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Peripheral vascular examination frequently appears in OSCEs. You’ll be expected to pick up the relevant clinical signs of peripheral vascular disease (PVD) using your examination skills. This peripheral vascular examination OSCE guide provides a clear step by step approach to examining the peripheral vasculature system, with an included video demonstration.

Check out the peripheral vascular examination mark scheme here.

Check out our Varicose Vein Examination OSCE guide here.



Wash hands

Introduce yourself

Confirm patient details – name / DOB

Explain examination

Gain consent

Ask if the patient currently has any pain

General inspection

Is the patient comfortable at rest?

Look around bedside for treatments or adjunctsmobility aids / O2 / cigarettes / medications

Obvious scars – may provide clues as to previous surgical procedures

Gross cyanosis / pallor of limbs 

  • General inspection
    General inspection

Upper body


Colour e.g. cyanosis / pallor

Tar staining smoking is a risk factor for PVD

Tendon xanthomashypercholesterolemia

Gangrene – necrosis secondary to inadequate limb perfusion

  • Inspect upper limbs
    Inspect upper limbs


Temperature if ↓ may indicate poor peripheral perfusion

Capillary refill timeshould be < 2 seconds




  • Assess rate and rhythm – palpate for at least 5 cardiac cycles
  • Assess for radio-radial delay – coarctation of the aorta


BRACHIAL PULSE – assess volume



  • Record BP in both arms – significant difference may suggest aortic aneurysm
  • You’ll usually not be required to perform this during the OSCE 
  • However ensure you acknowledge that you would ideally carry this out



  • Auscultate for a bruit if present avoid palpation due to risk of emboli
  • Medial to the sternocleidomastoid and beside the trachea
  • NEVER palpate both simultaneously
  • Auscultate for a bruit may suggest stenosis at carotid bifurcation
  • Assess & compare upper limb temperature
    Assess & compare upper limb temperature


AORTA – located in the midline of the epigastrium

  • Inspect the abdomen, looking for any obvious pulsation
  • Palpate either side of the aorta feeling for expansion –  aneurysm
  • Auscultate for aortic bruits –  suggestive of an aortic aneurysm
  • Palpate abdominal aorta
    Palpate abdominal aorta

Lower limbs


Compare the legs 
Scars bypass surgery / vein harvest sites

Hair loss – PVD

Discolouration – e.g. necrosis

Pallor – suggests poor vascular perfusion

Missing limbs / toes –  previous amputation

Ulcers – venous vs arterial – look between toes and lift feet up

Muscle wasting – may indicate PVD

Ask patient to wiggle their toes – gross motor assessment

  • Inspect legs
    Inspect legs


Temperature – compare between the legs

Capillary refill time–  < 2 seconds is normal – prolonged in PVD



Work proximal to distal – this allows you to assess and compare inflow into each leg.  If pulses are not palpable, a doppler can be used to assess blood flow through a vessel.


FEMORAL PULSE – best palpated at the mid-inguinal point 

  • The mid-inguinal point is located halfway between the anterior superior iliac spine and the pubic symphysis 
  • Palpate to confirm its presence and assess volume
  • Assess for radio-femoral delay – suggestive of coarctation of the aorta
  • Auscultate to detect any bruitsfemoral / iliac stenosis


POPLITEAL PULSE – palpated in the inferior region of the popliteal fossa

  • With the patient prone, flex the knee to 45º
  • Place your thumbs on the tibial tuberosity
  • Curl your fingers into the popliteal fossa to compress the popliteal artery against the tibia allowing you to feel its pulsation
  • This pulse is often difficult to palpate – NEVER lie and say you can feel it if you can’t. The popliteal artery is the deepest structure within the fossa, so the examiner will understand.
  • Auscultate to detect any bruits


POSTERIOR TIBIAL PULSE – posterior to the medial malleolus of the tibia

  • Palpate to confirm its presence and compare pulse strength to the other foot


DORSALIS PEDIS PULSE – dorsum of the foot

  • Lateral to the extensor hallucis longus tendon 
  • Over the 2nd/3rd cuneiform bones
  • Palpate to confirm its presence and compare pulse strength to the other foot
  • Leg temperature
    Assess & compare limb temperature


The aim when assessing sensation in this context is to identify limb paresthesia which can be a symptom of acute limb ischaemia.

Perform a gross assessment of peripheral sensation:

  • Assess light touch sensation, starting distally
  • If intact distally, no further assessment is required
  • If reduced, assess to identify the extent paresthesia – e.g. whole limb / below knee / foot
  • Lower limb sensation
    Assess light touch sensation distally

Buerger’s test

This test can be carried out to further demonstrate poor lower limb perfusion.

1. Ensure the patient is positioned supine


2. Standing at the bottom of the bed, raise both of the patient’s feet to 45º for 2-3 mins:

  • Observe for pallor – emptying of the superficial veins 
  • If a limb develops pallor, note at what angle this occurs e.g. 20º (known as Buerger’s angle)
  • A healthy leg’s toes should remain pink, even at 90º
  • A Buerger’s angle of less than 20º indicates severe limb ischaemia


3. Once the time limit has been reached, ask patient to place their legs over the side of the bed:

  • Observe for a reactive hyperaemiathis is where the leg first returns to its normal pink colour, then becomes red in colour – this is due to arteriolar dilatation (an attempt to remove built up metabolic waste)

To complete the examination

Thank patient

Wash hands

Summarise findings


Suggest further assessments and investigations:


Mr Craig Nesbitt (MD, FRCS, MBChB hons)

Consultant in Vascular Surgery

Mr Sandip Nandhra

SpR in Vascular Surgery


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