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Thanks Steve

The normal/abnormal distinction for exercise testing is not well defined. You can look at the references in this paper (38 and 40-42) and you will say that it’s still ambiguous, just as it was when Dr. Carter first published his 1972 paper (reference #42 in this paper). At the time of our last IAC recertification they insisted that we provide a threshold for abnormal. It’s arbitrary at best, but in my experience rarely ambiguous, i.e., the test is clearly normal or clearly abnormal.  We cited the Daigle text which offers a threshold of 60 mmHg absolute pressure as the cutoff, but without any supporting reference and that satisfied IAC. The statement in our operations manual is as follows: “Exercise is performed using a treadmill set at 2 mph and an incline of 12%. An exercise study is deemed “positive” for evidence of exercise induced ischemia if the absolute ankle pressure drops to 60 mmHg or less or if the ABI drops more than 50% or to <0.50 following exercise.”
Joe

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Steve Knight
Sent: Friday, March 04, 2016 7:41 PM
To: [log in to unmask]
Subject: Re: Segmental blood pressures

Here's a recent JVS article that discusses this:

"Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication"

jvascsurg.org/article/<http://www.jvascsurg.org/article/S0741-5214(14)02284-8/pdf>

Steve

On Fri, Mar 4, 2016 at 5:25 PM, Schneider, Joseph MD <[log in to unmask]<mailto:[log in to unmask]>> wrote:

My bad Dr. Kupinski, I think that i misread your post, it seems we take exactly the same approach with respect to stopping if we have normal ankle Doppler waveforms and ABIs
Joe


On Mar 4, 2016, at 12:51 PM, Ann Marie Kupinski <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Hi Wanda,

We will first do an ABI with multi-level PVR waveforms.  If the ABI is normal, then no segmental pressures.  If the ABI is abnormal then we add segmental pressures.

Ann Marie

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Wanda Ramos
Sent: Thursday, March 3, 2016 3:08 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Segmental blood pressures

Good Afternoon to all:
I am inquiring how many of dedicated vascular labs are still performing segmental blood pressures as part of their protocol for lower extremity arterial physiological evaluation?
In so, what is your reference to still doing so?


Thank you and happy weekend to all!

Wanda
Non Invasive Vascular Lab-MCVI-BHSF
Miami, FL




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