Polyvascular Atherosclerotic Disease: A Narrative Review of the Role of Systematic Bedside Vascular Examination.

Polyvascular atherosclerotic disease refers to clinically significant atherosclerosis involving two or more arterial territories and is associated with a greater risk of cardiovascular and cerebrovascular events than disease confined to a single vascular bed. Because atherosclerosis is a systemic process, the identification of disease in one territory should prompt clinicians to consider involvement elsewhere. Despite increasing reliance on advanced imaging, a systematic bedside vascular examination remains an accessible and inexpensive first step for identifying findings that may justify targeted investigation. This narrative review examines the role of clinical history and physical examination in evaluating patients with established or suspected atherosclerotic disease across multiple vascular territories. Particular attention is given to carotid auscultation, bilateral upper-extremity blood pressure and pulse assessment, cardiac evaluation, abdominal vascular examination, and examination of the femoral, popliteal, posterior tibial, and dorsalis pedis arteries, together with inspection for limb ischemic changes. The review also discusses the diagnostic limitations of individual physical findings and emphasizes that bedside examination should not be considered a substitute for objective testing. Rather, abnormal or suspicious findings can guide the selective use of ankle-brachial index (ABI) measurement, duplex ultrasonography, computed tomography angiography (CTA), magnetic resonance angiography (MRA), and appropriate cardiac investigations. A structured approach that begins with systematic clinical assessment and progresses to targeted testing may help identify clinically important multiterritory disease while avoiding indiscriminate imaging of asymptomatic vascular beds. Incorporating comprehensive vascular examination into routine assessment may therefore strengthen cardiovascular risk recognition and support more individualized investigation and management of patients with systemic atherosclerosis.