Week 1 - Advanced Vascular Assessment

Question 1

Importance of AVT

Answer 1

Up to 50% of patients with diabetes and foot ulceration have concurrent PAD which confers a significantly elevated risk of adverse limb events and cardiovascular diseases

Important to identify PAD with DFU at earliest possible stage as presence is associated with non-healing ulceration

Question 2

Guideline for PAD

Answer 2

Recommendation 1: in a person with diabetes WITHOUT a foot ulcer, take a relevant history for PAD, examine foot and palpate the foot min anually or with any clinical changes

Recommendation 2: In a person with diabetes WITHOUT a foot ulcer IF PAD is suspected, perform Doppler and ABI and TPI

Recommendation 3: In a person with diabetes WITH a foot ulcer OR gangrene, take relevant history for PAD, examine foot for signs and palate foot pulses

Recommendation 4: In a person with diabetes WITH a foot ulcer or gangrene, Doppler and ABI and API and measures to identify presence of PAD

Question 3

Category 0 - Frequency of API testing

Answer 3

Very Low Ulcer Risk
No LOPS no PAD signs
Frequency - once a year

Question 4

Category 1 - Frequency of API testing

Answer 4

Low Ulcer Risk
LOPS or PAD
Frequency - once every 6-12 months

Question 5

Category 2 - Frequency of API testing

Answer 5

Moderate ulcer risk
LOPS + PAD or LOPS and foot deformity or PAD and foot deformity
Frequency once every 3-6 months

Question 6

Category 3 - Frequency of API Testing

Answer 6

High Ulcer Risk
Lops or PAD and one or more of the following;
- history of foot ulcer
- a lower-extremity amputation (minor or major)
-end stage renal disease
Frequency once every 1-3 months

Question 7

Basic Vascular Assessment

Answer 7

Pulse (manual) - rate rhythm, grade
Doppler rate rhythm, waveform

Question 8

Ankle Brachial Calculation

Answer 8

Right ABI = Higher of either the DP or PT pressures/ higher of the brachial pressures (L or R)

Left ABI = Higher of either the DP or PT pressures/ higher of the brachial pressures (L or R)

Question 9

Advanced Vascular Testing - Used to indicate wound healing potential

Answer 9

<30mmHg = serve/critical ischemia wound unlikely to heal

ABI - 0.9-1.2 = normal
ABI >1.3 = arterial calcification
ABPI of <0.9 = abnormal
ABPI of 0.5-0.9 = intermittent claudication

Question 10

Inaccurate Readings

Answer 10

• The blood pressure cuff is not placed correctly at ankle
• Cuff size is incorrect
• patient is not rested prior to testing
• gross oedema is present
• patients with in compressible calcified arteries may demonstrate artificially elevated ankle pressures and would benefit from the measure of TPBI and possible referral to a vascular specialist