I think "duplication" comes from doing duplex and then having the pt go
through CTA and then arteriography. Doing both a physiologic exam and
then a duplex is useful and cost effective in my opinion if it saves the
pt from CTA, MRA, or a full diagnostic arteriogram.

Jeff

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Combs,
Kristin
Sent: Wednesday, January 21, 2009 12:16 PM
To: [log in to unmask]
Subject: Re: PVR's vs duplex

Thats one of the issues that I have with doing both PVRs and imaging-it
doubles the reimbursement in a time when we all must try to use our
health care resources very carefully and responsibly. Why duplicate if
there is no need? As far as healing potential, ABI's with imaging and
if necessary toe pressures are definitely enough to determine this-more
helpful and arteriography ( the supposed gold standard). I have nothing
against PVR and segmentals, but I think imaging is more efficient, takes
very limited time with experience and aids the surgeon is clinical
decision making. My opinion, thats all.......

________________________________

From: UVM Flownet on behalf of Smith, Matthew G.
Sent: Wed 1/21/2009 11:43 AM
To: [log in to unmask]
Subject: Re: PVR's vs duplex



I'm with Chris,

Our lab does a lot of PVRs/segmental pressures. If they're abnormal then
we scan to clarify the location and extent of disease. As this lab
works for a group of vascular surgeons, PVRs/segmental pressure testing
is quite efficient to follow up many vascular procedures over time. I
can easily blow through a complete plethysmography test in 15 minutes,
(efficiently weeding out those who need a duplex scan or not) versus the
scan time required to scan the entire arterial system. For patients with
a normal plethysmography test, why scan every inch of their arteries?
PVRs are a great tool to indicate an arterial problem before you even
start to scan. They should clue you in to the probable location of
disease. Although PVRs are limited in the sense that you can't
specifically describe the extent and exact location of a stenosis, when
combined with duplex scanning, it's tough to beat. With enough
experience, and a complete test, you can usually accurately determine
the level of any significant disease based solely on plethysmography
testing. Some surgeons may look at plethysmography results to evaluate
healing potential. I don't know that a duplex scan would yield this type
of info. If someone has a rotten toe, a duplex scan won't tell you if
it should heal. Although many tech's would rather just scan the
arteries, is that really because PVRs provide no useful information, or
is it just to big of a pain for some? Additionally, you can basically
double the reimbursement if you complete a plethysmography test and (if
abnormal) then scan the patient. Perhaps I'm biased because I enjoy the
variety of tests we perform, PVRs included.

 Matt


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Willis,
Chris
Sent: Wednesday, January 21, 2009 11:58
To: [log in to unmask]
Subject: Re: PVR's vs duplex

I must be in the minority here. We average at least 12 per day. We
exclusively perform pvrs/segmental pressures on 99% of patients with
suspected arterial insufficiency of the legs. We do however, perform
arterial duplex on post-op bypass grafts, as well as
atherectomy-stenting patients in combination with pvrs.

Thanks

Chris Willis RVT
Coordinator
Vascular Laboratory
Eastern Maine Medical Center
Bangor, Maine 04401
Phone: (207) 973-7471
Fax: (207) 973-7450

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