An elderly woman presents with intermittent leg pain. She states it is a burning heaviness that is not necessarily associated with activity. Inspection reveals several dilated and tortuous veins about the lower legs. The skin is edematous and speckled with dark brown areas of capillary dilation but no specific pallor. Distal motor and sensory examinations are intact. Which of the following is the most appropriate initial tests in the evaluation of these symptoms?
A. Angiography
B. Coagulation panel
C. Duplex ultrasonography
D. Electrodiagnostics

Duplex ultrasonography is a radiological non-invasive diagnostic test performed to evaluate the flow of blood through the blood vessels – arteries and veins. This applies sound waves to image the blood flow in the vessels to look for any blockage or narrowing.

A duplex ultrasonography of the extremities measures the flow of blood in the extremities to detect for peripheral artery disease (PAD).

The symptoms presented in the elderly woman like burning heaviness, dilated and tortuous leg veins, edematous skin with speckled areas are all representative of PAD.

Coagulation panel details blood clotting markers like prothrombin etc, and this may not be sufficient to diagnose the given patient’s conditions

Angiography involves the use of radiopaque contrast dye and catheter insertion, both of which may cause allergies or side effects. Hence this test is done only when required to assess the progress of disease at later stages.