Good reply. I thought you might have something to add...

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> From: Terrence D. Case <[log in to unmask]>
> To: [log in to unmask]
> Cc: [log in to unmask]
> Subject: Re: Incompressible vessels
> Date: Wednesday, January 22, 1997 9:39 AM
>
> Colleagues;
>
> The issue of incompressible vessels raises another issue that has become
> near and dear to me; that is, what are the alternatives available to the
> technologist when ankle pressures are unrelaible or deemed
> "incompressible"? Clearly, the toe pressure is a viable option but
> published studies of the accuracy of this test, are somewhat dubious.
>
> Last year, this laboratory presented a works-in-progress using
> oscillometric pressures to assess periperal arterial pressures. The
> oscillometric method, does not require vessel closure and
> therefore is capable of obtaining pressures in patients with
incompressible
> vessels. Sergio tells me he has been using this technique for years but
> the only published materail was in January 1997 issue of JVS.
>
> Another intersting study is called the "pole test". With this test, one
> needs only a Doppler, tape measure and a reference chart to obtain
> pressures in the ankles (no BP cuff). The pole test, utilizes the
> principles of hydrostatic pressure to determine absolute ankle pressue.
> While listening to a pedal pulse and at the same time raising the leg of
a the
> patient in the supine position, the technologists measures the height of
> the limb at the point the Doppler signal ceases and the length of the
> limb from the inguinal ligament to the pedal signal site. A chart is then

> used to coordinate a point that relates to a pressure. With our limited
> experience so far, we have been impressed with the apparent accuracy of
> this test but plan to perform more formal research. A real benefit of
> this test is that it works well in patients with low ankle pressures (<50

> mmHg).
>
> In sum, it is practical to arm the vascular technologists with reliable
> alternatives to the traditional Doppler derived ABI's. I look forward to
> hearing about your experience of this common dilema we are are often
faced
> with.
>
> Terry Case
> University of Vermont