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Looking at ankle ABIs from 1976 to 1986, comparing people with Type 1 and Type 2 diabetes with people without diabetes,
We found:
In people without diabetes, the ankle arteries in the same leg are usually at the same pressure
In people with Type 2 diabetes, often one will be low and the other normal.
   Of course, the in Type 2 diabetes, the ankle measurement might be falsely elevated in one artery due to medial calcification.
       when one vessel pressure at the ankle was low, in about half of the cases, the other was low.
   But our conclusion was that in Type 2 diabetes, the prevalence of distal pressure reducing stenosis was higher
     and in people without diabetes, the prevalence of proximal pressure reducing stenosis was higher,
      so when one vessel pressure at the ankle was low in nearly all cases, the other was low.
But, the major finding was that in the absence of a smoking history, the prevalence of low ankle pressure was near zero.
Over the last decade, we have seen an astonishing and welcome decline in smoking.

Tomorrow, at the feast of gratitude, I'll be thinking of the farmers, farm workers, food workers, transporters, shop workers and family culinary experts that make this bounteous culinary miracle possible.

Kirk


On Tue, 21 Nov 2017, Steve Knight wrote:

> Jeff et al,
> Let's remember that we measure the pressure of the arterial segment that is encircled by the cuff. If we compress all calf arteries proximally and listen at the mid calf or
> ankle, we are still only measuring the pressure at the level of the cuff. This may be relevant information in some way, but I don't think it would be correct to jumble it in with
> the pressures measured at the ankles. As we all know, lots of disease can happen between the distal popliteal artery and the ankle. As with Bill, I'm curious to know the
> rationale for knowing the pressure of the proximal peroneal artery alone, and not it's fellow conduit calf arteries. It seems to be an apples:oranges argument.
> 
> ~S
> 
> On Nov 21, 2017 9:52 AM, "Bill Schroedter" <[log in to unmask]> wrote:
>       Jeff, et. al., We use this technique as well.  Although we often use the duplex scanner to determine ankle pressure and that experience leads me to the conclusion
>       that sometimes when using a CW Doppler, I am likely to assume an artery when sometimes I am in fact insonating a branch artery.  Nonetheless, I am intrigued by this
>       discussion and believe there may be some merit however, I wish to play the clinical card. In what circumstances would you feel this is clinically useful or changes
>       the clinical course of the patient?
> 
>       Bill
> 
>       William B Schroedter, BS, RVT, RPhS, FSVU
>       4120 Woodmere Park Blvd
>       Suite 8B
>       Venice, Florida  34293
>       www.qualityvascular.com
>       www.virtualveincenter.com
> 
> 
> 
>       -----Original Message-----
>       From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Christina Lewis
>       Sent: Tuesday, November 21, 2017 12:11 PM
>       To: [log in to unmask]
>       Subject: Re: Peroneal ABIs
> 
>       Hi, Jeff!  I would think that any pressure taken in the proximal calf would use the same criteria you use for a segmental exam.   I use the peroneal artery for ABIs
>       not uncommonly, but I take it at the ankle, so I use ABI criteria.
> 
>       You didn't ask for this information, but others have mentioned that it may be difficult to access the peroneal artery for ABIs and I use techniques that I believe
>       make it quite easy.  I've found that having the patient scooch their foot barely off the table allows me to lay the pencil probe right into the posterior lateral
>       malleolus and, using the table as support, it doesn't slip off when inflating the cuff.  Alternatively, I will also have a patient bend their knee up and plant their
>       foot on the bed and access the area from there.  This also stabilizes the area and makes it less likely for me to lose my spot when inflating.
> 
>       I hope all is well with you!
> 
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