Toe-Brachial Index

Rationale

The 2026 ACC/AHA guideline (PMID 41252847) supersedes the previously cited acc 2025 for both the utility of the toe-brachial index (TBI) in high-risk populations and the diagnostic cutoff for PAD. Per the stale guideline replacement instructions, acc 2025 has been replaced with ACC/AHA in both bullet points where it appeared, as the newer guideline covers the same claims. No other content changes were required.

Evidence

Content Changes

* **Advantage:** less affected by medial calcification.
* **Useful:** diabetes, elderly, dialysis patients. [@acc2025][@acc2026]
* **Cutoff:** <0.7 = peripheral arterial disease (PAD). [@potier2011] [@aboyans2012] [@svs2024-gornik] [@acc2025][@acc2026]