Which finding on examination is most consistent with peripheral arterial disease?

Which finding on examination is most consistent with peripheral arterial disease?

• A. Abnormal pulses and abnormal ankle-brachial index
• B. Normal pulses and normal ankle-brachial index
• C. Abnormal pulses but normal ankle-brachial index
• D. Normal pulses and abnormal ankle-brachial index

Answer: (A)

Peripheral arterial disease disrupts blood flow to the legs, so exam findings typically show reduced perfusion in the affected limb. The ankle-brachial index (ABI) quantifies this by comparing the systolic pressure at the ankle with that in the arm; a value below 0.90 indicates PAD, with lower numbers reflecting more severe disease. When both distal pulses are diminished or absent and the ABI is decreased, it highly supports PAD. That combination is the most consistent pattern because it directly links the clinical sign of impaired arterial inflow (weak or absent pulses) with objective hemodynamic evidence (low ABI). If pulses are normal but the ABI is abnormal, that scenario is less typical and can occur due to measurement variability or conditions like arterial calcification that can affect the reading. Conversely, normal pulses with a normal ABI basically argues against PAD. Abnormal pulses with a normal ABI is also less consistent, since a true arterial occlusion usually lowers the ABI as well.

Peripheral arterial disease disrupts blood flow to the legs, so exam findings typically show reduced perfusion in the affected limb. The ankle-brachial index (ABI) quantifies this by comparing the systolic pressure at the ankle with that in the arm; a value below 0.90 indicates PAD, with lower numbers reflecting more severe disease. When both distal pulses are diminished or absent and the ABI is decreased, it highly supports PAD. That combination is the most consistent pattern because it directly links the clinical sign of impaired arterial inflow (weak or absent pulses) with objective hemodynamic evidence (low ABI).

If pulses are normal but the ABI is abnormal, that scenario is less typical and can occur due to measurement variability or conditions like arterial calcification that can affect the reading. Conversely, normal pulses with a normal ABI basically argues against PAD. Abnormal pulses with a normal ABI is also less consistent, since a true arterial occlusion usually lowers the ABI as well.