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      Response to Letter to the Editor 'The lost art of proper patient examination in the technology era’

      EJVES Vascular Forum

      Elsevier

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          Abstract

          In his letter, Andrés Reyes Valdivia emphasises the importance of clinical examination skills and that advanced imaging techniques complement rather than replace a thorough examination. 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! Figure 1 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. Figure 2 Examination of the femoral pulse.

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          Author and article information

          Contributors
          Journal
          EJVES Vasc Forum
          EJVES Vasc Forum
          EJVES Vascular Forum
          Elsevier
          2666-688X
          26 May 2020
          2020
          26 May 2020
          : 48
          : 37
          Affiliations
          University of Sheffield, Sheffield, UK
          Article
          S2666-688X(20)30023-X
          10.1016/j.ejvsvf.2020.05.005
          7575448
          Crown Copyright © 2020 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.

          This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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