The anatomy of (he radial, brachial and carotid pulses have been described I p. 83).
Femoral artery. The I'emoral artery is situated just below the inguinal ligament, midway between the anterior superior iliac spine and the pubic symphysis (mid-inguinal point). It is immediately lateral to the femoral vein and medial to the femoral nerve. In the obese it can be difficult to feel.
Popliteal artery. At the level of the knee crease, the artery lies deep in the popliteal fossa and the pulse is sometimes difficult to feel, even by the experienced clinician.
Dorsalis pedis artery. This is the continuation of the anterior tibial artery on the dorsum of the fool. It passes lateral the tendon of the extensor hallucis longus and is best fell at the proximal exlcnt of the groove between the first and second metatarsals. It may be absent or abnormally sited in 10% of normal subjects, sometimes being 'replaced' by a palpable perforating peroneal artery.
Individual pulses should be recorded as follows:
reduced ± absent aneurysmal ++
Fig. 3.38 Examine the femoral artery, simultaneously while checking for radiofemoral delay.
□ With the patient supine, firmly press down and cephalad in the groin crease (Fig. 3.38) using two or three extended fingers.
□ Auscultate for a bruit.
□ Check for radiofemoral delay.
□ Flex the knee to 30 degrees and make sure the patient is relaxed.
If the examiner is in any doubt aboul which pulse is beins; felt, it is useful for the clinician lo palpate his or her own pulse at the same time. Lack of synchronisation implies that it is the patient's pulse.
□ Examine the radial, brachial and carotid pulses (p. 83). Measure the blood pressure in both arms.
I Palpate and auscultate over the abdominal aorta in any patient with suspected vascular disease.
□ Inspect the legs and feet for changes of ischaemia including changes in temperature and colour,
□ Note any scars from previous vascular or non-vascular surgery and the position, margin, depth and colour of any ulceration.
□ Specifically look between the toes and at the heel.s lor ischaemic changes.
Fig. 3.39 Examination of the popliteal artery. Feel the popliteal artery with the fingertips, having curled both hands into the popiiteal fossa.
Fig, 3.40 Examination oi E the posterior tibial artery and IB the dorsal is pedis artery.
□ With the thumbs in front and the fingers behind, press firmly over the popliteal artery.
Feel for (he pulse in the midline 3^1 cm below the knee crease where the artery can be compressed against the posterior aspect of the tibia as il passes under the soleal arch (Fig. 3.39).
□ f-'eel 2 cm below and 2 cm behind the medial malleolus (Fig 3.40A).
□ Feel in the middle of the dorsum of the foot just lateral to the tendon of extensor hallucis longus (Fig. 3.40B).
□ With the patient lying supine, stand at the foot of the bed. Raise the feet and support the legs at 45 degrees to the horizontal.
□ Then ask (he patient to sit up and swing the legs over the edge of the bed.
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