I agree for the most part except for duplex vs angio by MR or CT.  Duplex is
cheaper, less risky, less costly and more convenient.  As for functional
analysis, I still think the Doppler/physiologic exams are better than
MR or CT for patients with the most difficult to diagnose disease,
"Moderate" PAD.  As for segmental pressures, currently re-evaluating our
assumptions and myths.  As for determining no or mild disease, nothing beats
duplex with a good piece of machinery and an appropriate protocol that
allows a fast exam.  MR and CT are better at imaging and better for
producing a good looking bottom line!/ Kemil Pilotte 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of SUBSCRIBE
UVMFLOWNET robert rosner
Sent: Monday, April 07, 2008 7:29 PM
To: [log in to unmask]
Subject: Re: lower arterial evaluations....

"If ABI and exercise are normal, that doesn't rule out some plaque being in 
there, it just rules out stenosis major enough to cause symptoms (even with 
increased demand, which is what the exercise is about). Doing segmentals 
won't add information to that, and could just muddy the water if there are 
technical problems"

Agree wholeheartedly, Don!

I feel that segmentals are old hat and usually useless, especially in the 
populations we serve predisposed with bokuu medial calcification. The newer,

less invasive modernized choices of subsequent clinical correlative value,
ex; 
(MRA Angiography) says that our job nowadays is really for us to find and 
document hemodynamically significant DZ. ABI's/TBI's below .7 need not apply

for exercise. STUDY OVER! MRA TO FOLLOW. NEXT PATIENT, PLEASE. And a 
post-exercise ankle pressure/toe pressure drop of more than 20% resting 
pressure should answer most diagnostic challenges as well. STUDY OVER! MRA 
TO FOLLOW. NEXT PATIENT, PLEASE. 

Perform then a Duplex Doppler? Wellllllll, I'd love to and I miss
em'.....then 
enjoy the watch-n-wait for the MRA/Angio confirmation of my work. Good old 
days of edu-maca-shun and self-prompted clinical correlation! 

I think the present lower extremity non-invasive examination should be 
updated and standardized. Do I sound like a madman to anyone?

And by the way, Daigle rocks.

RR

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