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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 timeconsuming 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. dIAGnoStIC CHALLEnGES

The characteristic clinical diagnostic feature of PAD is intermittent claudication (IC …