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Vascular > Doppler Segmental Pressures (LE) > Flashcards

Doppler Segmental Pressures (LE) Flashcards

1
Q

What are limitations of a Doppler segmental pressures exam

A
  • cannot discriminate between stenosis and occlusion, or the precise area of obstruction
  • cannot discriminate between CFA and external iliac disease
  • may give falsely elevated Doppler on calcified vessels (patients with diabetes and end stage renal disease are common with this)
  • wrong cuff size can give false pressures
  • difficult to interpret multi-level diseases
  • patients with CHF may have decreased ankle/brachial indices
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2
Q

Patients with these conditions may not be able to get pressure scans
(6)

A

DVT, dialysis access, lymphedema, stent, bypass graft, patients who had mastectomy

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3
Q

How long should patients rest before having this exam done

A

20 minutes

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4
Q

Ideally the cuff bladder should be placed over the______

A

Artery

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5
Q

It is VERY important that the width of the cuff is around ____% greater than the diameter of the limb

A

20%

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6
Q

With the four cuff (Bilateral) the cuffs are placed on the brachial (upper arm) and what other four areas?

A

High thigh (with a longer cuff for thighs)
Low thigh/above the knee (AK)
Below the knee (BK)/calf
At the ankle

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7
Q

With the three cuff method, the cuffs are placed at the brachial(upper arm), and what other 3 locations

A

One thigh cuff (19 X 40cm)
Below the knee/calf
At ankle

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8
Q

What is the average cuff size (excluding the thigh cuffs)

A

12 X 40 cm

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9
Q

For optimal Doppler signal the probe should be at a __ to __ degree angle to skin, with the blood flow moving ___ to the probe.

A

45-60 degree angle ( at the knee it may be closer to 90 degrees bc of vessel angulation)

Blood flowing towards the probe (Antegrade)

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10
Q

What is a sphygmomanometer

A

A hand held automatic cuff inflator

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11
Q

What is the order for a sphygmomanometer pressure exam, starting with
1. brachial artery

A
  1. At ankle (for PTA and DPA, **if necessary peroneal A.)
  2. Calf/BK (for PTA or DPA, use the HIGHEST pressure for this level)
  3. Above the knee/AK (same as calf, may need popliteal A. If difficult to obtain)
  4. High thigh/HT (same as above the knee)
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12
Q

Why are we performing segmental pressures from ankle to thigh?

A

To eliminate the possible underestimation of the systolic pressure measurements

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13
Q

Cuffs need to inflate ____ to ____ mmHg beyond last audible Doppler signal OR the same amount of mmHg higher than the highest brachial pressure

A

20-30 mmHg higher for both examples

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14
Q

For repeat measurements be sure to deflate completely and wait ____ minute(s) before repeat.

A

About one minute

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15
Q

To calculate ABI’s, divide the ankle pressure by _____

A

Ankle pressure divided by the HIGHER of the two brachial pressures

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16
Q 
ABI use the following chart to detect severity
> 1.0 = ?
> 0.9-1.0 =?
0.8-0.9 = ?
0.5-0.8 = ?
A

> 1.0 = normal
0.9-1.0 = may be within normal limits
0.8-0.9 = mild arterial disease
0.5-0.8 = claudication (moderate disease)

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17
Q

Incompressible vessels will give false elevations making it inaccurate, what is the range on the ABI index to consider it incompressible?

A

> 1.3-1.5

18
Q

T/F
Some authors think that an absolute ankle pressure of less than 50mmHg, rather than the ABI of .5 has a stronger weight for predicting symptoms at rest

A

TRUE

19
Q

An ABI of greater than and equal to ___ represents SINGLE segment disease

A

Greater or equal to .5

20
Q

ABI of less than .5 suggests ______ lesions

A

Multiple lesions

21
Q

Segmental pressure drop between two consecutive levels needs to be greater than what mmHg in order to suggest SIGNIFICANT obstruction

A

Greater than 30 mmHg

** some authors suggest greater than 20 mmHg

22
Q

If there is a pressure difference of greater than or equal to 20 or 30 mmHg between the right and left legs, this suggests?

A

Obstructive disease at or above the level in the leg with the lower pressure

23
Q

With a 4 cuff technique, the HIGH THIGH is normally how much higher than the brachial pressure?

A

Normally greater than or equal to 30 mmHg in thigh than brachial

24
Q

3 cuff methods, the thigh pressure should be what in comparison to the brachial pressure?

A

Should be similar in pressures

25
Q

Toes pressures of less than or equal to 30 mmHg are present in foot/toe ulcers that [did or did not] heal

A

Did not heal

26
Q

Toe pressures may be more reliable in what kind of patient

A

Diabetic patients

27
Q

What does exercise during segmental pressure tests help to differentiate?

A

True VS false claudication

28
Q

Name a few contraindications for ABI’s with exercise

A 
Shortness of breath
Severe hypertension
Significant cardiac problems
Stroke
Walking problems
29
Q

For the exercise portion of the ABI, the patient walks on a ____ ____ treadmill at a less than or equal to _____% elevation

A

Constant load treadmill at a < or equal to 12% elevation

30
Q

What is the speed and maximum time the patient walks for this test

A
  1. 5mph for a max of 5 minutes

* *or until symptoms are too severe for patient to continue

31
Q

With exercise ABI, we document these 3 things

A

Duration of walk
MPH
onset/location/progression of symptoms

32
Q

Post-exercise pressures are obtained on both _____, then ______

A 
Both ankles (abnormal first)
Higher of the two brachials
33
Q

Immediately after exercise, a normal ABI will ______ and an abnormal ABI will ______

A 
Normal = ABI increases
Abnormal = ABI decreases
34
Q

With a decreased ABI post-exercise (aka abnormal), we obtain pressures every 2 minutes untill……

A

Untill pre-exercise pressures are attained

35
Q

Post-exercise, _____ level disease will take 2-6 minutes for ABI to increase to the pre-exercise ABI. While _____ level disease takes 6-12 minutes.

A

SINGLE level disease takes 2-6 minutes

MULTI-level disease takes 6-12 minutes

36
Q

T/F

Reactive hyperemia patients for the most part CANNOT walk

A

True

37
Q

When a patient cannot walk (reactive hyperemia), what is the alternative method to exercise for an ABI

A

We inflate bilateral thigh cuffs (19 X 40) to a SUPRASYSTOLIC pressure level (usually 20-30mmHg above the higher BP), and maintain the pressure for 3-5 minutes

**this produces ischemia and vasodilation distal to the occluding cuffs

38
Q

With the “non-exercise” technique of ABI, what is the range for a normal limb drop

A

Normal limbs may show a transient drop of 17-34%

39
Q

With reactive hyperemia ( non-exercise) patients, a single level disease is < or = a 50% drop in ankle pressure, and a multi-level disease will have what

A

Multi-level disease is a >50% ankle pressure drop

40
Q

Why is the treadmill testing the preferable test for exercise ABI

A

It produces a physiologic stress that reproduces a patients ischemic symptoms

Vascular (15 decks)

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