Peripheral Artery Disease (P.A.D.)
Your Family and Medical History
P.A.D. is diagnosed based on a person's medical and family histories, a physical exam, and results from medical tests. A correct diagnosis is important because people who have P.A.D. are at higher risk for coronary heart disease (CHD), heart attack, stroke, and transient ischemic attack ("mini-stroke"). If you have P.A.D., your doctor also may want to check for signs of these diseases and conditions.
To learn about your medical and family histories, your doctor may ask about
- your risk factors for P.A.D. For example, he or she may ask whether you smoke or have diabetes.
- your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing
- your diet
- any medicines you take, including prescription and over-the-counter medicines
- family members with a history of heart or blood vessel diseases.
The Physical Exam
During the physical exam, your doctor will look for signs of P.A.D. He or she may check the blood flow in your legs or feet to see whether you have weak or absent pulses. Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit (broo-E). He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked artery.
Your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb. He or she may also check for poor wound healing or any changes in your hair, skin, or nails that might be signs of P.A.D.
Tests are used to diagnose P.A.D. These tests include
- an ankle-brachial index (ABI). This test compares blood pressure in your ankle to blood pressure in your arm. It shows how well blood is flowing in your limbs. ABI can show whether P.A.D. is affecting your limbs, but it won’t show which blood vessels are narrowed or blocked. A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10 to 15 minutes to measure both arms and both ankles. This test may be done yearly to see whether P.A.D. is getting worse.
- a Doppler ultrasound. This test looks at blood flow in the major arteries and veins in the limbs. During this test, a handheld device is placed on your body and passed back and forth over the affected area. A computer converts sound waves into a picture of blood flow in the arteries and veins. The results of this test can show whether a blood vessel is blocked. The results also can help show the severity of P.A.D.
- a treadmill test. This test shows how severe your symptoms are and what level of exercise brings on your symptoms. You will walk on a treadmill during the test. You may have an ABI test before and after the treadmill test. This will help compare blood flow in your arms and legs before and after exercise.
- a magnetic resonance angiogram (MRA). This test uses magnetic and radio waves to take pictures of your blood vessels. This test is a type of magnetic resonance imaging (MRI). An MRA can show the location and severity of a blocked blood vessel. If you have a pacemaker, man-made joint, stent, surgical clips, mechanical heart valve, or other metallic devices in your body, you might not be able to have an MRA. Ask your doctor whether an MRA is an option for you.
- an arteriogram. This test is used to find the exact location of a blocked artery. Dye is injected through a needle or catheter (thin tube) into one of your arteries, then an X-ray is taken. The X-ray can show the location, type, and extent of the blockage in the artery. Some doctors use a newer method of arteriogram that uses tiny ultrasound cameras. These cameras take pictures of the insides of the blood vessels. This method is called intravascular ultrasound.
- blood tests. These tests check for P.A.D. risk factors such as diabetes and high blood cholesterol levels.