Peripheral vascular examination: Lower limb Flashcards
(26 cards)
How do you explain to the patient what the lower limb peripheral vascular examination is?
Examination of the blood vessels
Includes checking the pulses in the feet, ankles, legs and abdomen
Before starting the examination, which 3 things should you confirm with the patient?
Are they okay with exposing legs and abdomen
Would they like a chaperone
Are they in any pain
In the lower limb peripheral exam, which 3 things should you look for?
- PAD signs
- VTE signs
- Scars
- How is patient positioned
What PAD signs should you look for?
Look from toes to hips:
Gangrene
Missing toes
Nail changes
Arterial ulcers
Smooth, shiny skin and hair loss
Pallor
Peripheral cyanosis
Xanthomata: Near achilles tendon, front of ankle
Where on the lower limbs should you look for arterial ulcers?
Bony prominences and pressure points:
Lateral malleolus, MCP joints, heel, between toes
What VTE signs should you look for?
Look from toes to hips:
Venous ulcers
Muscle wasting
Varicose veins
DVT signs
Superficial thrombophlebitis
Why is it important to look for scars in the lower limb peripheral vascular examination?
Can indicate vein graft for bypass surgeries or healed ulcers
Where on the lower limbs should you look for venous ulcers?
Gaiter area: On inner calf, between knee and medial malleolus
If the patient is positioned with their legs elevated, what does this indicate?
Chronic venous insufficiency eg. VTE
Venous disease improves with elevation, as it improves venous return due to gravity
If the patient is positioned with their legs dangling off the bed, what does this indicate?
Peripheral arterial disease
Arterial flow improves when walking or standing, as gravity causes arterial blood to reach lower limbs
After looking, what should you do in the peripheral vascular lower limb exam?
Feel temperature of both lower limbs from toes to hips
Symmetrically warm: Normal perfusion
Cold: Poor perfusion, suggests arterial disease
After checking temperature, what should you do in the peripheral vascular lower limb exam?
Capillary refill time
Before testing, ask patient if they have any pain in their legs
In the lower limb exam, which pulses do you palpate?
Femoral
Popliteal
Dorsalis pedis
Posterior tibial
In what order do you palpate the lower limb pulses?
From proximal to distal: To assess arterial flow and where it decreases
Where do you palpate the femoral pulse?
Midway between ASIS and pubic symphysis, along crease line where torso meets thigh
What 3 things are you checking for when you palpate the femoral pulse?
- Is it present
- Is there good volume (strong pulse) or low volume (weak pulse)
- Radio-femoral delay: Suggests aortic coarctation distal to left subclavian artery
After palpating the femoral pulse, what should you also check?
Femoral bruit: Auscultate with diaphragm for whooshing sound
Indicates turbulent flow in the femoral artery, which could be due to iliac artery stenosis, femoral artery stenosis, arteriovenous fistula
How do you palpate the popliteal pulse?
- Make sure the patient is lying with their legs flat
- Ask patient to relax legs as much as possible
- Bend knee to 30 degrees, then cup popliteal fossa with both hands
- Warn patient that you are going to squeeze behind knee, then compress popliteal artery against tibia to try to feel pulse
- Tell examiner whether you can feel it or not
When you are palpating the popliteal pulse, what pathologies can do you check for?
Popliteal aneurysm: Pulsatile mass
Baker’s cyst: Soft swelling that doesn’t pulsate
Ganglion cyst
When palpating the dorsalis pedis pulse, what 3 things do you check?
- Is it present
- Rate and volume
- Compare with other foot to see if they are equal strength
When palpating the posterior tibial pulse, what 3 things do you check?
- Is it present
- Rate and volume
- Compare with other foot to see if they are equal strength
What special test do you do in the lower limb peripheral vascular exam?
Buerger’s test: Checks arterial blood flow to lower limbs
Used if patient has suspected PAD eg. chronic limb ischaemia
How do you perform Buerger’s test with elevation (step 1)?
- Have the patient lie on their back.
- Lift one leg to 45° for up to 2 minutes, make sure that patient is still comfortable
- Observe the color of the sole of the foot:
Normal/negative: Remains pink even when elevated
Buerger’s Angle: The angle at which the foot becomes pale
<20° is severe ischemia
(i.e., if the foot becomes pale when only slightly raised)
How do you perform buerger’s test with dependency (step 2)?
- Ask the patient to sit up and dangle the legs over the side of the bed, AFTER STEP 1 (ELEVATION)
- Observe the color return:
Normal: Foot returns to pink within ~10 seconds
Positive Buerger’s Test:
Delayed color return (>30 seconds)
OR
Reactive hyperemia (foot turns dark red/purple before pink)
