Bill Johnson, Albuquerque, NM
Enjoying the discussion regarding medial calcification and its effect
on our studies. Has always been a bugaboo. I would ask Sid if you perform
complete arterial imaging if you have a non-diabetic patient, normal ABI's and
triphasic tibial waveforms? Do not mean this to be rude, and appreciate
standard protocols, but to you have any criteria for determining how much is
necessary to answer the clinical question. Also, in imaging the
non-compressible tibial arteries, do you observe any calcific shadowing?
I have seen patients where segments of shadowing occur, although adequate
Doppler signals may be obtained where the vessel can be visualized.
I think the message regarding demography is very important. I was
somewhat amazed when I moved to New Mexico from California at the number of
patients with incompressible vessels. This is partly due to the number of
Native Americans in our area, as well as a generally rural popylation.
Diabetes is often poorly controlled in these groups, and the incidence is
very high in Native Americans. The Hispanic population here also has a higher
incidence of diabetes, probably related to genetic inheritance due to
intermarriage. I had never experienced an incompressible digit until coming
here. When I talk about this with peers, the response is usually a bit
skeptical, but those of you in "Indian" country can probably appreciate this.
It is a good topic for discussion, and obviously we are all looking for