POCUS can be a valuable tool for screening both peripheral venous and arterial pathology.
If you suspect critical limb ischemia, you can use a similar approach to venous evaluation to assess for arterial occlusion.
- For lower extremity: start by surveying the common femoral artery, superficial femoral artery and popliteal artery.
- For upper extremity: start by surveying the carotid artery, subclavian artery, axillary artery and brachial artery
- You can then extend the exam to evaluate the area of tenderness.
Evaluate for:
- Compressibility with pulsation
- Visible clot in the lumen
- Doppler flow assessment with either color or spectral doppler
Conclusion: POCUS can expedite diagnosis and resources prior to definitive testing with CT angiography.
References
Gonzalez AA, Brenner DS. Arterial Thrombosis Diagnosed With Point-of-Care Ultrasound. Cureus. 2024 Sep 13;16(9):e69357. doi: 10.7759/cureus.69357.
Frederick MK, Stolz LA, Duran-Gehring PE. Vascular Ultrasound. Emerg Med Clin North Am. 2024 Nov;42(4):805-818. doi: 10.1016/j.emc.2024.05.011.
Drake A, Dreyer N, Hoffer M, Boniface K. Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med. 2022 Feb;6(1):1-7. doi: 10.5811/cpcem.2021.11.54904.