Peripheral Arterial Disease- Lecture 3 Flashcards
capabilities of laser doppler
- determine the healing potential of ulcer, would or amputation
- can be utilized in calcified arteries, edema and check pedal flow in patients with diabetes
laser doppler
- measures the characteristics of the microvascular blood volume in capillary beds of the skin***
- uses optical light waves
- skin perfusion pressure (SPP)
SPP laser doppler of _________ is good healilng
________ is marginal healing
________ less likely ulcers will heal
greater than 40mmHg
30-40 mmHg
less than 30 mmHg
vasculogenic impotence affects as many as ________ american men
_____ men have a varying degree of erectile dysfunction
one million, 30 million
causes of of vasculogenic impotence
hormonal imbalance
psychological neurogenic dysfunction
cavernosal venous leak
arterial insufficiency
-organic or psychogenic impotence***
what size cuff is used for PBI (penile Brachial Index)
2.5 cm x 9.0 cm
calcified plaque of the tunica
Peyronie’s disease***
non-imaging interpretation - PBI
Normal…
marginal…
abnormal…
normal PBI - greater than 0.75-1.0
marginal - 0.65-0.74
abnormal - less than 0.65
what PBI is consistent with vascular impotence?
reduced pressure highly suggestive of more proximal arterial disease
less than 0.65
penile flow should go from _____ resistance to ____ post injection
high, low
when testing for impotence, dorsal veins should _____ increase, which could suggest venous leak
normal EDV is less than _____ cm/sec
abnormal is greater than _____ cm/sec
not
5
6
- little flow in cavernosa
- arterioles in the corpora covernosa are constricted
- high resistance flow
flaccid state
blood flow begins in _________ to __________ to________ (which is the main arterial supply to rectile tissue) to dorsal arterty
hypogastric, internal pudenal, cavernosal
physiology of erection
- relaxation of vasoconstriction within cavernosal arteriole
- blood flow increases into the corpora as resistance decreases (low)
- increase in arterial inflow, decrease in venous outflow
- blood is trapped, inflow and outflow temporarily ceases
- tumescence occurs
in impotnece testing, the ________ arteries are assessed by PSV and EDV
after ____ min, repeat measurements in _____ min increments
cavenous
1-2
5
normal diameter of cavernous arteries should _______ post-injection
normal range greater than _____ cm/sec
marginal _____ cm/sec
reduced less than _____ cm/sec
increase
30-35
25-29
25
is PPG a true plethysmography?
NO
is PVR a true plethysmography?
yes
___ is most often used to evaluate the digits and penile vasculature
PPG
plethysmography is an _______ assessment and can’t discriminate between major arteries and collaterals
indirect
PVR:
VPR:
PCR:
pulse volume recording
volume pulse recording
pulse contour recording
- records a volume change in a limb or organ related to pulsatile arterial flows
- overall volume of flow coming into the limb segment with each heart beat (difference between arterial inflow and venous outflow)
- PVR waveform analysis is accomplished by a combination of QUALITATIVE and QUANTITATIVE assessment
pulse volume recordings (PVR)
biggest limitation of PVR
cannot distinguish stenosis from total occlusion**
PVR troubleshooting
*** AC mode, calibration is required, very sensitive to pt conditions (ie: tremors)
concave is _______ while convex wavforms are _______
normal, abnormal
-transducer, amplifier and strip-chart recorder (toes/fingers)
-detects cutaneous blood flow changes and records pulsations NOT volume
-not true plethysmography
-in AC mode
sends infared light into the tissue w/light-emitting diode cutaneous blood flow is determined
PPG plethysmography
toe cuffs at least ____ times that of the toe; usually _______ size
- 2
2. 5-3 cm
anacrotic notch is consistent with …
vasospasms and Raynaud’s
amplitude of the waveform is greater in the fingers than in the toes
following cold immersion, abnormal cold sensitivity is likely if the amplitude fails to return to baseline levels within ______ min
5-10
_____ MHz transducer is used for UE
5-7
proximal to stenosis: velocities are usually _______
dampened
at the entrance, through, and end of stenosis:
increase in velocity with spectral broadening, flow becomes disorganized
at the exit of a stenosis:
post stenotic turbulence characterized by flow reversals, flow separation, vortices, and eddy currents
with pulsed doppler, _____ degrees is optimal angle
______ is acceptable in peripheral studies and ______ degrees is not doppler shift
0, 45-60, 90
what should be evaluated in a dialysis access graft?
- inflow artery
- arterial anastomosis***
- scan through the graft
- observe for aneurysm, puncture sites, perigraft fluid
- venous anatomsis**
- outflow vein
low PSV obtained throughout the access graft could suggest
an arterial inflow problem
in dialysis access grafts, _________ and ________ are the most common site for stenosis
venous anastomosis, outflow vein***
in dialysis access grafts there is increased ________ in the vein.
-intimal hyperplasia
arterial pressure
early graft failure is from
intimal hyperplasia
complications of dialysis grafts…
- intimal hyperplasia
- increase of IVC and hepatic veins
- pt develop anemia in lower extremities and CHF
- ‘steal syndrome’ distal arterial flow is reversed causing pain, pallor, and coolness
a major pitfall of stenosis profile is ….
calcified vessels
aneurysm is present if the diameter of a vessel is _____% times greater than the adjacent, more proximal segment
50
Focal velocity greater than 100% suggests
a greater than or equal to 50% stenosis
a stenotic PSV ra of greater than 400 cm/sec suggests
greater than or equal to 75% stenosis
most common site for arteriovenous fistulae
CFA and CFV
-in-situ grafts most common complication
considered the gold standard for diagnosis of arterial stenosis
contrast arteriography
limitations of contrast arteriography
- fails to visualize outflow and inflow in very low-flow situations
- delays prompt treatment
- misses thrombosed popliteal aneurysms
used to vasodilate in extreme disease, not commonly used
sympathectomy
a catheter with rotational device cuts and pulverizes the plaque
atherectomy
- a balloon-tiped catheter is used to dilate the vessel by pushing the plaque against the vessel wall
- used for focal lesions in large vessels such as iliac artery, femoral and popliteal artery
angioplasty
with renal transplants evaluate for increase kidney size and a RI of greater than _____ may suggest rejection
0.75
renal-aorta ratio
less than ___ = less than 60% stenosis
greater than ___ = greater than 60% stenosis
3.5, 3.5
synthetic grafts are used for ____ the knee
below the knee native veins are used (long term duration)
above
preoperative arterial mapping
-radial artery evaluate for:
- calcified wall
- stenosis
- diameter of vessel
- measure peak systolic velocities proximal and distal
