Palpation of all pulses, capillary refill time, Buerger's test. Used sensibly with common sense one can make a decision on ischemia at rest.

Most valuable manual test is Ankle Arm (AA) or Ankle Brachial (AB) Index. Its easy and feasable even in cases of whom peripheral pulses are non palpable. (by usind a hand doppler which is available in most centres). you can even decide the type of surgery (if needed) by just using this measurements. you can measure the index from popliteal artery with posterior tibial artery and connect those data with palpable pulses. If you can not palpate the pulses and there is no signal with an hand doppler, an angiographic examination is necessary. otherwise the AAI (ABI) is the most valuable and feasable method to evaluate the seriousness of peripheral vascular disease.

Dear Iftikhar Ali,

I agree with allI  all previous opinions  remembering that are low cost and easily performed.

I would also add after these steps the noninvasive imaging Color Doppler ultrasound arterial segment to be analyzed.

Just take care when your patient is a diabetic, that the Ankle brachial Pressure indices may be falsely elevated due to calcification of the distal arteries. We prefer to do toe pressures in this group instead as the artery of the hallux is spared from calcification, giving better accuracy of peripheral aterial supply.  Remember that you need a  8mHz handheld Doppler for assessment of vascular flow and that you cannot borrow the Doppler used for fetal assessments as a stand in for vascular flow assessment.  

Combining a ABI with a peripheral doppler and interpreting the results along with patients symptoms in consideration gives a very good idea about the PVD both anatomically and physiologically.

You can even get an idea what is going on with your patient based on their history before you start examining them. 

Ask if they sleep well at night, do their feet bother them at night or wake them up at night, do they sleep with their feet dangling out of the bed, do they have to get up to walk around the room at night, do they have sores on their feet that take a long time to heal, do they smoke and if so for how long, do they have diabetes or heart disease, how far can they walk, if not far, why and are they having pain in their legs and where exactly

When you examine them, check for pulses, DP, PT, popliteal, femoral, check the capillary refill, check between the toes because you may find sores the patient never noticed, check for hair growth, check for warmth, pinch their toes and see if it is the same bilaterally, check muscle strength and see if it is the same bilaterally.

Be sure to check the abdomen for pulsatile mass or see if you can hear a bruit.

There are more things you can check for via the patient's history and your physical exam which should give you a good idea what is going on before you start doing your imaging studies

Completely agree with Craig: the history and physical examination is extremely important. In addition check for skin colour and skin lesions (ulcerations?).