Week 7 Flashcards
What is peripheral artery disease?
narrowed arteries reduce blood flow to the limbs
causes symptoms, most notably claudication
PAD is likely to be a sign of a more widespread accumulation of:
fatty deposits in other arteries as well as heart and carotids
(can also be from vessel inflammation, injury to limbs, unusual anatomy of your ligaments or muscles, or radiation)
If PAD is caused by buildup of plaque, there is also a risk of developing:
critical limb ischemia
begins as open sores that don’t heal, injury or infection on feet/legs. Can lead to gangrene
Where’s the most common location for claudication? What level is the obstruction with this?
calf pain
obstruction is above this level in the PopA or FemA
What are some PAD symptoms?
claudication leg numbness/weakness coldness in lower leg sores on toes/feet/legs that won't heal change in color on legs hair loss/slower hair growth slower growth of toenails shiny skin on legs no pulse/weak pulse on legs ED in men
What are the 5 P’s associated with critical limb ischemia?
pain pallot (pale skin) pulselessness paresthesia paralysis
Arterial ulcers are located:
borders/sides of foot
lateral
Neuropathic ulcers are located:
plantar surface of foot
Venous ulcers are located:
medial aspect of leg superior to medial malleolus
Palpation:
temperature- cool suggests poor circulation, sides should be compared
pitting edema- should be tested in dependent locations-dorsum of foot, shins, etc.
Ausculation:
for FA bruits, listening with a stethoscope in the groin area for wooshing sounds
Arterial pulses:
dorsalis pedis artery pulse- dorsal surface of foot (running lateral on the tendon on the first toe)
posterior tibilar artery pulse- posterior and inferior to the medial malleolus
popliteal artery pulse- behind the knee
FemA pulse- in fem triangle/halfway between the ASIS and pubic tubercle
A sonographer should visually assess for:
shiny skin
hairlessness (esp on toes)
ulcers on foot
asymmetry of limbs
What assesses peripheral vascular disease?
Ankle brachial pressure indev
but may be unreliable in patients w/ calcified arteries or extensive edema–so then use TBPI
With arterial bypass graft the are several places we perform Spectral doppler:
prox to anastomosis (inflow) prox anastomosis prox graft mid graft distal graft distal anastomosis outflow artery
If peripheral artery disease progresses, the patient may experience:
(after claudication)
rest pain
What are risk factors for PAD
smoking diabetes obesity BMI>30 high BP (140/90) high cholesterol (>240mg/dL) inc age family hx high levels of homocysteine
What is homocysteine:
a protein component that helps build and maintain tissue
People who smoke or have diabetes have the greater risk of developing:
PAD due to reduced blood flow
What are signs of PAD?
weak/absent pulse in narrowed area of artery
whooshing sounds/bruits
evidence of poor wound healing
dec BP
Blood testing for PAD measures what in the blood:
triglycerides and cholesterol
Angiography:
injecting a contrast material into the blood vessels, allows a specialist to view blood flow through the arteries
then imaging techniques such as X-ray, CTA, or MRA
allows for simultaneous diagnosis and treatment
Treatment for PAD:
non-diabetic
cholesterol lowering meds high BP medi angioplasty bypass surgery thrombolytic therapy
Treatment for PAD:
diabetic
meds to control blood sugar
medications to prevent blood clots
Did not do many cards for the protocol -arterial testing PPT
so look at that
What ABI ratio is indicative of disease?
<0.9 mild-0.8-0.89 moderate-0.5-0.79 severe-<0.5 ischemic rest pain-<0.3
People with claudication during exercise usually have an ABI of:
- 0 prior to exercise
0. 6-0.8 following exercise
Reactive hyperemia:
temporary increase of blood flow to an area as a result of arterial blockage.
test is reactive hyperemia that is induced by cuff inflation
Exercise testing steps:
positioned on treadmill
should walk for 5 mins or until onset of claudication
if pain is so intense, the patient is quickly returned to table and pressures are obtained
*usually these patients are elderly so it’s not always easy
The brachial and ankle pressures are repeated within _________ after stopping treadmill:
1 minute
Pressures should be obtained 4-5 minutes after and then until they return to pre-exercise levels. True or false
False 2-3
How is exercise testing interpreted?
The magnitude of immediate pressure drop following exercising and the length of time required for the ankle pressure to return to pre-exercise level.
Why are people with arterial disease encouraged to walk?
they want collaterals to form which relieves symptoms. This can then be used to avoid surgery
Read further interpretation slide on exercise testing
too much to write
What is a ddx of intermittent claudication?
pseudoclaudication– patients should be investigated for other MSK or neurospinal disorders
Reactive hyperemia testing:
patients who can’t do a treadmill test
not useful in patients who demonstate an abnormal resting ABI..only normal ABI
Which testing method is preferred, reactive hyperemia or treadmill testing?
treadmill - reactive hyperemia can be uncomfortable
What position is the patient in for reactive hyperemia testing? Where are the cuffs put on the leg?
supine– one leg at a time. a cuff is put around the ankle and thigh
Reactive hyperemia testing, the thigh cuff inflates ______mmHg above the regular resting pressure
30, then hold inflated for 3 mins. Deflate the cuff and obtain the pressures at 15s intervals until it returns to normal
Normal patients do not demonstrate a drop in ankle pressure following exercise, but they do have a transient drop following reactive hyperemia. True or false
True
Abnormal results for reactive hyperemia:
Significant disease >1min to return to normal and pressure levels frop more than 35%
Single level disease results in _______pressure drop.
Multi level disease results in ______ pressure drop
<50%, >50%
Do we put a cuff over a bypass graft or stent?
not if you want them to live
What are limitations of reactive hypermia tests?
obesity
calcified arteries
Why do we do ABI before our scan?
helps determine what degree of stenosis we are looking for
we also are listening to the sound w/ a pencil probe (CW).
What is a pitfall with listening to the arteries?
collaterals
