Peripheral artery disease (PAD): The Daily PANCE Blueprint
A 62-year-old woman is being seen in the primary care clinic for evaluation of leg pain. She has a history of hypertension, diabetes mellitus, and coronary artery disease. She reports having right calf pain associated with activity. The woman states that after walking approximately 2 or 3 blocks, she develops a cramping discomfort in her calf region that resolves with rest. She denies any change in skin color or temperature, edema, numbness, muscular weakness, chest pain, palpitations, shortness of breath, dizziness, or other associated symptoms. Her blood pressure is 145/85 mm Hg, pulse rate is 78/min, respirations are 18/min, oxygen saturation is 99% on room air, and temperature is 36.9°C (98.4°F). Her heart and lung examinations are normal. Evaluation of her lower extremity includes some dependent rubor with noted blanching on elevation. Her dorsalis pedis and posterior tibial pulses are palpable but diminished. There is mild muscular atrophy and hair loss compared to the contralateral extremity. Which of the following corresponds to the appropriate ankle-brachial index (ABI) used in the diagnosis of this patient’s disorder?
A. ABI greater than 1.4
B. ABI 1.0 - 1.4
C. ABI 0.9 - 1.0
D. ABI 0.5 - 0.8
E. ABI less than 0.5
Answer and topic summary
The answer is D. ABI 0.5 – 0.8
The appropriate ankle-brachial index (ABI) for the diagnosis of peripheral artery disease (PAD) in this patient is between 0.5 and 0.8. An ABI within this range indicates moderate arterial disease, which is consistent with the patient’s symptoms of claudication (pain with walking that resolves with rest) and physical findings such as diminished pulses and dependent rubor. The recommendation for patients with an ABI in this range is to refer to a vascular specialist.
| ABI VALUE |
INTERPRETATION |
RECOMMENDATION |
| Greater than 1.4 |
Calcification/Vessel Hardening |
Refer to a vascular specialist |
| 1.0-1.4 |
Normal |
None |
| 0.9-1.0 |
Acceptable |
None |
| 0.8-0.9 |
Some Arterial Disease |
Treat risk factors |
| 0.5-0.8 |
Moderate Arterial Disease |
Refer to a vascular specialist |
| Less than 0.5 |
Severe Arterial Disease |
Refer to a vascular specialist |
Incorrect Answer Explanations:
- A. ABI greater than 1.4: An ABI greater than 1.4 indicates calcification or vessel hardening, which is often seen in patients with diabetes mellitus or advanced age. It is not consistent with typical PAD.
- B. ABI 1.0 – 1.4: An ABI in this range is considered normal and does not indicate PAD. This range does not align with the patient’s symptoms and physical findings.
- C. ABI 0.9 – 1.0: This range is considered acceptable and does not indicate significant arterial disease. The patient’s moderate symptoms suggest a lower ABI.
- E. ABI less than 0.5: An ABI less than 0.5 indicates severe arterial disease, which is usually associated with more significant symptoms such as rest pain or tissue loss. This is more severe than the patient’s current presentation.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the General Surgery PAEA EOR topic list
