Non-invasive testing
Applied
Type
AdditionConfidence
90%
Created
Mar 19, 2026
Evidence
2 sources
Rationale
The section was expanded to include recent 2025 guidance from the ACC regarding PAD in diabetes, specifically highlighting the limitations of ABI due to medial arterial calcification and the importance of TBI. Additionally, a value-based medicine perspective was integrated to emphasize that non-invasive hemodynamic testing should precede advanced imaging to ensure appropriate resource allocation.
Evidence
Content Changes
removedadded
Non-invasive hemodynamic teststests—including (ankle-brachialankle-brachial index (ABI), toe-brachial index (TBI), TcPO₂,transcutaneous SPP)oximetry are(TcPO₂), and skin perfusion pressure (SPP)—are essential for peripheral arterial disease (PAD) diagnosis, severity stratification, and wound-healing prediction. These tests represent the high-value, first-line diagnostic approach, helping to avoid the misallocation of more expensive advanced imaging resources [@raskin2025-narrative]. In patients with diabetes, where medial arterial calcification (MAC) may lead to falsely elevated or non-compressible ABI values, TBI and other physiological assessments are particularly critical for accurate assessment [@acc2025-c]. For measurement techniques, see [[Diagnostics in Vascular Surgery|Ch. 3]]. For chronic limb-threatening ischemia (CLTI) thresholds and Wound, Ischemia, and foot Infection (WIfI) integration, see [[Peripheral Artery Disease|Ch. 10]].