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Vascular Lab > RPVI-Lower arterial duplex > Flashcards

RPVI-Lower arterial duplex Flashcards

1
Q

what are pitfall in LED?

A

edema
obese
low outflow

calcified
imaging pop at trifurcation
tandem lesions

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2
Q

what is normal waveform?

A 
fast upstroke
reversal in early diastole
forward in late diastole
high resistance flow which is normal
PSV gradually decrease distally
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3
Q

What does a biphasic waveform look like

A

reversal in early diastole but no forward flow in late diastole

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4
Q

what does mono phasic look like

A

slow upstroke and no early diastole reversal

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5
Q

What are stenotic effects to the waveform at the site os stenosis

A

early D flow reversal decreases and disappears with severity
S acceleration time slowed
S peak is rounded and reduced (tarsus and parvus)
decreased PSV
turbulent flow
dampened

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6
Q

What are average velocities for the LE vessels?

A 
CFA 114
SFA P 90
SFA D 90
POP A 70
PTA 40-50
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7
Q

How to we define stenosis

A

compare one set to another
if is doubles then 50% stenosis or greater
2-4 cm prox to stenosis then at stenosis

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8
Q

What features represent normal LE flow?

A

PSV 70-100 cm/s

triphasic

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9
Q

What features represent 20-49% LE flow?

A

> 30% increase in psv

triphasic

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10
Q

> 50%

A

> 100% increase in psv

monophasic/turbulent beyond stenosisl

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11
Q

> 75%?h

A

> 400cm/s or quadruple

monophasic/high velocity

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12
Q

What is a hemodyn signif stenosis? what does is cause?

A

50%
vasod and collateral formation
not necessarily cause symptoms

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13
Q

What is different about flow in stents?

A

may have increased velocities b/c smaller diameters and lack of normal arterial elasticity

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14
Q

what is appropriate bypass surveillance?

A

within 7 d
1month
3-6 months x 1 year
then 1-2 year

do this to increase patency. primary assisted patency

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15
Q

where do you sample the bypass

A

sample every 2-3 cm of the graft

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16
Q

what is the bypass graft stenosis criteria?

A

PSV sten/ PSV 2-4 cm prox

ratio >2 >50% stenosis
ratio >3 >75%
ratio >4 surgical intervention
EDV >100-120c,/sec severe stenosis

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17
Q

What are normal velocities in bypass?

A

70-100cm/s

<45 should be monitored this is better predictor in ptfe then vein

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18
Q

What are signs that graft is at increased risk?

A

triphasic-monophasic
PSV400 cm/sec
ratio >3.5

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19
Q

what defines an aneurysm in LE?

A

50% increase in size from normal segment

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20
Q

What is plethysmography?

A

indirect measurement of volume changes in the extremities. ABI is air. PVR
photo is for digits ppg

21
Q

what is a normal PVR or ppg?

A

sharp upstroke with dicrotic notch

22
Q

what happens to pvr or ppg with disease

A

loss of dicrotic notch
delayed upstroke
rounded waveforms

23
Q

what are limitations to CW

A 
can't determine depth
less sensitive then PW
can't determine direction
calcification can effect
room temp can effect
24
Q

what size should BP cuff be

A

> 20% then limb diameter
narrow is falsely elevated
wide falsely low pressures

25
Q

what are abi criteria?

A

> 0.9 normal
0.4-0.9 mil to mod disease (0.70)
<0.4 severe

26
Q

what is the margin of error for ABI?

A

0.15

27
Q

what is a normal high thigh /brachial index?

A

> 1.2
0.8-1.2 inflow/prox dz
<0.8 inflow occlusion/severe stenosis

28
Q

what is normal changes between segmental pressure?

A

<20mmhg

29
Q

what are some abi artifacts?

A

cuff mismatch
non-compressible vessels
patient movement
improper angle

30
Q

post exercise testing?

A

pressures after exercise every 2-3 minutes

31
Q

post exercise changes, how long until return to normal for single level dz? multilevel

A

2-6 min

10 min

32
Q

what are normal post exercise changes? abnormal

A

increase in pressures

decreas in pressures

33
Q

what if patient not able to exercise? what does single level, multilevel look like?

A

do reactive hyperemia.
occlude vessels for 3-5 mins with cuff
normal limb may also have a drop
single 50%

34
Q

when do we do toe pressure?

A

if non compressible ankle
abnormal ankle level waveforms
non-healing ulcers
diabetic

35
Q

what is a ppg that will still likely heal ulcer

A

> 50 hhmg more

36
Q

what is normal TBI?

A

> 0.7 normal
0.4-0.69 mil-mod
0.2-0.39 severe
<0.2 critical

37
Q

what is tcpO2?

what abnormal

A

measure amount of o2 diffusing from the skin
>35-40 good
10-35 intermediate
<10 poor

38
Q

what is normal worst brachial index? finger brachial index?

A

<0.9

<0.7 abnormal

39
Q

what stress manoeuvres can you perform in UE testing for TOS?

A

rest–90 degree arms-overhead raise
military position-then turn head right and left
any position that the have symptoms

40
Q

how do you perform an allens test

A

ppg on 2 and 5th digits

asses rest, compression, after release

41
Q

how do you test for raynauds?

A

baseline

ppg after ice water for 2-5 minutes

42
Q

what are normal AVF hemodynamics?

A

low resistance, high flow, can be monophasic

43
Q

how to measure AVF

A 
native artery prox to AVF
native artery distal to AVF
anastomosis
evaluate outflow superficial vein
first 10cm of draining vein for branches
44
Q

what is the ideal fistula

A

> 4mm vein
mean volume >500ml.min
600 for grafts
depth less then 5mm

45
Q

what are criteria for avf stenosis for artery

A

PSV at stenosis, then 2cm prox

3:1 ratio = >50%

46
Q

what are criteria for avf stenosis for draining vein/graft narrowing?

A

2:1 velocity ratio = >50%

47
Q

what is criteria at venous anastomoso

A

2: 1 > 50%
3: 1 > 75% stenosis

48
Q

What is arterial steal in an avf?

A

retrograde flow in the native artery distal to anastomosis
because blood flow to area of least resistance
gentle compression of avf shows a return of ante grade flow

Vascular Lab (5 decks)

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