7. We recommend arterial pulse examination and measurement of ankle-brachial index (ABI) on all patients with venous leg ulcer (Grade 1, Level B).
8. Key components of the physical examination include measurement of blood pressure in both arms, cardiac auscultation, leg examination (changes in color, skin temperature, muscle atrophy, decreased hair growth, hypertrophied nails), and complete pulse examination (palpation for aneurysms; auscultation for bruits in carotid, aorta, or femoral region; palpation of the radial, ulnar, brachial, carotid, femoral, popliteal, dorsalis pedis, and posterior tibial artery pulse). Lower extremity Doppler examination is standard for patients with suspected PAD.
9. The typical cutoff point for diagnosis of PAD is ABI ≤0.90 at rest, with ABI ≤0.50 usually corresponding to critical limb ischemia.
10. In patients with diabetes, renal insufficiency, or other diseases that cause vascular calcification, tibial vessels at the ankle become noncompressible, leading to a false elevation of the ankle pressure and ABI.
11. For ABI ≤0.90, referral should be made to a vascular specialist for further arterial evaluation