What screening tests are available for vascular disease?

Screening Tests Available for Vascular Disease

For asymptomatic adults in the general population, routine screening for peripheral arterial disease is not recommended, but targeted screening using ankle-brachial index, carotid ultrasound, and abdominal aortic ultrasound is reasonable for moderate-risk individuals with multiple cardiovascular risk factors. 1

Non-Invasive Physiological Tests

Ankle-Brachial Index (ABI)

• The ABI is the primary screening test for peripheral arterial disease, measuring the ratio of Doppler-recorded systolic pressures in the lower and upper extremities 1
• An ABI <0.9 indicates ≥50% stenosis between the aorta and distal leg arteries, with 79% sensitivity and high specificity for detecting peripheral arterial disease 1
• This test is easy to perform, reproducible, and adds value beyond traditional risk factor assessment, as 50-89% of patients with ABI <0.9 lack typical claudication symptoms 1
• An abnormal ABI independently predicts future angina, myocardial infarction, congestive heart failure, stroke, and need for revascularization procedures 1

Segmental Limb Pressures and Pulse Volume Recordings

• These physiological tests help localize the level and severity of arterial obstruction in symptomatic patients 2, 3
• Pulse volume recordings assess arterial flow through plethysmographic waveform analysis at multiple leg levels 2

Vascular Imaging Modalities

Carotid Duplex Ultrasound

• Carotid ultrasound is reasonable for risk assessment in asymptomatic individuals at moderate cardiovascular risk 1
• The examination assesses for atherosclerotic plaque in the common and internal carotid arteries using grey-scale imaging and evaluates stenosis using spectral Doppler 1
• Carotid intima-media thickness (IMT) is an independent predictor of cerebral and coronary events, appearing more predictive in women than men 1
• A screening carotid duplex uses a limited but clearly defined protocol and does not include formal IMT measurement 1

Abdominal Aortic Ultrasound

• Abdominal ultrasound can detect abdominal aortic aneurysms during screening 4
• This is particularly relevant for older adults with cardiovascular risk factors 4

Duplex Ultrasonography of Peripheral Arteries

• Duplex scanning provides anatomic localization of arterial lesions in the lower extremities 2, 5
• This modality combines B-mode imaging with Doppler flow analysis to assess stenosis severity and plaque characteristics 2

Advanced Imaging for Selected Patients

Computed Tomography Angiography (CTA)

• CTA is appropriate for comprehensive evaluation when noninvasive tests suggest significant disease requiring intervention planning 1, 2
• The role of CT scanning for routine screening in asymptomatic patients requires further investigation and is not currently recommended 1
• CTA is valuable for suspected mesenteric ischemia to assess mesenteric arteries 4

Magnetic Resonance Angiography (MRA)

• MRA serves as an alternative to CTA for lesion localization when symptoms or findings do not correlate with physiological testing 2, 5
• MRI for vascular plaque detection remains investigational for cardiovascular risk assessment in asymptomatic adults 1

Coronary Artery Calcium Scoring

• Measurement of coronary artery calcifications may be reasonable for cardiovascular risk assessment in asymptomatic adults at moderate risk 1
• The extent of coronary calcifications correlates with total coronary plaque burden, though prospective studies proving value for screening (level A evidence) do not yet exist 1

Arterial Stiffness Assessment

• Arterial stiffness measurement provides added value in patient stratification, particularly in hypertensive patients with arterial wall damage 1

Population-Specific Screening Recommendations

Who Should NOT Be Screened

• Routine screening of asymptomatic adults in the general population is not recommended because the prevalence of peripheral arterial disease is low in this group and treatment at the asymptomatic stage beyond standard cardiovascular risk management shows little evidence of improved health outcomes 1
• The harms of routine screening (false-positives, unnecessary workups) exceed benefits in unselected populations 1

Who SHOULD Be Screened

• Asymptomatic individuals at moderate cardiovascular risk (multiple risk factors including smoking, hypertension, diabetes, hyperlipidemia, family history) 1
• Individuals over 55 years of age, where ABI <0.9 may be found in 12-27% 1
• Patients with established cardiovascular disease in one vascular bed should be assessed for polyvascular disease in other territories 4

Clinical Pitfalls to Avoid

• Do not rely solely on history and physical examination, as most patients with peripheral arterial disease present with subtle findings and lack classic claudication symptoms 5
• Abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color are physical findings that warrant objective testing 5
• An elderly population (71-93 years) with low ABI identifies a higher-risk coronary heart disease subgroup requiring aggressive risk factor management 1