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Kelly,
        Thank you for the additional details on the use of arterial duplex
in your laboratory.  You are right, our patient populations are
different.  We are much less likely than you are to be sure that our
patients will probably go directly to intervention.  Our doctors are more
conservative and are more likely to treat patients medically if symptoms
do not signficantly limit their lifestyle.  Some of our patients are high
surgical risks.  Quite frankly, we have a fair number of immobile
 patients with ischemic ulcers and sometimes the medical question is
just "Will this ulcer heal" or even "What should the amputation level be?"
Therefore, we reserve arterial duplex imaging for those cases which I
mentioned in my previous communication and usually when it is ordered by a
vascular surgeon or interventional radiologist.   We also substitute
arterial duplex with ABI for the PVR/segmental pressures in any instance
in which the patient is known to have current DVT.
                Thank you!
                        Mary