In Reply to: Case 497_02 -- Pressure gradients and clinical outcome posted by Editor on April 18, 1997 at 11:18:50:
Sorry for being so late to comment. I've just gotten a chance to review the cases.
There are,as DR. Haskal has commented, a # of discrepancies with the pressures as recorded. 1st, a significant iliac lesion, stenosis of the common fem art, criticals of the SFA, occluded popliteal, and a reconstituted PT are absolutely incompatible with ABI's of 1.02 and clinical rest pain is found when the ABI is <0.50.
We have all but stopped doing pressures with our old equipment as they have been unreliable to the extent of finding retrograde aortic pressures LOWER than pressures distal to stenotic iliac lesions and not entirely reproducible. We have also found no really great reduction in post-Aplasty measurements on occasion. Our post TIPS measurements have been accurate enough( I think).
We are going to install a new MacLab 3000. I'll post a note when it's installed if it's any more accurate.
2) I wouldn't be too hung up on the #'s. It's hard to imagine that rest pain would respond to the placebo effect; especially if objectively the foot is improved. I would not have dilated further nor would I have managed the case differently.
3) These are the patients that I feel Wallstents were made for: Long lesions in non-straight vessels and especially those with dissections either post angioplasty or reason for intervention (as Post cardiac procedure). I have started to heparinize long Wallstent patients while the stent is placed because there is a tendency for immediate (and I mean IMMEDIATE) thrombosis of a long Wallstent for whatever reason and I confess I don't know why. It may be charge related and be the result of platelet attraction.