Extremity Arterial Flashcards by Patricia Lee

no duplicated brachial artery

high brachial bifurcation into radial and ulnar arteries

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distribution in diabetes

tibioperoneal trunk

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distibution in non diabetics

distal SFA or bifurcation

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arterial ulceration dry gangrene

foot/toes

irregular

shallow

minimal/no bleeding poor granulation

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venous ulceration wet gangrene

medial malleolus

deep irregular shape

round edges

mild/moderate pain

granulating base

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irregular ulcers

venous

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shallow ulcers

arterial

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granulating ulcers

venous

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characteristics of ischemic rest pain

at night with foot elevated relieved by dangling foot or walking

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waveform prior to stenosis

peaked -

monophasic -

high resistance

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waveform distal to stenosis

parvus et tardus

monophasic

low resistance

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hyperemic flow

all above baseline

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ABI predicts severity in absence of calcified vessels

not reliable with calcified vessels

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significant ABI change = 0.15

increasing severity of disease

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ABI > 0.5

single level disease

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ABI

multilevel disease

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claudication

0.5 - 0.9

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rest pain

0.25 - 0.5

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normal ABI

0.9 - 1.3 (other chart 0.96 - 1.3)

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mild disease ABI

0.80-0.94 (other chart 0.85-0.95)

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ABI moderate disease

0.50 - 0.79 (other chart 0.51- 0.84)

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ABI severe disease

0.30 - 0.49 (other chart 0.25 - 0.50)

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ABI critical

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falsely high pressures

due to medial calcification in diabetes and CRF

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if greater than 15 mm difference btw PT and DP

proximal disease

effects on PVR amplitude

stroke volume blood pressure vasomotor tone blood volume limb size limb position

prosthetic graft normal velocity & velocity ratio

prosthetic graft moderate stenosis

180-300 cm/sec ratio \> 2

prosthetic graft high grade stenosis

PSV \> 300 cm/sec ratio \> 3.5

impending prosthetic graft failure

PSV

vein graft normal velocity

\> 45 cm/sec ratio

vein graft moderate stenosis

250-300 cm/sec ratio \> 3.0

vein graft high grade stenosis

\> 350 cm/sec ratio \> 3.6

prior femoropopliteal endovascular intervention \> 50% stenosis

\> 180 cm/sec ratio \> 2.5

prior femoropopliteal endovascular intervention \> 70% stenosis

\> 300 cm/sec

in stent \> 50% restenosis of SFA

PSV \> 190 cm/sec ratio \> 1.5

in stent \> 80% restenosis of SFA

PSV \> 275 cm/sec ratio \> 3.5

graft flow velocity

average of peak systolic velocities from 3-4 nonstenotic graft segments normally between 40-45 cm/sec can be less with larger grafts

monphasic bypass graft waveform

inflow tract obstruction

staccato waveform - no diastolic flow

distal anastomotic or outflow obstruction

exercise recovery

15 min severe occlusive disease

% pressure decrease post exercise - normal range

17-34%

% pressure decrease post exercise single level disease

35-50%

% pressure decrease post exercise multi level disease

\> 50%

Takayasu's arteritis

aorta and branches usually dilation and aneurysm females usually ages 20-40

Giant cell arteritis (temporal arteritis)

medium/large size vessels temporal artery and ECA branches 75-85 year old (women)

Kawasaki's disease

small medium arteries including coronaries age 2-5 years

elevated celiac artery velocity

exclude median arcuate syndrome record PSV after deep inspiration if normalizes, then confirms diagnosis

fasting SMA waveform

like triphasic arterial waveform

non fasting SMA waveform

low resistance, slow acceleration/deceleration continuous diastolic forward flow

retrograde common hepatic artery waveform

suggestive of celiac stenosis or occlusion

normal celiac artery velocity

98-105 cm/sec

normal SMA velocity

97-142 cm/sec

normal IMA velocity

93-189 cm/sec

Bernoulli principle

decrease area results in increased velocity increased velocity decreases pressure area inc - velocity dec - pressure inc

longer stenosis

smaller velocities

Reynolds number threshold

2000 normal 2000-4000 transitional \> 4000 turbulence

before stenosis at or just past stenosis after stenosis

increased PSV - decreased pressure post stenotic turbulence parvus tardus

cuff bladder \*\*\* what percentage of limb diameter

40% limb circumference or 20% of limb diameter

going distally in leg pressure and velocity change

pressure increases and velocity decreases

exacerbation of popliteal entrapment

leg hyperextension dorsiflexion and plantar flexion

arteritis with concentric narrowing

Takayasu and giant cell arteritis

UE arterial index normal pressure normal

0.8 \> 70 mm Hg

medium vessel arteritis

Kawasaki Behcet Churg Strauss Polyarteritis nodosa

large vessel arteritis

Takayasu giant cell

small vessel arteritis

wegener Henoch schonlein purpua cryroglobulemia microscopic polyangitis SLE RA

Extremity Arterial Flashcards

(66 cards)