When to Refer

Patients should be referred for evaluation if they:

  • Have a history of vascular disease elsewhere in the body
  • Show symptoms of PAD, such as leg pain (especially when they walk), sores in their feet or legs or an abnormal ankle brachial index (see below for a full listing of PAD signs)
  • Have long obstructions (longer than 10 cm) or attempts to bypass an obstruction have failed

Signs of PAD

  • Initial development - An ankle brachial index (ABI) shows the blood pressure in a patient's foot is 10 to 15 percent less than their arm. Another sign of developing PAD is the inability to feel a pulse in the patient's foot.
  • Mild to moderate PAD - Characterized by claudication in the patient's calf. Blood pressure in the patient's ankle is approximately 60 percent of the pressure in their arm.
  • Chronic critical limb ischemia (CCLI) - PAD can develop into this serious disease, marked by a lack of blood flow to the nerves. CCLI can require a limb amputation unless a revascularization procedure is performed. CCLI is characterized by rest pain, tissue loss, skin ulcers or non-healing ulcers.