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May 7, 1982

Evaluation of Peripheral Vascular Disease

JAMA. 1982;247(17):2369-2370. doi:10.1001/jama.1982.03320420025016

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To the Editor.—  I should like to comment on the article by Stefan A. Carter, MD, "Arterial Oscultation in Peripheral Vascular Disease" (1981; 246:1682). Dr Carter makes the point, among others, that stress-amplified bruits and diminished ankle BPs can aid in the diagnosis and evaluation of vaso-obstructive disease of the lower extremities. I should like to comment on a protocol that I have used for years in the initial evaluation of the "claudicator" both from the perspective of diagnosis as well as assessment of the degree of disability present.I receive a large number of patients with leg pain on exertion and quite a few of them turn out to be "pseudoclaudicators." To make this distinction, I routinely walk each patient on a treadmill, measuring ankle BPs before and after the stress. These patients are generally walked an average of three to five minutes at 1.6 to 2.4 km/hr with