Print Friendly, PDF & Email

Lower limb vascular (venous system) examination

Lower limb venous system examination and questions for medical student exams, finals, OSCEs and MRCP PACES



  • Wash your hands
  • Introduce yourself
  • Identity of patient – confirm
  • Permission (consent and explain examination)
  • Pain?
  • Position – initially standing
  • Privacy
  • Exposure – trousers/skirt removed


General Inspection

  • Surroundings
    • Monitoring and treatments
    • Paraphernalia – especially walking aids
  • Patient
    • Well or unwell?
    • Comfortable or in pain?
    • Body habitus


Systemic examination

  • Inspect (standing)
    • Ask patient to externally rotate each leg. Inspect long saphenous vein and perforator veins of the superficial system (2, 3 and 5cm above medial malleolus).
      • Pay close attention to the saphenofemoral junction (SFJ) for a saphena varix (2.5cm lateral and below the pubic tubercle).
    • Ask patient to turn away from you to inspect the short saphenous vein and sapheno-popliteal junction.
  • Inspect (supine at 45 degrees)
    • Signs of venous insufficiency – entire leg and foot but especially gaiter area:
      • Venous ulcers
      • Scars from healed venous ulcers
      • Haemosiderin deposit
      • Venous eczema
      • Lipodermatosclerosis and inverted champagne bottle shaped legs
      • Atrophie blanche
      • Venulectasias (thread veins)
    • Signs of thrombophlebitis
      • Swollen, red, tender vein
      • Hardened thrombus within vein
    • Signs of DVT
      • Swollen, red, painful calf often with dilated superficial veins


Vascular examination video


  • Palpate
    • Temperature
    • Calf tenderness (DVT)
    • Pitting oedema
    • Palpate over course of long saphenous, perforators and short saphenous vein (varicosities, thrombophlebitis)
    • If there is a saphena varix:
      • Ask the patient to cough to emphasise it
      • Palpate for a thrill over varix
    • Tap test:
      • Tap long saphenous vein (medial) at knee and palpate SFJ simultaneously. A palpable impulse at the SFJ indicates venous insufficiency in the long saphenous vein.
  • Auscultate
    • Any large clusters of veins (continuous ‘machinery’ murmur suggests AV fistula)



  • Thank patient
  • Ensure patient is comfortable
  • Check if they need any help getting dressed
  • Wash hands
  • Turn to examiner, hands behind back, holding stethoscope before saying: “To complete my examination, I would like to…”
    • Further examinations:
      • Perform a peripheral arterial examination (mixed vessel disease may contraindicate venous compression stockings)
      • Perform an abdominal examination (to exclude abdominal cause of varicose veins)
    • Bedside investigations:
      • Confirm site of venous incompetence with hand-held Doppler probe
    • Further investigations
      • Colour flow venous duplex of superficial and deep system
      • Colour flow arterial duplex if mixed vessel disease suspected
      • Consider venography in complicated cases
    • For further information on special tests in the venous exam (Trendelenberg’s, Pethes’ and the tourniquet test) please see the questions section.


Click here for medical student OSCE and PACES questions about Lower limb venous system examination

Common Lower limb venous system examination exam questions for medical students, finals, OSCEs and MRCP PACES


Click here to download free teaching notes on Lower limb venous system examination: Lower limb venous system examination

Perfect revision for medical students, finals, OSCEs and MRCP PACES