Peripheral Arterial Occlusive Disease Workup

  • Author: Vincent Lopez Rowe, MD; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Aug 10, 2011
 

Laboratory Studies

A laboratory workup is only helpful for identifying accompanying silent alterations in renal function and elevated lipid profiles.

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Imaging Studies

  • Angiography still remains the criterion standard arterial imaging study used in the diagnosis of PAOD, as depicted in the image below. However, this test is usually reserved for when an intervention (either endovascular or traditional open surgery) is planned.
  • Monaco et al examined the effects of systematic (routine) coronary angiography, as shown below, on patients undergoing surgical treatment of peripheral arterial disease.[4] Patients undergoing vascular surgery have a high-risk for cardiovascular complications and mortality. The authors found that routine coronary angiography had a positive impact compared with selectively determining if coronary angiography was needed. The routine coronary angiography improved survival (P=0.01) and no reports of death or cardiovascular events (P=0.003) occurred compared with those patients who were selectively chosen to have coronary angiography prior to vascular surgery. The authors recommend that multicenter trials confirm this finding in a larger population. Peripheral arterial occlusive disease. This angiogPeripheral arterial occlusive disease. This angiogram shows a superficial femoral artery occlusion on one side (with reconstitution of the suprageniculate popliteal artery) and superficial femoral artery stenosis on the other side. This is the most common area for peripheral vascular disease.
  • Magnetic resonance angiography (MRA) is useful for imaging large and small vessels. Although MRA was initially felt to provide inadequate images, this is no longer the case. With improved imaging capabilities, MRA can be used to not only diagnose but to help plan the type of indicated intervention.
  • Computerized tomographic angiography is another modality used to image arterial disease. Unfortunately, the study still requires a large amount of contrast media and requires an upgraded CT scanner to reconstruct helpful images.
  • Duplex ultrasonography is a method of evaluating the status of a patient’s vascular disease. Duplex scanning has the advantage of being noninvasive and requiring no contrast media. Unfortunately, duplex scanning is very technician dependent.
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Other Tests

See Physical.

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Contributor Information and Disclosures
Author

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

William H Pearce, MD  Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University, The Feinberg School of Medicine

William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Travis J Phifer, MD  Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport

Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

References

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  2. Conen D, Everett BM, Kurth T, et al. Smoking, smoking status, and risk for symptomatic peripheral artery disease in women: a cohort study. Ann Intern Med. Jun 7 2011;154(11):719-26. [Medline]. [Full Text].

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  4. [Best Evidence] Monaco M, Stassano P, Di Tommaso L, Pepino P, Giordano A, Pinna GB, et al. Systematic strategy of prophylactic coronary angiography improves long-term outcome after major vascular surgery in medium- to high-risk patients: a prospective, randomized study. J Am Coll Cardiol. Sep 8 2009;54(11):989-96. [Medline].

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Peripheral arterial occlusive disease. Measuring segmental pressures.
Peripheral arterial occlusive disease. This angiogram shows a superficial femoral artery occlusion on one side (with reconstitution of the suprageniculate popliteal artery) and superficial femoral artery stenosis on the other side. This is the most common area for peripheral vascular disease.
 
 
 
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