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
• Intermittent claudication: pain on walking a fixed distance which is relieved by rest.
• Rest pain.
• Ulceration.
• Gangrene.
• Cellulitis or osteomyelitis can complicate ulceration and gangrene.