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     I also apologize for not responding sooner, has been on my list of 
     things to do. I can't help with the 4 cuff (or any #) segmentals as we 
     no longer do them here. We feel we can image the leg as fast as you 
     can perform segmentals. However, regarding the ABI's and non-healing 
     ulcers, I would echo Steve's comment regarding the non-compressible 
     vessels. I think you will have a hard time finding good agreement on 
     an ABI to predict healing. The large majority of these patients are 
     diabetic and even those that aren't will sometimes have calcified, 
     incompressible vessels.
     
     BTW - anyone have any thoughts on "partially" compressible vessels? 
     That is, stiff enough to give a falsely high reading but not so stiff 
     as to be incompressible?? 
     
     Generally, provide good wound care and if the lesion is not heading in 
     the right direction or becomes infected, then intervention is 
     required. At that point, the patient needs to be imaged. Certainly, I 
     feel more comfortable when I get an ABI that is consistent with my 
     findings on imaging. Alright, alright, I admit it, a strong bias for 
     imaging! However, in todays economically driven health care 
     environment, the argument could be made for no testing for peripheral 
     vascular disease save for the few patients that the diagnosis can't be 
     made by history and physical exam, or those with mixed 
     neurogenic/vasculogenic claudication. When intervention is required, 
     then imaging allows the surgeon to plan the approach, cheaply, 
     non-invasively and occasionally avoiding angiography. 
     
     The ability to reliably predict healing vs. non from a simple test 
     would clearly be useful, but I don't think its going to happen. 
     Regardless, you will have to follow that patient for wound care 
     anyway.
     
     Bill Schroedter
     Venice, Fl.
     
     
______________________________ Reply Separator _________________________________
Subject: Cuff Artifact
Author:  [log in to unmask] at Internet 
Date:    1/13/97 8:30 AM
     
     
Please Help!  I am looking for information regarding the cuff artifact that 
is encountered when performing four cufff segemental pressure studies.  I am 
not very familar with this method (I had learned three cuff.).  I have three 
different books all giving different variations of this phenomena.  
     
I am also finding conflicting information regarding ABI's consistent with 
non-healing ulcers.  What are most vascular labs using now?
     
Thank You 
     
Brooke