Diagnosis of Peripheral Vascular Disease: Why Did the Doctor Decide This?

About Peripheral Vascular Disease

Physicians have several methods which they use to decide on a diagnosis of peripheral vascular disease (PVD). If your doctor informs you that you have PVD or an associated disease, like peripheral arterial disease (PAD), do not panic. It’s going to be alright. The most important thing you can do is learn as much about how your doctor came to this diagnosis and what you can do to take care of yourself in the future.

PVD is a general term referring to a few disorders that, in most cases, effect the extremities, but can effect internal organs. It is a disease of the arteries and veins away from the heart, lungs and brain, called the periphery. There are several causes for this disease (which you can read about here).

Diagnosis

The earliest stage of diagnosis is an accurate description of the symptoms. It is important that patients paint an accurate picture of what is ailing them. Physicians must decide from what they are told what is and is not an important factor in the diagnosis. If your legs or arms are tingling, going numb or you are experience large amounts of pain in them, especially during exercise (intermittent claudication), doctors should then perform a normal exam of the specified area. Generally, they are looking for the “5 P’s”: pulselessness, paralysis, paresthesia, pain, and pallor. Paralysis and paresthesia require quick decisive clinical intervention. Depending on where in your extremity the blood is being blocked, the upper or the lower part of your extremities may not display a pulse. Doctors determine the pain based on your description, so, remember, be accurate about how intense the pain is and when it occurs. The pallor assessment takes place based on whether or not the extremity is level or raised and how long it takes to appear.

Now that the physical examination is over, the fun really begins. Clinical tests must be performed in order to exclude the possibility that what you are experiencing is in fact PVD and not one of several other possible disorders. A disorder called spinal stenosis causes pain in the legs, especially during exercise, similar to PVD (pseudoclaudication) and is often misdiagnosed for PVD, or vice versa.

Regular blood tests are run in order to determine hemofactors that could be causing your pain. These include indicators like high cholesterol levels, diabetes or high levels of homocystine, an amino acid found in the blood. An electrocardiogram (EKG) may also be performed in order to determine if the peripheral discomfort is a result of cardiac dysfunction.

If the doctor is still uncertain, there are other non-invasive studies that may be ordered. These include the ankle-brachial index (ABI), which is the ratio of blood pressures taken from the arm and leg, Doppler ultrasonography determines the status of blood flow in the blood vessels of the extremities and magnetic resonance imaging (MRI), which can provide a picture of plaques formed in deep veins and arteries.

Sometimes it may be necessary to perform an invasive procedure called arteriography in which a catheter will be guided through the affected vessel to find the blockage. Usually the blockage can be treated during the same procedure with a balloon or a stent, which is a wire mesh tube. This procedure should not be performed if the case is an emergency; the associated ischemia may result in permanent damage in the time it takes to prepare for the surgery.

References

Mayo Clinic: Peripheral Vascular Disease Diagnosis

American Academy of Family Physicians: Peripheral Vascular Disease: Diagnosis and Treatment

eMedicine: Peripheral Vascular Disease

eMedicine: Peripheral Vascular Disease: Differential Diagnosis & Workup

MedicineNet: Peripheral Vascular Disease (Peripheral Artery Disease) Causes, Symptoms, Diagnosis, and Treatment