Hemodynamic Testing

in Overview of Vascular Disease

Applied

Type

Modification

Confidence

95%

Created

Mar 27, 2026

Evidence

2 sources

Rationale

The integration incorporates the latest 2025 ACC Scientific Statement on PAD in diabetes, which emphasizes the use of TBI and TcPO2 over ABI in patients with medial calcification (common in DM and CKD). It also includes a value-based medicine perspective reinforcing physiological testing (ABI/TBI) as the essential first step in PAD diagnosis to prevent imaging misallocation. Abbreviations for DM and CKD were expanded on first use as per instructions.

Evidence

Das SR et al. Management of Peripheral Artery Disease in Adults With Diabetes: 2025 ACC Scientific Statement: A Report of the American College of Cardiology. J Am Coll Cardiol. 2025. PMID: 41405527.
Verified source
PubMedDOI
Raskin D et al. A narrative review of imaging misallocation in peripheral artery disease: a value-based medicine perspective. Cardiovasc Diagn Ther. 2025. PMID: 41509627.
Verified source
PubMedDOI

Content Changes

* **ankle-brachial index (ABI):** Sensitivity ~80%, specificity ~95% for peripheral arterial disease (PAD) [@aboyans2012]. It is the recommended first-line, cost-effective physiological test for PAD screening [@raskin2025]. Limitations: falsely elevated in calcified arteries.arteries, frequently seen in patients with diabetes mellitus (DM) and chronic kidney disease (CKD) [@acc2025-c].
* **toe-brachial index (TBI):** Useful in diabeticspatients andwith renalDM diseaseand patientsCKD with calcification [@potier2011]. TBI is the preferred diagnostic physiological test in the diabetic population when ABI is non-diagnostic or elevated (>1.40) [@acc2025-c].
* **TcPO₂:** Values <30 mmHg indicate severe ischemia with poor wound-healing potential; 30–39 mmHg suggests moderate ischemia; ≥40 mmHg indicates adequate perfusion [@schepers2010]. Transcutaneous oximetry (TcPO₂) is particularly valuable for assessing microcirculatory status and wound-healing potential in diabetic foot ulcers [@acc2025-c].
* **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; Wound, Ischemia, and foot Infection (WIfI) staging integrates hemodynamics (toe pressure, TcPO₂), wound characteristics, and infection severity to stratify limb threat and guide revascularization [@conte2019-gvg].[@conte2019-gvg; @acc2025-c]. See [[Peripheral Artery Disease|Ch. 10]] for complete WIfI classification.
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