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Peripheral Arterial Disease (PAD)

What Test to Order for PAD
It is helpful to think of peripheral vascular disease in three different arterial beds: carotids, abdominal and lower extremity. Different imaging modalities are useful in these different anatomical regions. As with any patient, the approach must be tailored to the individual, based on a thoughtful history and physical exam.

  • Carotid Disease

    Carotid duplex scanning is indicated as a first-line test for the presence of bruits, TIA and to follow-up carotid revascularizations such as endarterectomy or stenting. Its advantages are the combination of anatomy and physiology in one test to assess the severity of a specific stenosis. It requires not only a skilled technician to acquire the raw data, but also a trained and experienced reader to interpret it. MRI and CT imaging provide detailed anatomic maps useful to plan an intervention or augment the information from the duplex.

  • Claudication

    If a detailed history and physical in a patient at risk for PAD is suggestive of claudication, then lower extremity disease can be easily assessed at the bedside or in the office with a simple ankle-brachial index. This test is quick, inexpensive and reproducible among all levels of health professionals. Depending on the patient, further testing may be needed to differentiate PAD from other causes of pain such as spinal stenosis. A  Lower Extremity Non-invasive Study (LENIS) improves on specificity by adding pressure-volume recording (PVR) to the rest ABI. Performing these measurements after exercise is the most sensitive and specific way to determine not only the presence, but often the extent of the disease and the claudication threshold. These physiologic tests can then be augmented by duplex ultrasound to image the anatomy and quantify the physiology of a specific stenosis. CT and MRA provide an angiogram in conjunction with these other tests for selected patients needing further study.

  • Abdominal Arterial Disease (Aorta and Renals)

    Duplex, CT and MRA are also useful as first-line tests to screen for aortic disease. Duplex is the best first test for renovascular hypertension in patients at risk.

  • Why CARI is a Good Choice for Your Patients with PAD

    CARI offers unique full consultation and testing for PAD at our Providence site where members of CARI with special expertise in the evaluation of PAD are able to address clinical problems efficiently. The advantage of having all imaging modalities (Duplex, MRA, CTA) on site is that it is usually possible for a patient to complete their evaluation with a recommendation for therapy on the first visit.

Risk Factors for PAD
  • Younger than 50 years with diabetes, and one additional risk factor (e.g., smoking, dyslipidemia, hypertension, or hyperhomocysteinemia)
  • Age 50 to 69 years and history of smoking or diabetes
  • Age 70 years and older
  • Leg symptoms with exertion (suggestive of claudication) or ischemic rest pain
  • Abnormal lower extremity pulse examination
  • Known atherosclerotic coronary, carotid disease

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Southcoast Physicians Group An affiliate of Southcoast Physicians Group.