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The resting ankle-brachial pressure index (rABPI) is used in the diagnosis of lower extremity peripheral arterial disease (PAD) in symptomatic and asymptomatic patients. This article compares the rABPI with a new optical device based on photoplethysmograph (PPG) technology with new algorithms for the assessment of PAD. Functional PPG (fPPG) is a promising noninvasive automated device using a novel cuffless functional test for assessing mild or significant PAD without the operator dependency issues associated with rABPI. This system utilizes both changes in pulsatile arterial blood volume and skin color redness in lower limbs. All subjects underwent rABPI, fPPG, and duplex angiography (DA). Significant correlation was found between fPPG and DA scores, rABPI and DA, and fPPG and rABPI. In the hands of operators with little experience, fPPG may prove to be superior to rABPI and may be useful as a simple screening tool for early detection of PAD in primary care.