Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
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.
Gaylis H. Diagnosis and Treatment of Peripheral Arterial Disease. JAMA. 2002;287(3):313-316. doi:10.1001/jama.287.3.313