Patrick,
CMS states no reason to do PVR and art duplex on same day, and AUC guidlines.

Art duplex is giving you all the information you need, hence your correlating art duplex to PVR which by the way is not the gold dtsndard. Art duplex is qualitative and specific.
PVR is quantitative and nonspecific.
My opinion , no need to do PVR to screen patients that have know disease and previous interventions.
If the patients has previous interventions and is complaining of cludication why do PVR and art duplex? No need , frankly a waste of money. The will surely need a 3rd modality (angio). 
I get people Love PVR, it's old and makes you feel warm, however interventionalist want to know exactly where the issue lies, not generally.
I can promise you will start to get denialist. The future with all the combination or codes you are using .




Dr Jason Roberts 
(C) 954-801-2496
(E) [log in to unmask]
Sent from my mobile phone, please excuse any typos 

-------- Original message --------
From: Patrick Doolan <[log in to unmask]>
Date: 11/5/18 11:00 PM (GMT-05:00)
To: [log in to unmask]
Subject: Re: PVR with stents

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.  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.

David M Williams, MS, RDCS, RVT

SC Cardiovascular Surgery

Suite B300, 805 Pamplico Highway

Florence, SC 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

 

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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

 

 

 

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