The doctor will inspect your legs and feet to examine the condition of the skin for signs of PAD, looking for paleness, dryness, absence of hair or the presence of sores.
The physical exam also includes measuring blood pressure in both arms and both legs to compare results. Normally, the pressure in both arms should be almost the same.
The doctor will then examine all the arteries with a stethoscope, listening for abnormal sounds, called bruits. These are caused by narrowing of the arteries and are similar to the sound of water passing through a bent pipe.
The doctor will also use palpation, touching different areas of the legs and feet to check your pulse (the beating of blood as it moves through the arteries) and to test the temperature of the skin. If the arteries are narrowed, the tissue (skin) supplied by the artery may become colder.
A small device called a Doppler is used to measure blood pressure in the leg arteries. If your blood pressure is much lower in the legs compared to the arms, it can signal the presence of a blockage. This is a quick and simple test that can be performed in a doctor’s office or at the hospital.
This test is used to locate the area of the blockage and to assess whether it is a large or small blockage.
This test involves ultrasound and the Doppler.
This test makes it possible to see exactly where the blockages are, and guides the doctor in choosing the appropriate treatment. An iodine-based dye is injected into the veins and then a CT scanner is used to provide detailed images of the arteries.
This test requires specialized equipment and technicians and is therefore more expensive. There is a risk of allergic reaction to the iodine dye and this material can also cause problems if the patient suffers from kidney disease (kidney failure).
This test makes it possible to see exactly where the blockages are and guides the doctor in choosing the appropriate treatment. A gadolinium-based dye is injected into the veins and then a magnetic resonance scanner (which creates images using magnetic fields instead of radiation, as with conventional scanners) is used to view the arteries. Gadolinium causes fewer allergies than iodine dye. This exam is more expensive than the conventional scanner, because of the highly specialized equipment and the personnel required to operate it. As a consequence, the waiting time for this test is often longer.