Peripheral Artery Disease may be progressing slowly and symptoms may go unnoticed particularly for those who are not walking enough to trigger the leg pain.
Depending on your medical history, your doctor will perform a thorough physical examination and order some tests of the leg arteries to rule in (or rule out) Peripheral Artery Disease.
In case of critical limb ischemia these tests will be done urgently. Be sure to let your doctor know if you have had any symptoms, such as those listed above.
Among others, your doctor will check your pulse at your groin, behind your knee, on the inner ankle, and on the top of your foot.
Your pulse shows the strength of blood flow. An absent or weak pulse in these spots is a sign of Peripheral Artery Disease.
Diagnostic tests include:
Ultrasound
• Doppler Ultrasound: It is a non-invasive simple test that can assess blood flow within the leg arteries.
In its simplest form it is a hand-held device producing and transmitting ultrasound waves towards the blood stream flowing cells.
These ultrasound waves are reflected back and are transformed to a pulsatile waveform and sound. Faintness or absence of sound may indicate an obstruction in the blood flow.
• Ankle-brachial index (ABI): It is measured with a regular blood pressure cuff and a Doppler ultrasound device by comparing the blood pressure in the arms and in the legs.
To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
It is simple, fast, non-invasive and quite accurate in the diagnosis of Peripheral Artery Disease and assessment of its severity.
It can be used for screening or surveillance of known Peripheral Artery Disease.
• Pulse Volume Recording (PVR): To assess blood flow in the limbs, pulse volume recordings (PVRs) may be also performed, usually in conjunction with the ABI.
Blood pressure cuffs are inflated on different levels of the limb and blood pressure is measured. This is a technique used to calculate blood volume changes in the legs using a recording device that displays the results as a pulsatile waveform.
Loss of this pulsatility may indicate arterial obstruction at the investigated leg level.
It is simple, fast, non-invasive and quite accurate in the diagnosis of Peripheral Artery Disease and assessment of its severity.
• Peripheral Arterial Duplex or Triplex Ultrasound: It is a simple, fast, non-invasive study that images the leg arteries indicating the site of the blockages caused by a blood clot or an atherosclerotic plaque.
It can also indicate the severity of the narrowing of the artery.
Computed Tomography Angiography (CTA)
• Computed Tomography Angiography (CTA): It is a very accurate study for the diagnosis of Peripheral Artery Disease. It can give high resolution 3D pictures of the leg arteries and the blockages.
This comes at the cost of the need for radiation and intravenous dye (iodinated contrast) that may be harmful for the kidneys, especially in patients with impaired renal function.
CT scans are not ordered routinely, unless an intervention needs to be planned.
Magnetic Resonance Angiography (MRA)
• Magnetic Resonance Angiography (MRA): It can be as accurate as the CTA, doesn't require radiation and if intravenous contrast is used (gadolinium) it is less harmful for the kidneys.
Drawbacks are that it may be time consuming, it is expensive and it may be contraindicated in patients with claustrophobia or metallic implants.
Traditional Angiography
• Traditional Angiography: It is an invasive imaging study done in a surgical environment as it requires arterial access through a groin puncture.
It requires radiation and intravenous contrast and it may be used to assist your vascular surgeon's operative plan.
In contemporary practice, it is not routinely recommended for diagnosis.
It will eventually be used as part of your treatment if balloon angioplasty or stenting has been decided.