Hi Don, et al:  My first thought:  did you do a complete DVT study first to
rule out acute DVT before applying segmental pressure cuffs?  Next
question:  did he have any symptoms HE was complaining of, besides the
subjective findings (LLE edema, rubor, cool to touch, no pain, noncompliant
RLE segments, etc.)?.  Did he have claudication, buttock pain,
pseudoclaudication?  The coolness could have been neurogenic; did he have
back problems?  "RLE thigh and calf cuff could not be totally occluded"
could be due to cuff placement, noncompliant vessels, leg size, any number
of reasons.  What were his pulses like?  What were the waveforms like?
What kind of hair growth and distribution did you note?  "LLE pressures
were within normal limits but waveforms were diminished."  Were they
blunted?  Were they displaying delays in the systolic upstrokes?  "Left
ankle could not be totally occluded either", could also be due to
noncompliance or cuff placement, cuff size or ankle size.  Overall, did you
hear bruits anywhere along the abdominal aorta, either groin, thigh or
popliteal fossae?  Did he have Diabetes, what were the toe pressures, and
what were the ankle/arm indices?  More importantly, what WERE the segmental
pressures, brachial pressures, and segmental indices?  This would have been
a study to make me scratch my head, too.  My thoughts would be: 1) R/O
acute DVT, 2)  Use appropriate size cuffs for the limb sizes, 3)Get a
really good H&P to help explain the possibility of advanced
arteriosclerosis, which could explain the noncompliant vessels or segments.
 Some medications can produce unilateral edema; I believe Cardizem is one
of them.  Was he on that?  Wow, this is an interesting one.  I'll be
interested to see what others think.  Good luck.

Shirley McLean, RVT
San Marcos, CA
----------
> From: Don Thompson <[log in to unmask]>
> To: [log in to unmask]
> Subject: arterial vs venous
> Date: Tuesday, September 07, 1999 1:11 PM
>
> I had a very interesting study today and would like to pick all you
> brains for your opinions.
> I had a 78 year old man in for lower arterial testing. He had past
> history of DVT left pop-post tib found first in May and re-imaged in
> July with some recanalization noted.
> Has been on home therapy for DVT.  His nephrologist ordered segmental
> pressures with doppler to I guess rule out occuded vessels.  His left
> leg had 2-3+ edema was red from foot to mid shin.  But also his left leg
> was very cool to touch from mid shin down, warm from there up.  He
> stated he had no real pain or tenderness.
> Testing findings were normal right leg except that up thigh and calf
> cuff could not be totally occluded.  Left extremity thigh had all
> pressure within normal limits also, but wave forms were diminished, and
> even had toe pressures noted.  Left ankle could not be totally occluded
> either.  Otherwise the  study would be considered normal by  most
> standards, except for the fact the leg was swollen, cool, and red.
> Consulted senior retired vascular surgeon and he agreed with the fast
> that the DVT should be evaluated again...The coolness of the leg was our
> biggest discussion....
> I am ready for all your opinions....and very interested in them too.
>
> thanks,
> deb thompson, cvtech, HVCH