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
- ≤0.9 is PAD
- 0.91 - 1.0 is borderline
- >1.00 - 1.4 is normal

References

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

[1] Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–1324

[2] McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease. associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599–1606.

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