Case+6

__Case #6__ Below are the segmental pressures you obtained on Mr. Right. Calculate the ABI’s: Jess: Right ABI is 1.1 and left is .52 McKenna; The left ABI is 0.52 and the right ABI is 1.1 Tatyana: ABI's - Left 74/143= 0.52, and right 158/143=1.1


 * Will you complete an exercise protocol with Mr. Right? Why or why not?**
 * Does he have disease? Where specifically? Single level or multilevel?**

Jess: I wouldn't do an exercise protocol because we already know that there is disease on the left side. It is multilevel and would start around the left upper thigh. Even though the ratio for the left upper thigh is above one, it is more than 20 mmHg less than the right upper pressure reading. McKenna: I do not feel that an excercise protocol is necessary due to the fact that the patient already has disease on the left side of the body. There is multilevel disease and you can tell this due to the fact there is more the 20 mmHg difference between the high thigh and mid thigh. The disease also continues down the leg because the ratios are under 1.0 Tatyana: I do not think that there is an indication for an exercise protocol in this case because we could determine the presence of disease based on segmental pressures and ABI's. It looks like Mr Right has multilevel arterial disease through out his whole left lower extremity considering differences between segmental pressures (more than 20 mmHg) and ABI's less than 0.9.

Jess: Ultrasound duplex imaging with help. It will show us the exact location(s) causing the disease but images and Dopper
 * What is the other portion of the exam that will help you determine disease?**

McKenna: Another portion of the exam that would help determine disease would be Doppler waveforms and PVR. These will all give waveforms that will also agree with the degree of stenosis given here. A Duplex exam could also be done to get the exact location of the disease. Tatyana: There is an indication for duplex ultrasound exam in this case as it will give us the exact "picture" where the disease is and also we can determine the extent of the stenosis.