Hemodynamic Testing

in Overview of Vascular Disease

Applied

Type

Modification

Confidence

92%

Created

Apr 26, 2026

Evidence

1 source

Rationale

The 2026 ACC/AHA guideline on Management of Lower Extremity Peripheral Artery Disease (PMID 41252847) supersedes the previously cited @acc2025-management for the same claims regarding TBI preference in diabetes/CKD and WIfI-guided revascularization decisions. Per the stale guideline replacement instructions, @acc2025-management has been replaced with @acc2026 in both instances rather than co-citing both, as the newer guideline covers the same recommendation patterns. The existing citation key @acc2026 is already listed in the chapter's existing keys, confirming this is the correct key to use.

Evidence

ACC/AHA. Management of Lower Extremity Peripheral Artery Disease: Guidelines From the ACC/AHA. 2026. PMID: 41252847.
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.
* **toe-brachial index (TBI):** Preferred over ABI in patients with diabetes or chronic kidney disease (CKD) due to medial arterial calcification and non-compressible vessels [@potier2011, @acc2025-management].@acc2026].
* **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.

In chronic limb-threatening ischemia (CLTI), toe pressure <30 mmHg or TcPO₂ <30 mmHg indicates severe ischemia and poor wound-healing potential. The Wound, Ischemia, and foot Infection (WIfI) staging system integrates hemodynamics (toe pressure, TcPO₂), wound characteristics, and infection severity to stratify limb threat and guide revascularization decisions [@conte2019-gvg, @acc2025-management].@acc2026]. See [[Peripheral Artery Disease|Ch. 10]] for complete WIfI classification.
Go to section in textbookDispute / Submit evidenceAll updates