Noninvasive Imaging of Peripheral Arterial Disease

Bilateral ABI calculations should be performed, which include bilateral brachial arteries and bilateral ankle pressures. The ABI should take the clinical situation into context to avoid false-negative calculations. The absolute ankle pressures should also be included in conjunction with the ABI calculation. Finally, in heavily calcified arteries, a TBI should be considered.

An ABI is a mandatory part of a physiologic examination. For segmental pressures, four cuffs can be used. The recommended location of the blood pressure cuffs are the upper thigh, lower thigh, upper calf, and ankle.

PVRs are ideal for evaluating segmental disease and are not affected by calcification. They should be considered as part of a complete noninvasive examination.

Continuous-wave Doppler analysis should be performed at multiple segments when assessing the lower extremities for PAD. Continuous-wave Doppler analysis should be available as part of a complete noninvasive examination.

Exercise testing is useful to assist in the diagnosis of PAD in patients with claudication, and should be available as a component of the evaluation because it unmasks PAD not evident at rest. Exercise testing is mandatory in all patients with normal resting examinations who have exertional symptoms. Exercise testing can also be used as a part of surveillance testing in posttherapeutic PAD patients.