My viewpoint same as yours, Dianne, for lower extremities.  If the
question is "Are these symptoms caused by arterial occlusive disease
affecting the lower extremity?" then a 'simple' ABI w/wo exercise will
provide the answer.  The recovery time of the post-exercise ABI to
resting level will indicate whether the PAOD is single or multi-level. 

Measurements of systolic rise time/acceleration rate from a CFA duplex
waveform are routine in our testing protocol and are not billed
separately. They can indicate presence of significant PAOD proximal to
the CFA - and are more sensitive for detecting iliofemoral disease than
an abnormal high thigh pressure.  

A duplex of the whole lower extremity may be indicated only if the
results above are abnormal.

For a new patient with symptoms of intermittent claudication:
physiological test(s) first, duplex second. 

Terry N.

Terry Needham
Heart & Vascular
Erlanger Health System
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-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Dianne
Sent: Tuesday, October 18, 2005 9:49 AM
To: [log in to unmask]
Subject: Re: ABI questions from curious student

Back to poking sticks  (doing imaging as the primary test, and ABI's "if

needed"). Having just had a dialogue with a radiologist on this subject,
would be interested to hear it addressed (ok, again). My position was 
physiologic first, imaging if needed for clarification (this is the 
protocol we observe here). His was imaging first, abi's if imaging shows

disease. Viewpoints?

Dianne Gruber RVT RDMS
Maryville, TN

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