Diagnosis & Treatment of Peripheral Arterial Disease (PAD)
Screening for PAD
Vascular arterial studies are considered third-party reimbursable when performed using a bidirectional Doppler that produces a hard-copy output.¹ Koven Technology non-invasive vascular Doppler models Smartdop® XT, Smartdop® 45, Smartdop® 30EX, and Bidop® 3 (when used with Smart-V-Link® Vascular Software) meet these criteria.
¹Individual coverage requirements may vary by state. Please refer to individual carrier requirements.)
Typically, an Ankle Brachial Index (ABI) is performed to screen for Peripheral Arterial Disease (PAD). An ABI uses a vascular ultrasound Doppler to assess the ratio of ankle pressure to arm pressure. An ABI of .96 or greater is generally considered normal.² However, an ABI of 1.3 or higher may indicate vessel calcification, especially in diabetic patients and those with undiagnosed atherosclerosis. In this case a PPG toe pressure study may be useful.
² Buchbinder D, Flanigan DP; Arterial Disease of the Lower Extremities, Diagnosis September 1986
A PPG toe pressure and related Toe Brachial Index (TBI) uses an infrared photoplethysmograph (PPG) module to determine the small vessel vascular condition distal to the ankle. Toe pressure studies are also useful to determine ulcer-healing potential in the diabetic foot.
Segmental Pressure studies are used to localize the site of atherosclerosis. A significant pressure difference between two adjacent cuff sites indicates a narrowing of the artery along that portion of the leg. Segmental Pressures are performed similar to an Ankle Brachial Index study, but with three additional cuffs placed above and below the knee and on the upper thigh.
Pulse Volume Arterial (PVR) waveforms use pulse volume (pneumoplethysmography) to identify changes in leg blood volume. Rather than temporarily occluding blood flow, the cuffs are only inflated slightly so that blood continues to flow. Blood pulses in the arteries cause the vessels to expand which changes the air volume in the cuff. PVR studies are particularly useful in patients where vessel calcification can cause inaccurate Doppler signal processing and falsely elevated pressures.
Treatment of PAD
Although there is no cure for PAD, early diagnosis and treatment can help restore mobility, decrease incidents of heart attack and/or stroke and lower the incidence of having to perform amputations.
Treatments for PAD include:
Lower blood pressure and cholesterol
Follow a healthy eating plan
If blood flow in one or both legs becomes almost or completely blocked, a surgical procedure may be necessary.