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Peripheral Arterial Evaluation Flashcards

0
Q

Arterial is more _______ not pain like in venous

A

cramping

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1
Q

Peripherial arterial evaluation is because of a ________ disease

A

progressive

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2
Q

peripheral arteries develop ________

A

plaque

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3
Q

Why would you need an arterial study?

A

chronic atherosclerosis

acute occlusion

aneurysm

pseudoaneurysm

arteriovenous fistula

follow of bypass grafts

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4
Q

What are some reasons for noninvasive arterial testing?

A

pulsatile masses

suspected arterial trauma

angioplasty/stent placement

post op f/u including bypass graft surveillance

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5
Q

What do you need to see when looking at arterial circulation?

A

reduction of blood flow

condition of artery

collateral branches

changes with exercise

single or multiple level disease - where on the leg is the disease?

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6
Q

What is PAD?

A

peripheral arterial disease

aka: poor circulation

atherosclerosis

effects 8-12 million in USA

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7
Q

If you don’t treat PAD what may occur?

A

worsening claudication

leg bypass surgery

leg amputation

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8
Q

what is claudication?

A

may include:

pain

numbness

aching

heaviness

may also affect:

buttocks, thighs, calves and feet

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9
Q

What are the risk factors for arterial?

A

age

family history

male

HTN

Diabetes 4x more likely

elevated cholesterol

hyperlipidmia

smoking

atheroscerosis

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10
Q

What is the treatment for arterial disease?

A

lifestyle modification

dietary changes

exercise

smoking cessation

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11
Q

How can you fix arterial circulation problems if lifestyle doesn’t work?

A

grafts,

angioplasty,

stent

medication

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12
Q

What needs to be determined for arterial fixing?

A

restriction of flow

where

how severe

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13
Q

What are the symptoms of PAD?

A

mild - asymptomatic

moderate - claudication (cramping) (asymptomatic at rest) **most common symptom

severe - night pain

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14
Q

What are some adjectives that might describe claudication?

A

cramping

tightness

heaviness

tired

fatigued

charlie horse

sharp

dull ache

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15
Q

The ______of disease is _______to the location of the symptoms

A

level

proximal

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16
Q

if you have thigh pain, where is the arterial disease?

A

aortoiliac disease

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17
Q

if you have calf pain where is your arterial disease?

A

femoral or popliteal disease

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18
Q

What is claudication?

A

walking induced muscular discomfort - cramping

relieved by rest

not severe pain

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19
Q

What is the next level of pain after claudication?

A

ischemic rest pain

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20
Q

What is ischemic rest pain?

A

pain in horizontal position ( at night)

relieved by standing or dangling the foot in a dependent postion

decreased peripheral pulses

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21
Q

Blockages can occur in _______than one vessel

A

more

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22
Q

if you have a blockage what happens to the muscle?

A

below the blockage begins to die

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23
Q

Describe advanced lower extremity disease

A

ischemic

elevation = pallor (white

dependent (hanging down) = rubor (red)

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24
What happens beyond ischemic rest?
tissue loss **gangrene** and necrosis insufficient blood supply ulceration
25
What is the order of disease?
claudication ischemic rest gangrene
26
what is pulse palpating?
doctor determines the pulse force grading by touch 0 - absent 1 - weak, thready 2 - normal 3+ - bounding
27
What are the 7 P's of acute arterial occlusion
pain pallor pulselessness paresthesia (numbness) paralysis (weak) polar purplish
28
What are the arteries for a peripheral artery study up to the knee?
aorta common iliac arteries IIA and EIA CFA SFA profunda femoris artery (DFA) popliteal artery
29
What are the arteries of the lower leg?
``` popliteal anterior tib post tib dorsalis pedis plantar arch ```
30
What are branches off of the aorta?
from left to right: rt: INNOMINATE (brachiocephalic) (branches into rt subclavian, rt CCA) LCCA Lt SUBCLAVIAN
31
what are the arteries of the arm?
axillary artery brachial artery radial ulnar palmer arches
32
What is the standard of care for arterial flow?
arteriography
33
how will you get the patient ready in order to do an arterial study?
keep room warm to allow for peripheral dilation supine performed at rest cuff placement is key
34
Where do you put the cuffs?
PVR - pulse volume recording (plethysmography) at high thigh low thigh below knee ankle toe measurements are recommended
35
What do the cuffs do?
segmental systolic pressures at the different levels assess both limbs gives a wave (PVR) **not doppler*** just a wave form by a different machine
36
Do you scan when you do a PVR? Is it doppler?
no and no
37
What does the PVR indicate?
changes in segmental limb volume with cardiac cycle
38
draw the wave forms for normal to mild PAD
normal - high peaks severe - little lumps see slide 47 for picture
39
Calf recordings may have a _______ artifact which produces a ________amplitude than that in the thigh
cuff higher
40
if amplitude of calf is ______ or _______than the thigh SFA disease is suspected
equal smaller
41
What two things are measured for PAD?
pressure pulsed volume record
42
why should legs be at the same level as the heart?
because this position avoids hydrostatic pressure artifact
43
What is the rest period for an arterial study?
15-20 min
44
What should the pressure cuff width be?
20% greater than the diameter of the limb
45
how far do you inflate the cuff?
20-30mmHg above systolic pressure
46
The part of the cuff that gets the air?
the bladder
47
What are the advantages of the arterial study?
simple to perform short test time objective data instrumentation cheaper than imaging
48
What is PPG?
photoplethysmography for digit arteries uses infrared light to respond to blood circulation
49
What are the limitations for arterial testing with pressure cuffs?
casts or bandages CHF temperature changes doppler angle
50
Why would you do toe pressure?
evaluate distal limb and foot perfusion
51
if the ankle pressure is below 55mmHg what happens?
possible amputation ischemic lesion will not heal
52
What do you assess if you doppler the arteries?
CW doppler CFA, SFA, PA, ATA, and PTA assess on both limbs
53
be able to tell the difference between the doppler wave form and the PVR
slide 62 has picture
54
For CW doppler what is is the angle needed?
45-60 degrees
55
How do you figure out the ankle-brachial pressure (ABI)?
take the ankle pressure on the selected side divide by the highest arm pressure (which ever arm is the highest) used to diagnose arterial disease the systolic number (top)
56
what is the ABI numbers from normal to tissue loss?
normal > 1.00 claudication 0.50 - 0.90 rest pain 0.30 - 0.50 tissue loss < 0.30
57
if there is a difference of ________mmHg between the arm pressure and the leg there is a problem
20 mmHg
58
What kind of flow do you find in peripheral arteries?
triphasic
59
What is the Pulsatility index?
PSV - PDV / MEAN VELOCITY inverse relationship with arterial disease PI high = no arterial disease PI low = disease
60
What would a triphasic waveform indicate?
normal artery
61
what would a biphasic waveform indicate?
increased velocity through mild stenosis
62
How does a monophasic waveform appear?
greatly increased velocity through tight stenosis
63
femoral artery waveform picture
triphasic - see slide 89 recognize the picture waveform different from aorta
64
What do you adjust for arterial studies?
red is assigned to arterial flow color scale (PRF) color gain color box
65
What is the PRF when you see the baseline??
the numbers along the side
66
How should the PRF (scale) (sampling rate) be adjusted for venous vs arterial studies?
Venous Arterial low PRF High PRF
67
What determines the PRF?
the depth
68
If you cant get a good waveform what should you check?
see if the PRF needs to be adjusted Up for arterial (fast flow) down for venous down for slow flow (ovary, testicle, thyroid)
69
What is the wall filter?
Filters out low frequency and slow moving aka: high pass filter, wall-thump filter helps reduce movement when set high (echocardiogram - eliminates movement from the thumping of the heart) for GENERAL - we want a low wall filter
70
If you have a 50-99% diameter reduction stenosis what does it produce on the spectral waveform?
monophasic waveform extensive spectral broadening PSV of more then 100% relative to the proximal adjacent area
71
What are some complications of the upper extremity arterial system?
arterial embolization from the heart thoracic outlet syndrome Raynaud's
72
What is thoracic outlet syndrome?
(affects the arms and causes them to go numb because the vessels are compressed for some reason) **impingement of the vessels - compression** Tests: segmental pressure and PVR and CW Subclavian artery stenosis with duplex
73
What is Raynaud's phenomenon?
fingers become white due to lack of blood flow then blue as vessels dilate to keep blood in tissues finally red as blood flow returns
74
Arterial obstruction might cause what condition in the hands?
Raynaud's intermittent pallor in response to cold
75
What is primary Raynaud's?
no underlying disease - transient
76
What is secondary Raynaud's?
vasospasm secondary to disease
77
What do you test with indirect arterial testing?
brachial pressures should be obtained in both arms
78
What is reactive hyperemia?
purposely increasing the pressure in the cuff to determine blood flow
79
What is Takayasu's Arteritis?
Pulseless disease diminished pulses Artery issue throughout the body - non atherosclerotic
80
How does a dampened monophasic waveform appear?
with reduced velocity see slide 83 to learn from the pictures
81
What is a subclavian steal?
stenosis of the subclavian artery subclavian artery steals blood from the contralateral vertebral produces reversed vertebral flow
82
What arteries can you get aneurysms in?
aorta iliac CFA Popliteal Artery
83
What is a pseudoaneurysm?
perivascular collection neck collection results to trauma
84
What are the different kinds of grafts?
aorto-bifemoral (bypass diseased aorta or iliacs) femoral to femoral - jump graft

Vascular (6 decks)

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