ARTERIAL EXAMINATION OF THE LOWER LIMB
History:
 Pain in the legs? Site/Quality/Intensity/Timing etc
 Is onset of pain associated with exercise?
 Exercise tolerance before the onset of pain?
 Amount of time resting before pain subsides?
 Can the patient walk through the pain
 Duration of symptoms, have they improved or worsened over time.
 Lifestyle: smoking, diet, EtOH, Occupation.
 Rest Pain?
 How does patient relieve rest pain (?leg over side of bed etc.)
 Ulcers/sores.
 PMHx/PSHx: enquire about all arteriopathic conditions.
 Atherosclerotic Risk Factors.
Examination:
Performed with the patient lying down comfortably.
Trousera and socks removed.
Inspection:
General:
 Features of Cigarette Smoking
 CVS disease e.g. GTN Spray by bedside
 DM e.g. glucometer at bedside
Legs:
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Pallor
Guttering of veins
Discolouration
Shiny/thin skin
Loss of hairs
Scars suggestive of previous surgery.
Feet:
 Ulcers on pressure areas:
o Heels
o Malleoli
o Head of 5th metatarsal
o Tips of toes
o Between toes
o Ball of foot.
Palpation:
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Run dorsum of hands down legs, assessing for temperature change (cooler below
a significant vascular lesion).
Capillary refill time
Pulses: (palpate and Doppler)
o ?AAA
o Femoral
o Popliteal
o Dorsalis pedis
o Posterior tibial
Auscultate:
 For bruits:
o AAA
o Renal Arteries
o Femoral Arteries
o Adductor Hiatus
o Popiteal Arteries.
Buergers Test:
 From a lying position, raise the lower limb slowly.
 Watch the leg/foot carefully for:
o Blanching
o Guttering of veins. (Up to 900 is normal. <500 severe ischaemia, <250
critical ischaemia)
 Lower the leg steadily and allow it to swing down the floor (sitting the patient up
as you go).
 Observe the foot for a red/purple discoluration. This is reactive hyperaemia and
represents gravity assisting in returning blood to the foot.
To Complete the Examination:
 Examination of the heart and carotids.
 ECG (AF predisposes to distal embolisation).
 BP in both arms.
 Measure ANKLE BRACHIAL PRESSURE INDICES.