Quiz 4 Flashcards
When considering vascular disease of the upper extremities you must also consider (3 things):
Compression (TOS)
vasospasm in the digital arteries (Raynaud’s)
Trauma & embolic related events
Cuff Placement
Brachial 12cm
Forearm 10cm
wrist
digits
Cuff Artifact
the width of the cuff should be at least 20% wider than the diameter of the underlying limb. less of an issue with UE.
Pressure Gradient
Pressure Gradient > 15-20 mmHg btw arms suggest obstruction in the arm with the lower pressure.
Finger/brachial indices between _____ are normal
between .8-.9
Analog Doppler Waveforms are used to:
calculate pulsatility indices (PI) and/or to determine if triphasic, biphasic or monophasic flow is present.
Doppler tracing should be recorded from the following areas:
Subclavian Axillary Brachial Radial Ulnar Artery
Thoracic Outlet Syndrome (TOS)
compression of subclavian artery(vein and/or nerve) by extra cervical rib or thoracic musculature. Position dependent. ages 20-40. 4x’s more common in women.
TOS Performance
Perform resting study first. Common position: Adson’s Test- head turned toward arm. Costoclavicular (military)- chest forward, shoulders back. Hyperabduction- full abduction with 90 degree external rotation.
TOS Interpretation
any significant change in pressure suggest the presence of TOS (>15 mmHg). Any change in the PVR can change from a category 1 to 5.
Raynaud’s Syndrome
vasoconstriction caused by exposure to cold temperatures or even high emotional state conditions. Causes pain & color changes of hang. chronic secondary can cause ischemic changes.
Cold Immersion Studies Performance
perform resting study first. immerse hands in ice water for 2-5 mins. record pressure and or waveforms of the digits immediately after removing hands from ice water
Cold Immersion Studies interpretation of PVR
waveforms of the fingers in patients with Raynaud’s have “Peaked Pulse”. (also found in pts with Buerger’s, frost bite & other collagen disorders)
Cold Immersion Studies interpretation of pressures
Normal- systolic pressure drop in the fingers 20%.
PVR will flatten immediately after hand is removed from water. If patient has other type of disease it can be hard to prove.
AV Graft Steal
occurs when an AV graft for dialysis steals enough blood flow from the upper extremity to cause symptoms. cause cause pain & even ischemic signs & symptoms to the hang. can be in conjunction with underlying atherosclerosis disease of the UE.
AV Graft Steal Studies
resting study should show a reduction in waveforms & pressures. Compress the graft. If the waveform get bigger & looks normal that means its the graft making the symptoms.
Doppler Angle
Typically btw 45-60. never >60. Must be parallel.
Normal Flow Pattern
Laminar. Triphasic or biphasic, reversal becomes less prominent when resistance decreases. clear spectral waveform window (envelope)
Abnormal Flow Patterns
Spectral broadening. increased peak systolic velocities (PSV) at stenotic sites. turbulent signals just distal to stenosis. monophasic waveforms with decreased PSV distal to high grade stenosis. waveforms immediately pros to an occlusion will have low PSV with no diastolic flow
In the legs, the arteries are ______ to the veins.
anterior
Waveform at stenosis
rounded with spectral broadening
post-stenotic turbulent waveform
ice pick spectral broadening
waveform distal to stenosis
monophasic. tardus parvus
Classifications of arterial Lesions 1-19%
Triphasic waveform; minimal spectral broadeening; <30 % increase in PSV;prox & distal waveform normal.
Classifications of arterial Lesions 20-49%
triphasic waveform usually maintained (reversal flow might be diminished) prominent spectral broadening; 30-100% increase in PSV; prox & distal waveforms normal
Classifications of arterial Lesions 50-99%
monophasic waveform (forward flow through out cardiac cycle) extensive spectral broadening; >100% increase in PSV; distal waveform is monophasic with reduced PSV.
Occlusion
No flow; preocclusive “thump” just pros to occlusion; distal waveform is monophasic with reduced PSV
Velocity Ratio (Vr)
a way to determine severity of stenosis. PSV at stenosis (V1) / PSV pros to stenosis (V2).
Classification based on Vr
Normal or mild 2.0
Severe 70-99% Vr >3.0
Occluded no flow
