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Back in about 1988, just a few years into my career, I visited the lab at UW, where Miles Cramer graciously allowed me to hang out for a day to see how they did things. Their LE arterial protocol was uncommon in those days, I believe, just starting with ABI plus treadmill. If those were normal, the test was over. If they were abnormal, straight to duplex.

It sure made sense to me, and our lab went to that protocol not long afterward.

If ABI and exercise are normal, that doesn't rule out some plaque being in there, it just rules out stenosis major enough to cause symptoms (even with increased demand, which is what the exercise is about). Doing segmentals won't add information to that, and could just muddy the water if there are technical problems.

The bottom line is: What is the question being asked by the test? Adding superfluous testing doesn't answer the question better.

Good luck.

Don Ridgway
Grossmont Hospital
Grossmont College





-----Original Message-----
From: UVM Flownet on behalf of Nathalie Garbani
Sent: Tue 4/8/2008 12:06 AM
To: [log in to unmask]
Subject: Re: lower arterial evaluations....
 
My best suggestion to you is to prepare a nice speech substantiated by data of why it really does not make much sense to take all these pressures in a normal exam....

Nathalie
NSU
  ----- Original Message ----- 
  From: Kristy Peeler 
  To: [log in to unmask] 
  Sent: Monday, April 07, 2008 12:53 PM
  Subject: Re: lower arterial evaluations....


  I have reading MDs who want multilevel pressures recorded even when the ABIs are WNL and they will read indices at every segmental level.  (Segmental waveforms and PVR is already included in the exam). 

  This is new to me.  I'm thinking the slightly lower indices proximal to the normal ABIs are more likely due to cuff size artifact rather than a disease process. In the case of a normal ABI patient with hypertension, I would rather not inflate a high thigh cuff, if I even could. Does this extra information make the interpretation less reliable?

   

  Can I get some feedback from other labs and their policies on this?

   

  Thanks,

  Kristy 

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