• Diagnosing Peripheral Artery Disease (PAD)

     
     
     
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    PAD PhotoDiagnosis of peripheral artery disease (PAD) begins with careful attention to your own health. Primary care physicians may not routinely check for PAD, so if you have symptoms of PAD and even if you don’t but are concerned that you might be at risk for PAD, take charge of your health and make an appointment to discuss it with your doctor. 

    Office Visit with Your Doctor

    To diagnose and develop a treatment plan for PAD, your physician may ask you 

    • about your medical history, including whether you have high blood pressure, high cholesterol, or diabetes
    • if you have a history of heart disease in your family
    • about your symptoms, such as pain or heaviness in your legs muscles during exercise
    • if you smoke or have ever smoked
    • to name or provide a list of any medications you take
    • what you eat

    During the physical exam for PAD, your doctor may also 

    • check your ankle-brachial index (ABI) — a quick, painless, non-invasive test that compares the blood pressure in your arms and legs to determine if you have PAD. Even if you do not specifically ask about PAD, your doctor may recommend an ABI based on your medical history and physical exam. The ABI is so simple to perform and yields so much information about your arteries, there’s really nothing to lose and everything to gain from having it checked as often as necessary to determine if you have blockages or if they are getting worse. 
    • listen with a stethoscope for any abnormal sounds of turbulent blood flow in your legs that may indicate a narrow or blocked artery 
    • evaluate the strength of the pulse in your legs and feet
    • examine your legs and feet for wounds and if you have any, ask for details about how they have been healing
    • check for changes in your nails, skin, and hair loss on the legs and feet

    While no blood tests are needed to diagnose PAD, your doctor may still check for the following: 

    • high blood sugar and cholesterol, both risk factors for PAD to be monitored and managed
    • kidney function because restricted or blocked blood flow to your kidneys, or renal artery disease (RAS), could cause kidney failure

    Once your doctor has gathered all the information from your medical history, physical, and ABI, he or she can determine if you have PAD and if additional diagnostic testing is necessary to determine its severity.

    Diagnosing PAD Flowchart 

    You can view and print a copy (PDF version) of the SecondsCount Diagnosing PAD flow chart here.

    If you have mild PAD, your healthcare provider may provide treatments to help you manage the disease. But if your symptoms and other evaluations indicate that you have advanced PAD or your condition is growing more severe, your healthcare provider may refer you to a cardiologist or other vascular specialist for more testing and treatment.

    Your doctor may also recommend one or more of the following tests to more precisely assess the location and severity of any blockages and to gather the detailed information needed to develop an effective treatment plan:

    • PVR Segmental Pressures. Blood pressure cuffs on your arms, thighs, calves, ankles, feet, and toes are inflated and deflated separately to allow your doctor to pinpoint the location and severity of the artery blockage when you are at rest.
    • Stress Treadmill Test. This test finds the level of activity at which you feel leg pain or cramping.
    • Duplex Ultrasound Test. An ultrasound test allows your physician to see blockages or narrowing in your blood vessels and determine the size of your kidneys.
    • Computerized Tomographic Arteriography (CTA). This test, also called CTA or CT Angiography, uses x-rays and computers to create detailed images of the arteries vessels and the blood flow within them.
    • Magnetic Resonance Angiogram (MRA). This test uses magnetic fields and radio waves to produce two- or three-dimensional images of the arteries. 

    All of these tests can give your physician important insights into your heart and arteries, and determine if treatment is necessary. Most of the tests for PAD are similar to those for coronary artery disease. That’s because both diseases stem from the same problem—narrowed and blocked arteries that interfere with the flow of blood throughout the body. 

    The earlier PAD is diagnosed, the easier it is to treat. Early treatment can help to prevent disabling pain in the legs and feet, loss of limbs or amputation due to infection, as well as heart attack and stroke.