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Lab Name:
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Address Line 2:
Date of Service:
Last Name:
First Name:
Date of Birth:
MRN:
Lower Extremity Pulse Volume Recording with Ankle Brachial Indices
Indication:
Ordering Provider:
Technologist:
Pertinent History:
Technique
The patient was placed in a supine position with appropriately sized cuffs applied to the extremities. The PVR and ABIs were then obtained using the 3 cuff technique.
Findings
Right
Left
Waveforms
Thigh:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Calf:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Ankle:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Foot:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Toe:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Thigh:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Calf:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Ankle:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Foot:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Toe:
Normal
Mildly abnormal
Moderately abnormal
Severely abnormal
Not Applicable
See Comments
Pressures
Brachial
mm/Hg
Ankle:
mm/Hg
Toe:
mm/Hg
Brachial
mm/Hg
Ankle:
mm/Hg
Toe:
mm/Hg
Indices
ABI:
TBI:
ABI:
TBI:
Impression
Right
Left
Level of Disease
Normal
Inflow / femoral disease
Outflow / popliteal disease
Runoff disease
Multi-level disease
Not Applicable
See comments
Normal
Inflow / femoral disease
Outflow / popliteal disease
Runoff disease
Multi-level disease
Not Applicable
See comments
Severity of Disease
Normal
Mild disease
Moderate disease
Moderate to Severe disease
Severe disease
Falsely elevated due to vessel calcification
Not Applicable
See comments
Normal
Mild disease
Moderate disease
Moderate to Severe disease
Severe disease
Falsely elevated due to vessel calcification
Not Applicable
See comments
Comparison to Prior Exam
No prior study available for comparison
No change since prior study
Findings are worse than on the prior study
Findings are improved since the prior study
Recommendation
No follow up required
Follow up with repeat ultrasound in 1 year
Follow up with repeat ultrasound in 6 months
Follow up with vascular consultation
Comments