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DMST 343 Vascular 3 > Peripheral Arterial Disease 1 > Flashcards

Peripheral Arterial Disease 1 Flashcards

1
Q

What are some risk factors of PAD? 15.

A
  1. Diabetic
  2. Hypertension
  3. Hyperlipidemia
  4. Coronary artery disease (CAD)
  5. Previous history of CVA or MI
  6. Smoking
  7. Chronic renal insufficiency
  8. Age
  9. Family history
  10. Male
  11. Obesity
  12. Sedentary lifestyle
  13. Elevated levels of homocysteine
  14. Excessive levels of C-reactive protein
  15. History of radiation
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2
Q

What are some physical signs and symptoms of PAD? 8

A
  1. Skin changes
  2. Palpations
  3. Auscultations
  4. Limb pressures
  5. Claudication (intermittent)
  6. Ischemic rest pain
  7. Necrosis
  8. Pseudoclaudication
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3
Q

What are some skin changes seen in PAD? 9

A
  1. Pallor
  2. Rubor
  3. Dependent Rubor
  4. Cyanosis
  5. Temperature
  6. Nonhealing ischemic ulcers
  7. Gangrene
  8. Trophic changes (hair loss, nail thickening, skin thinning)
  9. Capillary refill time
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4
Q

In terms of PAD what are palpations?

A
  1. Pulses graded 0-4
  2. Aneurysms
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5
Q

In terms of PAD what can Bruits be caused by?

A

Significant stenosis

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6
Q

In stenosis how many bruits are not heard?

A

> 90%

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7
Q

In terms of signs and symptoms, what does the difference of limb pressures do?

A

Difference in limb pressures indicate disease, if there is a >20 mmHg in upper and lower extremity

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8
Q

What is claudication (intermittent)?

A

Lack of blood supply to a group of muscles

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9
Q

Is claudication reproducible?

A

Yes

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10
Q

What are common sites of claudication for PAD? 4

A
  1. Hip
  2. Buttock
  3. Thigh
  4. Calf
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11
Q

In terms of PAD sites of disease are always where in relation to the muscle group?

A

Proximal

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12
Q

How does claudication feel like?

A

Pain that occurs during exercise but subsides at rest

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13
Q

Ischemic rest pain is always an indicator of what?

A

Advanced multi-segment disease

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14
Q

In terms of ischemic rest pain, pain presents how?

A

Severe and constant

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15
Q

What does ischemic rest pain affect?

A

The dorsum of the foot and toes

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16
Q

Early onset of ischemic rest pain occurs when?

A

Only at night when the limb is not in a dependent position and may be relieved by lowering the foot or mildly exercising

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17
Q

In terms of ischemic rest pain, does rest relieve pain?

A

NO

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18
Q

What is the most severe symptom of PAD?

A

Tissue death

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19
Q

What is pseudoclaudication? Can it be reproducible?

A
  1. Pain caused by other factors
  2. No
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20
Q

What is the most common location of atherosclerotic disease?

A

Femoral artery at the adductor canal?

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21
Q

Atherosclerosis disease may appear how and affect what kind of levels?

A
  1. Focal or diffuse
  2. May affect any level or multiple levels
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22
Q

What are other common sites of Atherosclerosis besides common femoral?

A

At bifurcations and the popliteal artery

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23
Q

What is the most common cause of embolism?

A

From plaque breaking loose from the heart or a proximal aneurysm and traveling until it becomes lodged in a smaller vessel

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24
Q

What kind of plaque formation is embolism formed from?

A

Stenotic plaque formation

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25
Q

What is aneurysm? 3

A
  1. Dilation of all walls
  2. Trauma or atherosclerosis
  3. May contain a large amount of thrombus
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26
Q

Where are common areas of aneurysm? 3

A
  1. Abdominal aorta
  2. Femoral
  3. Popliteal arteries
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27
Q

What kind of upper extremity aneurysms are there? 2

A
  1. Subclavian aneurysms
  2. Ulnar aneurysms
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28
Q

In terms of subclavian aneurysms, embolization occur where?

A

Distal arteries in the hand

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29
Q

Subclavian aneurysms most commonly result as a result of what?

A

Compression of the subclavian artery due to the thoracic outlet syndrome

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30
Q

What are ulnar aneurysms due to?

A

Due to trauma from using the hand as a hammer

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31
Q

What are some sonographic features to look for in terms of aneurysms? 3

A
  1. Diameter increased >50%
  2. Colour doppler outlines thrombus and shows to and fro flow along the outer wall
  3. Note actual lumen size if there is thrombus
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32
Q

Where are measurements taken in terms of planes for aneurysm?

A
  1. Sag
  2. Trans
  3. AP
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33
Q

How do we measure for Aneurysms?

A

Outer wall to Outer wall

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34
Q

What does this image demonstrate?

A

Abdominal Aortic aneurysm

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35
Q

What are some uses for peripheral arterial duplex testing? 5

A
  1. Stenosis or occlusion
  2. Evaluate bypass grafts
  3. Presence of aneurysms
  4. Locate stenotic lesions Pre-surgery/ intervention
  5. Follow up poster surgery or effectiveness of medical therapy
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36
Q

What are some limitations of extremity duplex testing? 3

A
  1. Surface obstruction
  2. Obesity
  3. Calcified walls
37
Q

What are some upper extremity limitations?

A

IV/ PICC lines

38
Q

What are some patient history things to look out for? 12

A
  1. Exercise related claudicaiton
  2. Rest pain
  3. Paralysis
  4. Paresthesia
  5. Poikilothermia
  6. Ulceration/ gangrene of feet/ toe
  7. Previous therapeutic vascular procedure
  8. Arterial trauma
  9. Aneurysmal disease
  10. Abnormal ABI/WBI
  11. Absent peripheral pulses
  12. Bruit
39
Q

What are some indications for a lower extremity exam?

A

Decrease in ABI >0.15 compared to previous exam

40
Q

What is an indication for an upper extremity duplex test? 5

A
  1. Abnormal arterial arm pressure - pressure difference >20mmHg
  2. Thoracic outlet symptoms
  3. Evaluation prior to dialysis access
  4. Cold sensitivity
  5. Raynaud’s syndrome
41
Q

What are some things we look for in 2D images of lower extremity exams? 2

A
  1. Identification of lie of vessels
  2. Plaque assessment
42
Q

What are some beneficial things in terms of colour doppler that we see with lower extremity testing? 9

A
  1. Locate and follow vessels
  2. Vessel patency
  3. Flow direction
  4. Identify plaque
  5. Place doppler sample
  6. Stenosis or occlusion
  7. Evaluate bypass grafts
  8. Presence of aneurysm
  9. Follow up
43
Q

What can pulsed doppler do? 3

A
  1. Confirm patency of vessels
  2. Flow speed
  3. Waveform assessment
44
Q

What kind of probe do we use for a lower extremity arterial protocol?

A

5-7 mHz linear transducer
(3.5 mHz curvilinear for iliacs and CFAs)

45
Q

What is the patient position for Lower extremity arterial protocols?

A
  1. Supine
  2. Head slightly elevated
  3. Thigh externally rotated and knee flexed
46
Q

What are the arteries we assess in the lower extremity arterial protocol?

A
  1. Distal external iliac
  2. Common femoral artery
  3. Deep femoral artery
  4. Femoral artery
  5. Popliteal artery
  6. Bifurcation of tibal- perorenal trunk and anterior tibial arteries
  7. Dorsalis pedis and posterio tial arteries
47
Q

During a lower extremity arterial protocol, when indicated what do we record? 4

A

Additional greyscale images from the:
1. Abdominal aorta
2. Common iliac arteries
3. External iliac arteries
4. Tibial arteries

48
Q

What do we do when a stenosis is discovered?

A

“Walk” the sample gate through the stenotic area and obtain representative waveforms
1. Within 2cm proximal
2. Highs PSV
3. Distal to stenosis

49
Q

When a stenosis is discovered after walking the sample volume what should we do? 2

A
  1. Document post stenotic turbulence and colour bruit
  2. Measure the diameter reduction in sagittal and transverse
50
Q

In terms of a suspected stenosis, colour flow can do what?

A

Obscure the true luminal reduction if the gain is set too high, whenever possible, measure it in greyscale

51
Q

What does PSV stand for?

A

Peak systolic volume

52
Q

What are the PSV in lower extremity? (External iliac, common femoral, FA prox and distal, Pop)

A
53
Q

During a lower extremity arterial protocol we should document additional findings with what?

A

Greyscale and colour imaging

54
Q

What are things we should document during lower extremity protocol? 5 (things we would document if we see)

A
  1. Aneurysms
  2. Plaque
  3. Thrombus
  4. Wall irregularity
  5. AV fistula
55
Q

When an occlusion is suspected what should we do? 2

A
  1. Documentation of flow with PW and any collateral branches
  2. Note the level of flow reconstitution when seen
    REPEAT FOR THE CONTRALATERAL SIDE
56
Q

What kind of probe is used for a upper extremity protocol?

A

7-10 MHz linear transducer is used, a 2-5 MHZ may be used to visualize proximal subclavian or innominate

57
Q

What is the patient position for upper extremity exams?

A

Supine with a small pillow under the head with the arm externally rotated/ elbow flexed

58
Q

What are the arteries that are assessed in the upper extremity?

A
  1. Subclavian
  2. Axillary artery
  3. Brachial
  4. Radial artery
  5. Ulnar artery
  6. Palmar arch if necessary
59
Q

Label

A
60
Q

What is the typical protocol for upper extremity duplex? 5

A
  1. Record greyscale, colour and spectral images in a sag views.
  2. Document additional grayscale and colour images at areas of suspected stenosis
  3. Classify the stenosis according to department diagnostic criteria
  4. Document any additional abnormal findings with grayscale and colour imaging
  5. Repeat for the contralateral side
61
Q

What is the PSV of upper extremity arteries? (SCA, AXA, BrA, RA and UA, Palmar arch and digits)

A
62
Q

What are some findings that we might see with Upper extremity?

A
  1. Aneurysms
  2. Plaque
  3. Thrombus
  4. Wall irregularity
  5. AV fistula
63
Q

When doing a peripheral arterial interpretation what do we determine? 4

A
  1. Plaque location and characteristics
  2. PSV and flow characteristics
  3. V2/V1 PSV (VR)
  4. Any change in the spectral waveform
64
Q

What is an interpretation of a normal?

A

Absence of a hemodynamically significant lesion <50%

65
Q

What does a normal greyscale look like ?

A

No echoes are seen within the artery lumen

66
Q

What does a normal colour doppler look like?

A

Colour dopplers fill the entire lumen from wall to wall

67
Q

What does a normal doppler waveform and flow velocities look like?

A
  1. Normal waveforms are multiphasic and high resistance
  2. PSV are relatively uniform throughout the sampled arterial segment
68
Q

What does an abnormal greyscale look like?

A

Intraluminal echoes are seen and decreased lumen can be measured

69
Q

What does an abnormal colour doppler look like?

A
  1. Colour does not fill the entire lumen and colour jet is seen
  2. Colour mosaic seen due to post stenotic turbulence
70
Q

What is a multiphasic waveform?

A

waveform crosses the baseline and contains both forward and reverse components

71
Q

What kind of waveform is this?

A

Multiphasic

72
Q

What is a monophasic waveform?

A

Waveform does not cross the baseline and blood flows in a single direction

73
Q

What kind of waveform is this?

A

Monophasic

74
Q

What is a high resistance waveform?

A

Sharp upstroke and brisk downstroke, with or without diastolic flow reversal

75
Q

What kind of resistive waveforms are these?

A

High resistive

76
Q

What is a intermediate resistive waveform?

A

Sharp upstroke, brisk downstroke, visible presence of a end-systolic notch and continuous forward flow throughout diastole that is above the baseline

77
Q

What kind of resistance waveform is this?

A

Intermediate

78
Q

What is a low resistance waveform?

A

Prolonged downstroke in late systole and continuous forward flow throughout diastole. Prolonged diastolic downslope with presence of pan-diastolic flow

79
Q

What kind of resistive waveform is this?

A

Low resistive

80
Q

What would we see with a stenosis? 5

A
  1. Focal velocity increase (>double that of the proximal arterial segment)(>50% diameter reduction) Vr > 2.0
  2. Focal velocity increase (>triple that of the proximal arterial segment)(>70% diameter reduction) Vr >3.0
  3. Spectral waveform changes
  4. Colour aliasing (proper settings0
  5. Potential colour bruit
81
Q

What are some indirect signs of stenosis when a proximal velocity is difficult to obtain?3

A
  1. Increased velocities with luminal reduction and post stenotic turbulence
  2. Spectral waveform changes from one segment to the next
  3. Compare waveforms at the same site in the contralateral artery
82
Q

What type pf waveform indicates occlusion?

A

Staccato indicates a distal occlusion

83
Q

With an occlusion, how is flow detected?

A

Flow is not detected by colour or spectral doppler

84
Q

Occlusion extent can be determined if what happens?

A

A large collateral is seen at the proximal and distal ends

85
Q

If there is an occlusion we should use what?

A

Flow in an adjacent vein as a guide to identify an occluded artery. Always confirm by placing the doppler sample in the vessel lumen

86
Q

Label

A
87
Q

What are some medical treatments for occlusions? 5

A
  1. Modify the risk factors
  2. Exercise routine
  3. Antiplatelet medication
  4. Anticoagulation
  5. Thrombolysis
88
Q

What are surgical treatments of stenosis/ occlusions? 4

A
  1. Bypass grafting
  2. Artherectomy
  3. Resection
  4. Amputation
89
Q

What are some endovascular treatments for stenosis/ occlusions? 3

A
  1. Angioplasty
  2. Stent
  3. Intra-arterial directed thrombolysis

DMST 343 Vascular 3 (7 decks)

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