What physical exam finding is consistent with a diagnosis of peripheral artery disease in a patient with leg pain upon walking?

A decreased ankle-brachial index (ABI) is consistent with a diagnosis of peripheral artery disease (PAD) in a patient who experiences leg pain while walking, commonly referred to as claudication. The ABI is a simple test comparing the blood pressure in the patient's ankle to the blood pressure in the arm. In individuals with PAD, there is typically reduced blood flow to the lower extremities due to narrowed or blocked arteries, which results in lower blood pressure readings in the ankles compared to the arms. An ABI value of less than 0.9 is typically indicative of PAD.

In contrast, an increased ABI would suggest either normal arterial function or even falsely elevated readings in some specific cases, which wouldn't correlate with the expected findings in someone suffering from PAD. Normal pedal pulses may also be present in PAD patients, particularly in the early stages or in less severe cases, but they do not confirm the diagnosis. Elevated blood pressure in the legs is not a characteristic finding of PAD; rather, it would indicate possible hypertension or other vascular issues, which may not relate directly to the diagnosis of PAD.