Pulse Volume Recordings

Rationale

The integration of the 2025 ACC Scientific Statement is crucial for this section as it highlights the specific diagnostic utility of PVR in diabetic patients. Diabetic patients frequently present with medial arterial calcification, which renders the ABI unreliable; PVR serves as a vital alternative for assessing limb perfusion in this population. The rewrite expands necessary abbreviations (PVR, PAD, ABI) and maintains the existing citation structure while adding the new evidence.

Evidence

Content Changes

* ProvidesPulse volume recordings (PVR) provide waveform analysis of segmental volume changes.
* Flattened or dampened waveforms =indicate severesignificant peripheral arterialartery disease (PAD).
* Advantage: not affected by medial arterial calcification. This makes PVR particularly useful in patients with diabetes or non-compressible vessels where the ankle-brachial index (ABI) may be unreliable [@aha2016] [@rutherford2018-rutherford] [@acc2025-management].