler
Ilmuwan Austria