2. Assessing
Peripheral
Vascular
System
oA peripheral vascular assessment is a medical
examination to discover signs of pathology in the
peripheral vascular system. It is performed as part
of a physical examination, or when a patient
presents with leg pain suggestive of a
cardiovascular pathology. The exam includes
several parts: Position/lighting/draping.
3. Lower Extremities
◦ INSPECTION:
◦ While in supine position, expose the legs. Keep the genitalia covered. Inspect both legs together. Note skin
color, hair distribution, venous pattern, size (swelling or muscle atrophy), and any skin lesions or ulcer.
Measure the calf circumference with tape measure (if lower legs appear asymmetric or unequal in size).
4. Normal Findings:
Hair cover the legs.
The venous pattern in the legs is normally
flat and barely visible. Note obvious
varicosities (although these are best
assessed while standing).
Both legs are asymmetric in size, no
swelling or atrophy.
5. Abnormal Findings:
Skin in the legs appears pale with vasoconstriction; reddish with vasodilation; cyanotic with poor
oxygenation.
Thin, skinny skin, with pallor and coolness, loss of hair, ulcers, gangrene in the legs indicate arterial
insufficiency.
Bilateral edema in the legs may indicate systemic illness affecting the heart or kidneys.
Acute, unilateral painful swelling in the legs may indicate deep vein thrombosis.
Brown discoloration in the legs occurs with chronic venous stasis due to hemosiderin deposits from red
blood cell degradation.
Venous ulcers occur usually at medial malleolus because of bacterial invasion of poor venous return.
Arterial ulcers occur on tip of toes. Metatarsal heads and lateral malleoli
6. Palpation
Palpate for skin temperature along the legs down to the feet, with dorsum of the hands.
Assess for Homan’s sign by flexing the patient’s knee, then gently compress the gastrocnemius (calf) muscle anteriorly against
the tibia. There should be no tenderness. Or, ask the patient to point the toes upward (dorsiflex the foot) toward the tibia.
There should be no pain felt by the patient.
Palpate the inguinal lymph nodes. Small, palpable nodes (1cm. or less), movable and non tender are normal.
Palpate the following arteries in both legs: femoral, popliteal, dorsalis pedis and posterior tibial.
