Recherche en médecine familiale et en sciences médicales
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Detection of Flow Obstruction in Peripheral Arteries by Primary Care Providers: A Population-Based Registry Study

Robert C Master and Khuram Arif

Peripheral arterial disease (PAD) is a condition with serious comorbidities and mortality that is frequently under-diagnosed because it is not typically associated with the classic symptoms of claudication. In primary care settings, measurement of the ankle-brachial index (ABI) with pressure cuff Doppler systems is problematic due to the necessity of a vascular technician, the time required to perform the test, and the cost of a specialized vascular diagnostic unit or laboratory facility. One cost-effective approach that has been studied to identify PAD is to use a blood volume plethysmography system (VPS) at the point of care. Quantitative VPS gives primary care physicians and other clinicians a PAD test for use in the office setting that is practical in terms of time and cost and is operator independent. This paper reports on the use of VPS in a registry of 226,565 patients presenting to participating primary care practices in the United States. All patients were given a standardized, self-administered questionnaire to identify PAD symptoms and cardiovascular risk factors either in clinic or at home. Patients who met the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for screening for PAD were then tested with VPS for assessing flow obstruction in the lower extremities. Of the 226,565 patients registered, results showed 70,651 (31.3%) had moderate to severe flow impairment. The subset analysis of 27,079 patients for whom more detailed severity data was available showed 70.0% had no to mild flow disturbance, 17.2% had moderate flow obstruction, 7.9% had significant flow impairment and 4.9% had severe flow abnormalities. The registry study showed that clinical symptoms were unreliable in being able to discriminate disease from no disease. Earlier recognition of PAD might lead to earlier secondary preventive measures and improved outcomes for a population with documented high risk of cardiovascular morbidity and mortality.