Examinations
CPSA · Clinical examination · Vascular
Peripheral vascular (arterial) examination
Inspect → palpate pulses & temperature → auscultate for bruits → special tests (Buerger’s). Localises the level of arterial disease in the limb.
Practise it out loudPosition: Patient on the couch, both legs fully exposed.
The routine
Inspect
- 1Colour (pallor), trophic changes (hair loss, shiny skin), ulcers (arterial: punched-out, painful, pressure points), gangrene, scars, missing toes
- 2Between the toes and the heels (pressure areas)
Palpate
- 1Temperature (cool distally); capillary refill
- 2Pulses: femoral, popliteal, posterior tibial, dorsalis pedis (and radial/brachial in the arm)
- 3Abdominal aorta (expansile = AAA)
Auscultate & special
- 1Bruits over the femoral and abdominal aorta
- 2Buerger’s test: lift the leg to the angle of pallor, then hang down (reactive hyperaemia = sunset foot)
Signs & what they mean
Absent foot pulses, punched-out painful ulcer at a pressure point, cool footPeripheral arterial disease / critical limb ischaemia
Sudden painful, pale, pulseless, cold, paraesthetic, paralysed limbAcute limb ischaemia (the 6 Ps — emergency)
Buerger’s angle <20° with sunset rubor on dependencySevere arterial insufficiency
Expansile pulsatile abdominal mass + bruitAbdominal aortic aneurysm
To complete, I would…
- Measure the ankle-brachial pressure index (ABPI)
- Examine the venous system and the abdomen (aorta)
- Assess cardiovascular risk factors
OSCE tips
- Arterial ulcers are painful, punched-out, at pressure points; venous are shallow at the gaiter area.
- Acute limb ischaemia (6 Ps) is a surgical emergency — don’t miss it.
- Always feel for an AAA when examining the legs.