Hemodynamic Testing
Applied
Type
ModificationConfidence
95%
Created
Mar 27, 2026
Evidence
1 source
Rationale
The 2025 ACC Scientific Statement provides updated, high-level guidance specifically for the diabetic population, which is a critical subset of PAD patients. I integrated this to emphasize the preference for TBI over ABI in this cohort and to reinforce the clinical utility of the WIfI staging system as recommended by major society guidelines.
Evidence
Content Changes
removedadded
* **ankle-brachial index (ABI):** Sensitivity ~80%, specificity ~95% for peripheral arterial disease (PAD) [@aboyans2012]. Limitations: falsely elevated in calcified arteries. * **toe-brachial index (TBI):** UsefulPreferred over ABI in diabeticspatients andwith renaldiabetes or chronic kidney disease patients(CKD) withdue to medial arterial calcification [@potier2011].and non-compressible vessels [@potier2011, @acc2025-management]. * **TcPO₂:****transcutaneous oxygen tension (TcPO₂):** Values <30 mmHg indicate severe ischemia with poor wound-healing potential; 30–39 mmHg suggests moderate ischemia; ≥40 mmHg indicates adequate perfusion [@schepers2010]. * **Segmental pressures and plethysmography:** Localize stenoses and assess venous reflux. In chronic limb-threatening ischemia (CLTI), toe pressure <30 mmHg or TcPO₂ <30 mmHg indicates severe ischemia and poor wound-healing potential;potential. The Wound, Ischemia, and foot Infection (WIfI) staging system integrates hemodynamics (toe pressure, TcPO₂), wound characteristics, and infection severity to stratify limb threat and guide revascularization [@conte2019-gvg].decisions [@conte2019-gvg, @acc2025-management]. See [[Peripheral Artery Disease|Ch. 10]] for complete WIfI classification.