A 65-year-old man comes to the clinic reporting a 3-month history of right calf cramping. The discomfort consistently begins after walking approximately three blocks and resolves completely within a few minutes of rest. He has a history of type 2 diabetes mellitus, hypertension, and a 40-pack-year smoking history. His current medications include metformin and lisinopril. Vital signs are within normal limits. On physical examination, the skin of the right lower extremity appears thin and shiny with decreased hair growth. The right dorsalis pedis pulse is diminished compared to the left. Which of the following is the most appropriate initial diagnostic test to evaluate this patient's condition?
- Ankle-brachial indexCevap
- BComputed tomography angiography of the lower extremities
- CVenous duplex ultrasonography of the right lower extremity
- DMeasurement of serum D-dimer
- EExercise electrocardiography
Cevap
Ankle-brachial index
The patient's presentation of exertional calf pain relieved by rest, combined with thin, shiny skin and decreased distal pulses, is highly characteristic of intermittent claudication due to peripheral artery disease (PAD). The most appropriate initial diagnostic test for suspected PAD is the ankle-brachial index (ABI). The ABI compares the systolic blood pressure measured at the ankle to the systolic blood pressure measured at the brachial artery. An ABI of less than 0.90 is diagnostic for PAD. It is a highly sensitive, specific, and non-invasive first-line screening tool.
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Anahtar Kavram
Diagnosis of Peripheral Artery Disease (PAD)