What are the diagnostic tests for chronic Peripheral Vascular Disease (PVD)?

From the Guidelines

Testing for chronic peripheral vascular disease (PVD) should begin with a thorough clinical assessment, including medical history and physical examination, followed by the ankle-brachial index (ABI) as the primary diagnostic test, with a value below 0.9 indicating PVD, as recommended by the most recent guidelines 1.

Diagnostic Approach

The diagnostic approach for PVD involves several steps, including:

• Clinical assessment: A thorough medical history and physical examination to identify risk factors and symptoms of PVD.
• Ankle-brachial index (ABI): The primary diagnostic test, which measures the ratio of blood pressure in the ankle to that in the arm.
• Doppler ultrasound: Provides detailed information about blood flow and vessel blockages.
• Additional imaging tests: May be necessary for more severe cases, including CT angiography, MR angiography, or conventional angiography.

Risk Factors and Screening

Regular screening is recommended for individuals over 65, smokers, diabetics, and those with a history of cardiovascular disease, as early intervention with lifestyle changes and medications can prevent disease progression, as noted in 2.

Imaging Modalities

Noninvasive imaging modalities, such as ultrasound, CT angiography, and MR angiography, can reliably confirm or exclude the presence of peripheral vascular disease, but have technical limitations when classifying the location, extent, and severity of disease, as discussed in 3 and 4.

Conclusion is not allowed, so the answer will continue without one.

The ABI is a non-invasive and cost-effective test that can be used to diagnose PVD, and is recommended as the first-line test by the American College of Cardiology and the American Heart Association, as stated in 5. In cases where the ABI is not feasible or is inconclusive, other non-invasive tests such as the toe-brachial index, segmental pressures, and pulse volume recordings can be used, as mentioned in 6. It is essential to note that the diagnosis of PVD should be based on a combination of clinical assessment, medical history, and diagnostic tests, rather than relying on a single test or symptom, as emphasized in 1.

From the Research

Testing for Chronic PVD

• Chronic peripheral vascular disease (PVD) is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta 7.
• The most common symptom of PVD is intermittent claudication, which manifests as pain in the muscles of the legs with exercise 7.
• Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color 7.

Diagnostic Tests

• The standard office-based test to determine the presence of PVD is calculation of the ankle-brachial index (ABI) 7, 8, 9, 10.
• ABI is a non-invasive test that measures the ratio of blood pressure in the ankles to blood pressure in the arms 9, 10.
• Other non-invasive methods for lesion localization include magnetic resonance arteriography, duplex scanning, and hemodynamic localization 7, 8.
• Contrast arteriography is used for definitive localization before intervention 7.

Accuracy of ABI

• The sensitivity and specificity of ABI for diagnosing peripheral artery disease are moderate, with values ranging from 65.5% to 72.3% and 68.8% to 69.3%, respectively 9, 10.
• ABI has a moderate predictive value in the diagnosis of lower extremity arterial disease, but normal range outcomes cannot be taken to infer the absence of disease 9.
• Further non-invasive tests such as exercise studies or pulse volume waveforms should be considered if diagnostic uncertainty exists 9.

Correlation with Symptoms and Health-Related Quality of Life

• Health-related quality of life (HRQL) in patients with PVD correlates weakly with ABI, but exhibits a closer association with vascular symptoms 11.
• Patients with more severe symptoms, such as lifestyle-limiting claudication or limb-threatening ischemia, have lower HRQL scores compared with patients with non-lifestyle-limiting claudication 11.
• Multivariate analysis demonstrates that HRQL scores are better predicted by symptoms than by ABI 11.