Changes in posture of the lower extremities induce changes in skin blood flow, known as veno-arteriolar response(VAR). We investigated the relationship between ankle brachial index(ABI) and VAR in patients(ABI< 0.9) with peripheral arterial disease(PAD) and age-matched normal controls(ABI >1). We measured ankle pressure, ABI at rest, and post-exercise ABI. Using laser Doppler flowmetry, skin blood flow was measured with the lower extremity in extended and flexed positions and the fractional change(extended-flexed/ extended) in blood flow(VAR) was calculated. With external pressure applied serially to the lower extremity in the extended position using a sphygmomanometer, the pressure(PVAR) at which the VAR was similar to that in the flexed position was recorded. Patients and controls did not differ by age or comorbidity, except higher cigarette smoking in patients(95.8%vs. 4.3%, p=0.001). VAR and PVAR were significantly lower in patients than controls(0.42±0.16 vs. 0.65±0.11 flux/min, p=0.001 and 29±8 vs. 48±9 mm Hg, p=0.001, respectively). There was significant correlation between ABI-post and VAR(r=0.6, p=0.01) and between the VAR and PVAR(r=0.8, p=0.001). VAR< 0.3 flux/min was 100%sensitive, 80%specific, and area under curve of 0.88, p=0.001 for detecting PAD as defined by ABI< 0.9. Similarly, PVAR of 22 mmHg was 100%sensitive, 85%specific, and area under curve of 0.94, p=0.001 for detecting PAD. Skin blood flow by this method correlates with the presence and severity of an abnormal ABI. This may offer a method of monitoring the effect of therapy and regression of peripheral atherosclerosis. Changes in the lower extremities induce induce changes in skin blood flow, known as veno-arteriolar response (VAR). We investigated the relationship between ankle brachial index (ABI) and VAR in patients (ABI <0.9) with peripheral arterial disease We measured ankle pressure, ABI at rest, and post-exercise ABI. Using laser Doppler flowmetry, skin blood flow was measured with the lower extremity in extended and flexed positions and the fractional change (extended-flexed / extended) in blood flow (VAR) was calculated. With external pressure applied serially to the lower extremity in the extended position using a sphygmomanometer, the pressure (PVAR) at which the VAR was similar to that in the flexed Patients and controls did not differ by age or comorbidity, except higher cigarette smoking in patients (95.8% vs. 4.3%, p = 0.001). VAR and PVAR were significantly lower in patients than controls (0.42 ± 0.16 vs. 0.65 ± 0.11 flux / min, p = 0.001 and 29 ± 8 vs. 48 ± 9 mm Hg, p = 0.001, respectively). There was a significant correlation between ABI-post and VAR (r = 0.6, 0.8, p = 0.001). VAR <0.3 flux / min was 100% sensitive, 80% specific, and area under curve of 0.88, p = 0.001 for PAD as defined by ABI <0.9. % sensitive, 85% specific, and area under curve of 0.94, p = 0.001 for detecting PAD. Skin blood flow by this method correlates with the presence and severity of an abnormal ABI. This may offer a method of monitoring the effect of therapy and regression of peripheral atherosclerosis