The diagnosis of peripheral artery disease requires the integration of clinical assessment, imaging studies, and laboratory data to accurately determine the degree of arterial obstruction and disease progression. Physicians typically begin with a detailed medical history and physical examination to confirm whether the patient has typical symptoms such as intermittent claudication in the lower limbs and cold extremities. Further examinations are then arranged based on risk factors (such as advanced age, diabetes, and smoking history) to identify the location and severity of arterial stenosis or obstruction.
The diagnostic process must balance sensitivity and specificity to ensure that high-risk patients are not missed while avoiding over-reliance on invasive examinations. Modern diagnostic technologies, such as Doppler ultrasound and computed tomography angiography, can provide three-dimensional images of arterial structures, supplemented by hemodynamic indicators (such as the ankle-brachial index), effectively distinguishing atherosclerosis from other diseases with similar symptoms. Early diagnosis can prevent serious complications such as limb necrosis and heart attacks; therefore, diagnostic strategies must achieve a balance between accuracy and efficiency.
Clinical assessment is the foundation of diagnosis. Physicians will first inquire about the patient's medical history, particularly the nature and triggers of lower limb pain. The typical manifestation of intermittent claudication is pain in the calf or buttock muscles during walking, which alleviates with rest, related to the biological mechanisms of arterial ischemia. Physicians will meticulously document the intensity, duration, and correlation of the pain with activity, and assess whether it is accompanied by signs of peripheral circulation disorders, such as limb weakness, skin ulcers, or hair loss.
During the physical examination, physicians will measure blood pressure in the limbs, comparing the differences between upper and lower limb blood pressures. The pulse at the site of arterial obstruction is often diminished or absent; for example, the dorsalis pedis or popliteal artery pulses may not be palpable. Additionally, skin temperature, color, and wound healing status can reflect tissue perfusion conditions. If a patient has foot ulcers but no obvious signs of infection, peripheral artery disease leading to chronic ischemia should be highly suspected.
The Ankle-Brachial Index (ABI) is the preferred non-invasive examination, based on the principle of comparing the blood pressure ratio between the lower and upper limbs. A normal ABI ranges from 0.9 to 1.3; values below 0.8 indicate moderate obstruction, while those below 0.5 represent severe ischemia requiring immediate intervention. This examination can quickly screen high-risk groups, but it should be noted that diabetic patients may have uneven degrees of atherosclerosis, potentially leading to misinterpretation of ABI results.
In terms of imaging studies, Doppler ultrasound can show the specific location of arterial stenosis and blood flow velocity, while color Doppler imaging can present the morphology of plaques on the vessel walls. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) can reconstruct the vascular tree structure in three dimensions, assisting in determining surgical indications. Although invasive angiography is precise, it carries risks of trauma and is typically reserved for complex cases or preoperative evaluations.
Screening tools include simple questionnaires combined with biological indicators. The WILLIAMSON risk scoring system integrates factors such as age, sex, and blood pressure to predict the likelihood of developing peripheral artery disease within ten years. The ABI test, due to its low cost and quick execution, is listed by the American Heart Association as a routine screening item for smokers or diabetic patients. New biological markers, such as plasma C-reactive protein and fibrinogen levels, can serve as indicators of inflammatory activity but have not yet replaced the dominant role of imaging studies.
Risk stratification tools, such as the LEAD (Limb Extremity Artery Disease) assessment system, can classify patients into mild, moderate, and severe categories based on the extent of arterial obstruction, aiding in treatment strategy formulation. Home monitoring devices, such as pulse wave velocity measurement devices, although not yet widespread, can serve as long-term tracking tools for high-risk populations. During screening, it is important to note that obese and diabetic patients may have falsely normal ABI results due to uneven degrees of atherosclerosis, necessitating confirmation with other examinations.
Differential diagnosis must exclude other diseases causing lower limb pain. Neurogenic claudication (such as spinal stenosis) and arthritis symptoms may be confused with intermittent claudication and require differentiation through neurological examinations and joint X-rays. Thrombotic venous inflammation, although accompanied by redness, swelling, and heat, typically causes pain concentrated along deep venous pathways, differing from the exercise-induced muscle pain of arterial ischemia. Diabetic foot ulcers may exhibit features of both neuropathy and arterial ischemia, requiring combined interpretation of foot Doppler examinations and sensory nerve testing.
Patients with chronic venous insufficiency may present with lower limb swelling and pigmentation, but their pain usually worsens after prolonged standing, unlike the exercise-induced arterial ischemia. Patients with severe arterial stenosis may also have osteoarthritis of the hip joint, requiring confirmation of the lesion axis through angiography. When making differential diagnoses, attention should be paid to the timeline of accompanying symptoms, as the acute onset of arterial embolism and the chronic progression of arthritis show significant differences.
Early diagnosis allows timely intervention to slow the progression of atherosclerosis and reduce the risk of amputation. ABI screening can detect asymptomatic mild stenosis early, and combined with lipid-lowering medications and angiogenesis therapy, can significantly improve hemodynamic indicators. Early use of antiplatelet medications and angioplasty can reduce the risk of myocardial infarction and stroke, as peripheral artery disease often coexists with cardiovascular and cerebrovascular diseases.
Pre-symptomatic diagnosis can be achieved through genetic risk assessment and family history tracking, with regular ABI monitoring for those with a family history of early-onset atherosclerosis. Studies show that for every 0.1 decrease in ABI, cardiovascular mortality increases by 12%; early detection can block disease progression through lifestyle interventions (such as smoking cessation and aerobic exercise). Medical teams often combine imaging and biochemical indicators to establish personalized risk assessment models, enhancing diagnostic accuracy.
Physicians typically make an initial assessment based on symptoms such as "intermittent claudication" (pain in the lower limbs during walking that alleviates with rest), cold extremities, and skin ulcers that are difficult to heal. If the patient also has hypertension, hyperlipidemia, or diabetes, the physician may consider this disease more promptly.
Is invasive testing necessary to diagnose peripheral artery disease?Most diagnoses can be made through non-invasive tests, such as the "ankle-brachial index" (ABI) test or Doppler ultrasound; invasive tests like angiography are only used when further confirmation of vascular obstruction location is needed in complex cases.
How does family history affect the diagnosis of peripheral artery disease?If there is a family history of early-onset cardiovascular disease or peripheral artery disease, physicians may recommend testing earlier and more carefully assess the patient's lifestyle habits and risk factors to detect potential issues early.
Are the symptoms of peripheral artery disease easily misunderstood as other problems?Yes, many patients attribute lower limb pain to natural aging or arthritis, overlooking the possibility of vascular obstruction. If symptoms are activity-related and recurrent, professional evaluation should be actively sought.
What lifestyle habits might affect the accuracy of diagnostic results?Smoking, high blood sugar, or high cholesterol may exacerbate vascular lesions; these factors will be included in the overall assessment but will not directly affect the accuracy of test results. However, patients should honestly inform physicians of their relevant medical history to facilitate accurate interpretation of test data.
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