REVIEW
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Noninvasive Diagnostic Methods for Better Screening of Peripheral Arterial Disease.

BACKGROUND: Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to extremities, usually legs. It does not receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain while walking which is known as claudication. It is a common manifestation of type-2 Diabetes, but the relationship between other vascular diseases and lower limb peripheral arterial disease (LLPAD) has been poorly understood and investigated.

METHODS: When assessing a patient with clinical LLPAD, 2 methods are used to establish a diagnosis: one is noninvasive testing and other is invasive. Invasive methods are painful and get so bad that some people need to have a leg surgery. People with diabetes are at increased risk for amputation, and it is used only when the damage is very severe.

RESULTS: Diagnosis of LLPAD begins with a physical examination, patient history, and certain questionnaire, and noninvasive mode of diagnosis is started for the screening of patients. Clinicians check for weak pulses in the legs and then decide for further diagnosis. This article discusses the prevalence of LLPAD worldwide and in India, along with the clinical effectiveness and limitations of these methods in case of diabetes.

CONCLUSIONS: The focus of this review is to discuss only those noninvasive methods that are widely used for screening of LLPAD, such as ankle-brachial index (ABI), toe-brachial index (TBI), and use of photoplethysmogram (PPG) especially in case of diabetic patients. Also, this article gives an overview of the work carried out using ABI, TBI, and PPG for detection of LLPAD. These tests are not painful and could be performed in a cost-effective manner to avoid delays in screening/diagnosis and also reduce costs.

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