Peripheral Arterial Disease

Diagnosis

A comprehensive diagnosis will help determine the most appropriate treatment for patients with peripheral arterial disease (PAD). Mayo Clinic specialists may use many tools to diagnose PAD, including:

Physical Examination and Blood Tests
Mayo Clinic physicians review each patient's medical history and conduct a detailed assessment of risk factors for PAD, heart disease and stroke, including:

• Intermittent claudication (leg pain with walking) and other related medical conditions
• Hypertension (high blood pressure)
• Pulses in the arms and legs
• Bruits (whooshing sounds heard with a stethoscope), which may indicate restricted blood flow caused by narrowed arteries

Blood tests may be used to confirm cholesterol levels, diabetes, and other indicators of a high risk for hardening of the arteries, such as high levels of homocystine (an amino acid found naturally in the blood that acts as a building block for proteins).

Ankle-Brachial Index (ABI)
This noninvasive test compares the blood pressure between the arms and ankles. An abnormal ratio may indicate decreased circulation.

Ultrasound
Ultrasound is a painless, noninvasive procedure that sends high-frequency sound waves into the arteries. As the sound waves bounce back, specialists analyze the images and assess the degree of circulatory impairment.

Computed Tomography Angiography (CTA)
In this noninvasive test, a CT scanner rapidly rotates around the body, taking a series of images that are reconstructed, with the aid of a computer, to produce detailed images of the arteries and surrounding structures.

Magnetic Resonance Angiography (MRA)
MRA uses a powerful magnet and radio waves to produce a detailed, three-dimensional view of the arteries. Narrowed and blocked arteries can be identified in this noninvasive test.

Arteriography
In this procedure, a catheter (thin, flexible tube) is inserted into the artery through a skin puncture, usually in the groin. The catheter is threaded, with X-ray guidance, through the circulatory system to the affected artery. Dye is injected into the artery to give a detailed view of problem areas.

If a blockage or narrowing is discovered, it can occasionally be treated with a balloon or stent (a wire mesh tube) inserted into the artery, often during the same procedure.