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Summer 2014 - Intro to Vascular ✔️ > Peripheral Arterial Evaluation > Flashcards

Peripheral Arterial Evaluation Flashcards

0
Q

reasons for noninvasive arterial testing

A

evaluate pulsatile masses

evaluate suspected arterial trauma

evaluate angioplasty/stent placement

postoperative f/u, including bypass graft surveillance

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1
Q

reasons for arterial scanning

A 
chronic atherosclersis
acute occlusion
aneurysm
pseudoaneurysm
ateriovenous fistula
follow of bypass grafts
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2
Q

what are you looking for when scanning arterial circulation

A 
reduction of blood flow
condition of artery
collateral branches
changes with exercise
single or multiple level disease
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3
Q

what is PAD

A

peripheral arterial disease

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4
Q

describe PAD

A

effects 8-12 million in the usa

atherosclerosis

“poor circulation”

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5
Q

if peripheral arterial disease isn’t treated, what might occur

A

worsening claudication

ley bypass surgery

leg amputation

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6
Q

risk factors for arterial issues

A

increasing age
family history
male gender

HTN
**diabetes (x4 more likely)
elevated cholesterol
hyperlipidemia
smoking
atherosclerosis
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7
Q

treatment for arterial issues

A

lifestyle modification - diet changes, exercise, quit smoking

grafts, angioplasty, stent, and medication

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8
Q

retaining ______ extremity function is important to patients lifestyle

A

lower

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9
Q

what needs to be determined when dealing with arterial circulation issues

A

restriction of flow

where is the restriction

how severe is the restriction

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10
Q

arterial symptoms of PAD

A

mild - asymptomatic

moderate - claudication - asymptomatic at rest (MOST COMMON)

severe - night pain

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11
Q

what is claudication

A

CRAMPING of the leg muscles, not a severe pain

symptoms may ease after resting

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12
Q

adjectives used to describe claudication

cramping?
tightness?
heaviness?
tired?

A

cramping - fatigued
tightness - charlie horse
heaviness - sharp
tired - dull ache

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13
Q

PROXIMAL to the location of symptoms

thigh pain?
calf pain?

A

thigh pain - aortoiliac disease

calf pain - femoral or pop disease

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14
Q

wherever the pain is in the leg, the problem is be _______ to that pain

A

proximal or above

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15
Q

describe ischemic rest pain

A

pain in horizontal position (at night) relieved by standing or dangling foot in a dependent position

described peripheral pulses

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16
Q

describe advanced lower extremity ischemic

A

elevation pallor and dependent rubor

*leg up gets pale, leg down gets red

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17
Q

describe what happens to the tissue if there are arterial issues

A

tissue loss
gangrene and necrosis

  insufficent blood supply

  ulceration
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18
Q

describe ischemic ulcers

A

painful over dorsum of the foot

gangrene - neuropathy, vasospasm

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19
Q

doctor will assess the leg for arterial issue by doing what

A

listening for a bruit

thrill - a vibration felt by palpation

decreased perpheral pulse

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20
Q

pulse force grading system

A

3+ full, bounding

2+ normal

1+ weak

0 absent

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21
Q

acute arterial occulsion - name the 7 P’s

A

pain

pallor

pulselessness

paresthesia (numbness)

paralysis (weakness)

polar (cold)

purplish

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22
Q

physical signs of peripheral arterial disease

A

elecation pallor and dependent rubor

ischemic ulcers

gangrene

bruits

decreased peripheral pulses

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23
Q

name the arteries of the leg

A 
AO
commonn iliac
IIA and EIA
CFA
SFA
Profunda - DFA
Popliteal 
ATA
Tibioperoneal trunk
PTA
Peroneal
Plantar arch
Dorsalis pedis
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24
Q

major branches of the popliteal artery

A

sural arteries

genicular arteries

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25
Q

arterial anatomy of the heart

A

aortic arch

1st - innominate/brachiocephalic - rt subclavian & right CCA

2nd - Lt CCA

3rd - Lt subclabvian

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26
Q

describe subclavian artery

A

right - innominate or brachiocephalic

left - aortic arch

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27
Q

arterial anatomy of the arm

A 
axillary
brachial
radial
ulnar
palmar
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28
Q

what is the test ordered to see arteries

A

arteriography

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29
Q

describe arterial testing atmosphere

A

keep room temp comfortable and warm to allow for periphal dilation

supine

performed at rest

**cuff placement is key

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30
Q

describe the complete physiologic test - indirect/non imaging with cuffs on limbs

A

pulse volume recording (plethysmography) at high thigh, low thigh, below knee and ankle

segmental systolic pressures at the levels

assess on both limbs

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31
Q

what is PVR

A

pulse volume recording

changes in segmental limb volume with cardiac cycle

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32
Q

know pulse volume recordings for PAD and be able to tell the difference between PVR’s and CW doppler

A

study slide 47

33
Q

_____ recordings may have a cuff artifact which produces a higher amplitude than in the thigh

A

calf

34
Q

if amplitude of calf is equal or smaller than the thigh, ______ disease is suspected

A

SFA

35
Q

Indirect arterial testing:

segmental pressures are obtained with the patient in the ________ position

A

supine

36
Q

indirect arterial testing:

cuff size should be _____% larger than the limb

A

20

37
Q

indirect arterial testing:

the legs should be at the same level as the heart because the position avoids ______ ______ artifact

A

hydrostatic pressure

38
Q

who invented segmental pressures and when

A

Winsor in 1950

still remains a very sensitive indicator

39
Q

how long should the rest period be before indirect arterial testing

A

15-20 mins

40
Q

where are the blood pressure cuffs placed on the body

A 
upper arm
prox thigh
low thigh
calf
ankle
41
Q

cuff inflates to _______ mmHg above systolic pressure

A

20-30

42
Q

what is the part of the pressure cuff that contains the air

A

the bladder

43
Q

advantages to pressure cuff testing

A

simple to perform
short test time
objectibe data
instrumentation is cheaper than imaging

44
Q

describe PPG photoplethysmography

A

for toe arteries

uses infrared light to respond to blood circulation

45
Q

limitations to pressure cuff testing

A

casts or bandages
CHF
temperature changes
doppler angle

46
Q

ischemic lesion not healing if ankle systolic pressure is below _____ mmHg

A

55

foot ulcers and amputation

47
Q

describe direct/non imaging complete physiologic test

A

CW doppler of CFA, SFA, PA, ATA, PTA with correct angle (45-60)

assess on both limbs

48
Q

describe ankle-brachial pressue

A

take the ankle pressure on the selected side and divide by the highest arm pressure (does not need to be on same side)

49
Q

what is the ABI formula

A

brachial systolic pressure

50
Q

ankle-brachial pressure index

A

normal >1

claudication .50-.90

rest pain .30-.50

tissue loss <.30

51
Q

a pressure gradient of _____ mmHg between adjacent segments of the limb is ABNORMAL and indicates intercurrent disease

important

A

20

52
Q

review segmental pressure examples

A

slide 73-77

53
Q

a decrease of > ________ mmHg between two consecutive levels is considered significant and suggests obstructive disease

A

20-30

54
Q

what is the pulsatitly index

A

mean velocity

55
Q

______ relationship with arterial disease

A

inverse

56
Q

no arterial disease, PI is ______

A

high

57
Q

severe arterial disease, PI __________

A

decreases

58
Q

CW doppler has what 3 different kinds of waveforms

A

triphasic
biphasic
monophasic

59
Q

_______ waveform is normal artery

A

triphasic

60
Q

_______ waveform, with increased velocity, through a mild stenosis

A

biphasic

61
Q

______ waveform, with greatly increased velocity, through tight stenosis

A

monophasic

62
Q

______ ______ waveform, with reduced velocity

A

dampened monophasic

63
Q

PAD causes what…

A

arteries to narrow and decreases blood flow

64
Q

normal vessels - _______ waveform from AO to the ankles

A

triphasic

65
Q

characteristics of duplex imaging

A

red is assigned to arterial flow

color scale (PRF) adjusted - venous=low, arterial=high (sampling rate)
**PRF is determined by depth**

color gain adjusted

color box adjusted

66
Q

describe a normal triphasic waveform

A

high velocity forward flow followed by a brief flow reversal

PSV - 100 cm/s AO and decreases to 70 cm/s in popliteal artery

67
Q

what does the doppler spectral waveform demonstrate

A

percentage of narrowing

68
Q

______% diameter reduction stenosis produces what

A

50-99%

monophasic waveform
extensive spectral broadening
PSV of more than 100% relative to the proximal adjacent area

69
Q

arteries use a _____ degree angle for consistency

A

60

70
Q

limitations of lower extremity arterial duplex imaging

A

bowel gas or obesity

shadowing because of calcification

difficulty evaluating lesions

71
Q

list upper extremity issues

A 
arterial embolization from the heart
thoracic outlet syndrome - impingement of the vessels - compression
Raynaud's
segmental pressure and PVR and CW
subclavian artery stenosis with duplex
72
Q

describe Raynaud’s

A

intermittent pallor in response to cold

cold challenge test with PPG

may be due to arterial obstruction

73
Q

describe primary and secondary Raynaud

A

primary - NO underlying disease - transient

secondary - phenomenon - vasospasm secondary to disease

74
Q

describe indirect arterial testing

A

brachial pressures should be obtained in both arms

difference of equal to or greater than 20 mmHg occurs between arms = arterial obstruction (usually subclavian) suspected on the side with lower systolic pressure

75
Q

describe a subclavian steal

A

stenosis of the subclavian artery

subclavain artery steals blood from the contralateral vertebral

reversed vertebral flow

76
Q

describe arterial stress testing

A

stressed with exercise (treadmill)

reactive hyperemia - increased pressure with cuff

77
Q

mechanisms of disease…

atherosclerosis = ?
embolism = ?
aneurysm = ?
A

plaque
traveling clot
dilatation

78
Q

where do aneurysms occur

A

AO
iliac
CFA
popliteal artery

79
Q

describe pseudoaneurysms

A 
perivascular collection
neck connection
results to trauma
compression therapy
US guided thrombin injection
80
Q

describe Takayasu’s arteritis

A

pulseless diease
diminished pulses
non atherosclerotic

treatment – lifestyle modification, medications, surgery

81
Q

review slides about grafts…

A

slides 126-142

Summer 2014 - Intro to Vascular ✔️ (7 decks)

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