AbuRahma AF, Adams E, AbuRahma J, et al. - Via performing a retrospective review of prospectively collected data, researchers investigated limitations of the ankle-brachial index (ABI) and toe-brachial index (TBI), if done alone, in patients with symptomatic peripheral arterial disease (PAD), diagnosed by duplex ultrasound (DUS) examination. The investigation was particularly done in PAD patients with diabetes and chronic kidney disease (CKD). In this work, 2,226 ABIs and 1,383 DUS examinations were included: 46% of patients had diabetes, 16% had CKD, and 39% had coronary artery disease. Among symptomatic patients with PAD with 50% or greater stenosis on DUS examination, normal/inconclusive resting ABIs were reported in 43% (49% in diabetics and 57% in CKD). They identified TBI as useful in patients with inconclusive ABIs. They recommend performing further imaging in these patients to determine their proper treatment.