Checklist

WIPER

• Patient supine, legs and abdomen exposed

• Groin covered but accessible

Physiological parameters

General

• Bedside: GTN spray, cigarettes, lighter

• Hands: tar stains, finger pricks for glucose measurement (diabetes)

• Radial pulse: heart rate and rhythm (rule out AF)

• Eyes: xanthelasmas (hyperlipidaemia)

• Neck: carotid endarterectomy scar

• Chest: sternotomy or thoracotomy scars

• Abdomen: laparotomy scars, pulsating abdominal aortic aneurysm

Inspection

• Skin :

• scars: laparotomy, femoral cut-down, crossover grafts, bypass grafts, vein harvest (upper and lower limbs)

• sinuses or purulent discharge

• colour changes: – pallor/duskiness/cyanosis (ischaemia, thrombosis, phlegmasia) – erythema/cellulitis (infection)

• tissue loss: ulcers, gangrene (wet or dry)

• Soft tissues :

• trophic changes: skin, hair, nails, toe-tip infarcts

• calf swelling: DVT, lymphoedema

• calf wasting

• Bone :

• amputations

Palpation

• Skin : temperature

• Soft tissues : calf muscles and foot:

• tender (ischaemic or infected)

• tense (compartment syndrome)

• fluctuant (abscess)

• Vascular :

• capillary refill time (< 3 sec)

• pulses: aorta, femoral, popliteal, tibialis posterior (TP), dorsalis pedis (DP)

• pulses: bypass grafts

• Neurology : short neurological exam (touch sensation and movement, L3, L4, L5, S1)

Auscultation

• Bruits: common femoral and superficial femoral arteries, grafts or arteriovenous fistulas (not routinely done)

Special tests

• Buerger's angle: cadaveric pallor and venous guttering on leg elevation

• Buerger's test: reactive hyperaemia/rubor in the dependent leg following elevation

To complete the examination…

• Ankle – brachial pressure index (ABPI)

• Venous, lymphatic and neurological examination of the lower limbs

• Complete abdominal and cardiovascular examinations