Diagnosing Peripheral Artery Disease (PAD)

February 20, 2012 Rocco G. Ciocca, M.D.

(Ed. note - As it is heart month, we asked Dr. Rocco Ciocca, Chief of Vascular Surgery, to explain a little more about heart attacks and peripheral artery disease.)

In the last blog we defined a condition known as PAD, which is a constellation of problems related to narrowing of the arteries outside the heart.

PAD, If left untreated, can lead to having a stroke, worsening high blood pressure, difficulty walking, non-healing sores on the legs and feet and in extreme cases gangrene necessitating amputation of the involved body part.

I briefly mentioned how it can be diagnosed and would like to describe that in more detail here.

The great news is that doctors do not need order a bunch of painful or expensive tests to diagnosis PAD. The best and most cost-effective test is a thorough history and physical exam. During that, the health care provider will listen to your symptoms and ask questions about your medical history and your risk factors.

The major risk factors for PAD are:

  • smoking
  • diabetes
  • hypertension (high blood pressure)
  • high cholesterol levels

The provider will ask about your medications, allergies and if you have had previous surgeries. The provider then should do a thorough physical exam paying close attention to listen for sounds in the neck, feel for pulses in all for extremities, examine and listen to the abdomen. The provider may look at the legs and feet and check for sores or other sometime more subtle abnormalities.

If the physical exam is normal then the likelihood of having PAD is very, very low. If not, then some other very simple measures can be taken. The blood pressure should be taken in both arms. If there is a significant difference in blood pressure between the two arms, this is a strong indicator of PAD.

In addition, the blood pressure should be taken at both ankles. That blood pressure is then divided by the blood pressure in the arm (the highest arm pressure if there is a difference) to create what is known as the ABI (the ankle brachial index.) That number should be 1 or slightly greater than 1. If it is lower than 0.9 then that signifies significant PAD.

Your heath care provider may then decide to refer you to a vascular specialist. Usually other simple and painless non-invasive tests can be done to further illicit the extent and seriousness of the condition.

Let's continue the conversation about your heart - join us on Saturday, February 25 from 8 a.m. to noon at three different locations — Swedish/Cherry Hill in Seattle, Edmonds Conference Center in Downtown Edmonds and Meydenbauer Center in Bellevue. Register here to enjoy informative lectures, free screenings, a healthy breakfast and more at this free community event. If you want to start small and make a big impact in your diet, try one of our heart-healthy recipes in this archive of over one hundred tasty, heart-healthy dishes.

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