title: Physical examination and chronic lower-extremity ischemia: a critical review.
abstract: OBJECTIVE
  To determine the clinical utility of physical examination in patients with suspected chronic ischemia of the lower extremities.
  
  
  METHODS
  MEDLINE search (January 1966 to January 1997), personal files, and bibliographies of textbooks on physical diagnosis, surgery, and vascular surgery.
  
  
  METHODS
  Both authors independently graded the studies as level 1, 2, or 3, according to predetermined criteria. Criteria deemed essential for analysis of sensitivity, specificity, and likelihood ratios were (1) clear definition of study population, (2) clear definition of physical examination maneuver, and (3) use of an acceptable criterion standard test for comparison.
  
  
  RESULTS
  The following positive findings help clinicians diagnose the presence of peripheral arterial disease: abnormal pedal pulses, a unilaterally cool extremity, a prolonged venous filling time, and a femoral bruit. Other physical signs help determine the extent and distribution of vascular disease, including an abnormal femoral pulse, lower-extremity bruits, warm knees, and the Buerger test. The capillary refill test and the findings of foot discoloration, atrophic skin, and hairless extremities are unhelpful in diagnostic decisions. Mathematical formulas, derived from 2 studies using multivariate analysis, allow clinicians to estimate the probability of peripheral arterial disease in their patients.
  
  
  CONCLUSIONS
  Certain aspects of the physical examination help clinicians make accurate judgments about the presence of peripheral arterial disease and its distribution.
authors.affiliation: Department of Medicine, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle 98108, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: McGee
authors.forename: E J
authors.initials: EJ
authors.lastname: Boyko
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D011237:Predictive Value of Tests; D011674:Pulse; D012680:Sensitivity and Specificity