ABSTRACT
The noninvasive evaluation of patients with peripheral arterial disease (PAD) begins in the primary care physician’s office. Patients considered at risk for PAD are older (aged 50 years or more), have cardiovascular risk factors of smoking or diabetes, or have exercise-induced leg symptoms. The initial evaluation includes a thorough vascular history and physical examination, followed by measurement of the ankle–brachial index (ABI). PAD of the lower extremity causes two characteristic pain syndromes: intermittent claudication (IC) and ischemic rest pain. Claudication is derived from the Latin word meaning “to limp,” which accurately describes the walking pattern of the patient. The historical evaluation of patients with suspected PAD must also include symptoms suggestive of atherosclerosis elsewhere. Questions aimed at uncovering symptoms of transient cerebral ischemia, angina pectoris, and findings implying secondary causes of hypertension are important during the initial history.
