Pulse palpation is an effective method for population-based screening to exclude peripheral arterial disease

Abstract

There is a strong association between peripheral arterial disease (PAD) and future cardiovascular events. Therefore, intensive atherosclerotic risk factor reduction is recommended for people with PAD, and early detection is essential. This study assessed whether systematic pedal pulse palpation is an effective screening method for PAD in population-based screening programs. As part of a randomized screening project, The Viborg Vascular Screening trial, 18,681 men (mean age, 69.3years; range, 65-74years) participated in a screening program, which included bilateral pulse palpation and ankle-brachial index (ABI) measurement. PAD was defined as ABI ≤0.9 or ≥1.4. Analysis was conducted on sensitivity, specificity, positive predictive value, and negative predictive value for PAD and for the number of pedal pulses. PAD was present in 2215 participants (12.1%). The pedal pulse palpation test was set to be positive for having PAD if one or more pulses were missing. Sensitivity was 71.7% and specificity was 72.3%. No palpable pulses were associated with a 50% chance of ABI-verified PAD or with a false finding. Four palpable pulses were associated with 5% false-negative PAD cases. Pedal pulse palpation is was shown to be a reliable initial screening tool for PAD in population-based programs but only when four pedal pulses were present. Therefore, ABI measurement should routinely be measured in patients with fewer than four palpable pedal pulses so cardiovascular preventive actions can be initiated if PAD is confirmed.