• P.A.D. Diagnosis

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    Early diagnosis and treatment of P.A.D. can help prevent disabling pain in the legs and feet, as well as heart attack and stroke

    A simple test, called the Ankle-Brachial Index, or ABI, can quickly and painlessly determine if you have P.A.D. The ABI takes 10 to 15 minutes and can be done by your internist with a specialized “Doppler” stethoscope and blood pressure cuff. It involves simply measuring the blood pressure in each of your ankles and in each of your arms. Your doctor then compares the two readings. A normal ABI reading is 1.0 (with a range of .9 to 1.3). If your blood pressure is lower in the ankle than the arm, a blockage is likely present in an artery somewhere between your heart and ankle – and, if so, you have P.A.D. 

    Unfortunately, internists and family physicians may not routinely check for P.A.D. If you believe you have symptoms of P.A.D. or believe you are at risk for it, ask your primary care doctor about the Ankle-Brachial Index. Because it is a simple test, the ABI can be done yearly if needed to determine if blockages are getting worse.

    While no blood tests are needed to diagnose P.A.D., certain blood tests may be recommended if you have P.A.D. or are at high risk for it. These include measurements of the blood sugar and blood cholesterol. These tests may be important because  diabetes and  high cholesterol are conditions that increase your risk of P.A.D. In addition, your doctor may want to check your kidney function.

    If you have mild P.A.D., your internist or primary care physician may provide treatments to help you manage the disease. However, if your symptoms and other evaluations indicate that you have advanced P.A.D. or your condition is growing more severe, your internist may refer you to a vascular specialist, a doctor with special training in diagnosing and treating blood vessel problems. 

    To diagnose and develop a treatment plan for P.A.D., your physician will ask:
    The physician will also conduct a physical examination that may include: 
    • The Ankle-Brachial Index (ABI) test to determine if there is a difference in blood pressure between your arm and your ankle
    • Evaluating the strength of the pulse in your legs and feet
    • Listening through a stethoscope for any abnormal whooshing sounds in your legs, which can indicate a narrow or blocked artery
    • Examining your legs and feet for wounds and asking you how any sores you have are healing
    • Looking for other indications of P.A.D., such as changes in your nails, skin or hair loss on the legs/feet.
    To more precisely assess the location and severity of any blockages – and to gather the detailed information needed to develop an effective treatment plan, the physician may also recommend other tests, including: 

    Doppler Test. You may be referred to a specialized “vascular laboratory” where blood pressure cuffs are placed on your arms, thighs, calves, ankles, feet and toes. These will be inflated and deflated separately, and will allow your doctor to predict the location and severity of the artery blockage when you are at rest.

    Treadmill Test. You may be asked to take a stress, or treadmill, test. During a treadmill test, you will be asked to walk on a steeply inclined treadmill at a slow rate. This test will provide the doctor with more information on your symptoms and the level of activity at which you feel leg pain or cramping. Some people may feel pain, but most find it painless and very safe. 

    Ultrasound Test. Little or no discomfort is felt during a duplex ultrasound test, used to determine the degree of blockage in an artery in the legs or arms. It is performed in the vascular laboratory at a hospital or clinic. A gel is applied to the skin over the arteries being examined. Images are created as a transducer, the instrument that generates ultrasound waves and collects them as they reflect back off the body’s structures, is moved over the arteries under examination. There are no known risks associated with an ultrasound test. 

    Magnetic Resonance Angiogram (MRA). When magnetic resonance imaging (MRI) is used to diagnose problems with the blood vessels, it is often called MRA. An MRA uses magnetic fields and radio waves to produce two- or three-dimensional images of the vessels. These images provide doctors a more precise assessment of the severity and location of blockages in the arteries in the legs or arms. For the MRA, you go to a special lab, change into a gown and remove all jewelry or other metal objects. You may be sedated to help you lie still during the test, which typically takes 30 to 90 minutes. 

    You will be asked to lie on the MRA table. The technician will then slide the table into a hollow, donut-shaped chamber. There you will be exposed to magnetic fields and radio waves – both harmless and painless. If requested by your doctor, a small amount of dye will be injected through a catheter into your blood vessels. (If you have problems with kidney function, you cannot have dye injected for the MRA.) Lying still on the table in an enclosed area may be the most uncomfortable aspect of the test. 

    If you have a pacemaker, prosthetic joint, stent, surgical clips, mechanical heart valve, or other metallic devices in your body, you might not be eligible for an MRA. It depends on the type of metallic device you have.

    MRA is considered safe. However, people have been harmed if metal is in their body or in the room. Be sure to tell your physician if you have metal implants. And be sure to remove all metal from your body before the test.

    Computerized Tomographic Arteriography. This test, also calls a CTA, uses iodine-based dye injected into a small vein in the hand and x-rays to provide detailed three-dimensional images of your arteries. 

    Arteriogram or angiography. An arteriogram (often called angiography) provides the exact location of blockages in the arteries of the legs or arms. It involves first injecting dye (or “contrast material”) through a needle or catheter (thin, flexible tube) inserted into an artery. An x-ray is then taken to see how the dye flows through the artery, if there are blockages, and, if there are, where they are located. If the needle and catheter are inserted in the groin, you will be asked to lie flat on your back for several hours after the procedure to avoid bleeding. 

    You should ask your doctor about the risks of arteriogram. Possible risks include: 
    • Allergic reaction to the dye
    • Bleeding, infection and pain where the needle and catheter were placed
    • Blood vessel damage
    • Blood clots
    • Kidney damage from the dye (higher risk in those with diabetes)