Peripheral Vascular System

Anatomy & Physiology of the Peripheral Vascular & Lymphatic System

Peripheral Vascular System

The peripheral vascular system consists of arteries, veins, and capillaries responsible for blood circulation outside the heart and lungs.

• Arteries: Carry oxygenated blood from the heart to tissues.

  • Examples: Carotid, Brachial, Radial, Femoral, Popliteal, Dorsalis Pedis, Posterior Tibial arteries.

• Veins: Carry deoxygenated blood back to the heart.

  • Examples: Jugular, Subclavian, Femoral, Great & Small Saphenous veins.

• Capillaries: Microscopic vessels for gas and nutrient exchange

Lymphatic System

The lymphatic system helps in fluid balance, immune defense, and waste removal.

• Lymph Nodes: Filter fluid and trap pathogens.

  • Locations: Cervical, Axillary, Epitrochlear, Inguinal, Popliteal nodes.

• Lymphatic Vessels: Drain excess fluid from tissues into venous circulation.

Physical Examination Techniques

Key Pulse Points

• Upper Limb: Radial, Brachial, Carotid.

• Lower Limb: Femoral, Popliteal, Dorsalis Pedis, Posterior Tibialis.

Differentiating Normal & Abnormal Findings

Analyzing Findings from Interviews, General Survey &

Interview Findings:

• Chief complaints: Leg pain, swelling, numbness, tingling, non-healing wounds.

• History of: Smoking, diabetes, hypertension, previous DVT, varicose veins.

General Survey:

•  Ensure the patient is adequately exposed with draping in between the legs

• Remember to compare sides

• Vitals: bilateral and orthostatic blood pressures

Physical Exam

Specific locations

• Upper extremities (from the finger tips to the shoulder)

• Lower extremities (from the groin and buttocks to the toes)

• Inspect for:

  • Masses, scars, lesions,

  • Symmetry: muscle bulk (atrophy/hypertrophy)

  • Size: swelling, thickening

Continue…

Arterial insufficiency

• Cyanosis: central (frenulum and buccal mucosa) and peripheral (nails)

• Skin: cool, pale extremities, increased pigmentation, swelling, heaviness and aching in legs (usually medial lower third of legs)

• Ulcers: ischemic ulceration due to trauma of the toes and heel, develops rapidly, painful, and has discretely visible edges

Venous stasis

• Skin: warm, thickening and erythema over the ankle and lower leg (dependent areas), thickened (woody) fibrosis/lipodermatosclerosis

• Ulcers: stasis ulceration of ankle or above medial malleolus, develops slowly, painless, diffuses with no distinct borders

• Veins: engorgement, varicosities

Cont….

Palpation and Auscultation

Arterial

• Skin temperature: feel with back of hand warm vs. cool

• Capillary refill: compress nailbeds and determine the duration for return of 

• Circulation: normal adult = 2-3s

Pulses

• Rate: tachycardia >100 bpm, bradycardia <60 bpm

• Rhythm: regular, regularly irregular (consistent pattern), irregularly irregular

• Amplitude