![]() Renal function should be assessed before CTA or MRA are performed, due to issues around contrast nephropathy and nephrogenic systemic fibrosis, which has been associated with exposure to gadolinium based magnetic resonance imaging (MRI) contrast agents. Duplex ultrasound is, however, operator dependent and therefore reliant on a well-trained sonographer.īoth computed tomography angiography (CTA) and magnetic resonance angiography (MRA) provide good sensitivity and specificity compared to digital subtraction catheter angiography (DSA), although CTA can be more problematic with heavily calcified arteries and MRA does not show calcification, 14 which might be important information when interventions are being planned. It is also the main investigation for follow up of vascular interventions. The role of diagnostic imagingĭuplex ultrasound (DUS) is non-invasive, is useful to define sites of stenosis or occlusion, and is often the only imaging required to plan endovascular interventions. Detailed anatomic imaging is not necessary if endovascular or open surgical intervention is not planned, and aneurysmal disease can be confidently excluded on physical examination. More detailed anatomical information about PAD may be required to exclude abdominal aortic aneurysm (which can occur in up to 10% of patients with PAD 13), or popliteal aneurysm, which might be suggested by prominent popliteal pulses, and to plan endovascular or open surgical intervention. 12 Active pedal plantar flexion compares favourably with treadmill exercise and should be considered an appropriate alternative. If a treadmill is not available, then the walking exercise may be performed by climbing stairs or by walking up and down the hallway. This is usually performed following treadmill exercise (typically performed walking at 3.2 km/h, and a 10–12% grade). 11įor atypical exertional leg pain, post-exercise ABI should be measured. Ankle-brachial index measurement should be the initial diagnostic tool used in general practice, although nurse-determined oscillometric ABI has been shown to lack sensitivity. 9,10 DiagnosisĬareful history and clinical examination remain the initial means of diagnosing PAD. Screening for PAD using the ankle-brachial index (ABI) or questionnaire is not currently recommended in Australia, and has not been shown to be of benefit in randomised controlled trials although it is recommended for screening in other countries. 5 Symptomatic PAD patients have a worse prognosis than patients presenting with coronary artery disease or cerebrovascular disease, but their atherosclerosis risk factors are less intensively treated.6 Both asymptomatic and symptomatic PAD patients have a high risk of death from cardiovascular disease (CVD), 2,7 therefore early treatment reduces mortality. The most common symptom of PAD is intermittent claudication (IC) affecting the calf muscles, which may be present in as few as 10% of patients.
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