Patient 2

Biography

52 year old male.

Tingling in feet, especially at night

No cardio-vascular medication

Vascular Audio

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Right / Left

Consensus Opinion

There are no indications from the clinical information that this is vascular. The right popliteal confuses the clinical picture. This would be the type of referral made to vascular services from a diabetic foot screening and would be inappropriate based on this information. In order to gain better understanding here we would need to know what the pulse palpation is like. This is a likely a non-PAD individual. The popliteal pulse is a confusing factor and is likely user error. You need to know whether these pulses are palpable. If he had palpable pulses and these Doppler signals without the symptoms of claudication you may not need to do an ABPI but if you had ANY suggestion that these symptoms were claudication then an ABPI would be indicated.

Question: There are instances where you disagree on the pulse sound between biphasic and triphasic. Are you concerned with the difference between a biphasic pulse and a triphasic pulse?

Answer: No, but you should keep this in the context of the clinical picture. Symptoms of claudication and biphasic signals would require further assessment of an ABPI. You may even consider post-exercise APBI.