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Peripheral Vascular Examination

From Mediwikis

Start with the top half - touch their feet last.

Wash Hands

Introduction, Explanation, Consent

General Inspection

  • Generally well
  • Skin colour
    • Pallor
    • Discolouration

Arms

Hands
  • Clubbing
  • Nicotine stains
  • Capillary refill time (<2 seconds = normal)
  • Palmar erythema
  • Temperature changes (state where the change is)
Pulses
  • Radial
    • Rate, rhythm, character
    • Radial-radial delay (co-arctation of the aorta)
    • Radial-femoral delay (co-arctation of the aorta)
    • Raise arm upwards - check for collapsing pulse
  • Brachial
    • Palpable, rhythm, character
  • Carotid
    • Palpable, rhythm, character
    • Slow-rising? (aortic stenosis)

Neck

  • Raised JVP
  • Auscultate carotid for bruits/murmurs - ask patient to hold breath

Eyes

  • Pallor
  • Jaundice
  • Corneal arcus
  • Xanthalasma

Mouth

  • Central cyanosis
  • Anaemia - "beefy red tongue"

Torso

  • Skin changes
  • Pulsations
  • Scars
  • Abdominal Aortic Aneurysm
    • Palpate and auscultate above umbilicus
    • If pulsation below umbilicus, consider iliac aneurysm
  • Aortic bruit (atheromatous disease)
  • Renal artery bruit
    • Ausculatate anterior and posterior loins

Legs

  • Colour changes
  • Scars
  • Ulceration - especially between toes
  • Dry skin
  • Loss of hair (venous insuffiency)
  • Balls of feet & heels & posterior aspects (pressure area in bed-bound patients)
  • Temperature changes (state where the change is)
  • Pitting oedema (state where the change is)
Pulses

Using 3 fingers:

  • Femoral - located midway between symphysis pubis & anterior superior iliac spine
    • Palpable, asymmetry, character
  • Popliteal - located behind the kneecap (difficult to find)
    • Palpable, asymmetry, character
  • Posterior Tibial - 2 cm below and behind the medial malleolous
    • Palpable, asymmetry, character





  • Dorsalis Pedis - dorsal surface of the foot, proximal to the 4th interphalalangeal space
    • Palpable, asymmetry, character
Buerger's test
  • Lift the relaxed, extended feet up and support the leg at 45 degrees for 2 minutes
    • Pallor on elevation (emptying/guttering of superficial veins)
  • Sit up and swing legs over side of the bed for 2 minutes
    • Reactive hyperaemia/rubor

Further Examination

See Also