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Investigations in peripheral arterial disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:


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