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DMST 343 Vascular 3 > Ankle Brachial index > Flashcards

Ankle Brachial index Flashcards

1
Q

What kind of test is a Ankle Brachial index test?

A

Non invasive physiologic test that compares the systolic pressure at the ankle to the systolic pressure of the brachial artery

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2
Q

What kind of doppler waveform is used with ABI tests?

A

CW doppler waveforms are recorded to support the pressure data

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3
Q

During a ABI test, when an arterial lumen is narrowed to a critical level, what happens?

A

The distal arterial flow and pressure significantly increase

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4
Q

What is the ABI protocol?

A
  1. Wrap cuffs on the ankle and upper arms
  2. Should be placed snug and “straight” rather than “angled”
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5
Q

How should we place the ankle and arm cuffs for ABI protocols?

A

0-12 cm bladder (width) 2-3 cm above the medial malleolus

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6
Q

How do we obtain the posterior tibial artery signal? 7 step by step

A
  1. Obtain signal posterior to the medial malleolus
  2. Angle 45-60 degrees, pointing the probe towards the heart, with enough pressure to keep the probe in place without compressing the artery
  3. Record PTA signal
  4. Inflate the cuff 20-30 mmHg above the last audible signal
  5. Slowly deflate cuff (2-4 mmHg/ second)
  6. Systolic pressure is recorded in mmHg at the first audible signal
  7. Ensure the doppler pulse continues after the first pulse to confirm it is an actual signal and not an artifact
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7
Q

What is the problem with each of these images?

A
  1. Doppler probe is positioned over the artery at 90 degrees X
  2. Doppler probe is positioned to far distal to the medial malleolus X
  3. Doppler probe is in a good position over the PTA with a good angle and parallel to the long axis of the artery
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8
Q

What are we getting here?

A

Posterior tibial artery

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9
Q

When sampling the pedis artery (DPA) we need to avoid sampling to close to the toes why?

A

You will likely be listening to the plantar arch or digital vessel

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10
Q

When sampling the DPA if the signal is dampened, retrograde or absent what do we do?

A

Move to the anterior ankle area and search for the ATA signal

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11
Q

What do we do if we can’t locate the DPA or the ATA signal?

A

Find the peroneal artery (PerA) slightly anterior to the lateral malleolus

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12
Q

What procedure does this represent?

A

DPA

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13
Q

Where doe we obtain the bilateral brachial (BrA) Pressures?

A

On the radial artery

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14
Q

If the brachial pressure differs >20mmHg or if the waveforms are different, what do we examine? Why?

A
  1. The vertebral arteries to check flow direction.
  2. Retrograde vertebral flow on the same side as the lower brachial indicates subclavian steal syndrome
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15
Q

How do we calculate ABI?

A

Pedal pressure / Highest brachial pulse

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16
Q

In terms of ABI, what is the normal drop from heart to distal lower extremity?

A

10 mmHg

17
Q

In terms of ABI, corresponding increase in the amplitude of pulses distally, results from what?

A

Increased peripheral resistance and elastic recoil?

18
Q

In terms of ABI, Normal resting ankle systolic pressures are usually what?

A

The same or slightly higher than the brachial pressure

19
Q

IF ABI appears abnormal, what should be done?

A

Higher brachial should be measured again

20
Q

During ABI, At the ankle the PRA usually has higher pressure than what?

A

The ATA and DPA

21
Q

What is the average ABI supine?

A

1.1

22
Q

What is the normal ABI normally?

A

Usually >0.9 but values will differ in each lab

23
Q

Label the chart

A
24
Q

Falsely high ABIs will occur in patient with what?

A

Medical calcifications (5-10% too high)

25
Q

ABI’s >1.3 toe pressures (PPG) should be done why? And what is the normal toe/ brachial pressure?

A
  1. For accuracy
  2. > 0.75
26
Q

Systolic pressure is invalid and must rely on what?

A

Pulse waveforms and toe pressures

27
Q

What are indications that the artery is calcified? 3

A
  1. Doppler signal does not reappear at a clearly defined pressure
  2. Pulse amplitude increases with further cuff deflation
  3. Artifactually elevated pressure may not correspond with the pulse waveform
28
Q

ABI’s >1.3 mmHg occurs when? 2

A
  1. Diabetic patients
  2. Patients on steroid therapy for renal disease
29
Q

What is important to understand in terms of level of pressure measurement?

A

It is determined by cuff position and NOT by the site of doppler interrogation

30
Q

Placing the cuff too high on the calf does what?

A

Does not give an accurate reading on ankle pressure

31
Q

What are some limitations of ABI? 6

A
  1. Falsely increased pressures from calcified vessels, you can rely on a low pressure recording but not a high one
  2. Significant lesions with developed collateral circulation resulting in normal distal pressures and waveforms at rest
  3. Extensive bandaging or casts which cannot be removed
  4. Areas of trauma, surgery, ulceration, or graft placement that the pressure cuff should not compress
  5. Acute DVT in the lower extremities should not have pressure cuffs inflated over their thrombus
  6. Pressure measurements are usually not permitted on ipsilateral side of mastectomy or AVG/ AVF (arteriovenous graft/ Arteriovenous fistula
32
Q

In terms of exercise stress testing, what is acceptable for exercising for a symptomatic patient?

A

Treadmill walking is acceptable for exercising a symptomatic patient with suspected PAD, especially when the ABI is in the normal range

33
Q

Post- exercise ABI’s are used to assess what?

A

Functional impairment

34
Q

Exercise stress testing assesses what?

A

Whether walking limitations and induced pain is secondary to nonvascular conditions, such as MSK or cardio pulmonary disease

35
Q

What is the protocol for Exercise stress testing? 4

A
  1. Measure pre-exercise BP and ABI’s
  2. Patient walks on the treadmill at 10% grade and speed of 2 mph for 5 minutes or until claudication or other restrictions occur.
  3. Remeasure the BPs and ABIs within the first minute post exercise
  4. Measure BPs and ABIs every 2 minutes, until the ankle pressure returns to within 10 mmHg of the baseline pressure or for 6 -12 minutes
36
Q

What are limitations for exercise stress testing? 4

A
  1. Chest pain
  2. Arrythmias
  3. Post MI/ cardiac procedure and not cleared by cardiologist
  4. Hypertension greater than 180 mmHg
37
Q

What would normal ABI stress testing look like?

A
  1. Little or no decrease in ankle BP after 5 minutes of exercise
  2. Decrease in post- exercise systolic pressure should be <20% of the resting pressure and should return to baseline within 3 minutes after exercise
38
Q

Filling in the diagnostic criteria post treadmill exercise BP and ABI’s and recovery times

A
39
Q

What does abnormal recovery Exercise stress test look like? 2

A
  1. Immediate decrease from baseline in post-exercise ankle BP indicates significant arterial obstruction
  2. Severity of the disease is also related to the distance a patient can walk and the absolute pressure drop

DMST 343 Vascular 3 (7 decks)

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