Prior Probability of Peripheral Arterial Disease Show
Clinical examination findings for peripheral arterial disease of the legs must be interpreted in the context of the pretest probability. The prevalence varies with risk factors, but for general screening age is an important risk factor. By age 60, the prevalence of asymptomatic peripheral arterial disease is 5% and increases to 12% by age 70.1, 2 Patients 60 years and older with leg discomfort have a peripheral arterial disease prevalence of 15%.3 Population in Whom Peripheral Arterial Disease Should Be ConsideredPatients at risk for peripheral arterial disease include those of older age, with a history of vascular risk factors especially smoking, or diabetes, or atherosclerotic disease (stroke or myocardial infarction), but current recommendations do not support routine screening of the general population.4 Lower extremity symptoms and signs that should prompt an evaluation include pain, ulcers, or change in skin color of legs or feet. When assessing a patient with leg discomfort, a clinician should consider peripheral arterial disease in the differential diagnosis (Box 72-1). Box 72-1Differential Diagnoses for Leg Discomforta View Table||Download (.pdf) Box 72-1 Differential Diagnoses for Leg Discomforta
Assessing the Likelihood of Peripheral Arterial DiseaseThe clinical examination focuses on skin changes, pulses, and bruits (see Table 72-1). At the bedside, the clinician should use a Doppler probe to listen for the number of arterial components in the posterior tibial pulse and to measure the ankle-brachial index (see Figure 72-1). Inexperienced clinicians can practice listening to the number of arterial components by listening to their own radial pulses or audio recordings. (See also video “Doppler Auscultation of the Posterior Tibial Artery” available at http://jama.ama-assn.org/cgi/content/full/295/5/536/DC1.) Individual findings are as good as combinations of findings for identifying affected patients. However, combinations of normal findings are more efficient for identifying patients without peripheral arterial disease. Table 72-1Useful Findings for Diagnosing Peripheral Arterial Disease (PAD) View Table||Download (.pdf) Table 72-1 Useful Findings for Diagnosing Peripheral Arterial Disease (PAD) ...
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Meta © 2022 What test can detect peripheral artery disease?The ankle-brachial index (ABI) test is usually the first test used to diagnose PAD. The test compares blood pressure in your ankle with the blood pressure in your arm. Your provider uses a blood pressure cuff and ultrasound device for this painless test.
What are physical examination highlights for peripheral arterial disease?Physical examination findings suggestive of PAD include abnormal pulses, audible bruits, nonhealing lower extremity wounds, lower extremity gangrene, elevation pallor, dependent rubor, delayed capillary refill, and cool extremities ( Table 2 ). Patients with one or more of these findings should undergo ABI testing.
What do physical findings on the lower extremities associated with peripheral vascular disease include?Numbness, weakness, or heaviness in muscles. Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat. Paleness when the legs are elevated. Reddish-blue discoloration of the extremities.
What physical exam findings might you expect if the patient had peripheral vascular disease include arterial and venous findings?Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult.
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Does the clinical examination predict lower extremity peripheral arterial disease?
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