Patients with absent foot pulses should have the pressure index measured to confirm ischemia and to provide a baseline, so that subsequent deterioration can be detected. When the pulses are not palpable and the pressure index is >1, a reduced Doppler arterial waveform usually indicates ischemia. The main advantage in detecting peripheral vascular disease at this stage is that it is a sign of systemic atheroscerosis and treatment should be started with aspirin and statins and other risk factors for arterial disease such as hypertension and smoking should be addressed. If the patient has rest pain, disabling claudication, or the pressure index is below 0.5, further investigations of the peripheral arterial circulation should be carried out as described below under Stage 3.

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