Hi Bill,
There are so many variables - cuff to toe sizes, what pressure is on the PPG (very difficult to be precise in my experience) - except perhaps with tape which we no longer use (clamp with unknown pressure is provided by current equipment manufacturer), is the light on in the room, does the patient have and small vessel calcifications.
Don't get me wrong they are a part of our protocol and we do them. I just no longer believe the results particularly since a large part of our work is with diabetic wound care.
PAT has been  wonderful for us (even though it has limitations too).
Fond regards,
Bart

On Tue, Jun 1, 2021 at 10:54 AM Bill Schroedter <[log in to unmask]> wrote:
Hey Bart, 
Absolutely PAT's but could you please elaborate on your reservations re: toe pressures?
Thanks, 
Bill

-------- Original message --------
From: Barton Bean <[log in to unmask]>
Date: 6/1/21 1:41 PM (GMT-05:00)
To: [log in to unmask]
Subject: Re: Non compressiblility - tissue vs vessel

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

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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
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