Exercise ABI, post-exercise testing, and handling noncompressible arteries
Applied
Type
ModificationConfidence
92%
Created
Apr 26, 2026
Evidence
1 source
Rationale
The stale guideline citation acc 2025 c appeared three times in this section, each time supporting claims now covered by the superseding ACC/AHA guideline ACC/AHA (PMID 41252847). Per the stale guideline replacement instructions, acc 2025 c has been replaced with ACC/AHA in all three instances rather than co-cited, as the newer guideline covers the same claim patterns (exercise testing in diabetes, MAC/noncompressible arteries, and TBI/toe pressure thresholds). No new substantive content was added; the section structure, tone, and all other citations are preserved.
Evidence
Content Changes
removedadded
**Exercise ankle-brachial index (ABI) and Noncompressible Arteries** When clinical symptoms suggest peripheral arterial disease (PAD) but the resting ankle-brachial index (ABI) is normal, post-exercise testing should be performed using treadmill or heel-raise protocols. A decrease in ABI ≥20% or an ankle pressure drop ≥30 mmHg after exercise supports the diagnosis of PAD [@svs2024-gornik]. In patients with diabetes, exercise testing is particularly valuable as resting hemodynamics may be masked by arterial stiffness [@acc2025-c].[@acc2026-b]. An ABI >1.40 indicates noncompressible arteries due to medial arterial calcification (MAC), a condition highly prevalent in patients with diabetes and chronic kidney disease (CKD) [@acc2025-c].[@acc2026-b]. In such cases, toe systolic pressure and toe-brachial index (TBI) should be measured, as these metrics are less affected by calcification. A TBI <0.70 is generally considered diagnostic for PAD, while a toe pressure <30 mmHg suggests severe ischemia in chronic limb-threatening ischemia (CLTI) [@potier2011] [@mills2014] [@conte2019-gvg] [@acc2025-c][@acc2026-b] [@svs2024-gornik].