How Do You Test for Peripheral Artery Disease?

How Do You Test for Peripheral Artery Disease?

Testing for Peripheral Artery Disease (PAD) starts with a regular office visit. For that, the patient would have to be perfectly aware of their own health. That means, that they should be able to identify possible symptoms of the disease and report it to their primary care physician — someone who will know how to test for PAD.  

After preliminary reports, the patient will be put through a physical examination and tested for an Ankle-Brachial Index (ABI) score, which should determine the presence, or lack thereof, of PAD in the patient. Further testing might be necessary depending on certain factors.  

Office Visit 

Primarily, the diagnosis of PAD starts with a regular office visit. This visit will include an overview of the patient’s medical history. Then, the patient might be preemptively tested for PAD on the grounds of the following: 

  • Presence of high blood pressure, high cholesterol, or diabetes in the patient’s medical history (or the patient’s family medical history); 
  • A personal account of common PAD symptoms (claudication) — pain or numbness in the legs and feet during exercise; 
  • History of smoking; 
  • And/or if the patient is over the age of 50 (with a history in diabetes or smoking) or just over the age of 60.  

Physical Examination 

Once the physician begins to suspect the presence of PAD. They will continue forward with a basic physical examination of the patient’s leg. This physical examination will look closely at the patient’s lower extremities — to further determine possible symptoms that the patient themselves might not have noticed.  

  • Examination of legs and feet: First, the physician will examine the patient’s legs and feet for the presence of any physical weaknesses. Which might include something as mild as hair loss and brittleness in the nails and skin or something as severe as ulcers.
  • Evaluation of pulse and blood flow: With a stethoscope, the physician is also likely to evaluate the flow of blood in the patient’s legs and feet to preemptively identify possibly clogged arteries.
  • Identification of wounds: The physician might also inquire about possible sores or wounds in the legs and feet in order to identify another symptom of PAD — wherein present sores are not able to heal.

Ankle-Brachial Index (ABI) 

The most popular way of testing for PAD is through an Ankle Brachial Index (ABI) Test. For this, the patient is asked to rest on their back and will have their blood pressure on their upper arms and ankles measured. Such measurements are taken with a sensitive doppler probe — which broadcasts high-fidelity sounds of pulse waveforms in the arteries.  

Toe-Brachial Index Test might be necessary if the patient is displaying signs of abnormally high calcification in the arteries. ABI and TBIs are identical in practice, except for the fact that with a TBI blood pressure is read from the upper arms and big toes (rather than the upper arms and ankles.)  

Further Testing 

Further testing might be required if there are discrepancies with the diagnosis. For example, some patients might report having PAD symptoms but receive normal ABI results. Whilst others might be diagnosed with PAD but not fit the profile of an average PAD patient. In either case, a patient might be put through further testing. Such as:  

  • Ultrasound Scan: Ultrasound imaging that uses sound waves to build a picture of the arteries in the legs to determine the exact location of narrowed or blocked up arteries.
  • Stress Testing: A form of ABI testing that is conducted to identify the effects post-exercise stress on a patient.
  • Angiogram: The use of dye (contrast material) injected in the blood vessels and X-ray imaging, Magnetic Resonance Angiography (MRA), or Computerized Tomography Angiography (CTA) to trace the contrast material through the arteries.

Conclusion — How Do You Test for Peripheral Artery Disease? 

PAD is largely left undiagnosed and untreated, and whilst most symptoms are mild, there are occasions that have led to coronary artery disease, stroke, heart attack, and even death in some patients (especially in patients with a history in diabetes and smoking.) As such, early diagnosis is very important.  

 

REFERENCES 

  1. “Archive of All Online Content.” Arteriosclerosis, Thrombosis, and Vascular Biology, www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.114.303517?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed. 
  2. Høyer, C, et al. “The Toe-Brachial Index in the Diagnosis of Peripheral Arterial Disease.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, July 2013, www.ncbi.nlm.nih.gov/pubmed/23688630. 
  3. Lin, J S, et al. “The Ankle Brachial Index for Peripheral Artery Disease Screening and Cardiovascular Disease Prediction in Asymptomatic Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/24156115