Extremity Arterial Flashcards
no duplicated brachial artery
high brachial bifurcation into radial and ulnar arteries
distribution in diabetes
tibioperoneal trunk
distibution in non diabetics
distal SFA or bifurcation
arterial ulceration dry gangrene
foot/toes
irregular
shallow
minimal/no bleeding poor granulation
venous ulceration wet gangrene
medial malleolus
deep irregular shape
round edges
mild/moderate pain
granulating base
irregular ulcers
venous
shallow ulcers
arterial
granulating ulcers
venous
characteristics of ischemic rest pain
at night with foot elevated relieved by dangling foot or walking
waveform prior to stenosis

peaked -
monophasic -
high resistance
waveform distal to stenosis
parvus et tardus
monophasic
low resistance
hyperemic flow
all above baseline
ABI predicts severity in absence of calcified vessels
not reliable with calcified vessels
significant ABI change = 0.15
increasing severity of disease
ABI > 0.5
single level disease
ABI
multilevel disease
claudication
0.5 - 0.9
rest pain
0.25 - 0.5
normal ABI
0.9 - 1.3 (other chart 0.96 - 1.3)
mild disease ABI
0.80-0.94 (other chart 0.85-0.95)
ABI moderate disease
0.50 - 0.79 (other chart 0.51- 0.84)
ABI severe disease
0.30 - 0.49 (other chart 0.25 - 0.50)
ABI critical
falsely high pressures
due to medial calcification in diabetes and CRF
if greater than 15 mm difference btw PT and DP
proximal disease
effects on PVR amplitude
stroke volume
blood pressure
vasomotor tone
blood volume
limb size limb position
prosthetic graft normal velocity & velocity ratio
prosthetic graft moderate stenosis
180-300 cm/sec ratio > 2
prosthetic graft high grade stenosis
PSV > 300 cm/sec
ratio > 3.5
impending prosthetic graft failure
PSV
vein graft normal velocity
> 45 cm/sec ratio
vein graft moderate stenosis
250-300 cm/sec
ratio > 3.0
vein graft high grade stenosis
> 350 cm/sec
ratio > 3.6
prior femoropopliteal endovascular intervention > 50% stenosis
> 180 cm/sec
ratio > 2.5
prior femoropopliteal endovascular intervention > 70% stenosis
> 300 cm/sec
in stent > 50% restenosis of SFA
PSV > 190 cm/sec ratio > 1.5
in stent > 80% restenosis of SFA
PSV > 275 cm/sec ratio > 3.5
graft flow velocity
average of peak systolic velocities from 3-4 nonstenotic graft segments
normally between 40-45 cm/sec
can be less with larger grafts
monphasic bypass graft waveform
inflow tract obstruction
staccato waveform - no diastolic flow
distal anastomotic or outflow obstruction
exercise recovery
15 min severe occlusive disease
% pressure decrease post exercise - normal range
17-34%
% pressure decrease post exercise single level disease
35-50%
% pressure decrease post exercise multi level disease
> 50%
Takayasu’s arteritis
aorta and branches usually dilation and aneurysm females usually ages 20-40
Giant cell arteritis (temporal arteritis)
medium/large size vessels temporal artery and ECA branches 75-85 year old (women)
Kawasaki’s disease
small medium arteries including coronaries age 2-5 years
elevated celiac artery velocity
exclude median arcuate syndrome record PSV after deep inspiration if normalizes, then confirms diagnosis
fasting SMA waveform
like triphasic arterial waveform
non fasting SMA waveform
low resistance, slow acceleration/deceleration continuous diastolic forward flow
retrograde common hepatic artery waveform
suggestive of celiac stenosis or occlusion
normal celiac artery velocity
98-105 cm/sec
normal SMA velocity
97-142 cm/sec
normal IMA velocity
93-189 cm/sec
Bernoulli principle
decrease area results in increased velocity increased velocity decreases pressure area inc - velocity dec - pressure inc
longer stenosis
smaller velocities
Reynolds number threshold
2000 normal 2000-4000 transitional > 4000 turbulence
before stenosis at or just past stenosis after stenosis
increased PSV - decreased pressure post stenotic turbulence parvus tardus
cuff bladder *** what percentage of limb diameter
40% limb circumference or 20% of limb diameter
going distally in leg pressure and velocity change
pressure increases and velocity decreases
exacerbation of popliteal entrapment
leg hyperextension
dorsiflexion and plantar flexion
arteritis with concentric narrowing
Takayasu and giant cell arteritis
UE arterial index normal pressure normal
0.8 >
70 mm Hg
medium vessel arteritis
Kawasaki
Behcet
Churg
Strauss
Polyarteritis nodosa
large vessel arteritis
Takayasu
giant cell
small vessel arteritis
wegener Henoch schonlein purpua cryroglobulemia microscopic polyangitis SLE RA