Single level exams are traditionally the first step in diagnosing PAD. Single level refers to taking an ABI index at the ankle site and should not be confused by also taking the arm/brachial pressures. By taking a pressure at the ankle site you are effectively at the most distal point of the leg and will see signs of any proximal or ‘upstream’ occlusions. Newman Medical offers a variety of single level physiological exams to best serve your diagnostic needs.
Multi-level, also known as Segmental, exams serve to localize the diagnosis of PAD. By taking pressures and/or waveforms at multiple sites along the leg, the practitioner can determine where in the leg the occlusion is located. One is either looking for a 30mmHg pressure drop between sites or is looking for waveforms to transition from appearing normal to appearing abnormal.
ABI with Exercise or ABI Stress was traditionally done as a final stage in PAD diagnosis. However, recent studies and clinical thought have changed that perception. Since many people with PAD attribute leg pain to aging or arthritis, diagnosis of PAD was vastly underdiagnosed. Exercising a patient suspected of having PAD or one that complains of leg pain, will often improve PAD diagnosis. Recent studies have shown over 30% of patients with a normal resting ABI will show signs of PAD with exercise.