Week 8: Lower Extremity Arterial Scanning Flashcards
Anatomy: Aorta
Abdominal aorta tapers distally and ends at the _____ arteries
bifurcation of the iliac
Common iliac artery begins at the ____ & ends at the bifurcation into the _____ arteries
aortic bifurcation
internal and external
Common femoral artery begins at the 1 & ends at the bifurcation into the superficial and deep femoral arteries at about the level of the __2__.
- inguinal ligament
- saphenofemoral junction (SFJ)
Name the blood vessels 1-12
5 Abdominal aorta
6 Common iliac artery
9 External iliac artery
10 Internal iliac artery
4 Common femoral artery
12 Deep femoral artery
1 Superficial femoral artery
11 Popliteal artery
2 Tibioperoneal artery
8 Anterior tibial artery
3 Peroneal artery
7 Posterior tibial artery
Superficial Femoral Artery:
* Begins at the ____
* Courses through the adductor canal in the mid-thigh
* Ends at the ____ in the distal thigh
common femoral bifurcation
adductor hiatus
*note: The adductor hiatus (AH) can be described as an opening in the aponeurotic distal attachment of adductor magnus muscle, which transmits the femoral artery and vein from the adductor canal in the thigh to the popliteal fossa
Popliteal Artery:
* Begins at the ____
* Ends at the bifurcation into the
____ and ____
adductor hiatus
anterior tibial & tibioperoneal trunk arteries
Posterior Tibial Artery:
- Begins at the ____
- Courses down the medial calf,
posterior to the medial malleolus - Ends distal to the ____
tibioperoneal bifurcation
medial malleolus
Peroneal Artery:
* Begins at the____
* Courses near the posterior aspect of the fibula
* Ends near the ____
tibioperoneal trunk bifurcation
lateral malleolus
Anterior Tibial Artery:
* Begins at the ____
* Courses between the tibia and fibula
in the anterior lower leg
* Ends at the bend of the ankle and foot
* *Gives rise to the ____
popliteal bifurcation
dorsalis pedis artery
Dorsalis Pedis Artery:
* Begins at the end of the foot (distal anterior tibial artery)
* Ends halfway down the dorsum of the foot as it bifurcates into the deep plantar and arcuate arteries
Reasons to Perform Lower Extremity Arterial Studies (6)
- Chronic atherosclerotic obstructive disease
- Acute arterial occlusion
- Hematoma
- Pseudoaneurysm
- Arteriovenous fistula
- Bypass graft surveillance
Clinical History for reasons to Perform Lower Extremity Arterial Studies
diabetes
Diabetes
-High risk factor for arterial disease and non-healing ulcers (feet)
-More prevalent disease of the ____ and ____ vessels
-Tunica media calcifies causing the arterial walls to be echogenic
-Higher risk for amputation
distal popliteal, tibial
Risk factors for atherosclerosis: (4)
- hyperlipidemia - due to high cholesterol or genetic, diet, and lack of exercise
- smoking
- age
- male gender
When acute arterial occlusion is suspected look for the Five P’s:
- Pain
- Pallor (white)
- Pulselessness (cannot find pulse)
- Paresthesis (numbness)
- Paralysis (cannot move)
What is claudication?
limping.
a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.
Claudication
* Pain in muscles that occurs with ____(due to the demand of additional blood flow required by the muscles during exercise)
* Patients with claudication typically have ____
* Sometimes called **intermittent claudication **because pain is only with exercise
* True claudication is ____ and ____
* Symptoms are ____ (ex: walk two blocks and onset of pain occurs)
exercise
chronic atherosclerotic disease
predictable & reliable
consistent
“Today its okay but last week I couldn’t walk too far”
-Can be caused from a neurological issue (back injury, disk trauma), or musculoskeletal
This conditon is called:
pseudoclaudication
Pain
-Calf Pain: look for disease of the ____ or ____ artery
-Thigh Pain: look for disease of the ____ or ____ artery
-Buttock Pain: look for disease of ____ disease
*The arterial obstruction will be ____to the site of symptoms/pain
- trifurcation, femoral
- external iliac, common femoral
- aortoiliac
- proximal
Rest Pain
-____ etiology
-Common complaint is pain at night while sleeping that is only relieved by dangling legs over the side of the bed (due to gravity pulling blood down- hydrostatic pressure)
-Pain in foot, heel, toes, but NOT the ____
-Indicative of severe disease
-Can progress into gangrene due to absence of flow
Ischemic
calf
Visual Examination of the extremeties (5)
- color
- temperature
- ulceration: Distal ankle and feet
-If severe and non-healing, gangrene can occur and lead to amputation - hair loss: look for hairloss on top of toes
- toenails: thickened toenails are more consistent with disease
Look at the extremities
Color
1. ____: pale color
2. ____: darkish reddish due to damaged dilater vessels (acute emboli)
3. ____: lack of oxygen causing a bluish discoloration
Temperature
-Cold extremities is more indicative of lack of blood flow (decreased circulation)
-Compare temperature of both extremities
- Pallor
- Rubor
- Cyanosis
Palpate over pressure points
-Common femoral artery in the groin
-Popliteal artery in the popliteal fossa
-Posterior tibial artery at the medial ankle
-Dorsalis Pedis on the foot
Vascular Testing: Arterial
You want the examination room to be warm
–Too cold will cause vasoconstriction
-Can falsely create high resistive waveforms leading to a false- negative result or ambiguous results
Allow patient to rest after walking from waiting area
-Perform exam at the resting state
