Lower limb peripheral vascular examination Flashcards
What do you do first in a introduction?
Wash hands
Introduce yourself
Patient details - Name, DOB (+age)
Explain a LLPV exam to a patient
I’ve been asked to examine the blood supply to your legs today,
it’s going to involve me having a general inspection of your legs, face and chest before having a feel of your pulses in your legs and listening with my stethoscope.
What else would you say before starting the exam?
For this I’m going to need you to take your top and pants off if that’s okay?
Would you like a chaperone?
Ask if patient currently has any pain or discomfort.
What do you inspect in a LLPV exam?
General
Bedside
Eyes
Mouth
Abdomen
Legs
Feet
Toes
When inspecting generally / bedside what are you looking for?
Are they comfortable at rest?
Any mobility aids, dressings or limb prosthesis.
Look for evidence of cyanosis or pallor of the limbs.
When inspecting the eyes what are you looking for?
Conjunctival pallor
Corneal arcus
When inspecting the mouth what are you looking for?
Central cyanosis
Dehydration
When inspecting the what abdomen are you looking for?
Scars
Visible masses
Visible pulsations
When inspecting the legs, feet and toes what are you looking for?
Scars
Hair loss
Discolouration
Pallor
Missing limbs/toes
Muscle wasting
Ulcers
Why might someones legs have scars?
Bypass surgery/vein harvest sites
What is hair loss on the legs associated with?
PVD
What would you want to rule out in the legs, feet or toes are dicoloured?
?Necrosis
What would pallor of the lower limbs indicate?
Poor arterial supply
When would someone be missing limbs / toes?
Previous amputation
What can lower limb muscle wasting be associated with?
PVD
When inspecting an ulcer what do you want to assess?
Site
Depth
Size
Margins
Ulcer bed
Exudate
Ordour
Where do you want to look for ulcers other than the shin area and dorsum of the foot?
Between toes
Posterior aspect of legs
Describe arterial ulcers
Very painful.
Punched out appearance.
Located at end of digits, sole or lateral surface of ankle.
What pulses do you palpate in a LLPVE?
Abdo aorta
Fermoral pulses
Popiteal pulses
Posterior tibial pulses
Dorsalis pedis pulses
Where can you feel the femoral pulse?
What do you assess?
Best palpated at mid-inguinal point (halfway between anterior superior iliac spine + pubic symphysis).
Assess volume.
Assess for radio-femoral delay;
If there is a radio-fermoral delay present what could this indicate?
Aortic coarctation
Where can you feel the popiteal pulse?
Best palpated in the inferior region of the popliteal fossa.
Patient prone, ask them to relax legs, thumbs on tibial tuberosity, passively flex knee to 30° + curl fingers into the popliteal fossa feeling the pulse as you compress the popliteal artery against the tibia.
Where can you feel the posterior tibial pulse?
What do you assess?
Best palpated posterior to the medial malleolus of the tibia.
Assess volume
Compare both feet
Where can you feel the dorsalis pedis pulse?
What do you assess?
Best palpated over the dorsum of the foot, lateral to the extensor hallucis longus tendon, over the 2nd and 3rd cuneiform bones.
Assess volume + compare to other foot.
What type of sensation do you want to assess in the LLPV exam?
Where should you start?
Light touch sensation
starting distally to identify limb paraesthesia which can be a symptom of acute limb ischaemia.
Where do you assess power in the LLVP exam?
Legs + foot
Hip flex + exten
Knee flex + exten
ankle dorsi + plantar flexion
toe - dorsi + plantar flexion
Where do you auscultate in the LLVP exam?
What do you listen for?
Abdo aorta
Fermoral arteries
Bruits
How do you perform Buerger’s test?
Patient supine, elevate both legs to 45° and hold for 1–2 minutes.
Sit patient up + ask them to hang legs down over the side of the bed at 90°.
Gravity aids blood flow + colour returns in the ischaemic leg.
The time it takes to become pink/red relates to the severity of ischaemia (Buerger’s time).
Both legs examined simultaneously.
In buerger’s test what does pallor indicate?
ischemia
What is Beurger’s angle?
What angle is considered to indicate severe limb ischaemia?
Poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale
<20 degrees
After completelting the exam what do you do first?
Wash hands
Thank patient
To complete my exam…
I’d like to perform an upper limb peripheral arterial examination, measure the ABPI, BP, perform a foot examination and measure the blood glucose
Doppler for venous insufficiency if needed
Summarise a normal LLPV exam
Today I performed an upper limb peripheral arterial examination on ____ a ___ year old ___.
On general inspection, ___ appeared comfortable at rest.
There was no peripheral stigmata of peripheral arterial disease.
Abdominal aortic pulse was not palpable and there were no audible bruits.
Pulses were present bilaterally in lower limbs and had normal rate, rhythm and character
The pulse was ___bpm
Sensation of the lower limb was intact
To conclude, this is consistent with a normal lower limb peripheral arterial examination
