Dr Roberts, I prefer to do an arterial physiological exam first and, if necessary, an arterial duplex. I like having the ability to correlate the results. That is why I like doing both tests, just not in all cases. I probably wasn’t clear with that. I’m not devaluing RVTs. Having the physiological exam results in hand is helpful going into a duplex exam, especially when there is a considerable amount of plaque burden. Having another test to confirm findings is just good science. I’m originally a chemist that worked in the pharmaceutical industry for ten years performing qualitative and quantitative analysis before changing careers to vascular ultrasound. Now, regarding your remark about PVRs being quantitative and “no need to argue the point.” We’re not debating the best Beatles’ album (somewhat ironically it’s Revolver), quantitative and qualitative have very specific definitions, so please tell me what part you’re considering as a quantity (amplitudes?) versus the qualities of the peak shape. Sorry for the late response. Patrick Doolan, BS, RVT On Mon, Nov 5, 2018 at 9:53 AM Williams, David M. < [log in to unmask]> wrote: > The physician with whom I work does not want PVR waveforms or pressures > taken at the site of intervention due to compression worries. We avoid all > application of pressure at those sites. Having said that, we have found > that ankle/toe pressures along with PVR and digital PPG waveforms can be a > great help in determining distal perfusion especially in > post-intervention/operative brittle diabetics. In a “distal” bypass graft > (vein used as conduit below the knee for limb salvage), the tech must be > VERY cautious as to where a cuff is placed. These exams are done only by an > experienced tech, not a newbie. Rule of thumb, cuff use is sanctioned 5 cm > or further below the distal surgical site. TBI is another helpful tool. > <https://maps.google.com/?q=805+Pamplico+Highway+%0D%0A+%0D%0A+Florence,+SC&entry=gmail&source=g> > In my experience, duplex can tell us if a graft or stent is patent or > obstructed, but even the imperfect quantification of perfusion (using > techniques like PVR, PPG, ABI and TBI) can be a great help in determining > graft and tissue viability after intervention. > > <https://maps.google.com/?q=805+Pamplico+Highway+%0D%0A+%0D%0A+Florence,+SC&entry=gmail&source=g> > > David M Williams, MS, RDCS, RVT > > SC Cardiovascular Surgery > > Suite B300, 805 Pamplico Highway > <https://maps.google.com/?q=805+Pamplico+Highway+%0D%0A+%0D%0A+Florence,+SC&entry=gmail&source=g> > > Florence, SC > <https://maps.google.com/?q=805+Pamplico+Highway+%0D%0A+%0D%0A+Florence,+SC&entry=gmail&source=g> > 20505 > > 843-676-2760 (o) > > 843-601-6629 (c) > > > > > > > > *From:* UVM Flownet [mailto:[log in to unmask]] *On Behalf Of *Schneider, > Joseph MD > *Sent:* Sunday, November 04, 2018 4:29 PM > *To:* [log in to unmask] > *Subject:* [EXTERNAL] PVR with stents > > > > *WARNING: **This email came from outside of CHS’s email system. **DO NOT > CLICK LINKS **or **ATTACHMENTS **in this email unless you recognize the > sender. * > > > > Hello > > We do not do PVRs in our lab (this seems to be a favorite in the > Northeast, probably the lingering influence of John Mannick and Jeff > Raines, we are Midwestern and likely are still influenced by Jimmy Yao and > Eugene Strandness) so I would like to ask how labs approach the problem of > pressure cuffs in subjects with previous interventions, especially with > stents. We would not do full segmental pressures in such patients and would > limit pressure measurements to the ankle (ABI) to avoid possible > compression of the treated/stented arteries. I am wondering if those of you > who use PVR (where the base pressure of 65 mmHg is much less than would be > required in segmental pressure measurements) limit your PVR measurements to > the ankle and foot to avoid any compression of the stents? > > Thanks > > Joe > > > > > > > > This message and any included attachments are intended only for the > addressee. The information contained in this message is confidential and > may constitute proprietary or non-public information under international, > federal, or state laws. Unauthorized forwarding, printing, copying, > distribution, or use of such information is strictly prohibited and may be > unlawful. 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