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. > > > > > > 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$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > <IMAGE.jpeg> > > > On Jun 1, 2021, at 1:50 PM, Harvey Wilson <[log in to unmask]> wrote: > > > > > > Thanks so much, Jill. Your talk for the NWVT was my favourite by far! I > will try more practice for sure. One thing helpful is the MVI or micro > vascular imaging on the GE LE10 it is quite sensitive to low flow states > and I also use it for temporal arteritis so as not to override the vessel > wall. I was curious about using a hockey stick probe and that to look at > the digital artery - has anyone ever done a digital acceleration time? > > > > > >> On Tue, 1 Jun 2021 12:10:24 -0700, Jill Sommerset <[log in to unmask]> > wrote: > > >> > > >> Great conversation here! I’ve attached our publications on PAT. We find > it valuable not only in the arterial/CLTI pt but also on the venous wound > pt where there is question of compression can be applied. The lateral > plantar and Arcuate are fairly easy to image and obtain at PAT however like > anything there is education and practice that comes along with it. Please > reach out with any questions or thoughts. I’d love to hear them. > > >> > > >> Kindly, > > >> Jill Sommerset > > >> > > >> > > >> > > >> > https://urldefense.com/v3/__https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00258-2/fulltext__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUSFmIotSo$ > <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$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>>>> > > >>>>>> To unsubscribe or search other topics on UVM Flownet link to: > > >>>>>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>>>> > > >>>>>> -- > > >>>>>> > > >>>>>> Sent from Gmail Mobile > > >>>>>> > > >>>>>> To unsubscribe or search other topics on UVM Flownet link to: > > >>>>>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>>>> To unsubscribe or search other topics on UVM Flownet link to: > > >>>>>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>>> > > >>>>> > > >>>>> > > >>>>> -- > > >>>>> Barton A. Bean IV, RVT, FSVU > > >>>>> Orange County Vascular Specialists > > >>>>> 23236 Via Bahia > > >>>>> Mission Viejo, CA 92691-2114 > > >>>>> E-mail [log in to unmask] > > >>>>> (714)803-6288 > > >>>>> To unsubscribe or search other topics on UVM Flownet link to: > > >>>>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>>> To unsubscribe or search other topics on UVM Flownet link to: > > >>>>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>> > > >>>> > > >>>> > > >>>> -- > > >>>> Barton A. Bean IV, RVT, FSVU > > >>>> Orange County Vascular Specialists > > >>>> 23236 Via Bahia > > >>>> Mission Viejo, CA 92691-2114 > > >>>> E-mail [log in to unmask] > > >>>> (714)803-6288 > > >>>> > > >>>> To unsubscribe or search other topics on UVM Flownet link to: > > >>>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >>>> > > >>> > > >>> To unsubscribe or search other topics on UVM Flownet link to: > > >>> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >> > > >> To unsubscribe or search other topics on UVM Flownet link to: > > >> > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > >> > > > > > > To unsubscribe or search other topics on UVM Flownet link to: > > > > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > > > To unsubscribe or search other topics on UVM Flownet link to: > > > https://urldefense.com/v3/__http://list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$ > <https://urldefense.com/v3/__http:/list.uvm.edu/archives/uvmflownet.html__;!!KXLdbwIpKtyU!7pXbNc1jDdvs0cTe17_bkp4HNw_gA85VtReyR-s0YdRhVtuaFeUS3bWJ9LM$> > > 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 > 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 To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html