How is peripheral artery disease (PAD) diagnosed?

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Dr. Lyndon C. Box, MD
Cardiologist (Heart Specialist)

Peripheral artery disease can be diagnosed simply by history and a medical exam. Lyndon Box, MD, from West Valley Cardiology Services, says other tests include blood pressure cuffs, ultrasound, CT scans and angiograms.

Peripheral artery disease (PAD) is initially diagnosed with a physical exam done by a doctor who specializes in the cardiovascular system. The ankle-brachial index (ABI) test is done to check blood flow by comparing blood pressure in the ankles and the arms.

If there is a significant difference in the two pressure readings, the diagnosis is usually PAD. Normally, the ankle and brachial pressures should be the same. In a person with PAD, there are blockages in the arteries going to the legs, which can cause changes in blood pressure in the area.

Dr. Anthony G. Smeglin, MD
Interventional Cardiologist

Peripheral artery disease (PAD) may be diagnosed through the following:

  • A thorough medical history is taken and discussed. This will help delineate whether the symptom is coming from a blockage in the arteries or that it's more likely due to a nerve, musculoskeletal or spine problem.
  • A diagnostic procedure called an ankle brachial index (ABI) will be done. This is recommended for all people over 65 with risk factors, and anyone over 50 who has a history of smoking or diabetes. The ABI is very sensitive and specific when done properly for picking up or screening for peripheral artery disease. If the ABI alone is not enough, the person would exercise (walk slowly) on a treadmill while an ABI is performed.
  • More advanced tests called pulse volume recording or an ultrasound of the legs may be performed.

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Dr. Manesh R. Patel, MD
Cardiologist (Heart Specialist)

It’s a very simple test called the ankle brachial index. You put a blood pressure cuff on your arm and one on your leg. The blood pressure in your arm should be the same as your leg. If the blood pressure in your leg is decreased, we assume that there is a narrowing or a blockage somewhere between your arm and your leg. This test gives us an idea of whether you have peripheral arterial disease.

Peripheral artery disease can be diagnosed right in the physician's office. This may include a test called an ankle-brachial index. A physician can also diagnose peripheral artery disease in the office simply by taking pulses. Very frequently, pulses to the feet—or what are called the dorsalis pedis pulse and posteror tibial pulse—are absent, which is an indication that there is peripheral artery disease. A simple test may include an ultrasound of the lower extremities looking at the arteries at rest and then with exertion. This is a very simple, non-expensive diagnostic test that can diagnose peripheral artery disease. Further testing can include a CT angiogram or an MRA (a magnetic resonance angiogram) which can actually look at blood flow to the arteries of the legs.

Most people do not know they have Peripheral Arterial Disease (PAD), particularly in the early stages. PAD is often silent. This is a problem because having PAD is a marker for heart attack and stroke. If you have fatty plaque buildup in the small arteries of your legs, it is likely you have this same buildup in other arteries. The vascular system is one big superhighway and it is all connected. 

Diagnosis often comes once the disease has progressed and the person is experiencing symptoms. The typical symptom is intermittent claudication, which is a way of saying that the person has pain when they are walking that subsides when he or she rests. 

Simple tests are available to screen for and diagnose PAD. Doctors can listen and feel for the pulse in your lower legs and do a physical exam of your feet. In addition, an Ankle-Brachial Index (ABI) test is a quick, easy, non-invasive test that can detect PAD very accurately. As your doctor about this test or look for a community screening that offers it.

The ABI test is particularly important if you are over age 50, smoke or have diabetes.

Peripheral arterial disease (PAD) is diagnosed based on your medical and family histories, a physical exam and results from tests. PAD often is diagnosed after symptoms are reported. An accurate diagnosis is important, because people who have PAD are at increased risk for coronary artery disease (CAD), heart attack, stroke and transient ischemic attack ("mini-stroke"). If you have PAD, your doctor also may want to look for signs of these conditions.

Specialists involved
Primary care doctors, such as internists and family practitioners, may treat people who have mild PAD For more advanced PAD, a vascular specialist may be involved. This is a doctor who specializes in treating blood vessel problems.

A cardiologist also may be involved in treating people who have PAD. Cardiologists treat heart problems, such as CAD and heart attack, which often affect people who have PAD.

Medical and family histories
To learn about your medical and family histories, your doctor may ask:

  • Whether you have any risk factors for PAD
  • About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing or climbing
  • About your diet
  • About any medicines you take, including prescription and over-the-counter medicines

This answer from the National Heart, Lung and Blood Institute has been reviewed and/or edited by Dr. William D. Knopf.

The ankle brachial index (ABI) is one test used to diagnose peripheral arterial disease (PAD). This test compares the blood pressure in your ankle to the blood pressure in your arm. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PAD. An expert panel brought together by the American Diabetes Association recommends that people with diabetes over the age of 50 have an ABI to test for PAD. People with diabetes younger than 50 may benefit from testing if they have other PAD risk factors.

These other tests can also be used to diagnosis PAD:

  • Angiogram: a test in which dye is injected into the blood vessels using a catheter and x-rays are taken to show whether arteries are narrowed or blocked.
  • Ultrasound: a test using sound waves to produce images of the blood vessels on a viewing screen.
  • Magnetic resonance imaging (MRI): a test using special scanning techniques to detect blockages within blood vessels.

To diagnose peripheral artery disease (PAD), your doctor will ask you questions about your symptoms and medical history. He or she will perform a physical exam that includes checking your pulses in your extremities. Your doctor may also recommend special vascular testing such as an ankle brachial index (ABI): taking a blood pressure reading at the ankle and comparing it to that in the arm. This gives your doctor an idea of how well your blood is traveling down your legs into your feet. If it looks like you may have PAD, then you will make an appointment with a board-certified vascular surgeon for an examination.

Continue Learning about Vascular Disease

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.