Ankle brachial index (ABI) remains the gold standard for first-line PAD diagnostic in patients without diabetes. There are several different ways to perform an ABI. Ultrasound is the most common method used at vascular labs, while the less accurate oscillometric devices have gained popularity in primary care settings1. However, only low ABIs should be trusted in patients at risk for calcified vessels, e.g., diabetes and chronic kidney disease. Normal values, ABI greater then 0.9, should always be confirmed with toe pressures. If the toes are missing then tcpO2, PVR and skin perfusion pressures are alternatives2,3.