[Diagnostic strategy of vascular diseases of the lower limbs]

Peripheral arterial disease requires different diagnostic strategies according to the clinical presentation: tissue ischemia, asymptomatic disease or polyarterial disease. In the presence of resting or effort ischemia, complementary investigations are indicated: arteriography should be reserved for indications of arterial reconstruction: ankle systolic pressure may be measured by all physicians to quantify the distal repercussions of the lesions. Asymptomatic peripheral disease is becoming more widely recognised and may be detected with flowmeter tests. Polyarterial disease is associated with increased mortality of patients with peripheral arterial disease. Symptoms of coronary artery disease are an indication for coronary angiography and myocardial scintigraphy. Patients with cerebrovascular events will require ultrasonic, CT scanning and cardiac investigations. The diversity of the diagnostic approach to peripheral arterial disease is creating a need for a new profile of vascular physicians.