Screening check
Should I be screened for peripheral artery disease?
Peripheral artery disease (PAD) is atherosclerosis, the build-up that narrows arteries, in the legs. The US Preventive Services Task Force looked at whether adults with no symptoms should be screened with the ankle-brachial index test. Check what it says for you.
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What you will see
What the USPSTF says about PAD screening for you.
Educational only, not medical advice. This does not test for PAD. Talk to a clinician about any leg symptoms.
Source
US Preventive Services Task Force, July 2018 recommendation on screening for peripheral artery disease and cardiovascular risk with the ankle-brachial index. It is still the current statement.
Validated in
Adults without symptoms and without a known diagnosis of PAD, cardiovascular disease or severe chronic kidney disease.
Limits
It does not test for PAD and cannot tell whether your arteries are narrowed. It does not cover people with leg symptoms or known disease.
What the USPSTF recommends
| Who | Recommendation | Grade |
|---|---|---|
| Adults without symptoms and without known PAD, cardiovascular disease or severe chronic kidney disease | Evidence is insufficient to weigh the benefits and harms of screening with the ankle-brachial index | I |
The USPSTF found inadequate evidence on how accurate the ankle-brachial index is for finding PAD in people without symptoms, and on whether screening and treatment prevent PAD from getting worse or prevent heart attacks and strokes (USPSTF 2018). Literature scans in August 2023 found no new evidence to support an updated review, so the 2018 statement still applies (USPSTF 2018).
Why it matters
PAD is atherosclerosis in the legs. It can make walking harder and, in severe cases, lead to tissue loss, infection and amputation. People with PAD also have a higher risk of heart attack and stroke (USPSTF 2018). US survey data from 1999 to 2004 found a low ankle-brachial index (0.9 or less) in 5.9% of adults 40 or older, rising from 1.9% at ages 40 to 59 to 17.5% at 75 or older. More than half of people with a low ABI have no symptoms or atypical ones (USPSTF 2018).
Why the evidence falls short
Only one fair-quality study tested the ABI against a reference standard in a relevant group. In one study of adults older than 70, compared with whole-body MRA scans, an ABI below 0.9 picked up only 15% to 20% of people with PAD (sensitivity), while 99% of people without PAD tested normal (specificity) (USPSTF 2018). The direct harms of the test are minimal, but false positives, anxiety, labeling and contrast dye from follow-up scans are possible (USPSTF 2018). The major risk factors for PAD are already used to estimate heart risk, so people with a low ABI may already be advised to take steps such as quitting smoking and lowering cholesterol and blood pressure (USPSTF 2018).
Common questions
What raises the risk?
Older age, diabetes, current smoking, high blood pressure, high cholesterol, obesity and physical inactivity. Smoking and diabetes have the strongest link (USPSTF 2018).
What is the ankle-brachial index?
It compares the blood pressure at your ankle with the blood pressure in your arm while you lie down. A ratio below 1, usually defined as below 0.9, is considered abnormal and is often used to define PAD (USPSTF 2018).
Also see the heart risk calculator, the carotid artery screening check, the aortic aneurysm screening check, the quit smoking check and all screening tests by age.
Sources
- US Preventive Services Task Force. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(2):177-183. www.uspreventiveservicestaskforce.org/uspstf/recommendation/peripheral-artery-disease-in-adults-screening-with-the-ankle-brachial-index
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-10-30. Spotted an error? See About.