Background: Conventional contrast angiography (CA) is the standard diagnostic modality for peripheral artery disease of the lower extremities. However, CA presents possible risks, including contrast nephropathy and radiation exposure. An invasive procedure, it is not chosen to evaluate non-invasive physiologic procedures testing for vascular disease. Alternatively, Duplex ultrasonography (Duplex) is used to assess other non-invasive procedures that evaluate the presence or extent of peripheral artery disease. However, Duplex is not an infallible tool. Rather, another non-invasive physiologic test for peripheral artery disease is a volume plethysmography system (VPS), a blood volume waveform visualization and evaluation tool.