Ch. 11 Vascular Flashcards
In POAD, intermittent claudication is
pain in large muscle groups caused by activity that subsides with rest
Where does intermittent claudication usually occur where in the body? and approx. what location of each portion?
calf, thighs, buttocks, distal to the site of disease
What are risk factors of PAOD
smoking, diabetes, obesity, high blood pressure, high cholesterol, high triglycerides
TRUE claudication symptoms are
relieved with quiet standing, easily reproducible with the same amount of activity
What are some diseases that mimic claudication
SPINAL STENOSIS, herniated disk, osteoarthritis
What disease would be relieved by sitting down
spinal stenosis
In PAOD, what are the symptoms of rest pain
pain in foot while patient is lying down, represents increasing severity of disease
What are advanced symptoms of PAOD
thickening of toenails and loss of toe hair, skin discoloration and scaliness, elevation pallor, dependent rubor, ulceration/gangrene, blue toes may indicate aneurysmal disease
Blanching of leg if raised above heart level
elevation pallor
Feet turn red over the toes and foot when hanging down
dependent rubor
What should patient position be for PAOD
supine with head on pillow and NOT elevated, SAME LEVEL AS THE HEART
For systolic pressures, it is important to let the patient rest for _____ before beginning exam
10-15 mins
Why do patients need to rest before the exam
to ensure true resting levels of blood flow
What should the width of the cuff be for systolic pressure
20% wider than the diameter of underlying limb
What happens if the cuff is too narrow
falsely elevated pressure
What happens if the cuff is too wide
falsely lower pressure
For ABIS, cuffs are placed
upper arm and ankle
For multilevel lower extremity pressures, cuffs are placed
upper arm, thigh, calf, ankles
Doppler signal is obtained _____ to cuff
distal
Where are the cuffs placed distally
PTA or DPA
Once doppler signal is obtained, cuff is inflated to
register systolic pressure
The cuff should be inflated to
20mmHg above point where signal disappears
Cuff should be deflated at a rate of
about 3 mmHg/s
How do you calculate ABI
by dividing highest systolic ankle pressure by the higher of the two brachial systolic pressures
What systolic pressures should all be calculated for ABI
bilateral brachial, PTA, DPA
What is normal ABI
1.0`
A change of _____ between repeat studies is considered significant
0.15
What ABI values correspond with worsening PAOD
lower
What ABI values typically correspond to calcified arteries
excessively high
Systolic pressure is invalid when the underlying artery is calcified and incompressible. T/F
T
ABI identifies overall severity of PAOD but not necessarily
the site
What can add additional information to ABI about disease location
segmental limb systolic pressures
How is the 3 cuff method performed
one large cuff on thigh, one cuff around calf just below the knee and one cuff at the ankle
How is the 4 cuff method performed
two smaller cuffs on thigh (high thigh and above knee), one at calf and one at ankle
What does the 4 cuff method have the ability to define level of disease and separate
iliofemoral disease from superficial femoral artery disease
In SLSP, doppler signal is obtained where and pressures are abstained from where
ankle / ankle, calf and thigh levels (START DISTALLY AND MOVE SUPERIORLY)
What pressure is used in SLSP for pressure measurement up the limb
highest of the PTA or DPA
MAIN DETERMINANT of doppler characteristics is
peripheral resistance
Systolic pressures usually ______ as blood flows distally in the lower extremity
increase
_________ affects the amplitude of the waveform as you travel ______
increased peripheral resistance, distally
Any reduction in DISTAL pressure should be ______ between adjacent segments
<30mmHg
Pressure drop >30mmHg indicates presence of
proximal obstruction
The width of thigh cuff changes interpretation. A single ____ thigh cuff results in a thigh pressure _____ to the _____ pressure
large, equal, brachial
Use of a narrower thigh cuff results in ______ thigh pressure
higher
What is exercise testing primarily used for
patients with intermittent claudication with normal or close to normal ABIs at rest
Typical treadmill settings are
10% grade, 1-2 mph, walking time of 5 mins
What are the contraindications for treadmill testing
chest pain, arrhythmias, post MI or cardiac procedure, unsteadiness, hypertension
What is considered hypertension
> 180mmHg
Lowest value of post activity ABI categorizes
functional severity of the limb
ABI that returns to pre-exercise level within 5 mins is associated with
single level disease
ABI that returns to pre-exercise level >10 mins is associated with
multilevel disease
What angle to the skin should be used for doppler waveforms
45 degrees
What are normal doppler waveforms
bi- to triphasic
Flow reversal related to greater
resistance flow
What is (air) plethysmophraphy also called
pulse volume recording (PVR), volume pulse recording (VPR)
Does plethysmography identify specific arteries
no
Like segmental pressures, plethysmography can use either
one or two cuffs on the thigh plus one calf cuff and one ankle cuff
In plethysmography, each cuff is inflated to
55-65 mmHg
What happens to VENOUS flow during plethysmography when cuffs are inflated
it is restricted
Changes under the cuff are from
arterial inflow
NORMAL PVR waveforms should include
rapid upstroke with well-defined peak, dicrotic notch, bends towards baseline through diastole
Result of the reflected wave in healthy high resistance vessels
dicrotic notch
In plethysmography, moderate to severe disease has waveforms of
delayed onset peak, round peak, convex diastolic phase
What does TBI stand for
toe-brachial index
What is a normal TBI value
greater than or equal to 0.8
When is TBI useful
when ankle vessels are incompressible
Tow pressure of ______ indicates adequate pressure for healing
50mmHg
PAOD in the upper extremity is encountered in ____ of all cases
<5%
Upper extremity PAOD typically occurs as
TOS syndrome, Raynaud disease
What are symptoms of thoracic outlet syndrome
numbness, aching, tiredness with positional changes of the shoulder
Where is PAOD most likely to happen in the upper extremity
subclavian, proximal axillary arteries
____ difference in brachial systolic pressures indicates presence of subclavian artery stenosis
> 20mmHg
What does DBI stand for
digital-brachial index
What is a normal DBI value
greater than or equal to 0.9
scular compression by structures in the shoulder girdle is called
thoracic outlet syndrome
In TOS, compression is a common finding but what is rare to experience
symptoms, especially with arterial compression
_____ may have neurovascular compression of the structures of the ____ and be ______
60%, shoulder, asymptomatic
Symptoms of TOS can be
reproduced in a specific position or with a particular activity
How is TOS commonly tested
using PPG to record digital waveforms
What are the positions for TOS
arms resting in lap, military position, arms elevated above head, arms abducted rearward, adson maneuver
What is the military position
elbows to rear and arms upright, palms front
what is the adson maneuver
arms straight out to sides with head ahead, then left, then right
Raynaud disease can be classified as either
primary or secondary
What is primary raynaud
vasospasm only
What is secondary raynaud
fixed obstruction with associated vasospasm
Primary raynaud tends to affect what age and gender of patients
teens, female
What colors do the hands change to during raynauds
white, then blue, then red (with warming)
What test is used to determine digital perfusion prior to certain surgical procedures
allen test
