PVD Examination
1. General inspection:
 Patient – colour, respiration, peripheral swelling
 Around bed – mobility aids, O2, cigarettes, medications
2. Hands:
 Temperature
 Colour
 Fingernails – nicotine staining, capillary refill
 Tendon/palmar xanthomata
 Radial pulse (character, rate, rhythm) in both arms
 BP in both arms
5 P’s of PVD:
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Pulselessness
Paralysis
Paraesthesia
Pain
Pallor
3. Face:
 Eyes – xanthelesma, sclera and conjunctiva pallor.
 Mouth – central cyanosis
4. Abdomen:
 Inspection – obvious pulsations, masses, scars.
 Palpate and percuss liver edge (check for pulsations)
 Palpate and percuss spleen
 Palpate and ascultate aorta
5. Legs:
Inspection (comparing both legs):
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Trauma/injuries
Scars
Dry/shiny skin
Oedema
Pallor & Erythema
Ulcers
Missing hair/nails/toes
Muscle wasting
Check between toes & ask patient to wiggle them (motor dysfunction in acute ischemia)
Palpitation:
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Temperature
Capillary refill
Pitting oedema
Sensation testing – tell patient to close eyes
Pulses: normal/absent/reduced
Pulses:
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Dorsalis pedis artery pulse - on dorsal surface of the foot, running lateral to the tendon of the
first toe
Posterior tibial artery pulse - posterior and inferior to the medial malleolus
Popliteal artery pulse - behind the knee, typically done with both hands
Femoral artery pulse - in the femoral triangle / halfway between the ASIS and pubic symphysis
6. Auscultate femoral artery
Buerger’s test:
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Ask patient to lie flat. Note the colour of the feet – they should be pink.
Raise both legs to 45 degrees and hold them there for at least 1 minute – pallor (whiteness) is
rapid if there is poor arterial supply.
Then ask the patient to place their legs at 90 degrees over the edge of the bed. Normally the
feet quickly turn pink. In significant PAD, upon hanging the legs over the side of the bed the skin
may at first turn bluish (as blood is deoxygenated from its passage over the ischemic tissue) and
then flush red, due to reactive hyperaemia from post-hypoxic vasodilatation.
+ buerger’s test suggests significant PAD and ischemia.