Diagnosis

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The first sign of PAD may be symptoms such as intermittent claudication: leg muscle discomfort that gets worse with exercise but improves with 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

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 also become fragile, permitting bacteria to flourish and leading to painful and life-threatening infections.

To diagnose PAD, your health care professional should take a thorough medical history and ask about any risk factors such as smoking, diabetes, high blood pressure or high blood cholesterol.

Your doctor will also perform a physical examination feeling the pulsations of the arteries in key locations, such as at the groins, at 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 doctor might also take your blood pressure on each arm and ankle.

Comparing blood pressure readings between the arms and legs determines how well blood is flowing to each limb. This painless procedure is called the ankle-brachial index (or ABI) and helps determine if further testing is needed. The ankle pressure is normally at least 90 percent of the arm pressure, but with PAD, the ankle pressure may be less than 50 percent of the arm pressure.

However, this test may not be precise enough in people with diabetes. In those cases, the doctor may take pressure measurements of your toes, or you may be referred to a vascular laboratory for more sophisticated tests described below.

You may also undergo a treadmill test if your ankle-brachial index is questionable or to assess the severity of your 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 possible tests include:

• Duplex ultrasound. This test uses sound waves to determine the site and severity of artery blockages.

• A computed tomographic angiogram (CT). This is a noninvasive test that provides an image of the arteries in the abdomen, pelvis and legs.

• Magnetic resonance angiogram (MRA). This is a noninvasive test that provides information similar to a CT scan but without the use of x-rays. The MRA provides a very detailed picture of the arteries. This test is not accurate or safe in people who have pacemakers or stents.

• Contrast arteriogram. In this test, an x-ray is taken of your arteries after a small tube (catheter) is inserted into an artery and a contrast dye injected. The dye makes areas of atherosclerosis and structural changes more obvious.

Beyond the usual diagnostic approaches that your doctor might offer, there are other ways you could be tested for PAD. One method is to find a local PAD screening program, such as a "Legs for Life" site. "Legs for Life" is sponsored by the Society of Interventional Radiology and has long offered free screenings for PAD. You can find a site at www.legsforlife.org. Similar screening programs are offered by the American Vascular Association (sponsored by the Society for Vascular Surgery), the for-profit Lifeline Screening Company, other private, for-profit screening businesses, and many hospital systems throughout the country. If a screening test is positive, you will need to see your doctor to review these results, likely repeat the test and discuss care plans.