Buerger's test

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Buerger's test is used to assess the adequacy of the arterial supply to the leg. It is performed in two
stages.

With the patient supine, elevate both legs to an angle of 45 degrees and hold for one to two minutes.
Observe the color of the feet. Pallor indicates ischaemia. It occurs when the peripheral arterial pressure
is inadequate to overcome the effects of gravity. The poorer the arterial supply, the less the angle to
which the legs have to be raised for them to become pale.

Then sit the patient up and ask them to hang their legs down over the side of the bed at an angle of 90
degrees. Gravity aids blood flow and colour returns in the ischaemic leg. The skin at first becomes blue,
as blood is deoxygenated in its passage through the ischaemic tissue, and then red, due to reactive
hyperaemia from post-hypoxic vasodilatation.

Both legs are examined simultaneously as the changes are most obvious when one leg has a normal
circulation.

Buerger's test is used in an assessment of arterial sufficiency. The vascular angle, which is also called
Buerger's angle, is the angle to which the leg has to be raised before it becomes pale, whilst lying down.
In a limb with a normal circulation the toes and sole of the foot, stay pink, even when the limb is raised
by 90 degrees. In an ischaemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause
pallor. (This part of the test checks for elevation pallor.) A vascular angle of less than 20 degrees indicates
severe ischaemia.[1]

Allen's test is a test used to determine the integrity of the blood supply to the hand.

With the hand elevated both the ulnar and the radial arteries are occluded, which leads to blanching of
the hand. Then, one of the arteries is released and, in the normal case the blanching disappears over the
whole of the hand. This is repeated with both arteries - in theory the whole of the blood supply of the
hand can come from either artery