There is also the possibility of abnormal arm pressures due to subclavian stenosis.  Unusual for bilateral disease upper ext, but I have seen it on angio.  

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Derek Butler
Sent: Wednesday, July 07, 2010 7:54 AM
To: [log in to unmask]
Subject: Re: monophasic waveforms????

Was the monophasic waveform a sharp upstroke, tardus parvus or... The
word monophasic can mean so many things as in hyperemia conditions and
arterial wall stiffness.

If it was a sharp upstroke with low diastolic creating a high resistive
index ratio then I suspect Sue is correct.

Thoughts?

Derek

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Maguire,
Susan
Sent: Wednesday, July 07, 2010 7:06 AM
To: [log in to unmask]
Subject: Re: monophasic waveforms????

I would also question Diabetic Medial Calcinosis.  This may explain
elevated pressures with monophasic waveforms and the minimal drop in
indices post exercise.


________________________________
From: UVM Flownet [[log in to unmask]] On Behalf Of Nozad Koro
[[log in to unmask]]
Sent: Tuesday, July 06, 2010 11:02 PM
To: [log in to unmask]
Subject: monophasic waveforms????

Hello everyone,

I need your input in this case.

I had patient complained of pain and soreness to the left toe who was in
the ER. Request was arterial study.
Duplex scan showed no evidence of any focal arterial stenosis bilateral
examinations starting at external iliac down to the tibial vessels.
Doppler waveforms appeared to be monophasic in character bilaterally
throughout which I could not explain.  ABI is normal at rest; patient
could not perform toe raises exercise due to pain, only (3 min reactive
hyperemia testing) was performed with only showed 10% drop (essentially
wnl).  I know you are thinking of possible aortoilac disease, but how
could the ABI be normal?  Could the exercise (3 min reactive hyperemia)
not be sufficient enough to show a drop??  Let me know and thank you in
advance for your input.  Personally I will never say I know it all, I
will always be learning. I have mentioned in my preliminary that the
aortoiliac disease may not be excluded.

Thank you again.

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