13
Figure 2. Diagnostic Testing for Suspected CLI
History and physical examination
suggestive of PAD without rest
pain, non-healing wound or
gangrene (Table 3)
NO YES
Search for alternative
diagnosis
(Table 7 & 8)
ABI
(Class I)
Non-compressible
arteries ABI: >1.40
Normal ABI: 1.00–1.4
Borderline ABI:
0.91–0.99
Abnormal ABI:
≤0.90
TBI
(Class I)
Non-healing wound
or gangrene
Additional perfusion
assessment, particularly
if ABI >0.70:
• TBI with waveforms
TcPO
2
a
• SPP
a
(Class IIa)
YES NO
Search for
alternative diagnosis
(Table 7)
Perfusion assessment:
• TBI with waveforms
b
• TcPO
2
a
• SPP
a
(Class IIa)
Normal
(>0.70)
Abnormal
(≤0.70)
Search for
alternative diagnosis
(Table 8)
Abnormal Normal
Anatomic assessment:
• Duplex ultrasound
• CTA or MRA
• Invasive angiography
(Class I)
Normal
Abnormal
Colors correspond to Class of Recommendation on page 26–27.
a
Order based on expert consensus.
b
TBI with waveforms if not already performed.
