Clinical meaning
Advanced vascular assessment integrates history, physical examination, and non-invasive testing to localize disease, quantify severity, and determine intervention timing. Arterial disease assessment relies on pressure measurements (ABI, segmental pressures) and flow studies, while venous disease assessment evaluates valve competence and reflux using duplex ultrasonography.
Diagnosis & workup
Diagnostics & workup: - Order ABI with exercise testing for claudication - Order segmental pressures and pulse volume recordings - Order CT angiography for interventional planning - Order duplex ultrasound for venous reflux quantification - Order toe pressures and TcPO2 for critical ischemia - Order MR angiography for renal-safe alternative
Risk factors: - Failure to palpate ALL peripheral pulses bilaterally and document findings - Not performing ABI in patients with PAD risk factors (diabetes, smoking, claudication, non-healing wounds) - Missing acute limb ischemia (6 Ps) — delay to revascularization leads to limb loss - Confusing arterial ulcers (lateral malleolus, deep, punched-out, painful) with venous ulcers (medial malleolus, shallow, less painful) - Not recognizing non-compressible vessels in diabetics (ABI >1.4 = falsely elevated — use TBI instead) - Failure to assess for DVT risk factors and apply Wells criteria before ordering D-dimer or duplex ultrasound