No, we don't perform complete arterial imaging/doppler if there are palbable
pulses, triphasic pulses at ankle and abi at rest > or = 1.0. If claudication
is indication for study, we'll "walk" the patient in the hall until symptoms
occur and check pulses at ankle and if still triphasic, etc., no further
testing. If the "walk" drops the abi or triphasicity at the ankle is lost,
then full imaging study is done from diaphragm to toes.
Our criteria are basically those above. We believe in imaging/doppler of the
entire major named arterial segments as the best test to determine ease or
risk of intervention, etc. We reserve physiologic testing (usually the "walk"
described above) for the atypical claudication type patient. I guess our >85%
medicare population has forced us to streamline our operation.
When incompressible vessels are insonated with doppler and/or imaging, we
usually find calcification/shadowing and "work" around it. If we can't work
around it and intervention is planned, then we will fall back on angiography.
Let me volunter Bill Schroedter to fill in any gaps.
Sid Holec, Medical Director
Bon Secours Venice Hospital Vas Lab