In his letter, Andrés Reyes Valdivia emphasises the importance of clinical examination
skills and that advanced imaging techniques complement rather than replace a thorough
It is important that vascular surgeons know how to examine the abdomen for aortic
and femoral pulses.
Examination of the abdomen cannot always exclude an abdominal aortic aneurysm (AAA),
especially if the AAA is small or the patient large (obese), but there is a good chance
that use of a specific two handed technique will detect one (Fig. 1). The technique
is to place your hands on either side of the rectus muscles, above the umbilicus.
Ask the patient to breathe in and, as they do, press gently but firmly downwards and
then bring your hands towards each other until you feel the aortic pulsation. This
technique will give you the best chance of palpating the aorta, and a normal calibre
aorta will be palpable in a slim patient. As a rough estimate, the diameter of the
aorta is equal to the distance between your hands minus the thickness of the abdominal
wall, but an ultrasound scan is obviously more reliable!
Examination of the aortic pulse.
Examination of femoral pulses also requires a specific two handed technique (Fig. 2).
Use one hand to push the abdominal wall upwards (this needs effort if the patient
is obese). Use the other hand to palpate the femoral artery, which lies midway between
the pubic tubercle and the anterior superior iliac spine. If no pulse is palpable,
then the hardened artery should be palpable. If you cannot feel a pulse or a hardened
artery then you are probably in the wrong place.
Examination of the femoral pulse.