Peripheral Arterial System

Question 1

Risk factors for peripheral arterial disease.

Answer 1

Diabetes, HTN, hyperlipidemia, CAD, previous CVA or MI, smoking, age, male, family history, obesity, sedentary lifestyle, history of radiation, elevated homocysteine, excessive C-reactive protein

Question 2

Physical signs

Answer 2

Skin changes, palpations (pulses), auscultation (bruit), limb pressure differences

Question 3

Pallor

Answer 3

Pale colour due to deficient blood supply

Question 4

Rubor

Answer 4

Red or discoloured skin from dilated or damaged vessels

Question 5

Dependent rubor

Answer 5

Pallor when elevated, rubor when hanging

Question 6

Cyanosis

Answer 6

Blueish colour of the skin

Question 7

Trophic changes

Answer 7

Due to lack of nourishment, shiny, scaly skin with thick toenails and hair loss

Question 8

What difference in pressure could indicated disease?

Answer 8

20mmHg

Question 9

What are some signs and symptoms of peripheral arterial disease?

Answer 9

Intermittent claudication, Ischemic rest pain, necrosis, paralysis (weakness), parasthesia, poikilothermia (cold limbs), gangrene/ulceration, previous therapeutic vasc procedure

Question 10

How would you differentiate claudication and pseudoclaudication?

Answer 10

Claudication is reproducible, pseudo is not

Question 11

What are 3 mechanisms of disease?

Answer 11

Atherosclerosis, embolism, aneurysm

Question 12

What are the uses of peripheral arterial duplex testing?

Answer 12

Determine if there is a stenosis/occlusion or aneurysms, evaluate bypass graft, locate stenotic lesions pre-surgery, follow up post-surgery

Question 13

What arteries are assessed in an LE arterial duplex protocol?

Answer 13

Distal external iliac, common femoral, common femoral bifurcation, superficial femoral, popliteal, bifurcation of the tibial-peroneal trunk and anterior tibial

Question 14

What arteries are asses in an UE protocol?

Answer 14

Subclavian, axillary, brachial, radial, ulnar, palmar if needed

Question 15

What are normal peak systolic velocities of the UE arteries?

Answer 15

Subclavian and axillary- 70-120cm/s
Brachial- 50-120cm/s
Radial and ulnar- 40-90 cm/s
Palmar and digits- lower

Question 16

When a stenosis is seen, where do you obtain your waveforms?

Answer 16

• 2cm prox
• highest PSV
• distal to the stenosis

Question 17

What are normal PSV of the LE arteries?

Answer 17

Triphasic flow
External iliac: 120 +/- 22 cm/s
Common femoral: 114 +/- 25 cm/s
Superficial femoral (SFA) prox: 91 +/- 14
SFA distal: 94 +/- 14
Popliteal: 69 +/- 13

Question 18

What is a biphasic arterial signal?

Answer 18

Strong forward flow in systole, loss of flow in early diastole, decrease in late diastole

Question 19

What is a monophasic arterial signal?

Answer 19

Decreased pulsatility and no reversed flow in late systole, diastolic flow may or may not be seen, blunted systolic part

Question 20

When is a monophasic signal commonly seen?

Answer 20

Distal to a hemodynamically significant stenosis or occlusion

Question 21

What % stenosis causes a velocity increase of more than double?

Answer 21

> 50%

Question 22

What % stenosis causes a velocity increase to triple?

Answer 22

> 70%

Question 23

What type of waveform is seen with a distal occlusion?

Answer 23

Staccato

Question 24

What are some medical treatment for arterial disease?

Answer 24

Change lifestyle factors, exercise, antiplatelets, anticoagulants, antithrombolytics

Question 25

What are some surgical treatments for arterial disease?

Answer 25

Bypass grafting, artherectomy, resectioning, sympathectomy, amputation

Question 26

What are some endovascular treatments for arterial disease?

Answer 26

Angioplasty, stent, intra-arterial directed thrombolysis

Question 27

Pulsating hematoma from a leaking artery and confined by surrounding tissue and has a communicating channel between the main artery and pulsating mass

Answer 27

False (pseudo) aneurysm

Question 28

Inflammation of the arterial

Answer 28

Arteritis

Question 29

Most common arteritis?

Answer 29

Buerger’s disease

Question 30

Congenital narrowing of the thoracic aorta that may result in LE ischemia

Answer 30

Aorta coarctation

Question 31

Two types of Raynaud’s

Answer 31

1. Primary (idiopathic, spastic Raynaud’s syndrome) | 2. Secondary (obstructive)

Question 32

Swelling within the osteofascial compartments that causes a comprise of blood flow

Answer 32

Compression/entrapment syndromes

Question 33

Focal stenosis or occlusion of the popliteal artery compressed by a cyst

Answer 33

Adventitious cystic disease

Question 34

Compression of the subclavian artery/vein/nerves that lead to hand and arm ischemia and pain/weakness

Answer 34

Thoracic outlet syndrome

Question 35

Communication between an artery and an adjacent vein

Answer 35

AV fistula

Question 36

Toe ischemia due to micro-emboli

Answer 36

Blue toe syndrome

Question 37

1. Establish baseline hemodynamics post revasccularization 2. Identify correctable lesions before graft thrombosis 3. Provide info to aid in decisions regarding treatment alternatives

Answer 37

Role of Doppler in the study of bypass grafts

Question 38

What are the 4 graft locations?

Answer 38

1. Aorto-iliac 2. Aorto-fem 3. Ax-fem 4. Fem-fem

Question 39

Mean PSVs in LE arteries:

Answer 39

External iliacs: 120 +/- 22 cm/s Common femoral: 114 +/- 25 cm/s SFA (prox): 91 +/- 14 cm/s. SFA (dist): 94 +/- 14 cm/s Pop: 69 +/- 13 cm/s