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| Peripheral Arterial Disease: Diagnosis |
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| CONVENTIONAL MEDICINE - Circulatory: Heart (Rheumatic, Valvular, Vascular), Heart Attack, Stroke, Arterial & Lymphatic Disorders | |
You may first become aware of peripheral arterial disease (PAD) through symptoms such as intermittent claudication - leg muscle discomfort that worsens with exercise the is consistently relieved by rest or warmth. As PAD becomes more severe, other symptoms in the legs may occur: * pain in the foot at rest, or when lying down, that is not caused by arthritis or neuropathy * leg sores that don't heal * gangrene, or tissue death * impotence If any tissue in the body does not receive the oxygen and nutrients needed via the circulating blood, over time that tissue will die. With very severe PAD, the skin of the feet may become painful and gangrenous. The skin may become fragile, and permit bacteria to flourish, leading to painful and life-threatening infections.
To diagnose PAD, your health care professional will take a thorough medical history, asking especially about your exposure to risk factors (such as smoking, diabetes, high blood pressure, or high blood cholesterol) and will ask questions to determine if you have any leg symptoms, so be prepared to discuss these. A physical examination will be performed, during which your doctor will feel the pulsations of the arteries in key locations, such as the backs of your knees, the tops of your feet and just behind the bone on the inside of each ankle. Using a blood pressure cuff and a special ultrasound stethoscope called a Doppler, your health care professional also might take your blood pressure on each arm and leg (at the ankle). The blood pressure at the arms and legs will be compared to determine how well your blood is flowing to each limb. This painless procedure is called the ankle-brachial index (or ABI) and helps to determine if further testing is needed. However, for some individuals with diabetes, this test may not be precise. In that case, and when more detailed diagnostic information is needed, your health care professional may take pressure measurements of your toes, or you may be referred to a vascular laboratory for more sophisticated tests (listed below).
Patients may also be asked to undergo a treadmill test if their ankle-brachial index is questionable or to assess the severity of any leg symptoms. Treadmill testing may also be used to determine the cause of your leg symptoms (whether from PAD or from spinal or nerve diseases) and to assess the effectiveness of treatments. Other tests might include: * an ultrasound, which uses sound waves to determine the site and severity of artery blockages * a magnetic resonance angiogram (MRA) or computed tomographic angiogram (CTA), which provides a very detailed picture of the arteries * a contrast arteriogram, an x-ray taken of arteries after a small tube (catheter) is inserted into an artery and a contrast dye injected. The dye enables areas of atherosclerosis and structural changes to be seen more clearly. Hirsch AT, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286:1317-24. Belch JJ, et al. Critical issues in peripheral arterial disease detection and management. Archives of Internal Medicine 2003;163:884-92. Halperin JL. Evaluation of patients with peripheral vascular disease. Thrombosis Research 2002;106:303-11. CAPRIE (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events trial) Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischemic events. Lancet 1996;1329-39. "Possible Side Effects of Drugs that Lowered Blood Pressure." American Heart Association. http://www.americanheart.org . Accessed Feb. 2004. "Answers to frequently asked questions." Vascular Surgical Societies. http://www.vascsurg.org/doc/1058.html . 1999. Accessed Oct. 2000. " Peripheral Arterial Disease." Vascular Disease Foundation. http://www.vdf.org/PAD_Frame.htm . January 2002. Accessed Dec. 8, 2004. "Peripheral vascular disease." American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4692 . Accessed December 8, 2004. "Peripheral Arterial Disease." Society of Interventional Radiology. http://www.sirweb.org/patPub/pvdPad.shtml . Accessed December 8, 2004. "Legs For Lifer National Screening for PVD Leg Pain."Society of Cardiovascular and Interventional Radiology. 2004. http://www.legsforlife.org/ . Accessed December 8, 2004. "Stanford Program in Vascular Medicine and Biology: Clinical Research" Stanford University Medical Center. Updated Nov. 2001. http://cardiology.stanford.edu/VascularMedicine/clinical_research.htm . Accessed Dec. 2001. "Clinical Resources: Peripheral Vascular Disease" LeMaitre Vascular, Inc. 2001. http://www.vascutech.com/patient/ . Accessed Dec. 2001. "Minnesota Vascular Diseases Center: Research" Minnesota Vascular Diseases Center. Updated July 2001. http://www.dept.med.umn.edu/medicine/Clinical_services/Cardiology_Clinics/mvdc/research _mvdc/research_mvdc.html . Accessed Dec. 2001. "Peripheral Artery Disease and Intermittent Claudication" Medscape Health for Consumers. 2001. http://cbshealthwatch.medscape.com/cx/viewarticle/404629 . Accessed Dec. 2001. Editorial Staff of the National Women's Health Resource Center 2002/11/14 2005/03/16 When your muscles don't get the oxygen and nutrients they need during exercise such as walking, the result is a cramping discomfort called intermittent claudication. This muscle discomfort is one of the primary symptoms of peripheral arterial disease (PAD), a catch-all term for various problems caused by poor circulation due to clogged arteries to the legs. Arteries, Atherosclerosis, Buerger's disease, Circulation, Diabetes mellitus, Homocysteine, Peripheral Arterial Disease (PAD), Peripheral vascular disease.~
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