vascular assessment

• History
• Observation
• Pulse palpation
• Chair-side tests
• Diagnostic tests

• Establishing any previous/ current vascular problems
• Any current medications related to vascular health

• Arterial
• Venous
• Lymphatic
• or current vascular concerns

• Anti-hypertensives (bring blood pressure down)
• Statins (lower the level of low-density lipoprotein - LDL cholesterol) 

• How long have symptoms been present?
• How often do symptoms occur or recur?
• Are there any seasonal/ diurnal (daily) variation?
• Is there a family history?
• What are the patients’ hobbies/ lifestyle?
• What are current/ previous treatments and were they effective?
• Any surgical history?

• Skin texture and health
• Nail texture and health
• Skin colour 
• Vein appearance 
• Oedema (swelling)
• Hair growth (present/absent) 

light touch

1. After observations  we want to feel the legs and feet for the temperature gradient. 
2.  Using the back of your hand, moving proximal to distal. 
3. There should be a gradual temperature change from warm to cool. 

check Capillary refill

Check capillary refill by compressing the apex of the hallux until the skin blanches (goes white), release the pressure and observe the return of normal colour to the digit (pink) – usually within 2-3 seconds.  

a Buerger’s test 

1. With the patient supine, raise the effected limb to 45degrees until all of the veins in the dorsal arch of the foot have emptied.
2. The plantar surface of the foot will also appear pale. Mild pallor should be seen in about 1 minute. In the presence of poor arterial supply, pallor rapidly develops.  
3. Following this, on placing the feet over the side of the couch, colour returns slowly.
4. The time taken for the skin on the plantar surface of the foot to return to that of the other foot or for the dorsal veins to refill should be noted. This should occur in within 15 seconds. If it takes 20 seconds or more suggests that there is arterial insufficiency. More than 40 seconds signifies severe ischaemia. This will also be indicated by the limb being a dusky red in colour. This is different to reactive hyperaemia which can also occur.

• This is where on lowering the limb it will pass through the pink colour to a red-range colour due to the dilatation of the arterioles in their attempt to remove the metabolic waste that has built up.
• The limb will then revert to its normal colour.

• Pulse located on the dorsum of the foot 
• Located laterally to the extensor tendon of the hallux 
• Around the first inter metatarsal web space
• Light compression with finger tips 

• Pulse located around the medial ankle 
• Located between the medial malleolus (inner ankle) and calcaneus (heel)  
• Light compression with finger tips 

• Absent
• Monophasic (abnormal)
• Biphasic (disagreement)
• Triphasic (normal)
• Bounding
• Venous
   

• Pain (rest pain)
• Palour
• Pulselessness
• Parasthesia (camps and/or pins and needles)
• Paralysis 
• Perishing cold

1. Patient Questioning 
2. Observations 
3. Light touch 
4. Capillary refill 
5. Palpation of pulses 
6. Doppler 
7. Buerger’s Elevation Test

• Stop smoking 
• Exercise 
• Diet (balanced)
• Reducing alcohol in take 
• Mental wellbeing (stress, fatigue, anxiety) 
• Diabetes (poorly controlled diabetes can worsen PAD symptoms) 
• Medicines (statins, antihypertensives, blood thinning) 
• Surgery (aim to restore blood flow)

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