Comparative evaluation of non-invasive vascular assessment of the lower extremity in the presence of overt medial artery calcification

Objectives: The ankle brachial index (ABI) is routinely used to screen for peripheral artery disease (PAD); however, it has demonstrated reduced accuracy in people with diabetes or renal disease and the elderly, likely due to the presence of medial arterial calcification (MAC). For these populations, guidelines suggest the use of additional assessments, including the toe brachial index (TBI), toe systolic pressure (TP), and pedal Doppler waveforms. This study evaluated the comparative diagnostic accuracy of ABI, TBI, TP, and Doppler alone and in combination for PAD in people with and without (control) MAC.