Ankle-Brachial Index
Applied
Type
ModificationConfidence
95%
Created
Mar 20, 2026
Evidence
2 sources
Rationale
The section was updated to integrate the 2024 ACC/AHA/SVS guideline, which is the current gold standard for PAD management. This guideline provides updated class recommendations for ABI, TBI, and exercise testing. A 2022 systematic review was also added to support the comparative guideline recommendations. Abbreviations (ABI, PAD, TBI) were expanded on first use as per instructions.
Evidence
Content Changes
removedadded
* **Definition:** The ankle-brachial index (ABI) is the ratio of ankle systolic pressure to brachial systolic pressure. * **Normal values:** 1.00–1.40. * **peripheral**Peripheral arterial disease (PAD) diagnosis:** An ABI <0.90 indicates peripheral arterial disease;disease (PAD); <0.50 indicates severe ischemia.ischemia [@svs2024-i]. * **Noncompressible arteries:** Values >1.40 suggest medial arterial calcificationcalcification, (commoncommonly seen in patients with diabetes mellitus and chronic kidney disease).disease. In such cases, measure toe pressures and the toe-brachial index instead.(TBI) instead [@svs2024-i] [@uyagu2022-c]. * **Exercise testing:** If symptoms suggest PAD but the resting ankle-brachialABI indexis (ABI)normal isor normal,borderline (0.91–0.99), perform post-exercise ABI.ABI testing. A decrease ≥20% in ABI or a ≥30 mmHg drop in ankle pressure supports the diagnosis.diagnosis [@svs2024-i]. * **Guidelines:** AHA/ACCThe (2016)2024 multi-society guidelines (ACC/AHA/SVS) and the 2017 ESC (2017)guidelines recommend ABI as the first-line screening,diagnostic test for PAD, with exercise ABI and toe-brachial indexTBI (TBI)indicated when indicated.resting [@aboyans2012]ABI [@aha2016]is non-diagnostic despite clinical suspicion [@svs2024-i] [@esc2017] [@potier2011][@uyagu2022-c]. Previous recommendations from the AHA/ACC (2016) also established these thresholds [@aha2016] [@aboyans2012] [@potier2011].