Peripheral Vascular System Examination Session Handout

ANATOMY

A prerequisite for the understanding of peripheral vascular disease examination is a practical knowledge of the major named arteries and veins of the head and neck upper and lower extremities, and the abdominal cavity. This knowledge includes topographical anatomy of the vessels and an understanding of "silent vessels" in the physical examination.

PHYSIOLOGY

Arterial exam - Flow = Pressure/Resistance - Resting and exercise Venous exam - Valvular incompetence

PATHOLOGY 

Atherosclerosis, although a generalized metabolic disorder, tends to build up at bifurcations of major vessels (i.e., carotid bifurcation, aortic bifurcation). In the lower extremity, the superficial femoral artery becomes occluded at the adductor hiatus. Diabetics tend to have femoral-tibial occlusions whereas non diabetics tend to have ileal-femoral occlusions. Aneurysms of the abdominal aorta are associated with distal peripheral aneurysm.

A knowledge of this pathology allows for "directed" physical examination.

Effect of va1vular incompetence in the venous system.

HISTORY

PHYSICAL EXAM

Head to toe approach when exam directed at vascular tree. Includes observations, palpation and auscultation and occasionally includes repeat exams after exercise.

Pulse
Gradations

Bruits - desorption

Further examination of the extremities includes:

• Description of skin and lesions
• Elevation and dependency of the lower extremities
• Allen's test - intact palmar arch and to evaluate for small vessel disease

Venous Exam - Upper and lower extremity

• Varicosities, sequelae of venous stasis or acute thrombosis
• Superficial or deep system

Emphasis is on a precise anatomic diagnosis to expeditiously direct work-up and treatment.