Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording
CPT4 code
Name of the Procedure:
Limited Bilateral Noninvasive Physiologic Studies of Upper or Lower Extremity Arteries
Common Name(s): Ankle/Brachial Index (ABI) Test, Doppler Waveform Analysis
Summary
This procedure measures blood flow in the arteries of the arms or legs to check for any blockage or narrowing. It involves using blood pressure cuffs and a Doppler ultrasound device to record blood flow sounds and calculate blood pressure differences between the limbs.
Purpose
This test is used to diagnose peripheral artery disease (PAD), a condition where narrowed arteries reduce blood flow to the limbs. Its primary goal is to identify blood flow issues that may cause pain, cramping, or more serious complications like wounds that won’t heal.
Indications
- Symptoms: Leg pain while walking, leg numbness, or non-healing wounds.
- Conditions: Suspected peripheral artery disease (PAD) or poor circulation.
- Criteria: Patients with risk factors such as diabetes, smoking, high blood pressure, or high cholesterol.
Preparation
- No fasting required.
- Wear loose, comfortable clothing.
- Medications can typically be taken as usual, but confirm with your healthcare provider.
- Any recent tests or imaging studies should be brought to the appointment.
Procedure Description
- The patient will lie down on an examination table.
- Blood pressure cuffs are placed on the arms and legs.
- A Doppler ultrasound device measures blood pressure at various points on the limbs.
- The ankles' pressures are compared to the arms’ to calculate the Ankle-Brachial Index (ABI).
- Bidirectional Doppler waveform recordings capture the blood flow in specific arteries.
Equipment: Blood pressure cuffs, Doppler ultrasound device, and possibly a gel to aid ultrasound transmission. Anesthesia: None required.
Duration
The procedure typically takes around 30 to 60 minutes.
Setting
This procedure is usually performed in an outpatient clinic or a hospital's vascular lab.
Personnel
- Vascular technologist or trained technician.
- Reviewing physician, usually a vascular specialist or cardiologist.
Risks and Complications
- Very minimal risk as it is noninvasive.
- Rare: Skin irritation from the blood pressure cuffs.
Benefits
- Provides an early diagnosis of PAD.
- Helps guide treatment options to improve circulation.
- Painless and quick.
Recovery
- No downtime required.
- Patients can resume normal activities immediately.
- Follow-up appointments may be scheduled to discuss results.
Alternatives
- Duplex ultrasound: More detailed imaging but more time-consuming.
- Magnetic Resonance Angiography (MRA): Detailed images but requires injection of contrast dye.
- Computed Tomographic Angiography (CTA): Detailed imaging also requiring contrast dye and exposure to radiation.
Patient Experience
- You may feel mild pressure from the blood pressure cuffs.
- There is generally no pain associated with the Doppler ultrasound.
- Immediate return to normal activities post-procedure.