Stephanie J. Nichols, MBA, RVT, a vascular technologist with Virginia Interventional & Vascular Associates, recently had an article published in the Journal for Vascular Ultrasound that underscores the need for two different tests when evaluating patients after arterial bypass graft procedures.
Recent changes in Medicare criteria stated that only one test was needed for routine follow up after an arterial bypass graft – either a graft duplex or a segmental pressures test. Alternatively, the Intersocietal Accreditation Commission states that if a graft duplex (or ultrasound) is performed, then an additional study that measures the segmental pressures, an ankle brachial index (ABI), must also be completed within two weeks at the same facility when there is no change in the patient’s symptoms.
Nichols reviewed a number of patient histories for cases in which the ABI results were within normal limits, but the graft duplex results revealed an abnormality. In each case, the patient had not reported specific vascular symptoms that would indicate a serious condition like claudication, but had mentioned more general symptoms of weakness or pain.
In her September article on “The Importance of Routine Graft Duplex in the Presence of Normal Ankle Brachial Indexes,” Nichols concluded that it is critical for laboratories to perform both tests. “The ABI is a good indicator of disease in the normal population, but in older patients and those with diabetes, it can yield false-positive results,” Nichols wrote. An abstract of her article is available at http://tinyurl.com/nicholsarticle.