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January 16, 2002

Diagnosis and Treatment of Peripheral Arterial Disease—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(3):313-316. doi:10.1001/jama.287.3.313

In Reply: We agree with Dr Gaylis that a good history and physical examination is a cost-effective means to diagnose PAD. Nevertheless, while the clinical examination can provide important signs of PAD, the peripheral pulse examination has been shown to be insensitive to accurately diagnosis PAD. In one study,1 the sensitivity of any abnormal pulse was 77%, the specificity was 86%, the positive predictive value (PPV) was 40%, and the negative predictive value was 97%. Another study,2 in contrast, found the sensitivity of an absent pulse for PAD was only 5%. Thus, in this study the PPV was as low as 20%. From these data we infer that the presence of a normal pedal pulse could potentially identify approximately 90% of patients who do not have PAD, but an absent pulse cannot serve as a reliable indicator of PAD. This imperfect sensitivity and PPV of the pulse examination are the critical reasons for our advocacy of greater use of the ABI. The judicious use of the simple, inexpensive handheld Doppler device, like the use of a stethoscope, can improve the accuracy of real-world PAD diagnosis.

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