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Bill, 
I agee with you.. But we all answered the question, there are several answers in the responses, but different views for each of the answers. I give credit to Matt, and You for several parts of this thread. One, you are experianced and have performed PVR's your way with a good outcome, such as myself and Matt. AND so has Lisa. The issue here arrogance, arrogance will always get in the way of an idea. But once again, its nice to see the forest through the trees. And because of arrogance an stalled idea's no one benefits. 
 
And you are right, all we have is old data, and maybe some new is warranted, but would many change their protocols??? That is the big question.  
 
I would have to move and suggest that if something works for you, do it, but do not be scared of someting different. If this contiues to be the case their can never be a standard. One half of us want progress and the other half in complacent and stuck..
 
 
I respect all of you that have responded to this thread, and this is research in it self. 
 
Jason
 


Date: Thu, 3 Feb 2011 21:29:27 -0800
From: [log in to unmask]
Subject: Re: Arterial Journals
To: [log in to unmask]


Bill Johnson, Port Townsend, WA
I am sorry, but something in this thread raises my hackles (not that I have hackles).  It seems that after 30 years of noninvasive vascular testing, technologist credentialing and lab accreditation, we still do not have standardization of practice of our profession, in my opinion.
Somehow this thread has incorporated photoplethysmographic findings, PVR and Doppler waveforms without any regard to the lack of standards.  The standards do exist, and have been established with decent research to back them, albeit some “>10 years old”.  Well, things do change, and if one wishes to question what is established, I would suggest it is time to re-evaluate the standards if they do not appear to be acceptable.   Do the study, present your findings for peer review, and I will possibly even accept them.
Personally, I would think that it does not matter how old a standard is until a new standard is shown to be better.  Yes, I am “old school” on that and I still trust my Doppler ears more than the spectral analyzers, or PVR/PPG waveforms.  The issues of collateral flow, cuff size vs. limb diameter, medial calcification, gains and even chart speed all need to be considered.  We must never remove our brains from our sensors.   I agree with Terry wholeheartedly.  
No offense intended to any on this list.  But seems the issue Nicole asked had to do with cuff size and adjusting the size of the waveforms we record.  I am still not sure of the answer we gave her, if any. 

On Thu, Feb 3, 2011 at 3:08 PM, Terry Zwakenberg <[log in to unmask]> wrote:


We seem to have forgotten the PVR is best utilized to evaluate collaterals.  Doppler waveforms, segmental pressures, and exercise are better tools to evaluate the underlying PAD in the primary vessels.  PVR will be compromised in the acute patient but can be virtually normal in the chronic PAD patient.



On Feb 3, 2011 4:42 PM, "JASON r" <[log in to unmask]> wrote:
> 
> Kudos?
> 
> 
> Jason 
> 
>> Date: Thu, 3 Feb 2011 15:46:46 -0500
>> From: [log in to unmask]
>> Subject: Re: Arterial Journals
>> To: [log in to unmask]
>> 
>> Kudos to you Matt!!
>> 
>> ________________________________
>> 
>> From: UVM Flownet on behalf of Smith, Matthew G.
>> Sent: Thu 2/3/2011 3:38 PM
>> To: [log in to unmask]
>> Subject: Re: Arterial Journals
>> 
>> 
>> 
>> Jason,
>> 
>> The issue is that with a significant SFA stenosis, or occlusion, the calf PVR waveform will be smaller than the thigh; if you jack around with the gain this will not be as obvious (regardless of dicrotic notch, because the thigh cuff is over the same area of disease, so it would also lack the notch; for that matter almost any patient who's an oldie but a goodie will have less than textbook perfect waveforms, it doesn't mean they need an angio). I personally like PVR and Doppler waveforms better than pressures any day to determine level of disease (unless you have a patient with a jimmy leg). In a perfect world, there would be a nice 20mmHg drop in pressures between levels or from side to side when significant disease is present, but unfortunately, in a world of diabetic/renal patients with varying degrees of vessel compressibility, and diffuse disease, I find this is rarely the case. Normal is easy to interpret, abnormal is not.
>> 
>> Matt
>> 
>> 
>> 
>> ________________________________
>> 
>> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of JASON r
>> Sent: Thursday, February 03, 2011 15:19
>> To: [log in to unmask]
>> Subject: Re: Arterial Journals
>> 
>> 
>> 
>> 
>> I do not see a problem with increasing or decreasing the gain on a PVR amplitude. I do agree that there should be a standard setting. However, if a PVR waveform has a upstroke, downstroke, and dicrotic notch its technicall normal...right.. So is one extremity waveform is smaller than the other cuff placement may be the issue. Given that limbs are not created equal, one limb will always be bigger than the other, thus, the issue of dissimilar PVR amplitudes. With this said, there should be not reason the gain cannot be adjusted within reason to accentuate the waveform. Think about this, a doppler waveform is Triphasic, who cares if it looks bigger or smaller on the screen. Also, a physiologic test encompasses many other inforamtics as well. 
>> While i am constantly looking a research data, the referenced data in many of these thoughts is old >10years, and should be revised. Does turning up the spectral doppler a little bit overly increase the velocities, yes and no. It could but, it will never degredate the the overall look of the spectral envelope. 
>> 
>> I thinks this topic should be revised, and the original data be revisited as well. I believe in standards modes of measures, but alittle bit of a skew will not hurt the overall test. Besides its a quantitative test. :)
>> 
>> 
>> 
>> 
>> 
>> 
>> Jason 
>> 
>> ________________________________
>> 
>> 
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