Hi all. Interesting discussion. I personally have not done PAT but
have printed some articles to research. Question...What are the
diagnostic criteria for AT in the pedal arteries...normal AT vs abnormal
AT? Thank you.
Sincerely,
Nicole Ball, BS, RVT
Technical Director, Vascular Lab
Concord Hospital
250 Pleasant Street
Concord, NH 03301
http://nnevs.org
>>> Jill Sommerset <[log in to unmask]> 6/1/2021 4:57 PM >>>
* CAUTION - This is an EXTERNAL email - DO NOT open attachments or
links in unexpected emails or from unknown senders *
Thank you Denise and Harvey. Yes, we use PAT on the dorsal and plantar
metararsal arteries. The hockey stick is nice for the dorsal metatarsal
arteries right at the edge of the wound bed.
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> On Jun 1, 2021, at 1:50 PM, Harvey Wilson <[log in to unmask]>
wrote:
>
> Thanks so much, Jill. Your talk for the NWVT was my favourite by
far! I will try more practice for sure. One thing helpful is the MVI or
micro vascular imaging on the GE LE10 it is quite sensitive to low flow
states and I also use it for temporal arteritis so as not to override
the vessel wall. I was curious about using a hockey stick probe and that
to look at the digital artery - has anyone ever done a digital
acceleration time?
>
>> On Tue, 1 Jun 2021 12:10:24 -0700, Jill Sommerset
<[log in to unmask]> wrote:
>>
>> Great conversation here! I’ve attached our publications on PAT. We
find it valuable not only in the arterial/CLTI pt but also on the venous
wound pt where there is question of compression can be applied. The
lateral plantar and Arcuate are fairly easy to image and obtain at PAT
however like anything there is education and practice that comes along
with it. Please reach out with any questions or thoughts. I’d love to
hear them.
>>
>> Kindly,
>> Jill Sommerset
>>
>>
>>
>>
https://urldefense.com/v3/__https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00258-2/fulltext__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUSFmIotSo$
>>
>>>> On Jun 1, 2021, at 12:03 PM, Harvey Wilson <[log in to unmask]>
wrote:
>>>
>>> Very interesting folks! I was only hoping for a bit of speculation
on tissue compressibility and got a bonus!
>>> We typically will fall back on getting waveforms if possible and a
TBI - but as Bart states they are not always possible, those short, fat
toes, etc. As for the toe clamp, we use tape still and if I need to get
good PPG contact on those greasy ones, I will place Saran wrap very
lightly around just to hold the PPG on without pressure.
>>> I have only tried a couple of times to get a PAT since watching a
lecture on it at the NWVT. I find those little guys in the plantar foot
quite tricky to find and our Radiologists and vascular surgeons might
have never heard of it. Are PAT's well validated and widely used?
>>> Partially compressible, yeah, what to do with that possibility?
What bugs me is to take obviously monophasic waveforms in the tibials
but an ABI of 1.0 and then see it reported as "no evidence of arterial
insufficiency" :( :(
>>>
>>> Harvey
>>>
>>>> On Tue, 1 Jun 2021 11:10:22 -0700, Barton Bean
<[log in to unmask]> wrote:
>>>>
>>>> Hi Bill,
>>>> There are so many variables - cuff to toe sizes, what pressure is
on the
>>>> PPG (very difficult to be precise in my experience) - except
perhaps with
>>>> tape which we no longer use (clamp with unknown pressure is
provided by
>>>> current equipment manufacturer), is the light on in the room, does
the
>>>> patient have and small vessel calcifications.
>>>> Don't get me wrong they are a part of our protocol and we do them.
I just
>>>> no longer believe the results particularly since a large part of
our work
>>>> is with diabetic wound care.
>>>> PAT has been wonderful for us (even though it has limitations
too).
>>>> Fond regards,
>>>> Bart
>>>>
>>>> On Tue, Jun 1, 2021 at 10:54 AM Bill Schroedter <
>>>> [log in to unmask]> wrote:
>>>>
>>>>> Hey Bart,
>>>>> Absolutely PAT's but could you please elaborate on your
reservations re:
>>>>> toe pressures?
>>>>> Thanks,
>>>>> Bill
>>>>>
>>>>> -------- Original message --------
>>>>> From: Barton Bean <[log in to unmask]>
>>>>> Date: 6/1/21 1:41 PM (GMT-05:00)
>>>>> To: [log in to unmask]
>>>>> Subject: Re: Non compressiblility - tissue vs vessel
>>>>>
>>>>> PAT's (pedal acceleration times)are invaluable in a patient like
this (and
>>>>> for that matter in our lab all wound care patients).
>>>>> In my experience ankle/toe pressure have some limited value but
we are
>>>>> moving to PAT studies pre and post intervention.
>>>>> I cannot seem to be consistent with toe pressure even though I
have
>>>>> performed thousands - I don't trust them any more.
>>>>> Best,
>>>>> Bart
>>>>>
>>>>> On Tue, Jun 1, 2021 at 4:35 AM Bill Schroedter <
>>>>> [log in to unmask]> wrote:
>>>>>
>>>>>> Good question Harvey. I agree with Denise. For wound care
patients, many
>>>>>> of which are diabetic, this is an issue and toe pressures are
really a
>>>>>> must.
>>>>>>
>>>>>> That said, I am trying to wrap my head around your question
about the
>>>>>> effect of tissue edema – seems like that should transmit the
pressure to
>>>>>> the vessel. Elaphantiasis Nostras would likely result in a
similar
>>>>>> situation to that is much more common, lipodermatosclerosis. The
resultant
>>>>>> tissue fibrosis / sclerosis in my mind would be more likely make
a
>>>>>> difference in pressure transmission to the vessel. If you are
30-40 mmHg
>>>>>> above brachial pressure, no problem - your question is answered.
But for
>>>>>> nearly my whole career I have wondered about what I call
partially
>>>>>> compressible vessels – ones that are stiff and could in fact
require more
>>>>>> than the transmitted tissue pressure to compress. What if the
vessel in
>>>>>> fact does compress so that we obtain a falsely elevated pressure
but is
>>>>>> impossible to determine the presence or degree – we really have
no way of
>>>>>> knowing that. Our solution - when doing these, we always keep in
mind that
>>>>>> we also have the Doppler waveform which should be strongly
considered in
>>>>>> the interpretation of ankle pressures. A monophasic signal (or
one with a
>>>>>> delayed upstroke) is unlikely to have a normal arterial
pressure. The great
>>>>>> strength of our technology – a lot of clues – they should all
point to the
>>>>>> same thing.
>>>>>>
>>>>>> Regards,
>>>>>>
>>>>>> Bill
>>>>>>
>>>>>>
>>>>>>
>>>>>> *From:* UVM Flownet <[log in to unmask]> *On Behalf Of
*Denise Levy
>>>>>> *Sent:* Tuesday, June 1, 2021 2:09 AM
>>>>>> *To:* [log in to unmask]
>>>>>> *Subject:* Re: Non compressiblility - tissue vs vessel
>>>>>>
>>>>>>
>>>>>>
>>>>>> Hi,
>>>>>>
>>>>>> You will have more success with a metatarsal cuff and a digital
toe cuff,
>>>>>> TBI using a PPG for the pressure.
>>>>>>
>>>>>> Very often ABI’s are falsely elevated due to diabetes plus 255
!
>>>>>>
>>>>>> The levels can be found on a search for TBI ranges.
>>>>>>
>>>>>> Thank you for your question,
>>>>>>
>>>>>> Denise Levy, RDMS, RVT
>>>>>>
>>>>>> Hill Vascular and Vein Center
>>>>>>
>>>>>> Vascular Lab Director
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>> On Mon, May 31, 2021 at 5:02 PM Bill Johnson
<[log in to unmask]>
>>>>>> wrote:
>>>>>>
>>>>>> Harvey i do believe your question is quite valid!
>>>>>>
>>>>>> Personally I can only recount a few cases and I know there was a
point
>>>>>> beyond which I would not increase the probe pressure. "Do no
harm seemed a
>>>>>> good idea then and still.
>>>>>>
>>>>>> So, what do you do in these cases? I assume you do some type
of
>>>>>> follow-up? Any lessons for us still learning?
>>>>>>
>>>>>>
>>>>>>
>>>>>> On Mon, May 31, 2021, 4:24 PM Harvey Wilson
<[log in to unmask]>
>>>>>> wrote:
>>>>>>
>>>>>> Hi,
>>>>>>
>>>>>> I've often wondered about getting non comp ABI's on wound clinic
patients
>>>>>> who have severe edema or something like Elaphantiasis Nostras.
How much
>>>>>> does hardening and thickening of tissue contribute in cases like
these vs
>>>>>> plain old calcification? I thought I'd post this here as I don't
have
>>>>>> anyone here to bounce ideas off.
>>>>>>
>>>>>> Thanks,
>>>>>>
>>>>>> Harvey Wilson RVT RDMS RDCS
>>>>>> Victoria
>>>>>>
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>>>>>>
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>>>>>>
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>>>>>>
>>>>>> --
>>>>>>
>>>>>> Sent from Gmail Mobile
>>>>>>
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>>>>>
>>>>>
>>>>>
>>>>> --
>>>>> Barton A. Bean IV, RVT, FSVU
>>>>> Orange County Vascular Specialists
>>>>> 23236 Via Bahia
>>>>> Mission Viejo, CA 92691-2114
>>>>> E-mail [log in to unmask]
>>>>> (714)803-6288
>>>>> To unsubscribe or search other topics on UVM Flownet link to:
>>>>>
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>>>>> To unsubscribe or search other topics on UVM Flownet link to:
>>>>>
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>>>>
>>>>
>>>>
>>>> --
>>>> Barton A. Bean IV, RVT, FSVU
>>>> Orange County Vascular Specialists
>>>> 23236 Via Bahia
>>>> Mission Viejo, CA 92691-2114
>>>> E-mail [log in to unmask]
>>>> (714)803-6288
>>>>
>>>> To unsubscribe or search other topics on UVM Flownet link to:
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>>>>
>>>
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>
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