What is the gold standard diagnostic test for peripheral artery disease?

• A. Duplex Ultrasound
• B. Ankle-Brachial Index
• C. CT Angiography
• D. Arteriography

Answer: (D)

Conventional catheter-based arteriography is the most definitive way to image the arterial system in PAD. It injects contrast directly into the arteries and provides high-resolution, real-time images of the entire limb vasculature, allowing precise visualization of where stenosis or occlusion lies and how severe it is. This exact anatomical mapping is why it’s considered the reference standard: it not only confirms disease but also guides treatment and enables intervention in the same procedure if needed.

Of course, this test is invasive and carries risks from arterial puncture, contrast, and radiation, so noninvasive tests are typically used first. An ankle-brachial index screening test helps detect PAD, duplex ultrasound assesses blood flow and can identify problematic segments, and CT or MR angiography can map anatomy without catheterization—but they don’t replace the definitive, lumen-focused detail that conventional arteriography provides, which is why it remains the gold standard for diagnostic imaging in PAD.