Peripheral vascular examination

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A peripheral vascular examination is a medical examination to discover

• Position/lighting/draping
• Inspection
• Palpation
• Auscultation
• Special maneuvers

Position/lighting/draping

Position – patient should be lying in the supine position and the bed or examination table should be flat. The patient's hands should remain at their sides with their head resting on a pillow.

Lighting – adjusted so that it is ideal.

Draping – the legs should be exposed, the groin and thigh covered. Drapes are usually placed between the legs.

Inspection

On inspection the clinician looks for signs of:

• trauma
• previous surgery (scars)
• muscle wasting/muscle asymmetry
• edema (swelling)
• erythema (redness)
• medial malleolus
  .
• hair – hair is absent in
  peripheral vascular disease
  (PVD)
• shiny skin – seen in PVD
• Haemosiderin
  deposits
• Lipodermatosclerosis

Palpation

• Temperature – cool suggest poor circulation, sides should be compared
• Pitting edema – should be tested for in dependent locations – dorsum of foot, if present then on the shins. If the patient has been in bed for a longer period of time one should check the sacrum.
• Capillary refill – should be less than 3 seconds.

Arterial pulses

• Dorsalis pedis artery pulse – on dorsal surface of the foot, running lateral to the tendon of the first toe
• Posterior tibial artery pulse – posterior and inferior to the medial malleolus
• Popliteal artery pulse – behind the knee, typically done with both hands
• Femoral artery pulse – in the femoral triangle / halfway between the ASIS and pubic tubercle

Auscultation

• For femoral artery bruits

Special maneuvers

• oedema, in which case toe pressure
  or Toe-brachial pressure index (TBPI) should be measured to aid in the diagnosis.
• Venous refill with dependency (should be less than 30 seconds) – the vein should bulge outward within 30 seconds of elevation for one minute.
• Buerger's test (assessment of arterial sufficiency):
  With the patient supine, note the colour of the feet soles. They should be pink. Then elevate both legs to 45 degrees for more than 1 minute. Observe the soles. If there is marked pallor (whiteness), ischemia should be suspected. Next check for rubor of dependency. Sit the patient upright and observe the feet. In normal patients, the feet quickly turn pink. If, more slowly, they turn red like a cooked lobster, suspect ischemia.
• Brodie-Trendelenburg test (assessment of valvular competence if varicose veins are present):
  One leg at a time. With the patient supine, empty the superficial veins by 'milking' the leg in the distal to proximal direction. Now press with your thumb over the saphenofemoral junction (2.5 cm below and 2.5 cm lateral to the pubic tubercle) and ask the patient to stand while you maintain pressure. If the leg veins now refill rapidly, the incompetence is located below the saphenofemoral junction, and vice versa. This test can be repeated using pressure at any point along the leg until the incompetence has been mapped out.

References

External links

• http://jama.ama-assn.org/cgi/content/full/300/2/197 JAMA: Ankle Brachial Index
• http://circ.ahajournals.org/cgi/content/full/105/7/886 Circulation: Tools for Coronary Risk Assessment