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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