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Answer :
Final answer:
Despite normal resting ABIs, the physician's concern for PAD is valid due to up to 50% of individuals with PAD being asymptomatic. Diabetes and other risk factors increase the likelihood of PAD, and normal ABIs do not rule out the disease, especially in asymptomatic patients or when the test is done at rest.
Explanation:
The physician's concern for Peripheral Artery Disease (PAD) despite normal resting Ankle-Brachial Index (ABI) values and somewhat atypical leg symptoms stems from the understanding that PAD can manifest without typical symptoms and has alternative diagnostic indicators. ABI is a commonly used diagnostic tool for PAD, where blood pressure readings at the ankle are compared to those at the upper arm;
however, this test can be normal in some PAD patients, especially when measured at rest. Having risk factors such as smoking, diabetes, high blood pressure, and high cholesterol heightens the suspicion for PAD even when ABIs are normal.
Significant for the patient's clinical picture is that up to 50% of individuals with PAD may be asymptomatic or have atypical symptoms. Furthermore, the presence of diabetes can mask PAD symptoms because diabetes can cause peripheral neuropathy, which may diminish pain perception. It's also important to remember that PAD is a progressive disease, and while resting blood flow might be sufficient despite arterial narrowing, challenges such as exercise or trauma can precipitate symptoms and complications due to insufficient blood flow.
Therefore, given the serious consequences of undiagnosed PAD, including increased risk of heart attack, stroke, and even limb loss, vigilance is warranted even in the presence of normal ABIs. A physician might consider stress testing, duplex ultrasonography, or angiography for a more definitive assessment, if clinical suspicion remains high.
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