Hi everyone. I am a little confused on how to best interpret toe pressures in 
the case of a patient who has non-compliant vessels.   This applies to either a 
segmental pressure exam, or an arterial duplex with ABI's.  Let me give a 
hypothetical example for you all to better understand:

Patient: John Doe, 70 y/o male, insulin dependent diabetes mellitus.
Exam:   Segmental Pressures

AT REST PRESSURES:
Rt Brachial: 140                        Lt Brachial: 140
High thigh: >250                       High thigh:  >250
Low thigh:  >250                        Low thigh:  >250
Calf:          >250                               Calf:   >250
Post Tib:    >250                          Post Tib:   >250
Dors Ped:   > 250                        Dors Ped:   >250
Great toe:   112                      Great Toe:     106

ABI- 1.79                                   ABI- 1.79
TBI- 0.80                                   TBI- 0.76

Triphasic waves at all segments Bilaterally.

Then, Patient was exercised for two minutes and pressures were taken once 
more:

Post Exercise Pressures
Rt Brachial: 150               
Rt Post Tib:  >250                 Lt Post Tib:   >250
Rt Dors Ped:  >250                Lt Dors Ped:   >250
Rt Great Toe:  84                Lt Great Toe:    80

ABI- 1.7                              ABI- 1.7
TBI- 0.56                            TBI- 0.53

Now, here is the dilemna..   I work at two different vascular labs, and both 
labs would give different results based on this test data.

Lab #1 would say this:
Moderate arterial disease post exercise in the lower extremities bilaterally, 
with a toe-brachial index of 0.56 on the right, and 0.53 on the left.  The 
segmental pressures are unreliable due to non-compliant (calcific) vessels.


Lab #2 would say this:
Abnormal examination.  There is essentially no evidence of arterial 
insufficiency in the large vessels of the lower extremities bilaterally.   Note is 
made of decreased toe pressures, suggestive of small vessel disease.




OKAY....SO WHAT DO YOU GUYS MAKE OF ALL THIS?  LOL!   Do you all agree 
with one finding, but not the other?   How does your lab interpret results such 
as these?

Thanks, Chris

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