Lee,
Yes, you will increase the sensitivity of an ABI by adding an exercise
component.
Terry J Zwakenberg BS RVT RDCS
-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Lee Tyler
Sent: Thursday, September 08, 2005 12:20 AM
To: [log in to unmask]
Subject: Re: ABI'S/POST EXERCISE ABI'S
Thank you Brian for your informative and appreciated response. I was asking
this question with screening exams in mind, and not full vascular lab
studies. Sorry. :O*( I should have mentioned that in my initial post.
Do you not think that taking the minimal amount of time necessary to have
the patient perform 100 slow, properly performed "killer" toe-raises.....
(NO "cheaters"..AKA... the knee-benders, heel bouncers, body-rockers, butt-
englishers, door-jam pullers, shoulder-shruggers, speed demons, etc.,
ALLOWED...ROFL!)
......would elicit an ankle pressure drop in asymptomatic individuals with
approximately 50-75% percent stenosis "somewhere" in the pipeline that
would be otherwise not be appreciated in the performance of a standard
static screening or physician's office performed ABI exam? I do.
Lee
On Wed, 7 Sep 2005 10:56:59 -0700, Brian Stockard <[log in to unmask]>
wrote:
>Lee,
>
>The process suggested here is a methodology to aggressively diagnosis
arterial disease and amounts to no more than screening for peripherial
arteial disease. This is outside the scope of the traditional vascular lab
whose goals (referencing a presentation by Marsha Neumyer) are to confirm
arterial occlusive disease and to determine if arterial disease is the
cause of the patient's symptoms. (The other two goals have nothing to do
with this converstion). Bearing that in mind, for diagnostic purposes one
should only stress patients with claudication symptoms. Medicare in the
states I have worked is even more restrictive in that the patients accepted
for arterial examinations must have abnormal ABI's or true claudication
symptoms and be candidates for intervention.
>
>I do believe there is a time and place for screening, however the fee
charged should reflect a screening procedure and Medicare must not be
billed for it.
>
>I realize this did not directly answer your inquiry, but I have an
additional comment. One does not use post exercise ABI's but instead looks
for a decrease in the post exercise ankle pressure as compared to the pre
exercise ankle pressure (and measure the recovery time). The protocol for
exercise studies uses treadmill walking for a limited time, at a limited
speed with limited elevation. A nonsymptomatic patient with normal ABI's
would usually have to be pushed well beyond those limits to show a drop in
post exercise ankle pressures.
>
>Hopefully these comments are helpful.
>
>Brian Stockard
>
>Lee Tyler <[log in to unmask]> wrote:
>Has there ever been a study comparing the accuracy for detecting disease
>between static ABI'S and post-exercise ABI'S? Doesn't the addition of a
>good exercise regimen and post exercise ABI'S markedly increase the
>sensitivity of the initial static ABI study? If so, by approximately what
>percentage/value? 2-fold? 4-fold?
>
>
>Thanks in advance----LT
>
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