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Arterial Procedures > Diagnostic Criteria > Flashcards

Diagnostic Criteria Flashcards

1
Q

What is the purpose of a physiologic arterial exam?

A
  • Presence
  • Severity
  • Location
  • Change
  • Healing
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2
Q

What is the purpose of a physiologic arterial exam?

A
  • Presence
  • Severity
  • Location
  • Change
  • Healing
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3
Q

What are some of the arterial physiologic techniques?

A
  • ABI
  • Segmental Pressures
  • CW Doppler
  • Segmental Plethysmography (VPR)
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4
Q

What do arterial physiological techniques evaluate?

A

These techniques ONLY evaluate HEMODYNAMICALLY SIGNIFICANT obstructions.

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5
Q

What does hemodynamically signifcant mean?

A

A blockage more than 50%

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6
Q

Why do we use all these techniques?

A

Using multiple physiologic exams improves the accuracy over any single test used alone.

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7
Q

What is the purpose of an ABI exam?

A
  • Presence
  • Severity
  • Change
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8
Q

What is the diagnostic criteria for an ABI change to be considered as a possible change?

A

> .15

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9
Q

What is the diagnostic criteria for an ABI change to be considered as a probable change?

A

> .20

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10
Q

What is the diagnostic criteria for an ABI to likely have a single level of obstruction?

A

> .50

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11
Q

What is the diagnostic criteria for an ABI to likely have multiple levels of obstruction likely?

A
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12
Q

What are some of the ABI limitations?

A
  • Calcified arteries (>1.35)
  • Ulceration
  • Intolerance of pressure cuff
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13
Q

What are the 3 locations of an obstruction with segmental pressures?

A
  • Aortio-illiac
  • Femoral-pop.
  • Infrapop
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14
Q

Where can obstructions be found when doing segmental pressures?

A

At or above the cuff.

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15
Q

What are some segmental pressure limitations?

A
  • Painful, especially at the upper thigh cuff.
  • Calcified arteries yield falsely elevated pressures, especially at ankles.
  • Cuff artifact yield falsely elevated pressures, especially at upper thigh.
  • Limited over ulceration.
  • Cannot tell stenosis from occlusion.
  • May miss obstructions distal to a more proximal obstruction.
  • May miss well-collateralize obstructions.
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16
Q

What does a CW Doppler look for?

A
  • Presence
  • Severity
  • Location
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17
Q

What are the CW Doppler descriptors?

A
  • Triphasic= Sharp upstroke, sharp peak, has a reverse flow component in late systole/early diastole.
  • Biphasic=Good upstroke, sharp peak, no reverse flow component.
  • Monophasic= Slow upstroke with blunted, wide peak, and slow downslope.
  • Barely or Non-pulsatile= flattened but audible.
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18
Q

What does parvus tardus?

A

No inflection point.

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19
Q

What is triphasic described as?

A

Normal.

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20
Q

What is biphasic described as?

A

Abnormal Mild/Mod

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21
Q

What is monophasic described as?

A

Abnormal severe.

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22
Q

What is barely or non-pulsatile described as?

A

Critical.

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23
Q

In a CW Doppler, a change from one level to the next indicates what?

A

It indicates an obstruction between the sites.

ie. triphasic-biphasic-monophasic-nonpulsatile-absent

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24
Q

What happens when a wave is abnormal?

A

once its abnormal, the wave is likely to stay abnormal.

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25
Q

At the CFA, if not triphasic, obstruction is typically?

A
  • aorto-illiac
  • illiac
  • proximal CFA
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26
Q

Why would a CW Doppler be abnormal?

A

It may be abnormal if waveform is taken just proximal to an occlusion or if well collateralized.

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27
Q

What are some CW Doppler limitations?

A
  • Blind= no image
  • Operator skill needed.
  • Calcification limits data deep to the calcific area.
  • Pre-at-post=stenosis Doppler change.
  • Qualitative analysis
  • Dependent on state of flow= may be interrupted by inflammation and/or exercise.
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28
Q

What is the diagnostic criteria for a PVR?

A
  • Presence
  • Severity
  • Location
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29
Q

What are some of the arterial physiologic techniques?

A
  • ABI
  • Segmental Pressures
  • CW Doppler
  • Segmental Plethysmography (VPR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What do arterial physiological techniques evaluate?

A

These techniques ONLY evaluate HEMODYNAMICALLY SIGNIFICANT obstructions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What does hemodynamically signifcant mean?

A

A blockage more than 50%

32
Q

Why do we use all these techniques?

A

Using multiple physiologic exams improves the accuracy over any single test used alone.

33
Q

What is the purpose of an ABI exam?

A
  • Presence
  • Severity
  • Change
34
Q

What is the diagnostic criteria for an ABI change to be considered as a possible change?

A

> .15

35
Q

What is the diagnostic criteria for an ABI change to be considered as a probable change?

A

> .20

36
Q

What is the diagnostic criteria for an ABI to likely have a single level of obstruction?

A

> .50

37
Q

What is the diagnostic criteria for an ABI to likely have multiple levels of obstruction likely?

A
38
Q

What are some of the ABI limitations?

A
  • Calcified arteries (>1.35)
  • Ulceration
  • Intolerance of pressure cuff
39
Q

What are the 3 locations of an obstruction with segmental pressures?

A
  • Aortio-illiac
  • Femoral-pop.
  • Infrapop
40
Q

Where can obstructions be found when doing segmental pressures?

A

At or above the cuff.

41
Q

What are some segmental pressure limitations?

A
  • Painful, especially at the upper thigh cuff.
  • Calcified arteries yield falsely elevated pressures, especially at ankles.
  • Cuff artifact yield falsely elevated pressures, especially at upper thigh.
  • Limited over ulceration.
  • Cannot tell stenosis from occlusion.
  • May miss obstructions distal to a more proximal obstruction.
  • May miss well-collateralize obstructions.
42
Q

What does a CW Doppler look for?

A
  • Presence
  • Severity
  • Location
43
Q

What are the CW Doppler descriptors?

A
  • Triphasic= Sharp upstroke, sharp peak, has a reverse flow component in late systole/early diastole.
  • Biphasic=Good upstroke, sharp peak, no reverse flow component.
  • Monophasic= Slow upstroke with blunted, wide peak, and slow downslope.
  • Barely or Non-pulsatile= flattened but audible.
44
Q

What does parvus tardus?

A

No inflection point.

45
Q

What is triphasic described as?

A

Normal.

46
Q

What is biphasic described as?

A

Abnormal Mild/Mod

47
Q

What is monophasic described as?

A

Abnormal severe.

48
Q

What is barely or non-pulsatile described as?

A

Critical.

49
Q

In a CW Doppler, a change from one level to the next indicates what?

A

It indicates an obstruction between the sites.

ie. triphasic-biphasic-monophasic-nonpulsatile-absent

50
Q

What happens when a wave is abnormal?

A

once its abnormal, the wave is likely to stay abnormal.

51
Q

At the CFA, if not triphasic, obstruction is typically?

A
  • aorto-illiac
  • illiac
  • proximal CFA
52
Q

Why would a CW Doppler be abnormal?

A

It may be abnormal if waveform is taken just proximal to an occlusion or if well collateralized.

53
Q

What are some CW Doppler limitations?

A
  • Blind= no image
  • Operator skill needed.
  • Calcification limits data deep to the calcific area.
  • Pre-at-post=stenosis Doppler change.
  • Qualitative analysis
  • Dependent on state of flow= may be interrupted by inflammation and/or exercise.
54
Q

What is the diagnostic criteria for a PVR?

A
  • Presence
  • Severity
  • Location
55
Q

What does a normal PVR waveform look like?

A

It has a dicrotic notch or downslope bowing in.

56
Q

What are some typical LE PVR normal amplitudes in the thigh, calf and ankle.

A
  • Thigh >15mm
  • Calf >20mm
  • Ankle >15mm
57
Q

What are some limitations to VPR?

A
  • Qualitative
  • Patient size (large limbs result in low amplitude)
  • Cuff application.
58
Q

During stress exercise testing, little to no drop in ankle pressure compared to resting values indicates that it is…normal or abnormal?

A

Normal.

59
Q

What indicates a single level of obstruction after a stress exercise test?

A

Ankle pressures very low or to zero immediately post exercise with recovery. (2-6 minutes)

60
Q

What indicates a multi-level obstruction after a stress exercise test?

A

Very reduced pressures or inaudible signals for >12 minutes.

61
Q

In PORH, what is considered normal?

A

A slight drop in ankle pressure (80% of baseline) that returns in 1 minute.

62
Q

In PORH, what is considered abnormal?

A

> 80% drop in baseline. Pressure taking more than 1 minute to return to baseline.

63
Q

In PORH, what indicates a single level obstruction?

A

<50% drop in ankle pressure.

64
Q

in PORH, what indicates a multi-level obstruction?

A

> 50% drop in ankle pressure.

65
Q

True or False: PORH is very sensitive as exercise.

A

False, PORH is not as sensitive as exercise.

66
Q

What are normal toe/brachial ratio?

A

> .60-1.0

67
Q

What are considered moderate decrease in perfusion toe/brachial ratio?

A
68
Q

What is considered a severe toe/brachial pressure?

A

<20-30 mmHg

69
Q

What pressure is considered sufficient for healing?

A

> 30-40 mmHG

70
Q

Why do we do all these test?

A

Using multiple physiological exams improves the accuracy over any single test used alone.

71
Q

What are some IAC vascular standards?

A
  • ABI required (presence, severe, change)
    • Use the highest brachial and ankle pressure for the ratios.
  • Non-imaging exams (location of obstruction)
    - Must have bilateral sampling from 3 or more levels.
    - Only one type of a waveform is required.
72
Q

What locations are required in a VPR?

A

Thigh, calf, ankle required at a minimum.

73
Q

What is required for a CW/PW Doppler?

A
  • Doppler at least 3 levels.

- CFA, POP, DP/PT are required.

74
Q

What is required in the pressures?

A

AT least one level (ABI is required)

75
Q

Requirements for a PPG?

A

It is not required, its supplemental.

76
Q

What is the minimum documentation in an IAC standard of exercise testing?

A
  • Pressure at rest.
  • Pressure at time intervals after rest.
  • Time of onset symptoms and maximum walking time.

Arterial Procedures (13 decks)

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