rest for final Flashcards
patients who complain of claudication only with exercise (intermittent claudication) usually have an ABI close to what?
ABI of 1.0 prior to exercise and an ABI in the 0.6 to 0.8 range following exercise and therefore require additional testing
why does exercise result in temporary limb ishemia?
diseased arterial tree’s inability to supply flow during the limb’s increased flow requirements
what is done before exercise testing?
obatin resting brachial and ankle pressures before exercising
how long should the patient walk for in exercise testing?
5 minutes or untill the onset of claudication
what should be done if the exercise pain causes the patient to stop?
patient is returned to the exam table and rests in a supine position
what is done within the first minute after stopping the treadmill?
the brachial and ankle pressures are repeated within the first minute after stopping the treadmill
how long do you test the ankle brachial pressure?
if pressure drop in detected in the minute after exercise then it should be repeated 2-3 times intervals up to 20 minutes until the ankle pressure returns to pre exercise levels
what pressure after exercise should a normal person have?
no drop in ankle pressure following exercise and may in fact show a slight increase in pressure
patients with arterial disease demonstrate what type of pressure after exercising?
fall in pressure to a poin below the pre-excersie level
what is the drop in pressure after exercise proportional to?
to the degree of arterial disease
how is drop in pressure after excerise assessed?
by the magnitude of immediate pressure drop following exercise and the length of time required for the ankle pressure to return to the pre-exercise level
when is there a probably single level disease?
if the ankle pressue returns to normal in a period of 2-6 minutes
when is there probably atherosclerotic disease present at multiple levels?
if the return pressure requires up to 12 minutes
when is it considered the patient has ischemic pain?
patients suffering from ischemic rest pain require more than 15 minutes to return to pre-exercise levels
what is pseudoclaudication?
patients suffer from intermittent claudication and their pressure remains normal then they should be investigsted for possible muscoskeletal or neurospinal disorders
when is reactive hyperemia testing done?
used to stress patients who are not capbale of preforming a treadmill test (physical instability, heart issues, etc)
when is reactive hypemia testing not useful?
in patients who demonstrate an abnormal resting ABI
when should reactive hyperemia testing only be used?
evaluate patients who demonstrate a normal resting ABI who complain of pain with exertion
what is used to stress a patient?
treatmill tesing
what is the technique of treatmill testing?
measuring the patients ankle pressure following temporary (3 min) leg ischemia caused by the application of a thigh tourniquet or cuff
in treadmill testing, are both legs done or just 1?
1 leg at a time
how much is the thigh cuff inflated?
30 mmHg above systolic pressure for a period of 3 minutes
how many second intervals is the ankle pressure obtained?
15 second intervals until the pre-exercise pressure is obtained
when do normal patients have a drop in ankle pressure?
transient drop following reactive hyperemia
when do normal patients return to pre-exercise levels?
within 30-60 seconds
in normal patients ankle pressure taken immediately after occlusion falls no more than ___ below resting level
35%
how long do patients with significant occlusive disease require to return to pre-exercise levels?
require more than 1 minute to return
what is the pressure drop in a single level disease?
<50% pressure drop
what is the pressure drop in a multilevel disease?
> 50% pressure drop
who may be impossible to preform hyperemia reactive testing?
very obese patinets
who do we not choose to preform hypermia testing on?
patients who have under gone recent bypass surgery due to pain and fear of occluding the graft
is hypermia pain less?
no its uncomfortable
the venous sytem of the lower limbs in fragile and easily damaged by what?
- thrombosis
- trauma
- inflammation
when thrombus doesnt clear completely, what can it result in?
chronic obstruction and damage to the valves
In limbs affected by DVT _____ had at least one segment of incompetent vein
69%
what does damage of the lower veins result in?
the loss of the protective action of the valves creating a constant column of blood between the heart and tissues if the calf, ankle, and foot
what is a gaiter area?
ulcer in medial foot (check notes)
in the erect position varicose veins may extend over how long?
1.25 meters
what does hydroststic pressure exerted in the tissues interfere with?
circulation of blood in the capillaries
what does no blood in capillaries affect?
transfer of nutrients and waste matter between blood and tissues
what may no blood in capillaries promote?
local inflammatory responces such as varcose veins, pigmentation, and ulceration
the pattern of damaged and incompetant valves can be defines with?
doppler US
what can be mapped out?
incompetent venous segments and incompetent perforating veins
what does mapping allow for?
appropriate surgical or medical interventions techniques to be applied
when may reccurance of varicose veins occur?
after surgery or scleotherapy
vein ablation
a heated cathedar is placed within the affected vein essentially closing it
sclerotherapy/compression stockings
a solution is injected into the varicose vein, drying it up
what are the 3 main patterns of recurrence for varicose veins?
1-a patent long saphenous vein may be present suggesting that it may have been missed at the time of operation
2-small collateral veins along the ling of the long saphenous vein may enlarge to reconstitute the path of the vein
3-drainage can occur through venous collaterals which take a variety of courses remote from the normal line of the vein
what is useful to assess the pattern of recurrence of varcicose veins?
color doppler so that appropriate surgical intervention may be planned
how many tributaries drain into the LSV at the level of the SFJ?
6
what can tributaries of the LSV at the SFJ be the source of?
primary or recurrent varicose veins
when doing varicose vein mapping, what is the patient position?
examined standing or with a large degree of head up tilt of examination table
why is the patient standing in varicose vein mapping?
ensures that adequate pressure will be exerted on the valves to test there incompetence, otherwise misleading measurement may be taken
is one or both legs examined in vein mapping?
both legs
where must patients put their weight when vein mapping?
weight must be places in the leg not being examined with slight flexion of the leg being examined
what is the most convenient method used to assess competence or incompetence of a venous segment?
squeeze the patients calf ot lower thigh to promote forward flow (augmentation)
what will incompetent valves allow?
reverse flow back through them after forward flow has ceased
what will competent valves show?
stop any reverse flow
what provides a more standardized stimulus than manual compresssion?
pressure cuffs being inflated and deflated rapidly
what may be done to induce reverse flow?
proximal compression (above the probe level)
what will valsalva manoever show?
incompetent segments
what are the disadvantages to induce reversal of flow?
1-the effect will only demonstrate reverse flow as far as the first competent valve so that any incompetant valves below this will not be demonstrated
2-patients do not always understant valsalva procedure and may not be consistent
when valsalva manover is not effective, what can be used to assess for reflux?
augmentation
when is augmentation useful?
popliteal vein and calf veins
what should happen when augmentation is done?
immediately after, the flow should return below the baseline
what does it mean when flow returns above the baseline?
indication there are incompetant valves below this level
what is reflux?
reverse flow occuring after the cessation of forward flow
when is reflux considered significant?
lasts more than 0.5 seconds
what may shorter periods of reversed flow represent?
the valve cusps coming together (slow closing valves)
what should reflux not be confused with?
reversal of flow which occurs with turbulence-this is seen on spectral doppler as reverse flow and forward flow occuring at the same time
color flow is used when the transducer is in what position?
TRV to asses cross section
what is required for examination protocol?
light probe pressure with a slight angle
what is done as the probe is slid cuadally?
valsalva manoever is in process
what can demonstrate reflux?
doppler spectrum
where does the exam begin?
in the groin
what vessels are examined and assessed?
CFV
SFJ
PFV
the patency and competence of the deep and superficial veins of thigh are assessed down to where?
level of the knee
what is suggestive of previous surgery with subsequent recanalization or collateral formation in the saphenous vein?
loss of normal smooth curve of the saphenous vein
what must be sought if the vein is incompetant below the SFJ?
presence of imcompetent perforatirs along the length of the LSV
where is the most comon location for an incompetant perfoating vein?
level of the junction of the mid and lower thirds of the thigh
where is the hunterian perforator?
mid thigh perforating vein (junction of the mid and lower thirds of the thigh)
what is the protocol when scanning the knee?
assess the popliteal vein and the sapheno-popliteal junction