This term usually refers to the lower extremities, your legs. I do a fair amount of Doppler flow studies to access blockage in patients legs. Individuals at risk are age< 50 years with diabetes and other atheroselerosis factors such as smoking, dyslipidemia, hypertension, or hyperhomocysteinemia.
50 to 69 yrs and history of smoking or diabetes
Age 70 yrs and older.
Leg symptoms with exertion (claudication) or ischemic rest pain.
Abnormal lower extremity pulse, sometime can be hard to palpate with fingers.
Also people with coronary , carotid or renal disease are @ risk.
The first category asymptomatic pt (20-50%) No obvious signs
Atypical leg symptoms (40-50%) discomfort on exertion, but does not consistently resolve with rest. consistently limits exercise.
Classic claudication (10-35%) symptoms confined to leg muscles with a consistent onset of exercise and relief with rest.
Critical limb ischemia (1-2%) ischemic rest pain, non-healing would(ulcer) or gangrene.
At this point the doctor will order an ankle/arm index. I take a pressure in arms and at ankles usually at the posterior tibial artery. Then divide the ankle pressure by the arm.
The ranges are: >1.30 noncompressible, due to medial calcinosis, usually diabetic
1.0-1.29 Normal
0.91-0.99 borderline (equivocal)
0.41-0.90 mild to moderate PAD
000-0.40 severe P.A.D. probable looking at amputation on the low end
Results are read by cardiologist or vascular surgeon or radiologist.
The appropriate therapies are discuss with patients.
