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 diagnostic priority of TBI over ABI in this population due to medial arterial calcification. It also adds a value-based medicine perspective from Raskin et al. (2025) regarding the appropriate sequencing of hemodynamic testing before advanced imaging to avoid misallocation of resources. All required abbreviations (MAC, CTA, MRA) were expanded on first use.

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]. Limitations: falsely elevated in calcified arteries.arteries, particularly in patients with diabetes or chronic kidney disease [@acc2025-f].
* **toe-brachial index (TBI):** Useful in diabetics and renal disease patients with calcification [@potier2011]. In patients with diabetes, TBI is recommended as the initial diagnostic test when ABI is non-diagnostic or falsely elevated due to medial arterial calcification (MAC) [@acc2025-f].
* **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.

Hemodynamic testing serves as the primary diagnostic tool; prioritizing these physiological assessments helps avoid the misallocation of advanced imaging, such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA), which should be reserved for procedural planning [@raskin2025-narrative]. 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]. See [[Peripheral Artery Disease|Ch. 10]] for complete WIfI classification.
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