Thank you Brian for your informative and appreciated response. I was asking this question with screening exams in mind, and not full vascular lab studies. Sorry. :O*( I should have mentioned that in my initial post. Do you not think that taking the minimal amount of time necessary to have the patient perform 100 slow, properly performed "killer" toe-raises..... (NO "cheaters"..AKA... the knee-benders, heel bouncers, body-rockers, butt- englishers, door-jam pullers, shoulder-shruggers, speed demons, etc., ALLOWED...ROFL!) ......would elicit an ankle pressure drop in asymptomatic individuals with approximately 50-75% percent stenosis "somewhere" in the pipeline that would be otherwise not be appreciated in the performance of a standard static screening or physician's office performed ABI exam? I do. Lee On Wed, 7 Sep 2005 10:56:59 -0700, Brian Stockard <[log in to unmask]> wrote: >Lee, > >The process suggested here is a methodology to aggressively diagnosis arterial disease and amounts to no more than screening for peripherial arteial disease. This is outside the scope of the traditional vascular lab whose goals (referencing a presentation by Marsha Neumyer) are to confirm arterial occlusive disease and to determine if arterial disease is the cause of the patient's symptoms. (The other two goals have nothing to do with this converstion). Bearing that in mind, for diagnostic purposes one should only stress patients with claudication symptoms. Medicare in the states I have worked is even more restrictive in that the patients accepted for arterial examinations must have abnormal ABI's or true claudication symptoms and be candidates for intervention. > >I do believe there is a time and place for screening, however the fee charged should reflect a screening procedure and Medicare must not be billed for it. > >I realize this did not directly answer your inquiry, but I have an additional comment. One does not use post exercise ABI's but instead looks for a decrease in the post exercise ankle pressure as compared to the pre exercise ankle pressure (and measure the recovery time). The protocol for exercise studies uses treadmill walking for a limited time, at a limited speed with limited elevation. A nonsymptomatic patient with normal ABI's would usually have to be pushed well beyond those limits to show a drop in post exercise ankle pressures. > >Hopefully these comments are helpful. > >Brian Stockard > >Lee Tyler <[log in to unmask]> wrote: >Has there ever been a study comparing the accuracy for detecting disease >between static ABI'S and post-exercise ABI'S? Doesn't the addition of a >good exercise regimen and post exercise ABI'S markedly increase the >sensitivity of the initial static ABI study? If so, by approximately what >percentage/value? 2-fold? 4-fold? > > >Thanks in advance----LT > >To unsubscribe or search other topics on UVM Flownet link to: >http://list.uvm.edu/archives/uvmflownet.html > > >--------------------------------- > Click here to donate to the Hurricane Katrina relief effort. > >To unsubscribe or search other topics on UVM Flownet link to: >http://list.uvm.edu/archives/uvmflownet.html To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html