Supplementary Notes to the Peripheral Vascular Exam (Leg):

Draping & Inspection:

• Inspection:

  • Hair loss: can be another sign of arterial insufficiency.

  • Venous ulcers- often occur in the region above the medial malleolus.

  

   

  • Aterial ulcers- most commonly occur distally on the foot (i.e. toes and the sole of the foot).

  

   

  • Edema- compare shape and size of the two legs.  There are two main types of edema, pitting and non-pitting.  Below is an example of non-pitting edema from lymphatic obstruction.

  

Palpation:

• Femoral Pulse: NOT DONE IN YEAR I.

• Popliteal Pulse: The knee can be slightly bent, in order to relax the hamstring group of muscles.

• Posterior Tibial: - is not present in 15% of the normal population.

• Edema:- REMEMBER to check for pitting or non-pitting edema.
   
   

Auscultation:

• Auscultation for bruits:  Auscultation for bruits can be performed in the abdomen (for abdominal aortic aneurysms) and at the femoral arteries.

Special Maneuvers:

• Pallor on Elevation:  To evaluate the arterial supply of an extremity, especially with weak or absent pulses.  Mild pallor on elevation is normal.  Marked pallor may signify arterial insufficiency.  Colour returns normally in less than 10 seconds, and superficial veins usually fill in less than 15 seconds.

• Rubor on Dependency:  With severe arterial insufficiency, the dependent limb often becomes very red after a period of elevation.