Peripheral Arterial Vascular Exam

1: Expose patient and do General inspection:

• Weight, Height, BMI
• Acute distress
• IV lines
• Medications or ointments in room.
• Stockings or dressings on leg

2: Inspection of Leg:

• Features: identify surgical scars, ulcers, dermatoliposclerosis..
• Colour: White equals a mildy ischaemic limb
• Necrosis: Inspect closely for pressure necrosis and ulcers on the lower limb. 
• Vein guttering. Elevate leg and look for guttering of veins which is abnormal 

3: Palpation

• Temperature. 
• Capillary refill
• Palpate all the pulse: Femoral(mid inguinal point: 1/2 between ASIS and Pub Symphysis), Popliteal, Dorsalis pedis, posterior tibial (behind the medial malleolus).
• If you cannot feel the Popliteal, then
  • Hyperextend the knee against the bed with fingers underneath the knee to pick up the artery,
  • Place the patient in the prone position, and feel along the line of the artery.

DPA: dorsalis pedis artery  DPN: deep peroneal nerve  EDL: extensor digitorum longus EHL extensor hallucis longus AT :anterior tibial tendon

4: Auscultation:

• Bruits over femoral and subsartorial canal
• Measure the blood pressure of the limb (but need to do Doppler for ankle:brachial index)
• Reactive hyperaemia test: Occlude the femoral artery in its adductor canal till the leg goes white. Thence release the cuff and time how long it take for the leg to turn red again. Normally is 1-2 seconds

5: Buerger’s Test (see Intermittent Claudication)

6: Neuromuscular exam:

• Get the patient to walk: look for abnormal gait
• Look for muscle wasting, fasciculations etc
• Test tone, power, reflexes, co-ordination and sensation throughout the limb