Buerger's test

Buerger's Test is a clinical diagnostic procedure used to evaluate the arterial circulation of the limbs, particularly to detect the presence and severity of peripheral arterial disease (PAD). This test is named after Leo Buerger, who first described it in the early 20th century. Buerger's Test is primarily performed on the lower extremities but can also be applied to the upper limbs.

Procedure

The procedure involves several steps to assess arterial blood flow:

1. The patient is asked to lie down on a flat surface, and the legs are elevated to an angle of 45 degrees for 2 to 5 minutes. This elevation helps in draining the blood out of the veins and can lead to pallor in the feet in cases of severe arterial insufficiency.
2. The patient is then instructed to sit with the legs dangling over the edge of the examination table. The examiner observes the time taken for the return of color to the feet and the filling of the superficial veins. A delay in these signs indicates compromised arterial blood flow.
3. The color change upon dependency (redness or rubor) is noted, which may indicate reactive hyperemia due to arterial insufficiency.

Interpretation

A positive Buerger's Test suggests significant arterial insufficiency. The normal color should return within 10 seconds, and venous filling should occur within 15 seconds. Delays in these times, pallor on elevation, or a deep red color (rubor) upon dependency are indicative of peripheral arterial disease.

Clinical Significance

Buerger's Test is a simple, non-invasive way to assess the arterial supply to the limbs. It is particularly useful in the early detection of PAD, a condition where narrowed arteries reduce blood flow to the limbs. PAD is often caused by atherosclerosis, and early detection is crucial for the management and prevention of complications, such as ulcers, gangrene, and limb loss.

Limitations

While Buerger's Test can be indicative of PAD, it is not definitive. Further diagnostic tests, such as Doppler ultrasound, ankle-brachial index (ABI), and angiography, may be required for a conclusive diagnosis. The test's sensitivity and specificity can vary, and it may not detect mild to moderate cases of PAD.

Related Conditions

• Peripheral Arterial Disease
• Atherosclerosis
• Thromboangiitis Obliterans (Buerger's Disease), a different condition also named after Leo Buerger, which specifically affects small and medium-sized arteries and veins in the arms and legs.

See Also

• Ankle-Brachial Index
• Doppler Ultrasound
• Angiography