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Yes Don, Now I have confirmation of the technologist having the sense to contact the ordering physician or the vascular reader. Here is some good advice from the best venous doctor I ever had the pleasure to work with, David E Smith, MD "I know of no venous protocol that requires ankle pressures or ABI. Clearly a lower extremity arterial duplex requires it but pressures can be avoided even in that study if a large open calf wound is present or if a recent graft goes to the ankle or foot. If the technologist documents the reason for not doing it I think almost any reason will fly. Hope this helps." David E Smith, MD FACS RVT RVPI On Fri, May 7, 2010 at 8:59 PM, Don Ridgway <[log in to unmask]> wrote: > > If you really, really needed a basic answer as to presence or absence of > significant arterial disease, right now and not later, I'll bet a toe > pressure would be pretty unlikely to launch an embolus. > > Don Ridgway > > > > > ________________________________ > > From: UVM Flownet on behalf of Denise Levy > Sent: Fri 5/7/2010 9:21 AM > To: [log in to unmask] > Subject: Re: TO ABI OR NOT TO ABI... > > > Hi, Both patients had an embolus from a dvt lower in the leg, free floating > ball, rotating around the CFV valve and it let go without any compression or > distal augmentation. I just happened to be there at the right time and > observer not the cause. Good to mention. > I don't think any ABI should be done on a new patient with acute DVT.. and > I don't know what the urgency is? We have to include others to make the > decision of ABI or not at the time of examination. > But the ICAVL requires ABI with an arterial duplex. If they have an acute > DVT call the vascular panel reader or the ordering physician. Nurses call > ordering physicians for questions for treatment if the condition of the > patient changes.. We are part of the medical plan of the patients care.. > Every case deserves consideration. > Denise Levy > > > On Fri, May 7, 2010 at 8:38 AM, Doug <[log in to unmask]> wrote: > > > Denise > Do you know from what level the DVT traveled? In other words were > you looking at a free-floating thrombus that suddenly left the station, or > were you insonating a different level and saw it cruise by? Just curious. > Also, I understand evaluating the PTA flow, but does that have anything to > do with taking an ABI or not in the presence of DVT (not being sarcastic, > humbly curious and trying to wrap my head Round it). Thanks! > D > > > Doug Marcum > RDMS,RDCS,RVT(APS),RPhS > *Advanced Ultrasound Consultants > *Global Vein Solutions > www.advancedusconsultants.com < > http://www.advancedusconsultants.com/> > [log in to unmask] > 321-231-2191 > Sent from my iPhone > > On May 7, 2010, at 10:41 AM, Denise Levy <[log in to unmask]> > wrote: > > > > HI all, > Severe cases of massive DVT you should look for PTA patency > and waveform. I have seen some cases of little arterial flow since there is > not return of the venous. Also depends if the DVT is being treated. > I have seen 2 clots travel in my entire 30 yr career.. and > they very small patient never missed a breath. > I think each case deserves confirming the procedure with the > ordering physician and consulting the vascular reader. Three thoughts are > better than guessing. What do ya think? > Denise Levy, RVT, RDMS, RDCS > San Jose, CA > > > On Fri, May 7, 2010 at 7:30 AM, Smith, Matthew G. < <mailto: > [log in to unmask]> [log in to unmask]> wrote: > > > I'm with Doug, > > I would do an ABI if properly indicated (or limited > lower extremity arterial plethysmography, as some would like me to use > proper terminology). I would not do a complete study with cuffs at the calf > and thigh levels. > > > > Matt > > > > > ________________________________ > > > From: UVM Flownet [mailto: <mailto: > [log in to unmask]> [log in to unmask]] On Behalf Of Doug > Sent: Friday, May 07, 2010 10:05 > > > > To: <mailto:[log in to unmask]> > [log in to unmask] > > Subject: Re: TO ABI OR NOT TO ABI... > > > > > > > > PE from ankle pressure... Never heard of that one? I > would find that highly unlikely.. > > > > D > > Doug Marcum > > RDMS,RDCS,RVT(APS),RPhS > > *Advanced Ultrasound Consultants > > *Global Vein Solutions > > <http://www.advancedusconsultants.com/> > www.advancedusconsultants.com <http://www.advancedusconsultants.com/> > > <mailto:[log in to unmask]> > [log in to unmask] > > 321-231-2191 > > Sent from my iPhone > > > On May 7, 2010, at 9:52 AM, "Ruhland, Greg F." < > <mailto:[log in to unmask]> [log in to unmask]> wrote: > > Hey everyone, > I always read the flow but I don't always > participate, I feel the interested in what we might have to say about this > subject. > > My lab has co-medical directors, > interventionalist and vascular surgeon. The question was brought up... do > you perform an ABI on a patient positive for DVT. A fairly heated discussion > followed from 3 surgeons and 1 interventionalist very firmly divided on the > subject. For all the obvious reasons. Possible to cause P.E., the need to > know of arterial complications. Would an ankle pressure really be enough to > cause P.E., Blah blah, blah. We all know there are good arguments for both > schools of thought. > > What do you think, and does your lab have > a set protocol? ( I think it should be different depending on each > particular case, extent of DVT, other complications...ect. > > Just wondering if it will spark the same > intensity of debate for one side or the other. > Greg Ruhland RVT > > > To unsubscribe or search other topics on UVM > Flownet link to: <http://list.uvm.edu/archives/uvmflownet.html> < > http://list.uvm.edu/archives/uvmflownet.html> > http://list.uvm.edu/archives/uvmflownet.html > > To unsubscribe or search other topics on UVM Flownet > link to: <http://list.uvm.edu/archives/uvmflownet.htmlTo> > http://list.uvm.edu/archives/uvmflownet.htmlTo unsubscribe or search other > topics on UVM Flownet link to: < > http://list.uvm.edu/archives/uvmflownet.html> > 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 > > 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 > > 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