The clinical evaluation of peripheral arterial disease (PAD) is difficult and yet critically important so that patients receive the care they need. The greatest problem is that clinical evaluation is limited in excluding significant PAD. In short, none of the various clinical findings have a high negative predictive value for PAD. Even simple pulse palpation is fraught with error. All patients with non healing ulcers or wounds or with exertional leg pain should undergo objective physiologic testing.
101 year old female, admitted to the hospital with foot and toe pain. Patient had a cool pulseless foot.
38 year old female with severe post thrombotic syndrome and severe venous ulceration for 8 years
82 year old male, heavy smoker, developed right heel ulcer during rehab after a femur fracture.