PAT's (pedal acceleration times)are invaluable in a patient like this (and for that matter in our lab all wound care patients). In my experience ankle/toe pressure have some limited value but we are moving to PAT studies pre and post intervention. I cannot seem to be consistent with toe pressure even though I have performed thousands - I don't trust them any more. Best, Bart On Tue, Jun 1, 2021 at 4:35 AM Bill Schroedter < [log in to unmask]> wrote: > Good question Harvey. I agree with Denise. For wound care patients, many > of which are diabetic, this is an issue and toe pressures are really a > must. > > That said, I am trying to wrap my head around your question about the > effect of tissue edema – seems like that should transmit the pressure to > the vessel. Elaphantiasis Nostras would likely result in a similar > situation to that is much more common, lipodermatosclerosis. The resultant > tissue fibrosis / sclerosis in my mind would be more likely make a > difference in pressure transmission to the vessel. If you are 30-40 mmHg > above brachial pressure, no problem - your question is answered. But for > nearly my whole career I have wondered about what I call partially > compressible vessels – ones that are stiff and could in fact require more > than the transmitted tissue pressure to compress. What if the vessel in > fact does compress so that we obtain a falsely elevated pressure but is > impossible to determine the presence or degree – we really have no way of > knowing that. Our solution - when doing these, we always keep in mind that > we also have the Doppler waveform which should be strongly considered in > the interpretation of ankle pressures. A monophasic signal (or one with a > delayed upstroke) is unlikely to have a normal arterial pressure. The great > strength of our technology – a lot of clues – they should all point to the > same thing. > > Regards, > > Bill > > > > *From:* UVM Flownet <[log in to unmask]> *On Behalf Of *Denise Levy > *Sent:* Tuesday, June 1, 2021 2:09 AM > *To:* [log in to unmask] > *Subject:* Re: Non compressiblility - tissue vs vessel > > > > Hi, > > You will have more success with a metatarsal cuff and a digital toe cuff, > TBI using a PPG for the pressure. > > Very often ABI’s are falsely elevated due to diabetes plus 255 ! > > The levels can be found on a search for TBI ranges. > > Thank you for your question, > > Denise Levy, RDMS, RVT > > Hill Vascular and Vein Center > > Vascular Lab Director > > > > > > On Mon, May 31, 2021 at 5:02 PM Bill Johnson <[log in to unmask]> > wrote: > > Harvey i do believe your question is quite valid! > > Personally I can only recount a few cases and I know there was a point > beyond which I would not increase the probe pressure. "Do no harm seemed a > good idea then and still. > > So, what do you do in these cases? I assume you do some type of > follow-up? Any lessons for us still learning? > > > > On Mon, May 31, 2021, 4:24 PM Harvey Wilson <[log in to unmask]> wrote: > > Hi, > > I've often wondered about getting non comp ABI's on wound clinic patients > who have severe edema or something like Elaphantiasis Nostras. How much > does hardening and thickening of tissue contribute in cases like these vs > plain old calcification? I thought I'd post this here as I don't have > anyone here to bounce ideas off. > > Thanks, > > Harvey Wilson RVT RDMS RDCS > Victoria > > To unsubscribe or search other topics on UVM Flownet link to: > http://list.uvm.edu/archives/uvmflownet.html > > To unsubscribe or search other topics on UVM Flownet link to: > http://list.uvm.edu/archives/uvmflownet.html > > -- > > Sent from Gmail Mobile > > To unsubscribe or search other topics on UVM Flownet link to: > http://list.uvm.edu/archives/uvmflownet.html > To unsubscribe or search other topics on UVM Flownet link to: > http://list.uvm.edu/archives/uvmflownet.html -- Barton A. Bean IV, RVT, FSVU Orange County Vascular Specialists 23236 Via Bahia Mission Viejo, CA 92691-2114 E-mail [log in to unmask] (714)803-6288 To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html