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In a message dated 12/9/98 7:58:25 PM Eastern Standard Time,
[log in to unmask] writes:

<< This brings me back to "Why do both physiologic and duplex as a
 routine?" >>
     This brings me to the length of time for a duplex study.  I am
amazed at your skill in performing a complete segmental exam and duplex
from the aorta down in 45-60 minutes.  We are a hospital lab.  A large
percent of our patients are elderly and very sick, often with diffuse
multilevel disease.  I am just curious what your patient population is
like and what impact this might have on length of study.

Mary,
        Our patient population is very much different, we are mainly outpatient, our
patients are walking, talking patients for the most part. This is significant
in the fact that my patients are much easier to do and the fact that I can
pretty much stick to a schedule, except for add on post op patients
Approximately 30% of our caseload is addon, the rest are scheduled. The
patient population that I scan is very positive however with a great majority
of them having multilevel disease. The Surgeon's and Cardiologist's philosophy
is what guides us in our efforts to do these studies. We are affiliated with a
large tertiary hospital and often our patients are admitted the day that we do
their study, so they are possibly going to have intervention that very day.
The Surgeons that I work for have their own OR and can operate at any time of
the day or night. Also, for non surgical intervention they have 12 angio
suites that are their own also and they do not have to share with other docs,
so anytime they need to they do an angio, stents, urokinase infusion or
whatever needs to be done they are free to do so. When we give them the
preliminary findings, they act on it, after explaining things to the patient,
they generally proceed that day with angio, or perhaps the next day. We do not
know what type of procedure the physician is going to perform at the time that
we do their study.
        They perform a great deal of stent procedures and often we will localize for
them exactly where the stenosis is and how long to help them plan a procedure.
For our AneuRX procedures they like to know specifically if the SFA and CFA
are diseased before they do an angio because if the disease is severe then the
patient is not a candidate for the procedure.
        On the topic of iliac scanning: Since we do not know whether a test is going
to be positive or not (on our new patients) we schedule them without being NPO
and scan them as needed. If the high thigh pressure is normal, then we do not
scan the aortoiliac segment. Very few of the patients actually have to come
back for rescanning due to bowel gas. Multiple patient positions and probe
pressure usually alleviate the problem. In the beginning of the learning curve
it takes a great deal longer than 45-60 minutes to do these exams, but after a
while it is just like any other procedure and with gained experience your
speed increases. I think that duplex is as good or better than angiography and
at times if the angio does not show the disease to be as severe as we stated,
the physician may do an intravascular ultrasound. The results are usually to
our favor and then the patient is managed accordingly.
        Sorry that this e mail is so long, but I just wanted to clarify why we do
what we do. Most everyones protocols are tailored to include the information
that the physician wants
and needs to affectively treat the patient. Our doctors want this specific
information and that is why we do it this way. I hope I have answered any
questions that you had, if not, please write back. I am very much interested
in the way other labs work.

Kelly Estes RT(R), RDMS, RDCS, RVT