Assessment of Peripheral Arterial Disease – Advanced Assessment

00:01 Alright, so now we're heading into the last section on our cardiovascular exam, and we're focusing on the vasculature.

00:07 And most notably, we're looking for peripheral arterial disease.

00:09 We've already talked about looking for peripheral edema in the prior section and how we can distinguish it from lymphedema.

00:16 But now we're looking at the circulation itself, not so much the venous circulation, but the arterial side.

00:21 There's a number of different findings that have variable levels of significance when making the diagnosis of peripheral arterial disease.

00:28 And we can see very quickly, just looking at our patient that the color of his legs looks good.

00:34 He has hair on his toes here.

00:37 There's no evidence of any ulcers either on the medial aspects or on the lateral aspects of his feet.

00:42 And there's evidence of good normal muscle bulk on both sides.

00:46 So this is not a person who were likely to find significant arterial disease.

00:50 But there are three particular findings which can be really helpful to pick up potentially subclinical peripheral arterial disease.

00:57 So let's look at those three aspects.

00:59 The first one is just temperature.

01:01 You know, if somebody has significant peripheral arterial disease on one foot compared with the other, you can expect the temperature from one foot to the other is going to be different.

01:10 And sometimes you can compare temperatures by first putting your hands on like this, and then swapping hands because you'll accentuate the difference between a cool limb and a warm limb.

01:19 Secondly, looking at the fill times for the capillary beds of the toes.

01:25 Simply you're going to squeeze a particular digit.

01:29 You're going to watch the color dissipates and when I release, it'll be pale.

01:33 And you want to see how quickly the color comes back to the toe.

01:38 But the third piece and the most important piece when you're trying to diagnose subclinical peripheral arterial disease, or I should say, disease that is manifesting with symptoms, but it's not showing up in obvious ways on the exam is the ankle-brachial indices.

01:54 This is essentially a test using simply a blood pressure cuff and a handheld Doppler to compare, how well your arms are being perfused? Peripheral arterial disease rarely manifests in the upper extremities, compared with how well is blood getting down into the lower extremities?