What about pole pressures? Never done them but im making a pole to start.
Only good for pressures <=70mmhg ish.

On Thu, Jun 3, 2021 at 1:14 AM Jill Sommerset <[log in to unmask]> wrote:

> Thank you for  sharing your thoughts, Bill.  PAT has only been validated
> in the  inframalleolar region of the foot. So we cannot apply this criteria
> to the distal  PTA, ATA, or peroneal Artery.
>
>
> We are encountering more and more pedal arch disease and variant Pedal
> anatomy
> . The value of PAT is evaluating the artery leading right to the wound
> bed. We call this “target artery PAT”  - this is especially helpful in the
> diabetic or renal failure patient with CLTI. When we evaluate PAT of the
> foot we can also obtain pedal flow hemodynamics and understand flow
> direction in the arch. This can be very helpful when we need to indirectly
> revascularization the patient.   As far as probe selection we generally
> always use a standard linear probe on the bottom of the foot and even on
> the top of the foot however in a thin foot or if scanning the dorsal
> metatarsal arteries one can use a high frequency probe.
>
> Jill
>
>
> On Jun 2, 2021, at 6:50 AM, Bill Schroedter <
> [log in to unmask]> wrote:
>
> 
>
> Thanks so much Jill. Clearly this is a useful, perhaps even critical
> parameter, especially in those patients with CLI. And I really liked your
> comment about its use in decision making for grading compression for venous
> ulcerations.
>
> Another question arose in my mind with the discussion of the high
> frequency transducer to obtain a waveform from the metatarsals or at the
> edge of the wound.  Is there any data or even in your experience, is there
> a significant difference (I suppose that means changing healing potential)
> when this is obtained from the the ankle versus out on the foot or at the
> wound margins?
>
> Thanks.
>
> Bill
>
>
>
> *From:* UVM Flownet <[log in to unmask]> *On Behalf Of *Jill
> Sommerset
> *Sent:* Wednesday, June 2, 2021 9:00 AM
> *To:* [log in to unmask]
> *Subject:* Re: Non compressiblility - tissue vs vessel
>
>
>
> Thanks for the question Nicole. I’ve attached the criteria.  Like
> anything, correct technique is key in the accuracy of PAT.
>
>
>
> Have a great day,
>
> Jill
>
> <image001.png>
>
>
>
> On Jun 2, 2021, at 4:39 AM, Nicole Ball <[log in to unmask]> wrote:
>
> 
>
> Hi all.  Interesting discussion.  I personally have not done PAT but have
> printed some articles to research.  Question...What are the diagnostic
> criteria for AT in the pedal arteries...normal AT vs abnormal AT?  Thank
> you.
>
>
>
> Sincerely,
>
>
>
> Nicole Ball, BS, RVT
>
> Technical Director, Vascular Lab
>
> Concord Hospital
>
> 250 Pleasant Street
>
> Concord, NH  03301
>
> http://nnevs.org
>
>
>
> >>> Jill Sommerset <[log in to unmask]> 6/1/2021 4:57 PM >>>
>
>
>
>
>
>
>
> * CAUTION - This is an EXTERNAL email - DO NOT open attachments or links
> in unexpected emails or from unknown senders *
>
>
>
>
>
>
>
> Thank you Denise and Harvey. Yes, we use PAT on the dorsal and plantar
> metararsal arteries. The hockey stick is nice for the dorsal metatarsal
> arteries right at the edge of the wound bed.
>
>
>
>
>
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>
> <IMAGE.jpeg>
>
> > On Jun 1, 2021, at 1:50 PM, Harvey Wilson <[log in to unmask]> wrote:
>
> >
>
> > Thanks so much, Jill. Your talk for the NWVT was my favourite by far! I
> will try more practice for sure. One thing helpful is the MVI or micro
> vascular imaging on the GE LE10 it is quite sensitive to low flow states
> and I also use it for temporal arteritis so as not to override the vessel
> wall. I was curious about using a hockey stick probe and that to look at
> the digital artery - has anyone ever done a digital acceleration time?
>
> >
>
> >> On Tue, 1 Jun 2021 12:10:24 -0700, Jill Sommerset <[log in to unmask]>
> wrote:
>
> >>
>
> >> Great conversation here! I’ve attached our publications on PAT. We find
> it valuable not only in the arterial/CLTI pt but also on the venous wound
> pt where there is question of compression can be applied. The lateral
> plantar and Arcuate are fairly easy to image and obtain at PAT however like
> anything there is education and practice that comes along with it. Please
> reach out with any questions or thoughts. I’d love to hear them.
>
> >>
>
> >> Kindly,
>
> >> Jill Sommerset
>
> >>
>
> >>
>
> >>
>
> >>
> https://urldefense.com/v3/__https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00258-2/fulltext__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUSFmIotSo$
> <https://urldefense.com/v3/__https:/www.annalsofvascularsurgery.com/article/S0890-5096(21)00258-2/fulltext__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUSFmIotSo$>
>
> >>
>
> >>>> On Jun 1, 2021, at 12:03 PM, Harvey Wilson <[log in to unmask]>
> wrote:
>
> >>>
>
> >>> Very interesting folks! I was only hoping for a bit of speculation on
> tissue compressibility and got a bonus!
>
> >>> We typically will fall back on getting waveforms if possible and a TBI
> -  but as Bart states they are not always possible, those short, fat toes,
> etc. As for the toe clamp, we use tape still and if I need to get good PPG
> contact on those greasy ones, I will place Saran wrap very lightly around
> just to hold the PPG on without pressure.
>
> >>> I have only tried a couple of times to get a PAT since watching a
> lecture on it at the NWVT. I find those little guys in the plantar foot
> quite tricky to find and our Radiologists and vascular surgeons might have
> never heard of it.  Are PAT's well validated and widely used?
>
> >>> Partially compressible, yeah, what to do with that possibility? What
> bugs me is to take obviously monophasic waveforms in the tibials but an ABI
> of 1.0 and then see it reported as "no evidence of arterial insufficiency"
> :( :(
>
> >>>
>
> >>> Harvey
>
> >>>
>
> >>>> On Tue, 1 Jun 2021 11:10:22 -0700, Barton Bean <[log in to unmask]>
> wrote:
>
> >>>>
>
> >>>> 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
>
> >>>>>>
>
> >>>>>> To unsubscribe or search other topics on UVM Flownet link to:
>
> >>>>>>
> https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$
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>
> >>>>>>
>
> >>>>>> To unsubscribe or search other topics on UVM Flownet link to:
>
> >>>>>>
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>
> >>>>>>
>
> >>>>>> --
>
> >>>>>>
>
> >>>>>> Sent from Gmail Mobile
>
> >>>>>>
>
> >>>>>> To unsubscribe or search other topics on UVM Flownet link to:
>
> >>>>>>
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>
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>
> >>>>>>
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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:
>
> >>>>>
> https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$
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>
> >>>>> To unsubscribe or search other topics on UVM Flownet link to:
>
> >>>>>
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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:
>
> >>>>
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>
> >>>>
>
> >>>
>
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