Presence of femoral bruits and absence of foot pulses were associated with abnormal ABI in asymptomatic people.
How well does physical examination identify patients with subclinical peripheral vascular disease? To answer this question, French researchers analyzed data from a cohort study of 2736 adults (mean age, 52) with no clinical histories of coronary, cerebrovascular, or peripheral vascular disease. A single physician examined all patients (with attention to the vascular system), and all patients underwent carotid ultrasound and measurement of ankle-brachial index (ABI).
The examiner found carotid bruits in 4% of patients, femoral bruits in 4%, and absence of ipsilateral dorsalis pedis and posterior tibial pulses in 3%. Presence of a femoral bruit predicted an abnormal ipsilateral ABI (odds ratio, 3.0, after adjustment for 10-year Framingham coronary risk). Absence of both dorsalis pedis and posterior tibial pulses also predicted abnormal ABI (adjusted OR, 3.7). However, carotid bruit did not predict the presence of high-grade internal carotid stenosis (OR, 0.9).
Comment: In this study, a femoral bruit or absence of both foot pulses signaled higher risk for abnormal ankle-brachial index. By itself, this finding doesn’t tell us whether searching for femoral bruits and foot pulses improves clinical outcomes in asymptomatic patients, but it lends credibility to these physical examination maneuvers. In contrast, the findings cast doubt on the usefulness of routine auscultation of carotid arteries. One caveat: It’s unclear whether this examiner tried to distinguish between "real" carotid bruits and radiation into the carotids of more proximal systolic murmurs or bruits.
Published in Journal Watch General Medicine January 10, 2008
Cournot M et al. Accuracy of the screening physical examination to identify subclinical atherosclerosis and peripheral arterial disease in asymptomatic subjects. J Vasc Surg 2007 Dec; 46:1215.