1. Introduction
The peripheral vascular examination of the lower limbs is used to assess arterial insufficiency and venous disease. It is particularly useful for suspected peripheral arterial disease, critical limb ischaemia and chronic venous insufficiency.
2. Inspection
Inspect from the end of the bed for walking aids, dressings, ulcers and asymmetry. Examine both legs for colour change, hair loss, muscle wasting, scars, varicose veins, oedema, ulcers and gangrene.
3. Temperature and pulses
Compare limb temperature with the back of your hand. Palpate the femoral, popliteal, posterior tibial and dorsalis pedis pulses, comparing side to side. Assess capillary refill in the toes if relevant. Auscultate the femoral arteries for bruits when indicated.
4. Special tests
If chronic limb ischaemia is suspected, assess Buerger''s angle and look for dependent rubor. If venous disease is suspected, inspect the calf for swelling and tenderness while remembering that Homan''s sign is not a reliable test for deep vein thrombosis and should not be used.
5. Completion
To complete the examination, assess cardiovascular risk factors, examine the abdomen for an abdominal aortic aneurysm when relevant, and measure the ankle brachial pressure index using Doppler if available.
Preparation
General inspection
Inspection
Palpation
Pulses
Auscultation
Special tests
Completion