Ankle-Brachial Index

in Vascular Diagnostics and Imaging

Applied

Type

Modification

Confidence

95%

Created

Mar 19, 2026

Evidence

2 sources

Rationale

The section was updated to include the 2024 ACC/AHA/SVS guideline, which represents the most current evidence-based standard for PAD management. A systematic review was also integrated to provide meta-evidence on the consistency of these diagnostic recommendations. Abbreviations (PAD, TBI, ABI) were expanded on first use in the body text as per the instructions, and all existing citations and structure were preserved.

Evidence

Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024. PMID: 38752899.
Verified source
PubMedDOI
Uyagu OD, et al. Quality assessment and comparative analysis on the recommendations of current guidelines on screening and diagnosis of peripheral arterial disease: a systematic review. BMJ Open. 2022. PMID: 36104133.
Verified source
PubMedDOI

Content Changes

* **Definition:** ratio of ankle systolic pressure to brachial systolic pressure.
* **Normal values:** 1.00–1.40.
* **peripheral**Peripheral arterial disease (PAD) diagnosis:** <0.90 indicates peripheral arterial disease;PAD; <0.50 indicates severe ischemia.
* **Noncompressible arteries:** Values >1.40 suggest medial arterial calcification (common in diabetes and chronic kidney disease). In such cases, measure toe pressures and toe-brachial index (TBI) instead.
* **Exercise testing:** If symptoms suggest PAD but resting ankle-brachial index (ABI) is normal, perform post-exercise ABI. A decrease ≥20% in ABI or ≥30 mmHg drop in ankle pressure supports the diagnosis.
* **Guidelines:** The 2024 ACC/AHA/SVS guideline recommends resting ABI as the primary diagnostic test for patients with clinical suspicion of PAD [@svs2024-h]. This reinforces previous recommendations from AHA/ACC (2016) and ESC (2017) recommendwhich advocate for ABI as first-line screening, with exercise ABI and toe-brachial index (TBI)TBI when indicated.indicated [@aboyans2012] [@aha2016] [@esc2017] [@potier2011][@potier2011]. Systematic reviews of international guidelines demonstrate high consensus on these diagnostic thresholds [@uyagu2022-b].
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