As segmental pressures are notoriously inaccurate in the presence of
calcified arteries (how many elderly, often diabetic, patients don't have
the duplex exam is virtually necessary for a good understanding of a
We have found that ABI's, toe plethysmography, and duplex (triplex actually)
help r/o neuropathy while more accurately defining the PAD if present.
As far as revenue enhancement - if ABI's, doppler ankle, and toe pressures
are normal the patient is spared the cost of a duplex exam. And in any case
the patient is never charged for a full segmental exam.
T Cunningham, RVT, RDCS