Peripheral Artery Disease

Diagnosis

An early diagnosis of peripheral artery disease (PAD) can prevent serious complications, such as the inability to walk or a foot or leg amputation. Early diagnosis can even save lives, helping identify people at risk of a heart attack or stroke. Primary care doctors may not routinely check for PAD. If you have symptoms of PAD—and even if you don’t but are concerned that you might be at risk for PAD—tell your doctor. Your doctor will discuss your symptoms and medical history, give you a physical exam, and order a series of tests if needed.

Physical exam

To diagnose and develop a treatment plan for PAD, your doctor will likely do the following:

• Ask about your medical history and consider if you have high blood pressure, high cholesterol, or diabetes.
• Ask about your family history of heart disease.
• Ask about your symptoms, such as pain or heaviness in your leg muscles during exercise.
• Take into consideration if you currently smoke or have smoked in the past.
• Review any medications you take.
• Ask about your diet and what you eat daily.
• Listen with a stethoscope for any abnormal sounds of turbulent blood flow in your legs that may indicate a narrow or blocked artery.
• Evaluate the strength of the pulse in your legs and feet.
• Examine your legs and feet for wounds; if you have any, ask for details about how they have healed.
• Check for changes in your nails and skin and hair loss on the legs and feet.
• Check your ankle-brachial index (ABI), a quick, painless, noninvasive test that compares the blood pressure in your arms and legs to determine if you have PAD. Even if you don’t specifically ask about PAD, your doctor may recommend an ABI based on your medical history and physical exam.

Tests

After your physical exam, your doctor can determine if you have PAD and if additional diagnostic testing is necessary to determine its severity. Most of the tests for PAD are similar to those for coronary artery disease (CAD) since both diseases stem from the same problem—narrowed and blocked arteries that interfere with blood flow throughout the body. Your doctor can use these tests to assess the location and severity of blockages more precisely and to gather the detailed information needed to develop an effective treatment plan.

These tests may include the following:

• Blood tests – While blood tests aren’t needed to diagnose PAD, your doctor may still want to check for high blood sugar, high cholesterol, and kidney function.
• PVR segmental pressures – Blood pressure cuffs on your arms, thighs, calves, ankles, feet, and toes are inflated and deflated separately to allow your doctor to pinpoint the location and severity of the artery blockage when you’re at rest.
• Stress test – A stress test on a treadmill finds the level of activity at which you feel leg pain or cramping.
• Duplex ultrasound test – An ultrasound test allows your doctor to see blockages or narrowing in your blood vessels and determine the size of your kidneys.
• Computerized tomographic arteriography (CTA) – This test, also called CT angiography, uses X-rays and computers to create detailed images of the arteries vessels and their blood flow.
• Magnetic resonance angiogram (MRA) – This test uses magnetic fields and radio waves to produce 2D or 3D images of the arteries.
• Angiography – This diagnostic procedure provides detailed pictures of your heart and its blood vessels.