Arterial Evaluation Flashcards
○ provides objective data about arterial perfusion of the lower limbs
○ Identifies individuals who are at risk for developing chest pain, ischemic ulcers or gangrene
○ Uses Doppler US
○ Provides objective data about arterial perfusion of the LE
Ankle Brachial Index
ABI Location on:
1. UE
2. LE
- Brachial Pulse
- Dorsalis Pedis Pulse
ABI Ranges
> 1.2 = Falsely elevated arterial disease or diabetes
1.19-0.95- Normal
0.94-0.75- Mild Arterial Disease + intermittent claudication
0.74-0.50- Moderate Arterial + rest pain
<0.50- Severe Arterial Disease
- Arterial closing and opening pressure at a specific anatomic location. Also, it measures BP segmentally.
- SP of > 10-15 mmHg between the brachial artery pressure and
the upper thigh systolic pressure = - Pressure gradient located between the upper and lower thigh
cuffs = - Gradient between the lower thigh and upper calf cuff=
- Gradient between the upper and lower calf cuffs =
- Segmental Pressure Measurement
- Aortoiliac Obstruction
- Superficial Femoral Artery Obstruction
- Distal Superficial Femoral or Popliteal Artery Obstruction
- Infrapopliteal Diseae
○ Use of Ultrasound
○ visualize and assess arterial aneurysms
○ detect flow velocity changes at sites of localized stenosis or occlusion
○ Helpful in:
■ assessing proximal iliofemoral stenosis that may be amenable to angioplasty
■ providing follow-up data to assess continued patency of both venous and prosthetic
arterial grafts
■ evaluating the patency of previous angioplasty sites or intravascular stent`
Duplex Scanning
○ traditional “gold standard” for lower extremity arterial evaluation
○ remains the definitive approach for perioperative evaluation in patients requiring
revascularization
○ Preoperative arteriography is an essential part of endovascular procedures
Contrast Arteriography
○ Uses X-ray
○ a standard noninvasive imaging modality for vascular anatomy and pathology
○ a mainstay for preoperative imaging of abdominal aortic aneurysms (3-5 cm)
○ provides accurate information not only of the size of an aneurysm but also the exact location and
critical measurements needed for repair
○ Pregnant patients are contraindicated
Computed Tomography Angiography
○ Uses sound waves
○ determine the morphology of blood vessels
○ assess blood flow velocity
○ evaluate the lumen for the presence of thrombosis
○ evaluate for the presence of hemorrhage, infection, or the status of the end organ
○ Not compromised by overlying bone, bowel gas or calcification (unlike CTA)
○ Optimum imaging alternative
■ patients who are pregnant
■ patients with severe iodinated contrast allerg
Magnetic Resonance Angiography
■ may play a role in inducing nephrogenic systemic fibrosis (NSF) are a concern
● NSF can be catastrophic
● Liver and kidney affectation
■ Caution is recommended in patients with reduced glomerular filtration rate (GFR)
(definitely a GFR less than 30, possibly less than 60) > 30
Gadolinium
Prognosis of PAD
1. PAD Mortality
2. Survival rate of asymptomatic
3, Survival rate of Symptomatic
4. Survival of severe symptomatic
5. Symptomatic and severe symptomatic patients have further decreased?
- 10-year survival rates
- 50%
- 25-50%
- 15%
- Decreased 10 year survival rate
Anti-hypertensives medications
Captopril
Enalapril
Fosinopril
Lisinopril
Risk Factor Management
○ Manage the underlying condition and comorbidities
○ Treat DM, HTn, hyperlipidemia (Metabolic Syndrome) → Less sugar, Anti HTn, Lipid lowering
○ Aggressive smoking cessation → refer; an actual DOH program
○ Weight loss and Diet control → for Obesity
Other Managements
- Statin Therapy (Simvastatin, Rosuvastatin, Atorvastatin)
- Angiotensin-Converting Enzyme Inhibitors (ACEi)
○ Anti-hypertensives - Captopril, Enalapril, Fosinopril, Lisinopril - Antiplatelet Therapy (Clopidogrel)
- Agents for Intermittent Claudication (Cilostazol and Pentoxifylline) 5
- PT Rehab
- Revascularization
