A 56-year-old male with severe peripheral artery disease presents with painful, non-healing ulcers on the tips of his toes and lateral malleolus. The foot is cool, pale on elevation, and displays rubor on dependency. Peripheral pulses are absent. What diagnostic test is the initial non-invasive vascular evaluation of choice?

Answer and explanation

Correct answer: B. Ankle-Brachial Index (ABI) measurement

  1. Step 1: The Ankle-Brachial Index (ABI), the ratio of the systolic blood pressure in the ankle to the systolic blood pressure in the brachial artery, is the initial non-invasive screening and diagnostic test of choice for suspected peripheral artery disease.
  2. Step 2: An ABI <= 0.90 is diagnostic of PAD, while <= 0.40 denotes severe, limb-threatening ischemia.
Answer
Ankle-Brachial Index (ABI) measurement.
Why not the others: 'Digital subtraction angiography' is an invasive interventional tool reserved for planning surgical revascularization, not initial screening; 'Magnetic resonance venography' assesses the venous system (e.g., deep venous thrombosis), not arterial occlusive disease; 'Tissue biopsy' of an ischemic ulcer impairs wound healing and risks limb necrosis.

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