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


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