Peripheral vascular examination

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In medicine, the peripheral vascular examination is a series of maneuvers to elicit signs of peripheral vascular pathology. It is performed as part of a physical examination, or when a patient presents with leg pain suggestive of a cardiovascular pathology.

The exam includes several parts:

Position/Lighting/Draping
Inspection
Palpation
Auscultation
Special maneuvers

1 Position/Lighting/Draping
2 Inspection
3 Palpation
- 3.1 Arterial pulses
4 Auscultation
5 Special maneuvers
6 See also
7 External link

[edit] 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 her sides with her head resting on a pillow.

Lighting - adjusted so that it is ideal.

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

[edit] Inspection

On inspection the physician looks for signs of:

trauma
previous surgery (scars)
muscle wasting/muscle asymmetry
edema (swelling)
erythema (redness)
ulcers - arterial ulcers tend to be on the plantar surface of the foot, venous ulcers tend on be on the medial aspect of the leg superior to the medial malleolus.
hair - hair is absent in peripheral vascular disease (PVD)
shiny skin - seen in PVD

[edit] 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)(the time it takes to say capillary return)

[edit] 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 symphisis

[edit] Auscultation

for femoral artery bruits

[edit] Special maneuvers

Ankle-brachial index (blood pressure)
Pallor on elevation - if there is marked pallor (whiteness) it is positive
Rubor on dependency - the feet turn red like a cooked lobster
Venous refill with dependency (should be less than 30 seconds) - the vein should bulge outward with in 30 seconds of elevation for one minute.