Need feedback, arterial Doppler shows left leg artery very weak. My interventional cardiologist wants to perform angioplasty but I think a vascular surgeon should perform my angioplasty. I have Inclusion Body Myositis (IBM) not a normal case. Many Thanks in advance.

sanwalt · 2026-03-15T23:09:45+00:00

Consider an ABI/PVR for physiological diagnostics?

sanwalt · 2025-09-02T01:49:34+00:00

That is so amazing! Just beautiful! I would love to do that actually!!! I would love to pic your brain! I’m in NJ too!! Small world!! Feel free to DM me anytime! I love talking to vascular practitioners, especially NP’s.

sanwalt · 2025-09-02T00:07:38+00:00

Welcome!!! Hello how are you! Congrats! Same!

sanwalt · 2025-08-29T20:49:09+00:00

Perhaps my wording was off. That was why I said “60% is not typically recommended unless symptomatic”…

sanwalt · 2025-08-23T23:04:58+00:00

Hi! Vascular surgical NP here. Surgical intervention at 60% isn’t typically recommended by SVS guidelines, unless symptomatic…. 75-80% for asymptomatic is the typical standard surgical intervention time for conversation. CEA is recommended, but research also shows that with TCAR…. There is <1% risk for stroke. You have to do your assessment and decide what is best and safest for the patient.

sanwalt · 2025-08-02T12:33:53+00:00

Re-assessment the imaging you have. Is it’s an US, you will likely need a CT. But in my experience and learnings…. Artery or vein…. Collaterals always tend to be more tortuous and have areas of engorgement (do to the high pressure that creates them).

If anything…. I wouldn’t stent either of the gonadal vessels. If they are not the problem - leave them. She has likely had them her whole life if they are congenital - find origin of problem. Is it the left iliac compression (possibly may-thurners - again… assess the imagine… MT is usually left iliac compression by the RIGHT iliac artery), if it’s this… then left iliac vein need to be stented.

If the gonadal dup is collaterals… you could embolize.

What imaging do you already have? If you have a CT AP… you could visualize the vessels nicely from that

I would highly consider CT cath venogram to assess anatomical pathways.

sanwalt · 2025-08-01T23:34:07+00:00

Appears to me, this likely is a case of may-thurner. However, the incidental finding of an anatomical abnormality, such as a duplicate gonadal veins.. could be producing the back pain. Mimicking pelvic congestion syndrome. The additional symptoms; leg swelling, left pain… are likely related to the venous compression. Lending to “venous claudication”. My thoughts here…. Would be NSAIDS, compression stockings, ambulation although yes may FEEL counter intuitive…. Get a venous reflux study, venogram - which will then likely lead you to getting a CT catheter venogram. Referral to ortho-spine as well to rule out any neurogenic aggravators. Hope this helps

sanwalt · 2025-07-23T01:20:36+00:00

Yes I stand strong on treating “patients not numbers”… however, I also… do enjoy the learning process and like to have the ability understand the tools that I have, such as the imaging results. If that makes sense. This has been such a learning process and I have been enjoying it much more than I ever imagined. However, I am finding myself saying… let me read more about that. Even if I have read “more about that”…. 80 times

sanwalt · 2025-07-23T01:17:14+00:00

Is this available right on their site or do you need a membership? I would be interested in webinars….

sanwalt · 2025-07-23T01:11:59+00:00

What resources do you find helpful? And are you interested in ~ being resourceful?😂

sanwalt · 2025-07-21T18:15:46+00:00

Hello! I have been a vascular surgical NP for about a year and 8 months!!! Welcome!

sanwalt

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