On Wed, 17 Jul 1996, Terrence D. Case wrote:

> Colleagues;
> How does ones one evaluate the elevated velocities which inevitably
> occur at the distal anastomosis as large vein is attatched to smaller
> native vessel? This seems to be a problem particularly with distal
> bypasses i.e. fem- DP or fem PTA.
> Terry Case
> University of Vermont

hi folks!

     with respect to elevated velocity, if it is focal with drop in
velocity/post stenotic turbulence/waveform contour changes etc. distally
then it may be a flow restricting thing/defect.  if the elevated velocity
is throughout the segment with caliber descrepency and there is no drop in
velocity/turbulence/waveform changes, then it is more likely
hyperemia/caliber descrepency vs. correctable defect. however if felt to
be a correctable defect there should also be some B-mode evidence of a
problem (plague/flap/thrombus etc.). can be a difficult call based on
elevated flow alone but if one uses all available info, B-mode/location
and lenth of elevated flow/waveform changes etc together you'll probably
get it right!