investigations in peripheral arterial disease

Last edited 03/2021 and last reviewed 05/2021

Routine investigations related to cardiovascular disease include fasting glucose and lipids.

Diagnosis of peripheral arterial disease (PAD) (1)

  • a person should be assessed for PAD if:
    • has symptoms suggestive of peripheral arterial disease or
    • has diabetes, non-healing wounds on the legs or feet or unexplained leg pain or
    • are being considered for interventions to the leg or foot or
    • need to use compression hosiery

  • if PAD is suspected the:
    • ask about the presence and severity of possible symptoms of intermittent claudication and critical limb ischaemia
    • examine the legs and feet for evidence of critical limb ischaemia, for example ulceration
    • examinine the femoral, popliteal and foot pulses
    • measure the ankle brachial pressure index

  • imaging for revascularisation
    • duplex ultrasound as first-line imaging if PAD for whom revascularisation is being considered
    • contrast-enhanced magnetic resonance angiography is indicated if PAD in (after duplex ultrasound) before considering revascularisation
    • computed tomography angiography should be used in patient with PAD who need further imaging (after duplex ultrasound) if contrast-enhanced magnetic resonance angiography is contraindicated or not tolerated

  • with respect to diagnosing peripheral arterial disease in people with diabetes

    • do not exclude a diagnosis of peripheral arterial disease in people with diabetes based on a normal or raised ankle brachial pressure index alone
    • do not use pulse oximetry for diagnosing peripheral arterial disease in people with diabetes

Notes:

  • noninvasive imaging modalities, include duplex ultrasonography, magnetic resonance angiography (MRA), and computed tomography angiography (CTA) (2)
    • duplex ultrasonography has a high specificity of 95% and a somewhat lower sensitivity of 88% for detecting hemodynamically significant lesions (>50% stenosis or occlusion
    • gadolinium-enhanced MRA appears to be more accurate than duplex ultrasonography, with a specificity of about 96% and a sensitivity of about 98%
  • computed tomography angiography
    • thinner slices, higher spatial resolution, and improvement of multidetector computed tomographic (CT) scanners enable scanning of the whole vascular tree in a limited period with a decreasing (but still substantial) amount of contrast medium. CTA has a reported sensitivity and specificity rates of around 98% for detecting PAD (2)
  • claudication distance is an element in the history which quantifies the distance walked before claudication occurs
  • exercise testing:
    • motorised treadmill or step tests - foot pressure normally rises with exercise but drops in the presence of occlusive arterial disease
    • the size of the pressure drop indicates the severity of the arterial insufficiency

Reference:

Related pages:

ankle-brachial pressure index

claudication distance