Peripheral Vascular Examination

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Peripheral vascular disease can mimic musculoskeletal causes of pain. Most patients do not have intermittent claudication but have atypical leg symptoms or no symptoms at all.[1][2] Therefore is important for the Musculoskeletal Medicine Doctor to know how to perform a competent peripheral vascular examination.

Special Tests

Ankle Brachial Pressure Index

  • The patient should lie in a supine positive for 5 minutes before measurement
  • Upper limb measurement
    • Place the cuff in the usual fashion
    • Inflate the cuff to 20 mmHg above systolic arterial pressure
    • Record the pressure using a doppler device by placing it over the brachial artery
  • Lower limb measurement
    • Place the cuff above the malleoli
    • Place the doppler probe over the posterior tibial and dorsal pedal arteries
  • The ABP is the highest systolic pressure value of the lower limbs divided by the higher of the brachial artery pressures
  • Interpretation
    • โ‰ค0.9 is PAD
    • 0.91 - 1.0 is borderline
    • >1.00 - 1.4 is normal


  1. โ†‘ Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317โ€“1324
  2. โ†‘ McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease. associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599โ€“1606.