We have seen at least one pt with incompressible toe arteries. This pt also
had incompressible brachial arteries and we had to rely on finger pressures for
a systemic reading. We also perform toe pressures on all diabetic pts. I
don't know why, but we seem to have a high population of diabetic pts here. We
have narrowed our segmental exam to ABI's and a thigh pressure with Doppler
waveforms at the ilio-femoral level, popliteal, DP and PT. We use the
ilio-femoral waveform to help determine inflow or outflow disease remembering
that this is an indirect test and that the results are never going to be exact.
If we want to evaluate for possible percutaneous angioplastiable lesions, then
we will duplex the arteries.
I don't understand the need to duplex all patient's with an abnormal ABI. This
seems like an expensive enterprise (both for the pt and the vascular lab)
especially when the patient is a claudicant who may never go to surgery, but
will be followed by ABI's for the rest of their lives. An angioplastiable
lesion can be identified by a segmental exam and then a focused duplex scan to
the iliac or femoral-popliteal segments. For those patients who are likely to
go to surgery, I agree that a duplex exam can be very useful and may even
obviate an arteriogram.
Dartmouth-Hitchcock Medical Center, NH