93923 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure

Name of the Procedure:

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels

Summary

This procedure involves noninvasive tests to assess blood flow in the arteries of either the upper or lower extremities. It includes measurements like the ankle/brachial index (ABI) and segmental blood pressures at different points along the arteries.

Purpose

The procedure is used to diagnose peripheral artery disease (PAD), where narrowed arteries reduce blood flow to the limbs. It aims to identify blockages or other issues affecting blood circulation to help guide treatment.

Indications

• Symptoms of PAD such as leg pain while walking (claudication), numbness, or coldness in lower legs.
• Atherosclerosis risk factors (e.g., diabetes, smoking, high blood pressure).
• Non-healing wounds or ulcers on feet or legs.
• Abnormal pulse readings in the extremities.

Preparation

• Wear loose-fitting clothing for easy access to the extremities.
• No fasting is generally required.
• Continue regular medications unless advised otherwise.

Procedure Description

1. The patient lies down on an examination table.
2. Blood pressure cuffs are placed on the arms, thighs, calves, ankles, and sometimes the toes.
3. Ultrasound gel is applied to the skin.
4. Doppler ultrasound devices measure blood flow and blood pressure at each level.
5. The ankle/brachial index (ABI) is calculated by comparing blood pressure in the ankle to blood pressure in the arm.

Duration

The procedure typically takes 30 to 60 minutes.

Setting

The procedure is performed in an outpatient clinic, hospital, or specialized vascular lab.

Personnel

• Vascular technologist or trained medical technician performs the test.
• Vascular specialist or physician interprets the results.

Risks and Complications

This is a noninvasive and low-risk procedure. Some risks include:

• Mild discomfort from blood pressure cuffs.
• Rarely, skin irritation from ultrasound gel.

Benefits

• Noninvasive and painless method to diagnose PAD.
• Helps in planning appropriate treatment.
• Results are usually available immediately.

Recovery

• No specific recovery time is needed.
• Patients can usually resume normal activities immediately after the procedure.

Alternatives

• Duplex ultrasound for visualizing blood flow.
• Invasive procedures like angiography.
• Each alternative has its pros and cons regarding detail, risk, and recovery time.

Patient Experience

• Patients might feel mild discomfort from the inflation of blood pressure cuffs.
• No sedation is required, and pain is minimal.
• The procedure is generally well-tolerated.