Noninvasive diagnosis of arterial disease
- Erica Mitchell, MD, FACS
Erica Mitchell, MD, FACS
- Professor of Surgery
- Division of Vascular Surgery
- Oregon Health & Science University
- Section Editors
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- Emile R Mohler III, MD
Emile R Mohler III, MD
- Section Editor — Vascular Medicine
- Professor of Medicine
- University of Pennsylvania School of Medicine
The evaluation of the patient with arterial disease begins with a thorough history and physical examination and uses noninvasive vascular studies as an adjunct to confirm a clinical diagnosis and further define the level and extent of vascular pathology. Vascular testing may be indicated for patients with suspected arterial disease based upon symptoms (eg, intermittent claudication), physical examination findings (eg, signs of tissue ischemia), or in patients with risk factors for atherosclerosis (eg, smoking, diabetes mellitus) or other arterial pathology (eg, trauma, peripheral embolism) .
A variety of noninvasive examinations are available to assess the presence and severity of arterial disease. Physiologic tests include segmental limb pressures and the calculation of pressure index values (eg, ankle-brachial index, wrist-brachial index), exercise testing, segmental volume plethysmography, transcutaneous oxygen measurements and photoplethysmography.
Ultrasound is the mainstay for vascular imaging with each mode (eg, B-mode, duplex) providing specific information that is useful depending upon the vascular disorder. Other studies frequently used to image the vasculature include computed tomography (CT) and magnetic resonance (MR) imaging. CT and MR imaging are important alternative methods for vascular assessment; however, the cost and the time necessary for these studies limit their use for routine testing . Contrast arteriography remains the gold standard for vascular imaging and at times can be a primary imaging modality, particularly if intervention is being considered. The role of these imaging in specific vascular disorders are discussed in detail separately (See "Clinical features and diagnosis of abdominal aortic aneurysm".).
INDICATIONS FOR TESTING
The need for noninvasive vascular testing to supplement the history and physical examination depends upon the clinical scenario and urgency of the patient’s condition. An exhaustive battery of tests is not required in all patients to evaluate their vascular status. In general, only tests that confirm the presence of arterial disease or provide information that will alter the course of treatment should be performed.
Patients can be asymptomatic, have classic symptoms of peripheral artery disease (PAD) such as claudication, or more atypical symptoms. Symptoms vary depending upon the vascular bed affected, the nature and severity of the disease and the presence and effectiveness of collateral circulation. The clinical presentations of various vascular disorders are discussed in separate topic reviews. (See "Clinical features and diagnosis of lower extremity peripheral artery disease" and "Overview of thoracic outlet syndromes" and "Clinical manifestations and diagnosis of the Raynaud phenomenon" and "Clinical features and diagnosis of abdominal aortic aneurysm".)
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- INDICATIONS FOR TESTING
- PHYSIOLOGIC TESTING
- Ankle-brachial index
- - High ABI
- Wrist-brachial index
- Toe-brachial index
- Segmental pressures
- - Lower extremity segmental pressures
- - Upper extremity segmental pressures
- Pulse volume recordings
- - Digit waveforms
- Exercise testing
- - Protocols
- - Interpretation
- TRANSCUTANEOUS OXYGEN MEASUREMENTS
- Continuous wave Doppler
- B-mode imaging
- Duplex imaging
- - Specific anatomic sites
- ADVANCED IMAGING
- Imaging comparisons for lower extremity arterial disease
- Imaging comparisons for other vascular diseases
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS