THE PERIPHERAL

VASCULAR
SYSTEM
Ralph Raoul A. Villamor, MD, DPCP
Associate Professor
Department of Physical Diagnosis
SWU-PHINMA school of Medicine
ARTERIES
ATHEROMA FORMATION
PULSES IN THE
ARMS AND
HANDS
 Brachial artery
 Radial artery
 Ulnar artery
PULSES IN THE ABDOMEN
PULSES IN THE LEGS
 Femoral artery
 Popliteal artery
 Dorsalis pedis artery
 Posterior tibial artery
VEINS
TRANSCAPILLARY FLUID
EXCHANGE
COMMON OR
CONCERNING
SYMPTOMS
 Abdominal, flank, or back pain
 Pain or weakness in the arms or legs
 Intermittent claudication
 Cold, numbness, pallor in the legs;
hair loss
 Swelling in calves, legs, or feet
 Color change in fingertips or toes in
cold weather
 Swelling with redness or tenderness
PERIPHERAL ARTERIAL
DISEASE
PERIPHERAL ARTERIAL
DISEASE
 Fatigue, aching, numbness, or pain that limits walking or
exertion in the legs; if present, identify the location. Ask
also about erectile dysfunction.
 Any poorly healing or nonhealing wounds of the legs or
feet
 Any pain present when at rest in the lower leg or foot and
changes when standing or supine
 Abdominal pain after meals and associated “food fear”
and weight loss
 Any first-degree relatives with an AAA
HEALTH PROMOTION AND
COUNSELLING
ANKLE
BRACHIAL
INDEX
CASE:
 A 58 years old male, hypertensive, smoker, consulted due to
intermittent calf pain
 Upper ext BP: 160/90 mmHg (both)
 Lower ext BP: 90/60 mmHg (left) 150/90 mmHg (right)

 What is the ABI?

 interpret?
INSPECTION
 Their size, symmetry, and any
swelling
 The venous pattern
 The color of the skin and nail
beds and the texture of the ski
PALPATION
 Radial pulse
 Brachial pulse
 Epitrochlear nodes
INSPECTION OF
THE LEGS
 Their size, symmetry, and any swelling or
edema
 The venous pattern and any venous
enlargement
 Any pigmentation, rashes, scars, or ulcers
 The color and texture of the skin, the color of
the nail beds, and the distribution of hair on
the lower legs, feet, and toes
 Inspect the saphenous system for varicosities
PALPATION: THE PERIPHERAL
PULSES
 The femoral pulse
 Press deeply, below the inguinal
ligament and about midway
between the anterior superior iliac
spine and the symphysis pubis
POPLITEAL PULSE
POPLITEAL PULSE
DORSALIS PEDIS AND
POSTERIOR TIBIAL
SWELLING AND EDEMA
THE ALLEN TEST
THE ALLEN TEST
THE ALLEN TEST
THE ALLEN TEST
POSTURAL COLOR CHANGES
POSTURAL COLOR CHANGES
RECORDING YOUR FINDINGS
 Extremities are warm and without edema. No
varicosities or stasis changes. Calves are supple and
nontender. No femoral or abdominal bruits.
Brachial, radial, femoral, popliteal, dorsalis pedis
(DP), and posterior tibial (PT) pulses are 2+ and
symmetric
 RECORDING YOUR FINDINGS
Radial Femoral Brachial Popliteal Dorsalis Posterior
pedis tibial

RT 2+ 2+ 1+ 1+ 1+ 1+

LT 2+ 2+ 1+ 1+ 1+ 1+