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Arterial vascular examination (upper and lower limb)

Upper and lower limb arterial 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 at 45°
  • Privacy
  • Expose upper limbs and chest initially


General Inspection

  • Surroundings
    • Monitoring:
      • Pulse oximeter
      • ECG monitoring
    • Treatments:
      • Oxygen therapy (method of delivery and rate)
      • GTN spray
      • Insulin pen
      • IV infusions
    • Paraphernalia:
      • Wheelchair or walking aids
      • Food and drink
      • Cigarettes/ nicotine patches/ gum
  • Patient
    • Well or unwell?
    • Comfortable at rest or in pain?
    • Body habitus: cachectic or obese?
    • Smoker’s facies or smell of cigarettes?
    • Colour: Peripheral cyanosis? Mottled?
    • Signs of peripheral arterial disease (ulcers, gangrenous toes, amputations)
    • Scars? (CABG, graft harvesting, groin scars from angiography)


Systemic examination

  • Upper limbs
    • Inspect
      • Colour (peripheral cyanosis/ mottled discolouration)
      • Cigarette tar staining (not nicotine!)
      • Blood glucose testing on fingertips
      • Tendon xanthomata (hyperlipidaemia)
      • Scars (radial artery harvest for CABG, wrist scars from angiography/ interventional radiology)
      • Subclavian artery aneurysm
    • Palpate
      • Temperature
      • Gross sensation (distal to proximal)
      • Capillary refill (at level of heart, both limbs, normal <2s)
      • Radial pulse (rate, rhythm)
      • Radio-radial delay
        • Aortic dissection
        • Aortic coarctation (delayed on left depending on level of coarctation)
        • Subclavian artery stenosis
      • Radio-femoral delay
        • Aortic coarctation
      • Brachial pulse [only necessary if you fail to feel a radial pulse]
      • Ask for blood pressure in both arms. Unequal BPs suggest:
        • Aortic dissection (BP reduced on left depending on level of dissection)
        • Subclavian artery stenosis (BP reduced on side of stenosis)
        • Aortic coarctation (BP reduced on left depending on level of coarctation)
      • Carotid pulse
    • Auscultate
      • Carotid bruits


Peripheral vascular exam video


  • Abdomen
    • Inspect (at level of patient)
      • Scars: midline laparotomy or T shaped scar (suggests emergency AAA repair)
      • Pulsatile aorta
    • Palpate
      • Aorta (above umbilicus): Pulsatile AND expansile? Approximate diameter?
        • The aorta should be pulsatile but should not be expansile.
      • Auscultate
        • Aortic bruit (above umbilicus)
        • Renal bruits


  • Lower limbs
    • Inspect
      • Colour: peripheral cyanosis/ mottled discolouration
      • Skin: shiny or hairless
      • Scars
        • Long saphenous vein harvesting for CABG
        • Groin scars from angiography/ interventional radiology/ EVAR/ angioplasty/catheter-directed thrombolysis
      • Ulcers
        • Arterial ulcer sites: dorsum of foot, between toes, tips of toes
        • Diabetic ulcer sites: pressure points (heel, metatarsal heads)
    • Palpate
      • Temperature
      • Gross sensation (distal to proximal)
      • Capillary refill
      • Femoral pulses: mid-inguinal point, halfway between ASIS and pubic symphysis
      • Radio-femoral delay (if not already done)
      • Popliteal pulses
        • 10% of patients with popliteal aneurysm have an AAA
        • 30% of patients with AAA have a popliteal aneurysm
      • Dorsalis pedis (lateral to tendon of extensor hallucis longus)
        • Absent in 10% of normal people
      • Posterior tibial pulses (2cm below and behind medial malleolus)
    • Auscultate
      • Femoral bruits



  • Thank patient, ensure they’re comfortable and ask if they need any help in 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 full cardiovascular examination
      • Perform neurological and venous examination of the upper and lower limb
      • Special test: perform Buerger’s test if indicated
    • Bedside investigations:
      • Ankle-Brachial Pressure Index (ABPI)
      • Measure claudication distance and total walking distance
      • 12-lead ECG
      • Capillary blood glucose
      • Fundoscopy (for hypertensive and diabetic retinopathy)
    • Further investigations:
      • Bloods (FBC, U&Es, lipids, ESR/CRP, glucose and HbA1c, thrombophilia screen if indicated)
      • Arterial duplex
      • Angiography


Click here for medical student OSCE and PACES questions about Upper and lower limb arterial examination

Upper and lower limb arterial examination exam questions for medical students, finals, OSCEs and MRCP PACES


Click here to download free teaching notes on Vascular (Arterial) Examination: Upper and lower limb arterial examination

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