Peripheral Arterial Disease

How Is Peripheral Arterial Disease Diagnosed?

Peripheral arterial disease (PAD) is diagnosed based on your medical and family histories, a physical exam, and test results.

PAD often is diagnosed after symptoms are reported. A correct diagnosis is important because people who have PAD are at higher risk for coronary heart disease (CHD), heart attack and stroke.

That risk is even higher if you have diabetes. If you have PAD, your doctor should also check for signs of these diseases and conditions.

Primary care doctors may treat people who have mild PAD but for more serious or advanced cases a vascular specialist may be consulted. A vascular specialist is a doctor who focuses on treating blood vessel diseases and conditions.

Your doctor may ask:

  • Whether you have any risk factors for PAD For example whether you smoke or have diabetes.
  • About your symptoms, including any that occur when walking, exercising, sitting, standing, or climbing.
  • About your diet.
  • About any medicines you take, including prescription and over-the-counter medicines.
  • Whether anyone in your family has a history of heart or vascular disease.

 Physical Exam and Diagnostic Tests

Your doctor will conduct a physical exam looking for signs of PAD by checking the blood flow in your legs and/or feet to see whether you have weak or absent pulses.

Your doctor also may check the pulses in your leg arteries with a stethoscope checking for an abnormal whooshing sound called a bruit. A bruit may be a warning sign of a narrowed or blocked artery.

Your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb. They will also check for poor wound healing or any changes in your hair, skin, or nails that may be signs of PAD.

Ankle-Brachial Index. A simple test called an ankle-brachial index (ABI) often is used to diagnose PAD The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs. The test can show whether PAD is affecting your limbs, but it won’t show which blood vessels are narrowed or blocked (additional tests will be required to determine which vessels are blocked).

The test takes about 10 to 15 minutes to measure both arms and both ankles. This test may be done yearly to measure the progression of the disease.

Doppler Ultrasound. A Doppler ultrasound examines the blood flow in the major arteries and veins in the limbs. During this painless test, a handheld device is moved back and forth over the affected area. A computer converts sound waves into a picture of blood flow in the arteries and veins. The results show if blood vessels are blocked, which vessels are affected and the severity of the disease.

Treadmill Test. A treadmill test can measure the severity of symptoms and the level of activity that brings them on. You’ll walk on a treadmill for this test which will show whether you have any problems during normal walking.

Your doctor may also schedule an ABI test before and after the treadmill test which will compare blood flow in your arms and legs before and after exercise.

Magnetic Resonance Angiogram. A magnetic resonance angiogram (MRA) uses magnetic and radio wave energy to take pictures of your blood vessels.

An MRA can show the exact location and severity of a blocked blood vessel. Unfortunately, if you have a pacemaker, man-made joint, stent, surgical clips, mechanical heart valve, or other metallic devices in your body, you might not be able to have an MRA. Ask your doctor whether an MRA is an option for you.

Arteriogram. An arteriogram is another method of providing a “map” of the arteries. Doctors use this test to find the exact location of a blocked artery particularly if an MRA isn’t possible.

During this test a dye is injected through a needle or tube into one of your arteries. After the dye is injected, an x ray is taken. The x ray can show the location, type, and extent of the blockage in the artery.

A new method of arteriograms uses tiny ultrasound cameras that take pictures of the insides of the blood vessels. This method is called intravascular ultrasound.

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