OBJECTIVE: This study aimed to evaluate and compare the screening capabilities of BlueDop Vascular Expert (BVE; BlueDop Medical Ltd., UK) and the ankle-brachial index (ABI) in detecting peripheral arterial disease (PAD) among a diverse patient population, including those with a history of smoking, obesity, diabetes and hypertension. METHOD: This prospective study used data from two separate studies; a current single-centre cohort and a previously published dataset by Tessendorf et al. Data from the current cohort was analysed independently and in combination with the study by Tessendorf et al. Individuals at risk for PAD underwent both ABI and BVE testing. Full leg arterial duplex interpreted by an independent vascular surgeon served as the reference standard. Subgroup analysis was undertaken to compare BVE and ABI capabilities among those with underlying comorbidities, such as diabetes, hypertension, tobacco use and obesity, as these factors affect PAD detection. RESULTS: For all patients in the combined dataset (new study: n=550 limbs assessed by BVE; previous study: n=201 limbs assessed by BVE; combined total: n=751 limbs assessed by BVE), overall BVE sensitivity was 82.5%, specificity was 93.9%, accuracy was 91.2% and κ=0.76. In contrast, ABI sensitivity was 58.3%, specificity was 87.4%, accuracy was 80.6%, and κ=0.46. Increased accuracy, sensitivity, specificity, and κ constant were present in all analysed subgroups when comparing BVE to ABI. CONCLUSION: In this study, BVE provided more accurate and reliable PAD screening than ABI across diverse patient populations, including those with comorbidities that reduce ABI accuracy. Its portability, ease of use and minimal need for specialised interpretation support its use as a first-line screening tool, particularly in rural and underserved settings. Broader implementation of BVE could help reduce diagnostic disparities and improve outcomes for patients at risk for PAD.