TY - JOUR T1 - Peripheral arterial disease: diagnostic challenges and how photoplethysmography may help JF - British Journal of General Practice JO - Br J Gen Pract SP - 323 LP - 324 DO - 10.3399/bjgp15X685489 VL - 65 IS - 635 AU - Scott Wilkes AU - Gerard Stansby AU - Andrew Sims AU - Shona Haining AU - John Allen Y1 - 2015/06/01 UR - http://bjgp.org/content/65/635/323.abstract N2 - Peripheral arterial disease (PAD) affects approximately 20% of patients aged ≥60 years.1 A GP with an average list size of 1800 patients can expect to have 50–60 patients with PAD. Ankle-brachial pressure index (ABPI), which is the ratio of the ankle to brachial systolic pressure measured by sphygmomanometer and hand-held Doppler ultrasound probe, is used to assess PAD in general practice. ABPI has been shown to have a sensitivity of 95% and specificity of 99% compared to angiographic imaging,2 however it is relatively time-consuming and requires adequately trained staff. There are limitations with ABPI in patients with diabetes, renal disease, and older people where an underestimation of disease can occur with a falsely high ratio due to the presence of incompressible calcified blood vessels.Clinical QuestionCan peripheral arterial disease be accurately diagnosed in general practice?The characteristic clinical diagnostic feature of PAD is intermittent claudication (IC), muscle pain brought on by exercise, relieved by rest and experienced in the calf with femoropopliteal disease and in the buttock, hip or thigh with aortoiliac disease. However it is sometimes difficult to distinguish clinically between claudication and leg pain from other causes such as spinal stenosis.ABPI methodologyThe first problem we face is that a significant proportion of patients in general practice who are arteriopaths are asymptomatic and ABPI has … ER -