12
Diagnosis
Figure 1. Diagnostic Testing for Suspected PAD
Colors correspond to Class of Recommendation on page 26–27.
History and physical examination
suggestive of PAD without rest
pain, non-healing wound or
gangrene (Table 3)
Suspect CLI
(Figure 2)
ABI with or without segmental
limb pressures and waveforms
(Class I)
Do not perform
invasive or noninvasive
anatomic assessments
for asymptomatic
patients
(Class III: Harm)
Non-compressible
arteries ABI: >1.40
Normal ABI: 1.00–1.4
Borderline ABI:
0.91–0.99
Abnormal ABI:
≤0.90
Exertional non–joint-
related leg symptoms
TBI
(Class I)
YES NO
Exercise TBI
(Class I)
Search for
alternative diagnosis
(Table 7)
Normal
(>0.70)
Abnormal
(≤0.70)
Search for
alternative
diagnosis
(Table 7)
Lifestyle-limiting
claudication
despite GDMT,
revascularization
considered
Abnormal Normal
Exercise ABI
(Class IIa)
Anatomic assessment:
• Duplex ultrasound
• CTA or MRA
(Class I)
Anatomic assessment
• Invasive angiography
(Class IIa)
Continue GDMT
(Class I)
NO
Options
YES
