Peripheral Vascular Disease

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Published on August 11, 2021

Peripheral Vascular Disease

Black and white photo of a person holding their calf which is highlighted orange to indicate painWhen Leg Pain Signals Something More Serious

An occasional leg cramp can be harmless, but cramping or fatigue in the legs can also be a sign of something more serious. In some cases, it may be a symptom of vascular disease, the narrowing of vessels carrying blood outside of the heart and brain.

“Vascular disease can be associated with higher risk of death from heart attack and stroke,” says Tina Ng MD, vascular surgeon at PIH Health. “Fortunately, most people with this condition can be treated with lifestyle changes such as diet and exercise alone or in combination with medication.”

To determine if you have peripheral vascular disease, your healthcare provider will ask you about your medical history. They will also give you a physical exam and they may order tests such as:

  • Angiogram. This is an X-ray of the arteries and veins to find blockage or narrowing. This procedure is done by putting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
  • Ankle-brachial index (ABI). This test detects peripheral vascular disease by taking blood pressure measurements on the arms and ankles using a pencil shaped ultrasound device called a Doppler. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm. It is one of the most reliable tests for peripheral vascular disease.
  • Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler test to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
  • Magnetic resonance angiography (MRA). This noninvasive test uses a large magnet, radio waves, and a computer to make detailed images of organs and other tissues in the body. Your doctor injects a special dye during the procedure. This is done so that blood vessels are more visible.
  • Treadmill exercise test. For this test, you will walk on a treadmill so your doctor can monitor blood flow during exercise.
  • Photoplethysmography (PPG). This exam is comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. Your doctor can then compare these measurements to the systolic blood pressure in the arm.
  • Pulse volume recording (PVR) waveform analysis. Your doctor uses this test to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
  • Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who can't walk on a treadmill. While you are lying on your back, your doctor takes comparative blood pressure measurements on the thighs and ankles to determine any decrease between the sites.

If your symptoms get worse or you get new symptoms, contact your doctor. To find a PIH Health doctor go to

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