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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
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.
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
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
- 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
Auscultation
- for femoral artery bruits
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.
See also
External link
- Peripheral Arterial Occlusive Disease - fpnotebook.com
"Peripheral vascular examination"