During a physical examination, your doctor may look for signs that indicate peripheral artery disease, including weak or absent artery pulses in the extremities, specific sounds (called bruits) that can be heard over the arteries with a stethoscope, changes in blood pressure in the limbs at rest and/or during exercise (treadmill test), and skin color and nail changes due to tissue ischemia (lack of blood and oxygen).
In addition to the history of symptoms and these physical signs of peripheral artery disease, doctors can use imaging tests in the diagnosis of peripheral artery disease. These imaging tests include:
- Doppler ultrasound: A form of ultrasound (measurement of high-frequency sound waves that are reflected off tissues) that can detect and measure blood flow. Doppler ultrasound is used to measure blood pressures behind the knees and at the ankles. In patients with significant peripheral artery disease in the legs, the blood pressures in the ankles will be lower than the blood pressure in the arms (brachial blood pressure). The ankle-brachial index (ABI) is a number derived from dividing the ankle blood pressure by the brachial blood pressure. An ABI of 0.9 to 1.3 is normal. An ABI of less than 0.9 indicates the presence of peripheral artery disease in the arteries in the legs, and an ABI below 0.5 usually indicates severe arterial occlusion in the legs.
- Duplex ultrasound: Is a color-assisted non-invasive technique to study the arteries. Ultrasound probes can be placed on the skin overlying the arteries and can accurately detect the site of artery stenosis, as well as measure the degree of obstruction.
- Angiography: An angiography is an imaging procedure to study the blood vessels similar to coronary angiogram. It is the most accurate test to detect the locations and severity of artery occlusion, as well as collateral circulations. Small hollow plastic tubes (catheters) are advanced from a small skin puncture at the groin (or the arm), under X-ray guidance, to the aorta and the arteries. Iodine contrast dye is then injected into the arteries while an X-ray video is recorded. An angiogram gives the doctor a picture of the location and severity of narrowed artery segments. This information is important in helping the doctor select patients for angioplasty or surgical bypass.
Because X-ray angiography is invasive with potential side effects (such as injury to blood vessels and contrast dye reactions), it is not used for initial diagnosis of peripheral artery disease. It is only used when a patient with severe peripheral artery disease symptoms is considered for angioplasty or surgery. A number of different imaging methods have been used in angiography examinations, including X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans.
- Magnetic resonance imaging (MRI) angiography uses magnetism, radio waves, and a computer to produce images of body structures and has the advantage of avoiding X-ray radiation exposure.
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Archived: March 20, 2014
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Read the Original Article: Peripheral Vascular Disease