A

• Ankle-Brachial Index (ABI)

  • Definition: Ratio of systolic blood pressure at the ankle to the systolic blood pressure at the brachial artery.

  • Purpose: Assesses for peripheral arterial disease (PAD).

  • Interpretation:

    • Normal: 1.0 – 1.4

    • Borderline: 0.91 – 0.99

    • PAD: ≤ 0.90

    • Severe ischemia: < 0.4

• Arterial Pulses

  • Sites to palpate: Radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis.

  • Assessment: Rate, rhythm, volume, symmetry, and character (e.g., bounding, weak, thready).

  • Clinical clues: Absent or diminished pulses suggest arterial occlusion or stenosis.

B

• Bruits

  • Definition: Audible vascular sounds (murmurs) heard over arteries, indicating turbulent blood flow.

  • Common sites: Carotid artery, abdominal aorta, femoral artery.

  • Clinical significance: Suggests stenosis or aneurysm.

• Buerger’s Test

  • Description: Elevate legs to 45 degrees for 1-2 minutes, observe for pallor; then lower legs and note time for color to return.

  • Purpose: Evaluates arterial insufficiency.

  • Positive test: Delayed color return indicates ischemia.

C

• Capillary Refill Time (CRT)

  • Method: Press on nail bed or skin until blanching, release, and measure time for color to return.

  • Normal: < 2 seconds

  • Prolonged CRT: Indicates poor peripheral perfusion or shock.

• Claudication

  • Definition: Cramping leg pain induced by exercise due to ischemia from arterial insufficiency.

  • History relevance: Helps localize level of arterial obstruction.

D

• Dermatological Signs

  • Assessment of skin: Color, temperature, texture, hair distribution, trophic changes (thin, shiny skin), ulcers.

  • Significance: Arterial insufficiency may cause pallor, hair loss, cool skin; venous disease often causes pigmentation, eczema.

• Deep Vein Thrombosis (DVT) Signs

  • Clinical features: Swelling, warmth, redness, tenderness of the limb.

  • Examination: Measure calf circumference, Homans’ sign (pain on dorsiflexion).

E

• Edema

  • Definition: Abnormal accumulation of fluid in interstitial tissues.

  • Types: Pitting (press skin leaves indentation) vs non-pitting.

  • Causes: Venous insufficiency, lymphatic obstruction, heart failure, renal disease.

• Elevation Pallor

  • Definition: Pale discoloration of limbs when elevated, indicating arterial insufficiency.

F

• Femoral Pulse

  • Location: Below the inguinal ligament, midway between the anterior superior iliac spine and pubic symphysis.

  • Clinical: Palpation important in assessing arterial flow to the lower limb.

H

• Homans’ Sign

  • Test: Pain in the calf on passive dorsiflexion of the foot.

  • Clinical utility: Historically used for DVT but has low sensitivity and specificity.

L

• Lymphadenopathy

  • Definition: Enlargement of lymph nodes.

  • Peripheral vascular exam: Palpate inguinal nodes for infection, malignancy, or inflammation.

• Lymphoedema

  • Description: Chronic swelling caused by lymphatic obstruction.

  • Characteristics: Non-pitting edema, skin thickening, and fibrosis.

M

• Medial Malleolus Ulcers

  • Description: Typical location of venous ulcers caused by chronic venous insufficiency.

  • Features: Irregular margins, shallow base, associated pigmentation.

P

• Peripheral Cyanosis

  • Definition: Bluish discoloration of extremities due to reduced oxygen delivery.

  • Causes: Vasoconstriction, arterial obstruction, or venous congestion.

• Peripheral Pulses

  • See arterial pulses.

• Phlebitis

  • Definition: Inflammation of a vein, often superficial, causing pain, redness, and swelling.

• Popliteal Pulse

  • Location: Behind the knee in the popliteal fossa.

  • Clinical relevance: Difficult to palpate; absence suggests arterial occlusion.

R

• Raynaud’s Phenomenon

  • Description: Episodic vasospasm of the small arteries of the fingers and toes causing color changes (white → blue → red).

  • History: Triggered by cold or stress; associated with pain and numbness.

S

• Skin Temperature

  • Assessment: Compare limb temperatures bilaterally.

  • Cool limb: Suggests arterial insufficiency.

  • Warm limb: Suggests inflammation or infection.

• Swelling

  • See edema.

T

• Trendelenburg Test

  • Purpose: Assess venous valve competence in the legs.

  • Procedure: Leg elevated, tourniquet applied to thigh, patient stands, observe venous filling.

  • Abnormal: Rapid filling indicates incompetent valves.

• Trophic Changes

  • Definition: Changes in skin and nails due to chronic ischemia or venous disease.

  • Examples: Hair loss, thickened nails, shiny skin.

V

• Venous Return

  • Observation: Examine for varicosities, venous ulcers, pigmentation.

  • Tests: Trendelenburg test, manual compression test for varicose veins.

• Varicose Veins

  • Definition: Dilated, tortuous superficial veins caused by valve incompetence.

  • Signs: Visible dilated veins, aching, heaviness.

• Venous Ulcers

  • Characteristics: Located above the medial malleolus, irregular edges, associated with stasis pigmentation and edema.

General Examination Tips

• Examine patient both standing and supine to assess arterial and venous systems accurately.

• Use inspection, palpation, and auscultation systematically.

• Always compare both limbs for symmetry in pulses, temperature, and skin changes.

• Consider systemic signs (e.g., clubbing, pallor, cyanosis) during the exam.

• Document findings clearly with attention to location, size, character, and associated symptoms.