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Ahhh. The art of the waveform. This trade will be lost with the consistant loss of dedicated vascular labs and dedicated vascular technologist.

Kudos



Dr Jason Roberts
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954-801-2496




-------- Original message --------
From: "Schneider, Joseph MD" <[log in to unmask]>
Date:
To: [log in to unmask]
Subject: Re: PVR waveform analysis


Points well taken, although the "embrace the PVR" reminds me of "Come to the dark side Luke". No matter, you have my attention Steve.  I need to bounce your excellent points around our lab and among my colleagues. 
Gee should I pull that chapter back for revision?
In all honesty I think this has been a very educational thread for me, as always I am amazed at the knowledge of the Professionals on this list.


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Steven Knight
Sent: Friday, June 14, 2013 1:53 PM
To: [log in to unmask]
Subject: Re: PVR waveform analysis

Anybody who knows me has heard me harp on the value of PVR's. As our population supersizes itself and Type II Diabetes becomes more prevalent (currently 1 in 4 Americans Medicare aged have diabetes and if the trend continues 1 in 3 Americans of all ages will have diabetes by 2050) and with the widespread use of Coumadin which seems to promote medial calcinosis in a large subset of patients, the ABI is becoming a meaningless value.
There, I said it. ABI's are becoming meaningless.
That means we need a reliable physiological test for this growing population. So let's get really good at obtaining quality PVR waveforms and get comfortable understanding what information they offer. Other technologies are being developed but most labs already have plethysmography.
I urge you all, embrace the PVR. (cue sound of me stepping off of soapbox).

~S
-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Ann Marie Kupinski
Sent: Friday, June 14, 2013 12:45 PM
To: [log in to unmask]
Subject: Re: PVR waveform analysis

Hi Dawn,

I am a little late to this discussion but I am a strong believer in PVRs.
They provide a very nice assessment of global limb perfusion.  The problem is indeed with the interpretation which is very subjective. 

Here is a paper from our vascular medicine colleagues which contains a nice table (Table 11) with PVR waveforms and descriptions for levels of disease.
Although some of the interpretation is still subjective, at least it is a framework.

Gerhard-Herman, Marie et al.  Guidelines for Noninvasive Vascular Testing:
A report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology.  J Am Soc Echocardio 2006; 19:955-972.

This should be acceptable to use as a reference for accreditation purposes.


Ann Marie Kupinski

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Dawn Stirrat
Sent: Wednesday, June 12, 2013 7:26 PM
To: [log in to unmask]
Subject: PVR waveform analysis

Hello my vascular gurus! 

I was having a discussion with a friend about pvr waveforms and how there are so many ways to describe them.  Does anyone have a good reference that describes them?

thanks,
Dawn

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