Beyond the ankle-brachial pressure index for the diagnosis of peripheral arterial disease - Time for a new look at photoplethysmography

Peripheral arterial disease (PAD) is common, affecting about 20% of people over 60 years.1 The PAD confers a high cardiovascular risk and there is a need for an easy test to confirm its presence in the primary care so that appropriate specialist referral can be made. For many years, the ankle-brachial pressure index (ABPI) has been available as a first-line quantitative assessment of PAD. However, it has been unpopular due to concerns about its repeatability in a nonspecialist setting. In this issue, Ro et al describe a comparison continuous wave (CW) Doppler ultrasound with ABPI and photoplethysmography (PPG) in the detection of stenotic peripheral disease.2 They show that the sensitivity of ABPI is poor particularly in diagnosing the disease in the tibial segment and that an improvement in sensitivity is gained by performing CW Doppler together with ABPI and PPG.