“Being curious during an exam, look for subtle changes, detect disease early — it can change everything for a patient.”
This philosophy has guided Denise Levy throughout her remarkable 50-year career in vascular diagnostics. Her work has saved countless limbs and lives, making her the perfect recipient of the Global PAD Association’s Lifetime Achievement Award in Vascular Diagnostics.
The timing couldn’t be more appropriate. During PAD Awareness Month, we’re spotlighting one of the biggest challenges in peripheral artery disease care: the lack of early vascular evaluation for high-risk patients. Denise’s career exemplifies the difference that skilled, thorough diagnostics can make.
((WATCH THE INTERVIEW WITH DENISE LEVY BELOW & LEARN MORE ABOUT PAD TESTING))
Denise’s journey began in 1973 as an x-ray student at Beth Israel Hospital in Boston. She was among the first wave of ultrasound technologists in America. “I was one of the first 300 people in the nation to take the exam. So my number is 212,” she explained during our award presentation, joined by Dr. Brad Hill of Hill Vascular in Campbell, California, where Denise has worked for the past four years.
After studying under ultrasound pioneer Ellie Schnitzer, Denise went to Yale where her research contributions quickly accelerated. “We did 12 papers in three years and a book. I mean, I was publishing papers with two years experience,” she recalled. One of her most impactful studies involved Dr. Tom Fogarty, the renowned cardiovascular surgeon and inventor. She conducted research on renal arteries before and after atherectomy, helping establish diagnostic criteria that are still used today.
The “ABC” Approach: How Curiosity and Comprehensive Evaluation Save Lives
Throughout her career, Denise has approached every examination with the patient’s complete health in mind. “Whenever I do a case, all I’m thinking about is how are we going to fix this patient?” she explained. This comprehensive approach has repeatedly caught issues that would otherwise be missed.
Dr. Hill witnessed this firsthand: “There was a patient that came in with leg pain and swelling… The thought was that she had a venous problem. She had an ulcer around the ankle. And Denise was doing an iliac vein ultrasound on this patient. And she looked at the artery too, not just the vein. Sure enough, she found like an 80% stenosis of the common iliac artery in this patient.”
That discovery led to same-day surgery, potentially saving the patient’s limb. It’s exactly the type of comprehensive care that can make the difference between limb salvage and amputation.
Accredited Vascular Labs: The Gold Standard for PAD Detection and Diagnosis
The quality of vascular testing is paramount, and Denise has championed rigorous standards throughout her career. “We’re accredited in all four modalities,” she noted about Hill Vascular’s lab. “We’re accredited in abdominal, carotid, arterial, and venous.” This Intersocietal Accreditation Commission (IAC) certification ensures that patients receive thorough, accurate testing.
The contrast with non-accredited labs can be stark. “Sometimes you’ll get a report and it will say suboptimal, could not see the peroneal, could not see this, could not see that,” Denise pointed out. Such incomplete testing can miss critical issues.
Dr. Hill emphasized this point: “Having very solid, reliable, non-invasive vascular imaging data is incredibly valuable when it comes to making the diagnosis and coming up with a tailored treatment plan.” Compared to alternatives like CT angiograms, ultrasound delivers diagnosis with less radiation and greater accessibility.
Beyond Standard Testing: Exercise Evaluation and the Critical Role of TBI Measurements
For those with PAD symptoms, proper testing must go beyond resting measurements. Denise and Dr. Hill regularly exercise-test patients whose ankle-brachial index (ABI) appears normal at rest but drops significantly with activity. “I’ll run into Dr. Hill and say, do you want me to exercise them? You want me to see if they drop?” Denise explained. This extra step often reveals PAD that would otherwise be missed.
This attention to detail extends beyond the immediate test. “I’m always thinking for incidental findings,” Denise shared, recounting how she once detected pancreatic carcinoma during a renal artery exam. “They came down and thanked me and said, you saved his life because they got it early.”
Her comprehensive approach embodies what Dr. Hill and I came to call her “ABC” philosophy: “Always Be Curious, Always Be Checking.” It’s a mindset that has made her an exceptional diagnostician throughout her 50-year career.
For patients with PAD risk factors—including smokers, diabetics, and those with kidney disease—Denise’s work underscores the critical importance of early, accurate vascular evaluation. As Dr. Hill noted, “It’s better if we see more labs being accredited, more vascular ultrasound being done. It’s better for patients.”
5 Essential Steps for High-Quality PAD Testing: Expert Recommendations
Denise and Dr. Hill’s insights highlight critical steps for anyone concerned about PAD or with risk factors like diabetes, smoking, or kidney disease:
- Seek accredited vascular labs - Ask specifically if the lab is accredited by the Intersocietal Accreditation Commission (IAC) for the type of test you need. Denise explained: “We’re accredited in all four modalities… And you have to submit cases from each staff… It has to be positive. You can’t just give them a normal study.” This accreditation ensures quality testing.
- Don’t settle for incomplete testing - If your report mentions “suboptimal” views or inability to visualize certain vessels, seek a second opinion. As Denise noted, “You have the tools to see it. So it’s important to take the extra time and find that vessel.”
- Request comprehensive testing - For leg circulation concerns, both ankle-brachial index (ABI) and toe-brachial index (TBI) provide crucial information. Denise observed: “It’s funny that we still have a lot of offices that don’t do TBI. And they stop at the ankle and that’s about it. And they do the ABI, they say you’re fine. And then they still can’t walk.”
- Consider exercise testing - If you have symptoms during activity but normal resting tests, request exercise evaluation. Many PAD cases only become apparent during activity.
- Call the Global PAD Association’s Leg Saver Hotline - If you have questions about symptoms or testing, this resource connects you with experts who can guide you. At the Global PAD Association, we regularly hear from patients confused by incomplete testing who call our leg saver hotline saying they don’t understand why they still have symptoms after being told they don’t have PAD. And we help them with critical questions to discuss with their doctor to ensure a proper diagnosis and care. Call 1-833-PAD-LEGS.
Use padhelp.org or padtest.org - These websites help you with additional educational information and potential frontline PAD testing sites near you.
Legacy of Excellence: How One Diagnostician’s Career Continues to Transform Vascular Care
During PAD Awareness Month, Denise Levy’s career reminds us that early detection truly changes everything. Her pioneering contributions to vascular diagnostics have set a standard of excellence that continues to save limbs and lives. Her legacy of curiosity, precision, and patient-centered care will influence the field for decades to come.
Kym McNicholas is Chairman & CEO of the Global PAD Association, dedicated to improving outcomes for patients with peripheral artery disease through education, advocacy, and research.