[Lower limb occlusive arterial disease: Diagnosis problems in 2014]

Diagnosis of peripheral occlusive arterial disease still raises many problems in 2014. Early detection is crucial and a very good tool is available: ankle brachial index. In some patients, toe systolic pressure measurement might be useful (patients with diabetes mellitus or renal failure). As far as walking symptoms are concerned, treadmill test usually gives the answer about the reason for pain. In some cases, other tests may be useful, i.e. treadmill TcPO2 in low back pain. Critical ischaemia is a major issue for treatment when revascularization has failed but diagnosis also raises concerns. Objective testing for ischaemia is mandatory (TcPO2, toe systolic pressure). Ankle pressure measurement is not sufficient in those patients. Patients suspected for critical limb ischaemia have to be investigated and treated in vascular centers. Many problems still concern diagnosis of peripheral occlusive arterial disease in 2014.