1. health and fitness
2. disease

Basic Vascular (Arterial) Examination
There are distinct differences between an arterial or venous vascular
examination, and in a clinical exam setting it is often important to be able to
differentiate which is most relevant in the circumstances. Of course this
makes the specifics of the history very important. In this ‘vascular
examination video’ we have focused primarily on an arterial examination of
the legs. However for completion you will also find information on the venous
examination within this proforma.
WIPE
•
Wash hands
•
Introduce yourself
•
Permission
•
Position
•
o
Arterial: Patient laying down flat, with pillow behind head for
comfort
o
Venous: Patient stood in front of you initially, before laying down
Exposure (patient should have legs and abdomen exposed, with
genitalia covered. For teaching purposes shorts have been utilised in
the video)
Identify Patient (confirm the following details before starting)
•
Name
•
Age
•
Date
Inspection
•
Start with general inspection
o Does the patient look in pain?
o Is he/she comfortable?
o Is he/she fully aware of what is happening?
o
Does the patient appear of ‘normal’ colour?
o Overall build (BMI)
o
•
Are there any indicative findings in the patient’s surroundings
(e.g. GTN spray etc)?
Hands
o Peripheral Cyanosis
o Temperature
o Tar staining
Arterial Specific
LEGS
Chronic Lower Limb Ischaemia
• Hair loss
• Guttering of Veins
• Shiny/thin skin
• Asymmetry (including wasting)
o features
of
impaired
nutrition
• Discolouration
o e,g.
Blackening
of
extremities (incl toes)
• Ulcers
Acute Lower Limb Ischaemia
• Pallor
Venous Specific
General inspection point
• Pregnant?
LEGS
• Visible dilated/tortuous veins
• Venous insufficiency (in gaiter
area especially)
o Oedema
o Hemosiderin deposits
o Lipodermatosclerosis
o Eczema
o Ulcers
Ulcers
Arterial Ulcers
Generally tend to be:
• Painful
• Found in areas of high pressure
o Heels, malleoli, head of
5th metatarsal, between
toes or on the balls of
feet
• ‘Punched out’
Venous Ulcers
Generally tend to be:
• Painless
• Found in gaiter area
o Calf perforators
• Sloughy
Palpation
•
•
Temperature
o Compare left and right at each level
o Often it is recommended that you start distally and work your
way up.
Capillary refill
•
Palpation of varicose veins (venous examination)
o Tenderness may suggest thrombophlebitis
• Pulses
(You must know each of the main pulses and assess these as
appropriate):
1. Radial
o Radial-Radial Synchrony
2. Abdominal
o AAA
3. Femoral
o Radial-Femoral Synchrony
4. Popliteal
5. Dorsalis Pedis
•
Saphena-femoral Junction (for Venous examination)
Auscultation
(Listening for bruits, not included on video)
• Renal Arteries
• Abdominal Aorta
• Femoral Arteries
• Over adductor hiatus
• Popliteal Arteries
In an exam you may only be asked to auscultate one or two of these, but is
important to understand and appreciate these in case you are questioned.
Special Tests:
•
Buerger’s test (should be offered, but normally performed if poor
capillary refill):
o Raise feet off table
o Watch for blanching and guttering
o Lower leg and have patient dangle feet over side of bed.
o Normal: <10secs for colour to return. <15secs for veins to fill
o Reactive Hyperaemia suggests arterial insufficiency
To conclude your arterial vascular examination you should:
•
Take the BP in both arms (should normally not be more than
15mmhg difference between arms)
•
Perform a cardiovascular examination
•
ECG (remember AF predisposes to distal embolism)
•
Ankle-Brachial Pressure Index (ABPI): A ratio less than 0.8
usually suggests arterial insufficiency
•
Doppler Ultrasound may be considered
To conclude your venous vascular examination you should:
•
Tap Test:
o Right hand over distal part of varicose vein
o Tap vein proximally (10-15cm) with left hand
o If fluid thrill felt with right hand it suggests
incompetent valves
•
Tourniquet Test
•
Trendelenberg’ Test
o Can be performed instead of Tourniquet test
•
Perthe’s Test
•
Abdominal and rectal examination (for masses)
Example of how to report clinical findings
•
General Findings
o
•
“This is Vincent Brown a 55 year old man who presented
with.... .. On examination I found...”
Important Positive Findings
o List these off
•
Important Negative Findings
o
•
However, there was no... these should be those relevant to ruling
out differentials)
Clinical Conclusions
o
“These findings are consistent with...”
o
Then be prepared to explain how you would like to proceed
(investigations and management etc)