/HLFHVWHU0HGLFDO6FKRRO
THE CARDIOVASCULAR SYSTEM
PERIPHERAL VASCULAR EXAMINATION
Impairment of the blood supply to any part of the body may be acute or chronic, caused, for
example, by a thrombus or atherosclerosis respectively. You must be able to systematically
examine for, and recognise, signs of vascular disease.
Preparation
Wash hands
Introduction
Consent and explanation
√
Comments
General Inspection
Pain
Conscious level
Amputation
√
Comments
Hands
Radial pulse
Ulnar pulse
Allen’s Test*
Left
Right
Comments
Arms
Brachial pulses
Blood pressure
Left
Right
Comments
Face
Corneal arcus
Xanthalasma
Central cyanosis
Anaemia
Left
Right
Comments
Neck
JVP
Palpate carotid pulses
Auscultate carotid pulses
Left
Right
Comments
Abdomen
Palpate abdominal aorta
Auscultate abdominal aorta
Palpate femoral pulses
Auscultate femoral pulses
Left
Right
Legs and Feet
Palpate pulses:
Popliteal pulses
Posterior Tibialis pulses
Dorsalis Pedis pulses
Temperature
Inspect for:
Colour
Capillary refill
Hair loss
Oedema
Varicosities
Ulceration/Gangrene
Scars
Trendelenberg Test*
Burgers Test*
ABPI*
Left
Right
Comments
Special Tests*
Ankle:Brachial Pressure Index (ABPI)
You need to know how to measure the ABPI, but you will not be required to perform it during
the Phase 1 OSCE
ABPI is measured using a hand-held Doppler and a sphygmomanometer.
- The patient must be rested in the supine position or ankles raised to the same
height as the heart.
- The systolic pressure is measured in the dorsalis pedis and posterior tibial
arteries of the same leg by holding the Doppler probe over the pedal artery while
a blood pressure cuff wrapped around the ankle is inflated.
- The pressure at which the Doppler signal disappears gives the systolic pressure
in that artery.
- The blood pressure (BP) should be taken in both arms and the ABPI is calculated
as follows:
ABPI =
Highest ankle systolic pressure
Highest brachial systolic pressure
- A value for ABPI should be obtained for each leg
Normally the systolic BP in legs ≥ arms so a normal ABPI should be ≥1 in the supine
position.
ABPI is a sensitive marker of arterial insufficiency. Typical values of ABPI are:
- ≥1
= Normal
- <0.9
= Abnormal
-
0.5 – 0.9
<0.5
= Claudication
= Critical Ischaemia
Buergers Test
-
With the patient lying supine, stand at the foot of the bed. Raise the feet and
support the legs at 45˚ to the horizontal.
When the legs are elevated look for pallor of the sole of the foot along with
emptying (or ‘guttering’) of the dorsal foot veins
Ask the patient to sit up and swing the legs over the edge of the bed
In the presence of critical limb ischaemia the foot will turn a deep red (‘sunset
foot’) due to reactive hyperaemia.
Allen’s Test
This tests the collateral blood flow to the hand
- Identify both radial and ulnar pulses and apply pressure simultaneously in order
to occlude the arteries.
- The patient should clench and unclench the hand until the palm goes pale.
- Release pressure from the ulnar artery and observe for the distinct pink
colouration (reactive hyperaemia) of the palm.
- If the re-colouration of the palm is ≤ 5 seconds, then the circulation to the hand
via the ulnar artery is adequate
- The procedure can then be repeated to check the patency of the radial artery by
releasing the radial artery first
Trendelenbergs Test
Used to test for saphenofemoral junction incompetence - only in the presence of varicose
veins
- Ask the patient to sit on the edge of the examination couch.
- Elevate the limb as far as is comfortable for the patient and empty the superficial
veins by ‘milking’ the leg.
- With the leg still elevated, exert digital pressure (or apply a tourniquet) over the
saphenofemoral junction
o Locate the femoral artery by feeling for the pulse. The vein is medial to
the artery and the saphenofemoral junction is about 2 fingers breadth
below the inguinal ligament
- Ask the patient to stand
- In the presence of saphenofemoral junction incompetence the varicose veins will
not refill until the digital pressure (or tourniquet) is removed.