Peripheral Arterial Examination – Clinical Examination

Peripheral Arterial Examination – Clinical Examination


Peripheral Arterial Examination A complete physical examination includes systematically assessing the peripheral arteries. For example, by starting at the
head, and working downwards. The examination includes palpating pulses and auscultating for possible bruits. If starting in the head and neck area,
palpable pulses include the superficial temporal artery of the head, the common
carotid artery medial to the sternocleidomastoid muscle, and the
subclavian artery posterior to the clavicula. There are some important things to
remember when palpating the carotid. Compressing both sides of the artery too
strongly or over stimulating the carotid sinus reflux can cause cerebral
hypoperfusion and consequently syncope. So palpation should only be done with
minimal pressure and never on both sides simultaneously.
In contrast, palpating the subclavian pulse on both sides may be done at the
same time. For assessing pulses of the upper
extremities, there is the radial artery on the lateral anterior surface of the
forearm and the ulnar artery on the medial side.
Additionally, the brachial artery can be palpated proximal to the cubital fossa.
The radial artery can be palpated with the second to fourth finger on the
lateral forearm and compared with the other side to uncover any differences
that may indicate a pathological condition. The ulnar pulse can be felt
likewise on the medial side. The brachial pulse is located on the
medial upper arm, between the biceps and the triceps. On the lower extremities, the femoral
popliteal, and posterior tibial artery, as well as the dorsalis pedis arteries, are
palpable. Examining the pulses in the legs is particularly important for
assessing peripheral artery disease. Palpation should begin as proximal as
possible, which means starting at the femoral artery under the inguinal
ligament. If the femoral pulses are felt, the pedal
pulses should be felt next. These include the posterior tibial
artery behind the medial malleolus, and the dorsalis pedis, lateral to the
extensor hallucis longus tendon. If the pedal pulses are palpable, a
stenosis of the leg arteries is unlikely and palpating the more difficult to find
popliteal pulse is generally not needed. If the pedal pulses are missing, however,
palpating the popliteal pulses with both hands at the back of the knee may help
in locating a stenosis. If there is an arterial obstruction in
the lower leg, the popliteal pulse is still palpable, whereas an occlusion in
the upper leg would result in an absent pulse. In addition to palpation, auscultation is
an important part of examining the peripheral arteries. Locations for auscultation include: the
common carotid artery in the carotid triangle, the subclavian artery above or
below the clavicula, the brachial artery above the cubital
fossa, the abdominal aorta in the upper middle abdomen, the renal arteries
lateral to this point, the iliac artery in the lower abdomen, the femoral artery
below the inguinal ligament, as well as the popliteal artery behind the knee. In healthy patients, sounds should not be
audible on auscultation. Circulation noises – known as brutes – arise only when blood flow is turbulent or accelerated due to, for example, atherosclerotic changes, or an aneurysm. When a brute is heard, its localization,
intensity, frequency, and relation to heartbeat, should be specifically
evaluated. Since the cause of a brute is not
possible to determine through auscultation alone, additional diagnostic
steps should be taken for further assessment. Another important procedure for
assessing the anastomosis between the radial and ulnar arteries is the Allen
Test which is described in another video. you

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