Noninvasive Imaging of Peripheral Arterial Disease
Publication Date: May 27, 2016
Last Updated: March 14, 2022
Recommendations
STANDARD TESTING MODALITIES
ABI
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.
6731
Segmental Limb Pressures
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.
6731
Segmental PVRs
PVRs are ideal for evaluating segmental disease and are not affected by calcification. They should be considered as part of a complete noninvasive examination.
6731
Continuous-Wave Doppler Waveforms
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.
6731
Exercise Testing
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.
6731
ANCILLARY NONINVASIVE TESTS
Reflection Photoplethysmography
Reflection photoplethysmography has utility in patients PAD and should be considered in the diabetic and chronic renal failure PAD subgroups.
6731
Oxygen Tension
Oxygen tension can be used as an adjunctive tool to predict benefit for revascularization therapy. Oxygen tension measurements should be made with the patient at rest in a supine or recumbent position in a comfortable, warm room with the extremity covered by a sheet or blanket, breathing normobaric oxygen for at least 10 minutes. An increase of greater than 10 mm Hg of foot oxygen tension between normobaric room air and at least 10 minutes of a normobaric 100% oxygen challenge with a pulmonary oxygen saturation of greater than 90% is recommended as a positive outcome from a revascularization procedure of the lower extremities. In the setting of tissue loss, oxygen tension studies should be considered before and after revascularization procedures to serve as the baseline and surveillance after intervention. Postintervention oxygen tension studies should be performed more than 1 week after the revascularization procedure, although oxygen tension values can exhibit continual increase for as long as 28 days.
6731
US
US grayscale imaging and Doppler imaging are recommended for assessment of PAD of the lower extremities. Periodic follow-up in patients who have undergone interventions and surveillance of patients with PAD should occur with US imaging; a standard surveillance protocol should include US evaluation twice in the first postinterventional year and annually thereafter. Multiple sonographic modes (eg, grayscale, power Doppler, color Doppler) are required to appropriately assess PAD in a single imaging session.
6731
Recommendation Grading
Overview
Title
Noninvasive Imaging of Peripheral Arterial Disease
Authoring Organization
Society of Interventional Radiology
Publication Month/Year
May 27, 2016
Last Updated Month/Year
August 1, 2023
Document Type
Other
External Publication Status
Published
Country of Publication
US
Document Objectives
The present document therefore reviews and provides recommendations for noninvasive lower-extremity imaging of PAD, which includes two broad categories: (i) functional tests and (ii) anatomic tests. The functional or physiologic tests include the ankle-brachial index (ABI), segmental limb pressures, pulse volume recordings (PVRs), segmental Doppler waveforms, and oxygen testing. The anatomic tests include duplex ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging.
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Hospital, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis
Diseases/Conditions (MeSH)
D058729 - Peripheral Arterial Disease
Keywords
ankle-brachial index, peripheral artery disease (P.A.D.), Peripheral artery disease
Source Citation
Position Statement on Noninvasive Imaging of Peripheral Arterial Disease by the Society of Interventional Radiology and the Canadian Interventional Radiology Association
Dhanoa, Deljit et al.Journal of Vascular and Interventional Radiology, Volume 27, Issue 7, 947 - 951