Arterial Exam (based on Browses, 3rd edition) 123xss

WIPER
Chaperone offered
Asks patient if there is any pain
Inspection
-

Full 360 of each leg for

o scars
o colour
o mottling (blue streaks around white patches if this is fixed the
ischaemia is irreversible)
o ulcers especially at the pressure points and between digits
o loss of hair may be a sign of chronic ischaemia but not very
reliable
Q: Where would you expect gangrene first?
Establishes vascular angle
o 15 to 30 degrees for 30-60 seconds may elicit pallor
o Less than 20 degrees implies severe ischaemia
o On returning to a dependent position, dusky red/blue implies
ischaemia
o Doing both legs together allows a comparison

Palpation
-

Skin temperature can only be assessed if both legs have been

exposed to the same ambient temperature for 5 minutes!
Cap refill
Palpate the pulses simultaneously where possible
o Upper limb
o Femoral
o Dorsalis pedis, in the v between the 1st and 2nd metatarsals, not
present in 10%
o Posterior tibial, just behind the medial malleolus
o Popliteal
o AAA

Auscultation
-

ABPI

Listen in
o Neck
o Abdomen
o Groin
o Thigh especially the adductor canal
Bruits are caused by turbulent flow beyond a stenosis or
an irregularity in the artery wall