16
Diagnosis
3.1. Resting ABI and Additional Physiological Testing
COR LOE
Recommendations
Resting ABI
1 B-NR
1. In patients with history or physical examination findings
suggestive of PAD (Table 6), the resting ABI, with or without
ankle pulse volume recordings (PVR) and/or Doppler
waveforms, is recommended to establish the diagnosis.
1 B-NR
2. The resting ABI should be reported as abnormal (ABI,
≤0.90), borderline (ABI, 0.91–0.99), normal (ABI,
1.00–1.40), or noncompressible (ABI, >1.40).
2a B-NR
3. In patients at increased risk of PAD (Table 5), screening for
PAD with the resting ABI, with or without ankle PVR and/
or Doppler waveforms, is reasonable.
3: No
benefit
B-NR
4. In patients not at increased risk of PAD (Table 5) and
without history or physical examination findings suggestive
of PAD (Table 6), screening for PAD with the ABI is not
recommended.
Exercise ABI and Additional Physiological Testing
1 B-NR
5. In patients with suspected PAD, toe pressure/toe-brachial
index (TBI) with waveforms should be performed when the
resting ABI is >1.40 (noncompressible).
1 B-NR
6. Patients with suspected chronic symptomatic PAD (ie,
exertional nonjoint-related leg symptoms) and normal or
borderline resting ABI (>0.90 and ≤1.40, respectively) should
undergo exercise treadmill ABI testing to evaluate for PAD.
2a B-NR
7. In patients with PAD and an abnormal resting ABI (≤0.90),
the exercise treadmill ABI test can be useful to objectively
assess, the functional status and walking performance.
2a C-LD
8. In patients with chronic symptomatic PAD, it is reasonable to
perform segmental leg pressures with PVR and/or Doppler
waveforms in addition to the resting ABI to help delineate
the anatomic level of PAD.
2a B-NR
9. In patients with suspected CLTI, it is reasonable to use
toe pressure/TBI with waveforms, transcutaneous oxygen
pressure (TcPO
2
), and/or or skin perfusion pressure (SPP) in
addition to ABI for assessment of arterial perfusion and to
establish the diagnosis of CLTI.
2a B-NR
10. In patients with CLTI with nonhealing wounds or gangrene,
it can be useful to use toe pressure/TBI with waveforms,
TcPO
2
, SPP, and/or other local perfusion measures to
determine the likelihood of wound healing without or after
revascularization.
