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To the Editor: Dr Hirsch and colleagues¹ concluded that "Prevalence of peripheral arterial disease (PAD) is high, yet the physician awareness of the diagnosis is relatively low." Consequently, "underdiagnosis of PAD in primary care practice may be a barrier to effective secondary prevention of the high ischemic cardiovascular risk factors associated with PAD." The authors suggest that a simple ankle-brachial index (ABI) measurement using a Doppler device in office-based practice would identify a large number of patients with previously unrecognized PAD. The authors make no mention, however, of the findings of the clinical examination, such as the state of the pulses, auscultation, postural color changes, etc. The inexperienced physician might thereby infer that physical examination is not necessary or perhaps unreliable and that Doppler examination is the mainstay of diagnosis for PAD.

Since the advent of recent technology for the diagnosis and the treatment of PAD there has been a . . . [Full Text of this Article]