Diagnostic Criteria Flashcards
(76 cards)
1
Q
What is the purpose of a physiologic arterial exam?
A
- Presence
- Severity
- Location
- Change
- Healing
2
Q
What is the purpose of a physiologic arterial exam?
A
- Presence
- Severity
- Location
- Change
- Healing
3
Q
What are some of the arterial physiologic techniques?
A
- ABI
- Segmental Pressures
- CW Doppler
- Segmental Plethysmography (VPR)
4
Q
What do arterial physiological techniques evaluate?
A
These techniques ONLY evaluate HEMODYNAMICALLY SIGNIFICANT obstructions.
5
Q
What does hemodynamically signifcant mean?
A
A blockage more than 50%
6
Q
Why do we use all these techniques?
A
Using multiple physiologic exams improves the accuracy over any single test used alone.
7
Q
What is the purpose of an ABI exam?
A
- Presence
- Severity
- Change
8
Q
What is the diagnostic criteria for an ABI change to be considered as a possible change?
A
> .15
9
Q
What is the diagnostic criteria for an ABI change to be considered as a probable change?
A
> .20
10
Q
What is the diagnostic criteria for an ABI to likely have a single level of obstruction?
A
> .50
11
Q
What is the diagnostic criteria for an ABI to likely have multiple levels of obstruction likely?
A
12
Q
What are some of the ABI limitations?
A
- Calcified arteries (>1.35)
- Ulceration
- Intolerance of pressure cuff
13
Q
What are the 3 locations of an obstruction with segmental pressures?
A
- Aortio-illiac
- Femoral-pop.
- Infrapop
14
Q
Where can obstructions be found when doing segmental pressures?
A
At or above the cuff.
15
Q
What are some segmental pressure limitations?
A
- Painful, especially at the upper thigh cuff.
- Calcified arteries yield falsely elevated pressures, especially at ankles.
- Cuff artifact yield falsely elevated pressures, especially at upper thigh.
- Limited over ulceration.
- Cannot tell stenosis from occlusion.
- May miss obstructions distal to a more proximal obstruction.
- May miss well-collateralize obstructions.
16
Q
What does a CW Doppler look for?
A
- Presence
- Severity
- Location
17
Q
What are the CW Doppler descriptors?
A
- Triphasic= Sharp upstroke, sharp peak, has a reverse flow component in late systole/early diastole.
- Biphasic=Good upstroke, sharp peak, no reverse flow component.
- Monophasic= Slow upstroke with blunted, wide peak, and slow downslope.
- Barely or Non-pulsatile= flattened but audible.
18
Q
What does parvus tardus?
A
No inflection point.
19
Q
What is triphasic described as?
A
Normal.
20
Q
What is biphasic described as?
A
Abnormal Mild/Mod
21
Q
What is monophasic described as?
A
Abnormal severe.
22
Q
What is barely or non-pulsatile described as?
A
Critical.
23
Q
In a CW Doppler, a change from one level to the next indicates what?
A
It indicates an obstruction between the sites.
ie. triphasic-biphasic-monophasic-nonpulsatile-absent
24
Q
What happens when a wave is abnormal?
A
once its abnormal, the wave is likely to stay abnormal.
25
At the CFA, if not triphasic, obstruction is typically?
- aorto-illiac
- illiac
- proximal CFA
26
Why would a CW Doppler be abnormal?
It may be abnormal if waveform is taken just proximal to an occlusion or if well collateralized.
27
What are some CW Doppler limitations?
- Blind= no image
- Operator skill needed.
- Calcification limits data deep to the calcific area.
- Pre-at-post=stenosis Doppler change.
- Qualitative analysis
- Dependent on state of flow= may be interrupted by inflammation and/or exercise.
28
What is the diagnostic criteria for a PVR?
- Presence
- Severity
- Location
29
What are some of the arterial physiologic techniques?
- ABI
- Segmental Pressures
- CW Doppler
- Segmental Plethysmography (VPR)
30
What do arterial physiological techniques evaluate?
These techniques ONLY evaluate HEMODYNAMICALLY SIGNIFICANT obstructions.
31
What does hemodynamically signifcant mean?
A blockage more than 50%
32
Why do we use all these techniques?
Using multiple physiologic exams improves the accuracy over any single test used alone.
33
What is the purpose of an ABI exam?
- Presence
- Severity
- Change
34
What is the diagnostic criteria for an ABI change to be considered as a possible change?
>.15
35
What is the diagnostic criteria for an ABI change to be considered as a probable change?
>.20
36
What is the diagnostic criteria for an ABI to likely have a single level of obstruction?
>.50
37
What is the diagnostic criteria for an ABI to likely have multiple levels of obstruction likely?
38
What are some of the ABI limitations?
- Calcified arteries (>1.35)
- Ulceration
- Intolerance of pressure cuff
39
What are the 3 locations of an obstruction with segmental pressures?
- Aortio-illiac
- Femoral-pop.
- Infrapop
40
Where can obstructions be found when doing segmental pressures?
At or above the cuff.
41
What are some segmental pressure limitations?
- Painful, especially at the upper thigh cuff.
- Calcified arteries yield falsely elevated pressures, especially at ankles.
- Cuff artifact yield falsely elevated pressures, especially at upper thigh.
- Limited over ulceration.
- Cannot tell stenosis from occlusion.
- May miss obstructions distal to a more proximal obstruction.
- May miss well-collateralize obstructions.
42
What does a CW Doppler look for?
- Presence
- Severity
- Location
43
What are the CW Doppler descriptors?
- Triphasic= Sharp upstroke, sharp peak, has a reverse flow component in late systole/early diastole.
- Biphasic=Good upstroke, sharp peak, no reverse flow component.
- Monophasic= Slow upstroke with blunted, wide peak, and slow downslope.
- Barely or Non-pulsatile= flattened but audible.
44
What does parvus tardus?
No inflection point.
45
What is triphasic described as?
Normal.
46
What is biphasic described as?
Abnormal Mild/Mod
47
What is monophasic described as?
Abnormal severe.
48
What is barely or non-pulsatile described as?
Critical.
49
In a CW Doppler, a change from one level to the next indicates what?
It indicates an obstruction between the sites.
ie. triphasic-biphasic-monophasic-nonpulsatile-absent
50
What happens when a wave is abnormal?
once its abnormal, the wave is likely to stay abnormal.
51
At the CFA, if not triphasic, obstruction is typically?
- aorto-illiac
- illiac
- proximal CFA
52
Why would a CW Doppler be abnormal?
It may be abnormal if waveform is taken just proximal to an occlusion or if well collateralized.
53
What are some CW Doppler limitations?
- Blind= no image
- Operator skill needed.
- Calcification limits data deep to the calcific area.
- Pre-at-post=stenosis Doppler change.
- Qualitative analysis
- Dependent on state of flow= may be interrupted by inflammation and/or exercise.
54
What is the diagnostic criteria for a PVR?
- Presence
- Severity
- Location
55
What does a normal PVR waveform look like?
It has a dicrotic notch or downslope bowing in.
56
What are some typical LE PVR normal amplitudes in the thigh, calf and ankle.
- Thigh >15mm
- Calf >20mm
- Ankle >15mm
57
What are some limitations to VPR?
- Qualitative
- Patient size (large limbs result in low amplitude)
- Cuff application.
58
During stress exercise testing, little to no drop in ankle pressure compared to resting values indicates that it is...normal or abnormal?
Normal.
59
What indicates a single level of obstruction after a stress exercise test?
Ankle pressures very low or to zero immediately post exercise with recovery. (2-6 minutes)
60
What indicates a multi-level obstruction after a stress exercise test?
Very reduced pressures or inaudible signals for >12 minutes.
61
In PORH, what is considered normal?
A slight drop in ankle pressure (80% of baseline) that returns in 1 minute.
62
In PORH, what is considered abnormal?
>80% drop in baseline. Pressure taking more than 1 minute to return to baseline.
63
In PORH, what indicates a single level obstruction?
<50% drop in ankle pressure.
64
in PORH, what indicates a multi-level obstruction?
>50% drop in ankle pressure.
65
True or False: PORH is very sensitive as exercise.
False, PORH is not as sensitive as exercise.
66
What are normal toe/brachial ratio?
>.60-1.0
67
What are considered moderate decrease in perfusion toe/brachial ratio?
68
What is considered a severe toe/brachial pressure?
<20-30 mmHg
69
What pressure is considered sufficient for healing?
>30-40 mmHG
70
Why do we do all these test?
Using multiple physiological exams improves the accuracy over any single test used alone.
71
What are some IAC vascular standards?
- ABI required (presence, severe, change)
- Use the highest brachial and ankle pressure for the ratios.
- Non-imaging exams (location of obstruction)
- Must have bilateral sampling from 3 or more levels.
- Only one type of a waveform is required.
72
What locations are required in a VPR?
Thigh, calf, ankle required at a minimum.
73
What is required for a CW/PW Doppler?
- Doppler at least 3 levels.
| - CFA, POP, DP/PT are required.
74
What is required in the pressures?
AT least one level (ABI is required)
75
Requirements for a PPG?
It is not required, its supplemental.
76
What is the minimum documentation in an IAC standard of exercise testing?
- Pressure at rest.
- Pressure at time intervals after rest.
- Time of onset symptoms and maximum walking time.
