I’ve seen patients with operable aortic aneurysms that have a normal ABI.  I personally would trust PVR and Doppler waveforms anyday over pressures as they can be variable due to atherosclerotic disease and calcification.  It sounds like the Doppler was abnormal.  If the PVRs are also abnormal, I would definitely suspect aorto-iliac disease.  You should not have monophasic Doppler waveforms in the external iliac arteries.

 

 

 

Hello everyone,

 

I need your input in this case.

 

I had patient complained of pain and soreness to the left toe who was in the ER. Request was arterial study.

Duplex scan showed no evidence of any focal arterial stenosis bilateral examinations starting at external iliac down to the tibial vessels.  Doppler waveforms appeared to be monophasic in character bilaterally throughout which I could not explain.  ABI is normal at rest; patient could not perform toe raises exercise due to pain, only (3 min reactive hyperemia testing) was performed with only showed 10% drop (essentially wnl).  I know you are thinking of possible aortoilac disease, but how could the ABI be normal?  Could the exercise (3 min reactive hyperemia) not be sufficient enough to show a drop??  Let me know and thank you in advance for your input.  Personally I will never say I know it all, I will always be learning. I have mentioned in my preliminary that the aortoiliac disease may not be excluded. 

 

Thank you again.