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DMS 500 Vascular > Class 11: LEA Physiological Testing Methods > Flashcards

Class 11: LEA Physiological Testing Methods Flashcards

1
Q

what is the purpose of indirect physiological testing?

A

to detect arterial disease in LEA that is hemodynamically significant

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2
Q

what % stenosis is considered hemodynamically significant?

A

60%

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3
Q

indirect physiological testing is often used as a screening process to ____

A

differentiate between true claudicators & pseudoclaudication

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4
Q

indirect physiological testing is used to assess graft ____

A

patency

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5
Q

5 limitations of indirect physiological testing

A
  1. can’t differentiate bw stenosis & occlusion
  2. only detects hemodynamically significant stenosis
  3. can’t precisely locate occlusive disease (no images!)
  4. hard to differentiate CIA & CFA stenosis
  5. may show falsely elevated pressures in diabetics
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6
Q

another name for ankle brachial index

A

ankle arm index

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7
Q

what is ABI used for?

A

screening process to differentiate true claudicators from pseudoclaudicators

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8
Q

ABI results are usually combined with ___

A

doppler waveform analysis

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9
Q

steps to take the ABI

A
  1. put patient in supine
  2. take BP of both arms; use the higher brachial BP
  3. take BP of both ankles (PTA or DPA)
  4. calculate both ABI ratios: LT ABI = LT ankle BP/highest brachial BP; RT ABI = RT ankle BP/highest brachial BP
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10
Q

what does an ABI ratio of 1.0-1.10 suggest

A

normal findings

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11
Q

what does an ABI ratio of 0.9-1 suggest?

A

minimal ischemia with minimal symptoms

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12
Q

what does an ABI ratio of 0.5-0.9 suggest?

A

mild to moderate ischemia with mild to moderate claudication

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13
Q

what does an ABI ratio of 0.3-0.5 suggest?

A

moderate to severe ischemia with severe claudication or rest pain

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14
Q

what does an ABI ratio of 0.3 or below suggest?

A

severe ischemia with rest pain or gangrene

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15
Q

what do doppler segmental surveys provide more information on?

A

location of disease

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16
Q

2 limitations of doppler segmental surveys

A
  1. can’t distinguish stenosis from occlusion
  2. still not location specific
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17
Q

2 techniques for doppler segmental surveys

A
  1. 3 cuff method
  2. 4 cuff method
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18
Q

which is preferred? 3 cuff or 4 cuff method?

A

3 cuff

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19
Q

why is 3 cuff method preferred over 4 cuff method with doppler segmental surveys?

A

the 4 cuff method can give falsely elevated pressures on the upper thigh

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20
Q

how do you inflate the cuffs with doppler segmental surveys?

A

start from ankle & go up to the thigh

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21
Q

what size should the blood pressure cuff be for doppler segmental surveys?

A

BP bladder should be 20% wider than the limb diameter

22
Q

a ___ mmHg pressure gradient is significant in the presence of an ____ ABI

A

20+ mmHg; abnormal

23
Q

if there is a pressure drop at the level of the high thigh, the disease level is at the ___

A

aortoiliac level

24
Q

if there is a pressure drop at the level of the low thigh, this indicates ___ disease

A

iliofemoral

25
Q

if there is a pressure drop at the level of the high calf, this indicates ___ disease

A

femoropopliteal

26
Q

if there is a pressure drop at the level of the low calf, this indicates ___ disease

A

tibioperoneal

27
Q

how long does a patient need to rest prior to doing a segmental limb survey?

A

20 minutes

28
Q

what patients’ segmental pressures may be unobtainable or too high?

A
  1. diabetics
  2. chronic steroid therapy
  3. renal dialysis patients
29
Q

what ABI is considered too high for segmental limb surveys?

A

> 1.4

30
Q

what causes some patients’ segmental pressures to be too high?

A

calcified arteries

31
Q

digit vessels are affected by calcific medial sclerosis. T/F?

A

false

32
Q

what is a normal toe brachial index (TBI)?

A

> 0.75

33
Q

what is an abnormal TBI?

A

< 0.66

34
Q

what is exercise stress testing used for?

A

to induce reactive hyperemia in patients who may be well-collateralized

35
Q

what is hyperemia?

A

increased blood flow to a part of the body

36
Q

how to perform exercise stress testing?

A
  1. perform ABI
  2. put patient on treadmill for max 5 min
  3. recalculate ABI
37
Q

pressures should ___ after exercise stress testing

A

increase

38
Q

what settings should the treadmill be at for exercise stress testing?

A

1.5-2 mph
10% grade
5 min

39
Q

what are 2 substitutes for exercise stress testing when there are contraindications present for patients?

A
  1. post-occlusive reactive hyperemia (PORH)
  2. toe raises
40
Q

what is post-occlusive reactive hyperemia?

A

when the distal thigh is occluded for 3 minutes with a blood pressure cuff

41
Q

how long should toe raises be done before recording post-exercise pressures?

A

1 minute

42
Q

what are two types of arterial plethysmography?

A
  1. air (pneumo) plethysmography
  2. photo-plethysmography
43
Q

pulse volume recordings are a type of ___ plethysmography

A

air/pneumo plethysmography

44
Q

for PVRs, limb volume changes with ____ & air is ____ within the cuff

A

systole; displaced

45
Q

instantaneous ___ ___ is recorded with PVR

A

pressure change

46
Q

PVR is unaffected by calcified arteries. T/F?

A

true

47
Q

an advantage for PVR includes ___ evaluation

A

metatarsal & toe

48
Q

an advantage for PVR includes assessment for global ___ ___

A

limb perfusion

49
Q

a disadvantage of PVR includes atrial fibrillation. T/F?

A

true

50
Q

how does photo-plethysmography work?

A

infrared light is transmitted into the tissue & reflected light is processed for cutaneous blood flow

DMS 500 Vascular (20 decks)

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