Chapter 5: Doppler Segmental Pressures (LE)

Question 1

Doppler segmental pressure capabilities

Answer 1

asses presence/ severity of arterial disease

combine with doppler velocity or volume pulse waveform

Question 2

segmental pressure results: stenosis vs occlusion

Answer 2

cannot differentiate between stenosis vs occlusion

Question 3

segmental pressure results: ? area of obstruction

Answer 3

cannot precisely localize area of obstruction

Question 4

segmental pressure results: CFA vs iliac disease

Answer 4

cannot distinguish between CFA or iliac disease

Question 5

segmental pressure results: calcified vessels

Answer 5

give falsely elevated doppler pressures

ex: diabetics, end stage renal disease

Question 6

segmental pressure results: uncompensated CHF

Answer 6

gives decreased ankle and brachial indices

Question 7

segmental pressure results: cuffs are too small/too tight

Answer 7

elevated pressures

Question 8

patient positioning for segmental perssures

Answer 8

pt should rest 20 minutes prior to exam
supine
legs same level as heart

Question 9

if the cuff is too large for a limb segment

Answer 9

BP is falsely lower

Question 10

if the cuff is too narrow for a limb segment

Answer 10

BP is falsely higher

Question 11

technique

Answer 11

cuff placed straight on extremity, not on bony prominence
cuff bladder placed over artery
width of cuff should be about 20% greater than diameter of limb

Question 12

the cuff bladder placement is important because

Answer 12

appropriate technique ensures the bladder inflation transmits pressure quickly into the tissue to compress the artery

Question 13

The four cuff method (bilateral)

Answer 13

brachial
high thigh
above knee
below knee
ankle

Question 14

the four cuff method size

Answer 14

12 x 40 cm

cuff bladders longer for thighs

Question 15

three cuff method (bilateral)

Answer 15

brachial
one thigh cuff (19 x 40cm)
below knee
ankle

Question 16

three cuff method size

Answer 16

thigh cuff 19 x 40cm but all else

12 x 40 cm

Question 17

difference between 4 cuff and 3 cuff method

Answer 17

two thigh cuffs provide prx and dst pressure measurements but falsely elevate BPs
3 cuff is more accurate due to one cuff on thigh

Question 18

optimizing doppler signal for segmental pressures

Answer 18

8-10 MHz probe
angle probe 45-60 degrees to skin
angle probe so blood flow moves antegrade (towards the probe)

Question 19

due to vessel angulation, probe angle behind the knee may be closer to

Answer 19

90 degrees to skin

Question 20

order of segmental pressures

Answer 20

Brachial (upper arm, brachial artery)
Ankle (PTA or DPA, peroneal only if necessary)
Calf (PTA or DPA whichever has highest pressure)
Above the knee (same as calf, can use pop artery if difficult to obtain)
High thigh

Question 21

what is the reason you start at the ankle and move proximally

Answer 21

to eliminate possibility of underestimating the systolic pressure measurement

Question 22

what is required of the BP cuff to make this accurate

Answer 22

complete cessation of blood flow is required
cuff inflated to 20-30mmHg beyond last audible Doppler arterial signal

OR

inflate cuff 20-30mmHg higher than the highest brachial pressure

Question 23

if pressure measurements must be repeated:

Answer 23

the cuff should be fully deflated for about a minute prior to repeat inflation

Question 24

systolic pressure is recorded as

Answer 24

the pressure at which the first audible doppler arterial signal returns

Question 25

ABI (ankle/ brachail index) is calculated by

Answer 25

dividing the ankle pressure by the higher of the two brachial pressures

Question 26

another term for ABI is

Answer 26

ankle/arm pressure index (API)

Question 27

ABI > 1.0

Answer 27

Normal

Question 28

ABI >.9 - 1.0

Answer 28

may be wnl

Question 29

ABI .8-.9

Answer 29

mild arterial disease

Question 30

ABI .5 - .8

Answer 30

claudication (moderate disease)

Question 31

ABI < .5

Answer 31

rest pain (severe disease)

Question 32

in compressible vessels:

Answer 32

falsely elevated and inaccurate pressures

Question 33

At what point is an ABI considered incompressible/unreliable?

Answer 33

> 1.3 - 1.5

Question 34

some authors feel that

Answer 34

ankle pressure <50mmHg is better at predicting symptoms at rest than an ABI of .5

Question 35

Strandness work suggests

Answer 35

ABI of > or = to .5 represents single segment disease and < .5 represents multiple lesions

Question 36

Segmental pressure drops of what between levels indicates significant obstruction

Answer 36

30 mmHg

Question 37

A horizontal difference of what suggest obstructive disease

Answer 37

20-30 mmHg suggests diesaes at or above level in the leg with the lower pressure

Question 38

four cuff technique high thigh pressure

Answer 38

usually > or = to 30 mmHg than highest brachial pressure

Question 39

Four cuff technique and at knee and below knee pressures

Answer 39

should be at least the same as the highest brachial

Question 40

Three cuff technique thigh pressure

Answer 40

similar to highest brachial pressure

Question 41

Toe pressures for foot and toe ulcers that failed to heal

Answer 41

<30mmHg

Question 42

when ankle pressures cannot be relied upon (diabetics) what is more reliable

Answer 42

toe pressures

Question 43

benefits of exercise and segmental pressures

Answer 43

helps differentiate between true and pseudo-claudication | determine presences / absence of collaterals

Question 44

contraindications of exercising for this exam

Answer 44

``` SOB severe hypertension cardiac problems stroke walking problems ```

Question 45

technique for exercise during segmental pressures

Answer 45

pt walks on tredmill at <12% elevation | 1.5 MPH for minutes or until symptoms increase to severity where pt must stop

Question 46

what should you document during exercise

Answer 46

duration of walking MPH onset location and progression of symptoms

Question 47

post exercise dopplers obtained:

Answer 47

both ankles (abnormal first) then higher brachial

Question 48

Normal post exercise ABI

Answer 48

increases

Question 49

Abnormal post exercise ABI

Answer 49

decreases minimally or to a severe amount

Question 50

with drop after exercise pressures should be obtained

Answer 50

every two minutes until pre exercise pressures are attained

Question 51

Segmental pressure ABI interpretation includes

Answer 51

Duration of exercise length of time to recover pressure changes from pre to post exercise

Question 52

single level disease recovery

Answer 52

takes 2 to 6 minutes for the ABIs to increase back to resting levels after exercise

Question 53

Multi level disease recovery

Answer 53

takes 6-12 minutes for the ABIs to increase back to resting levels after exercise

Question 54

If patient cannot walk on the treadmill what technique should be used

Answer 54

reactive hyperemia

Question 55

reactive hyperemia is an

Answer 55

alternate method for stressing the peripheral circulation

Question 56

reactive hyperemia technique

Answer 56

bilat thigh cuffs (19 x 40) inflated to 20-30mmHg above brachial BP maintain pressure for 3-5 min ABIs are obtained upon release

Question 57

how does the reactive hyperemia technique work

Answer 57

produces ischemia and vasodilation distal to the occluding cuffs

Question 58

normal limb ABI in reactive hyperemia

Answer 58

may show drop of 17-34%

Question 59

reactive hyperemia single level disease

Answer 59

less than or equal to 50% drop in ankle pressure

Question 60

reactive hyperemia multi level disease

Answer 60

>50% ankle pressure drop

Question 61

why is treadmill testing preferred?

Answer 61

produces physiologic stress that reprodruces patients ischemic symptoms