Ankle-Brachial Index
Applied
Type
ModificationConfidence
92%
Created
Apr 19, 2026
Evidence
1 source
Rationale
The stale Patel MR, et al citation was replaced with the superseding 2024 ACC/AHA/SVS guideline AHA per the stale guideline replacement instructions, as the newer guideline covers the same claims about ABI as the primary diagnostic test for PAD, exercise ABI, and TBI. The existing svs 2024 reference was also consolidated into AHA since both refer to the same 2024 guideline document. The European ESC 2017 guideline citation is preserved to maintain geographic balance for the international audience.
Evidence
Content Changes
removedadded
* **Definition:** ratio of ankle systolic pressure to brachial systolic pressure. * **Normal values:** 1.00–1.40. * **Peripheral arterial disease (PAD) diagnosis:** <0.90 indicates PAD; <0.50 indicates severe ischemia. * **Noncompressible arteries:** Values >1.40 suggest medial arterial calcification (common in diabetes and chronic kidney disease (CKD)). 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 or borderline (0.91–0.99), 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 reaffirms ABI as the primary diagnostic test for PADPAD, [@svs2024].with exercise ABI and TBI when indicated [@svs2024-gornik]. Previous recommendations from AHA/ACC (2016) andthe ESC (2017) also recommend ABI as first-line screening, with exercise ABI and TBI when indicated [@aha2016]screening [@esc2017] [@uyagu2022].