You go girl! Rita

-----Original Message-----
From: Combs, Kristin <[log in to unmask]>
To: [log in to unmask]
Sent: Wed, 21 Jan 2009 1:15 pm
Subject: Re: PVR's vs duplex

Thats one of the issues that I have with doing both PVRs and imaging-it doubles 
the reimbursement in a time when we all must try to use our health care 
resources very carefully and responsibly. Why duplicate if there is no need?  As 
far as healing potential, ABI's with imaging and if necessary toe pressures are 
definitely enough to determine this-more helpful and arteriography ( the 
supposed gold standard).  I have nothing against PVR and segmentals, but I think 
imaging is more efficient, takes very limited time with experience and aids the 
surgeon is clinical decision making.  My opinion, thats all.......


From: UVM Flownet on behalf of Smith, Matthew G.
Sent: Wed 1/21/2009 11:43 AM
To: [log in to unmask]
Subject: Re: PVR's vs duplex

I'm with Chris,

Our lab does a lot of PVRs/segmental pressures. If they're abnormal then we scan 
to clarify the location and extent of disease.  As this lab works for a group of 
vascular surgeons, PVRs/segmental pressure testing is quite efficient to follow 
up many vascular procedures over time. I can easily blow through a complete 
plethysmography test in 15 minutes, (efficiently weeding out those who need a 
duplex scan or not) versus the scan time required to scan the entire arterial 
system. For patients with a normal plethysmography test, why scan every inch of 
their arteries? PVRs are a great tool to indicate an arterial problem before you 
even start to scan. They should clue you in to the probable location of disease. 
Although PVRs are limited in the sense that you can't specifically describe the 
extent and exact location of a stenosis, when combined with duplex scanning, 
it's tough to beat.  With enough experience, and a complete test, you can 
usually accurately determine the level of any significant disease based solely 
on plethysmography testing.  Some surgeons may look at plethysmography results 
to evaluate healing potential. I don't know that a duplex scan would yield this 
type of info.  If someone has a rotten toe, a duplex scan won't tell you if it 
should heal. Although many tech's would rather just scan the arteries, is that 
really because PVRs provide no useful information, or is it just to big of a 
pain for some?  Additionally, you can basically double the reimbursement if you 
complete a plethysmography test and (if abnormal) then scan the patient.  
Perhaps I'm biased because I enjoy the variety of tests we perform, PVRs 


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Willis, Chris
Sent: Wednesday, January 21, 2009 11:58
To: [log in to unmask]
Subject: Re: PVR's vs duplex

I must be in the minority here.  We average at least 12 per day.  We exclusively 
perform pvrs/segmental pressures on 99% of patients with suspected arterial 
insufficiency of the legs.  We do however, perform arterial duplex on post-op 
bypass grafts, as well as atherectomy-stenting patients in combination with 


Chris Willis RVT
Vascular Laboratory
Eastern Maine Medical Center
Bangor, Maine 04401
Phone:  (207) 973-7471
Fax:  (207) 973-7450

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