Peripheral Vascular Exam Assessment for a 20-Year-Old Female with PFO
A comprehensive peripheral vascular exam for a 20-year-old female with a history of patent foramen ovale (PFO) should focus on detecting any signs of paradoxical embolism, which is the primary vascular concern in this population.
Initial Assessment
Inspection
- Skin color and temperature of both extremities (upper and lower)
- Presence of any wounds, ulcers, or sores on toes and feet (highly specific for peripheral arterial disease if present) 1
- Nail beds for cyanosis or clubbing
- Evidence of muscle atrophy or hair loss on extremities
- Symmetry of limbs
Palpation
- Bilateral assessment of skin temperature (warm and equal bilaterally)
- Capillary refill (<3 seconds in all digits)
- Peripheral pulses with documentation of strength (0-3+ scale):
- Radial
- Ulnar
- Brachial
- Femoral
- Popliteal
- Posterior tibial
- Dorsalis pedis
- Note: Palpation of foot pulses is the key diagnostic procedure for peripheral arterial disease assessment 1
Auscultation
- Carotid arteries (no bruits)
- Femoral arteries (no bruits)
- Abdominal aorta (no bruits or widening)
Special Tests
Allen Test
- Normal ulnar and radial artery flow to the hand
Adson's Test
- Negative for thoracic outlet syndrome
Buerger's Test
- Normal arterial supply to feet with elevation and dependent positioning
Advanced Assessment for PFO-Related Concerns
Deep Vein Thrombosis (DVT) Screening
- Homans' sign (negative)
- Calf tenderness (absent)
- Unilateral edema assessment (absent)
Neurological Screening
- Symmetrical strength in all extremities
- Normal sensation in all extremities
- No focal neurological deficits
Documentation of Risk Factors
- Absence of hypertension
- Absence of diabetes
- Absence of smoking history
- No family history of early cardiovascular disease
Interpretation
All findings are normal, indicating no evidence of peripheral vascular compromise. This is consistent with the expected findings in a young patient with an isolated PFO without complications. The patient should continue to be monitored according to guidelines for PFO management 2.
Clinical Considerations
While PFO is present in approximately 25% of the general adult population 3, the risk of paradoxical embolism in asymptomatic young patients is low. However, thorough peripheral vascular assessment remains important as part of comprehensive cardiovascular monitoring in patients with PFO.
The peripheral vascular exam should be repeated annually or if the patient develops any symptoms suggestive of thromboembolic events, as patients with PFO have a potential risk pathway for paradoxical embolism if they develop deep venous thrombosis 2.