Peripheral arterial disease physical examination

Peripheral arterial disease Microchapters
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Case #1
AHA/ACC Guidelines on Management of Lower Extremity PAD
Guidelines for Clinical Assessment of Lower Extremity PAD
Guidelines for Diagnostic Testing for suspected PAD
Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD
Guidelines for Medical Therapy for Lower Extremity PAD
Guidelines for Structured Exercise Therapy for Lower Extremity PAD
Guidelines for Minimizing Tissue Loss in Lower Extremity PAD
Guidelines for Revascularization of Claudication in Lower Extremity PAD
Guidelines for Management of CLI in Lower Extremity PAD
Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD
Guidelines for Longitudinal Follow-up for Lower Extremity PAD
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Editors-in-Chief: C. Michael Gibson, M.D., Beth Israel Deaconess Medical Center, Boston, MA; Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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Physical Examination

Vitals

• Decreased or absent pulses
• Palpation of the carotid pulses and notation of the carotid upstroke and amplitude and presence of bruits.
• Palpation of the pulses at the brachial, radial ulnar, femoral, popliteal, dorsalis pedis, and posterior tibial sites. Performance of Allen’s test when knowledge of hand perfusion is needed.
• Pulse intensity should be recorded numerically:
• 0, absent
• 1, diminished
• 2, normal
• 3, bounding
• Measurement of blood pressure in both arm and notation of any inter arm asymmetry.

Skin

• Pallor of feet with elevation
• Signs of chronic ischemia:
  • Hair loss, thickened nails, trophic sin changes hypertrophic nails, smooth and shiny skin, coolness, pallor or cyanosis.
• Dependent rubor

Auscultation

• Bruits can be heard over the sites of arterial narrowing.
• Auscultation of the abdomen and flank for bruits.
• Auscultation of both femoral arteries for the presence of bruits

Extremities

• Muscle atrophy

Peripheral Vascular Disease of the Hand: Advanced disease with gangrene of several digits.
(Image courtesy of Charlie Goldberg, M.D.)

References

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