Practical Guide about PAD

9 ↪ Practical Guide about Peripheral Artery Disease (PAD) It's me, hihi! Systolic pressure in left arm Systolic pressure in right arm Left dorsalis pedis artery Left posterior tibial artery Right dorsalis pedis artery Right posterior tibial artery Higher of two pressures taken at left ankle Higher pressure in both arms Higher of two pressures taken at right ankle Higher pressure in both arms 4. How is peripheral artery disease diagnosed? 4.1. Screening exam After the medical questionnaire and physical examination, a doctor who suspects PAD should try to confirm the diagnosis and its severity using more in- depth investigation methods. Generally, this process starts with a simple calculation called the ankle-brachial index . This inexpensive screening exam basically consists of calculating the ratio between blood pressure at the ankle and at the arm. After a 15 to 30 minute rest period, the patient lies on his/her back and a blood pressure cuff and a Doppler probe are used to measure blood pressure at the arms and ankles. Two results are obtained: one for the left leg and one for the right leg. These results are usually in proportion to the severity of the PAD, namely the lower the ankle- brachial index , themore severe the disease. When blood vessels are intact, blood pressure in the arm and leg are almost identical and the index is about 1.0. An index below 0.9 indicates PAD. If a patient with characteristic PAD symptoms has a normal index, a treadmill walking test may be recommended. The step described above is repeated after the treadmill stress test. 4.2. Doppler and Doppler ultrasound In patients with strongly suspected PAD and/or with a low ankle-brachial index , the investigation may be complemented by a Doppler exploration or Doppler ultrasound. These inexpensive techniques can define the degree and extent of impairment. Combining ultrasound and Doppler makes it possible to visualize blood vessels and their blockages, if any, by scanning the skin with an ultrasound probe and being more precise about disease severity. Although quite useful, this technique does have its limitations. It is considered to be less optimal in obese patients and patients with calcified arteries (arteriosclerosis), in which the vessel walls are calcified. Diabetics with kidney failure in particular may have calcified arteries. ↳ Figure 5 : A measurement tool: the ankle-brachial index