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Summer 2014 - Intro to Vascular ✔️ > Peripheral Arterial Evaluation > Flashcards

Peripheral Arterial Evaluation Flashcards

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0
Q

reasons for noninvasive arterial testing

A

evaluate pulsatile masses

evaluate suspected arterial trauma

evaluate angioplasty/stent placement

postoperative f/u, including bypass graft surveillance

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1
Q

reasons for arterial scanning

A 
chronic atherosclersis
acute occlusion
aneurysm
pseudoaneurysm
ateriovenous fistula
follow of bypass grafts
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2
Q

what are you looking for when scanning arterial circulation

A 
reduction of blood flow
condition of artery
collateral branches
changes with exercise
single or multiple level disease
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3
Q

what is PAD

A

peripheral arterial disease

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4
Q

describe PAD

A

effects 8-12 million in the usa

atherosclerosis

“poor circulation”

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5
Q

if peripheral arterial disease isn’t treated, what might occur

A

worsening claudication

ley bypass surgery

leg amputation

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6
Q

risk factors for arterial issues

A

increasing age
family history
male gender

HTN
**diabetes (x4 more likely)
elevated cholesterol
hyperlipidemia
smoking
atherosclerosis
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7
Q

treatment for arterial issues

A

lifestyle modification - diet changes, exercise, quit smoking

grafts, angioplasty, stent, and medication

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8
Q

retaining ______ extremity function is important to patients lifestyle

A

lower

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9
Q

what needs to be determined when dealing with arterial circulation issues

A

restriction of flow

where is the restriction

how severe is the restriction

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10
Q

arterial symptoms of PAD

A

mild - asymptomatic

moderate - claudication - asymptomatic at rest (MOST COMMON)

severe - night pain

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11
Q

what is claudication

A

CRAMPING of the leg muscles, not a severe pain

symptoms may ease after resting

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12
Q

adjectives used to describe claudication

cramping?
tightness?
heaviness?
tired?

A

cramping - fatigued
tightness - charlie horse
heaviness - sharp
tired - dull ache

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13
Q

PROXIMAL to the location of symptoms

thigh pain?
calf pain?

A

thigh pain - aortoiliac disease

calf pain - femoral or pop disease

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14
Q

wherever the pain is in the leg, the problem is be _______ to that pain

A

proximal or above

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15
Q

describe ischemic rest pain

A

pain in horizontal position (at night) relieved by standing or dangling foot in a dependent position

described peripheral pulses

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16
Q

describe advanced lower extremity ischemic

A

elevation pallor and dependent rubor

*leg up gets pale, leg down gets red

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17
Q

describe what happens to the tissue if there are arterial issues

A

tissue loss
gangrene and necrosis

  insufficent blood supply

  ulceration
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18
Q

describe ischemic ulcers

A

painful over dorsum of the foot

gangrene - neuropathy, vasospasm

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19
Q

doctor will assess the leg for arterial issue by doing what

A

listening for a bruit

thrill - a vibration felt by palpation

decreased perpheral pulse

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20
Q

pulse force grading system

A

3+ full, bounding

2+ normal

1+ weak

0 absent

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21
Q

acute arterial occulsion - name the 7 P’s

A

pain

pallor

pulselessness

paresthesia (numbness)

paralysis (weakness)

polar (cold)

purplish

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22
Q

physical signs of peripheral arterial disease

A

elecation pallor and dependent rubor

ischemic ulcers

gangrene

bruits

decreased peripheral pulses

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23
Q

name the arteries of the leg

A 
AO
commonn iliac
IIA and EIA
CFA
SFA
Profunda - DFA
Popliteal 
ATA
Tibioperoneal trunk
PTA
Peroneal
Plantar arch
Dorsalis pedis
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24
major branches of the popliteal artery
sural arteries genicular arteries
25
arterial anatomy of the heart
aortic arch 1st - innominate/brachiocephalic - rt subclavian & right CCA 2nd - Lt CCA 3rd - Lt subclabvian
26
describe subclavian artery
right - innominate or brachiocephalic left - aortic arch
27
arterial anatomy of the arm
``` axillary brachial radial ulnar palmar ```
28
what is the test ordered to see arteries
arteriography
29
describe arterial testing atmosphere
keep room temp comfortable and warm to allow for periphal dilation supine performed at rest **cuff placement is key
30
describe the complete physiologic test - indirect/non imaging with cuffs on limbs
pulse volume recording (plethysmography) at high thigh, low thigh, below knee and ankle segmental systolic pressures at the levels assess on both limbs
31
what is PVR
pulse volume recording changes in segmental limb volume with cardiac cycle
32
know pulse volume recordings for PAD and be able to tell the difference between PVR's and CW doppler
study slide 47
33
_____ recordings may have a cuff artifact which produces a higher amplitude than in the thigh
calf
34
if amplitude of calf is equal or smaller than the thigh, ______ disease is suspected
SFA
35
Indirect arterial testing: segmental pressures are obtained with the patient in the ________ position
supine
36
indirect arterial testing: cuff size should be _____% larger than the limb
20
37
indirect arterial testing: the legs should be at the same level as the heart because the position avoids ______ ______ artifact
hydrostatic pressure
38
who invented segmental pressures and when
Winsor in 1950 still remains a very sensitive indicator
39
how long should the rest period be before indirect arterial testing
15-20 mins
40
where are the blood pressure cuffs placed on the body
``` upper arm prox thigh low thigh calf ankle ```
41
cuff inflates to _______ mmHg above systolic pressure
20-30
42
what is the part of the pressure cuff that contains the air
the bladder
43
advantages to pressure cuff testing
simple to perform short test time objectibe data instrumentation is cheaper than imaging
44
describe PPG photoplethysmography
for toe arteries uses infrared light to respond to blood circulation
45
limitations to pressure cuff testing
casts or bandages CHF temperature changes doppler angle
46
ischemic lesion not healing if ankle systolic pressure is below _____ mmHg
55 foot ulcers and amputation
47
describe direct/non imaging complete physiologic test
CW doppler of CFA, SFA, PA, ATA, PTA with correct angle (45-60) assess on both limbs
48
describe ankle-brachial pressue
take the ankle pressure on the selected side and divide by the highest arm pressure (does not need to be on same side)
49
what is the ABI formula
ankle systolic pressure = ABI ---------------------------------- brachial systolic pressure
50
ankle-brachial pressure index
normal >1 claudication .50-.90 rest pain .30-.50 tissue loss <.30
51
a pressure gradient of _____ mmHg between adjacent segments of the limb is ABNORMAL and indicates intercurrent disease **important**
20
52
review segmental pressure examples
slide 73-77
53
a decrease of > ________ mmHg between two consecutive levels is considered significant and suggests obstructive disease
20-30
54
what is the pulsatitly index
PSV-PDV ------------ mean velocity
55
______ relationship with arterial disease
inverse
56
no arterial disease, PI is ______
high
57
severe arterial disease, PI __________
decreases
58
CW doppler has what 3 different kinds of waveforms
triphasic biphasic monophasic
59
_______ waveform is normal artery
triphasic
60
_______ waveform, with increased velocity, through a mild stenosis
biphasic
61
______ waveform, with greatly increased velocity, through tight stenosis
monophasic
62
______ ______ waveform, with reduced velocity
dampened monophasic
63
PAD causes what...
arteries to narrow and decreases blood flow
64
normal vessels - _______ waveform from AO to the ankles
triphasic
65
characteristics of duplex imaging
red is assigned to arterial flow ``` color scale (PRF) adjusted - venous=low, arterial=high (sampling rate) **PRF is determined by depth** ``` color gain adjusted color box adjusted
66
describe a normal triphasic waveform
high velocity forward flow followed by a brief flow reversal PSV - 100 cm/s AO and decreases to 70 cm/s in popliteal artery
67
what does the doppler spectral waveform demonstrate
percentage of narrowing
68
______% diameter reduction stenosis produces what
50-99% monophasic waveform extensive spectral broadening PSV of more than 100% relative to the proximal adjacent area
69
arteries use a _____ degree angle for consistency
60
70
limitations of lower extremity arterial duplex imaging
bowel gas or obesity shadowing because of calcification difficulty evaluating lesions
71
list upper extremity issues
``` arterial embolization from the heart thoracic outlet syndrome - impingement of the vessels - compression Raynaud's segmental pressure and PVR and CW subclavian artery stenosis with duplex ```
72
describe Raynaud's
intermittent pallor in response to cold cold challenge test with PPG may be due to arterial obstruction
73
describe primary and secondary Raynaud
primary - NO underlying disease - transient secondary - phenomenon - vasospasm secondary to disease
74
describe indirect arterial testing
brachial pressures should be obtained in both arms difference of equal to or greater than 20 mmHg occurs between arms = arterial obstruction (usually subclavian) suspected on the side with lower systolic pressure
75
describe a subclavian steal
stenosis of the subclavian artery subclavain artery steals blood from the contralateral vertebral reversed vertebral flow
76
describe arterial stress testing
stressed with exercise (treadmill) reactive hyperemia - increased pressure with cuff
77
mechanisms of disease... ``` atherosclerosis = ? embolism = ? aneurysm = ? ```
plaque traveling clot dilatation
78
where do aneurysms occur
AO iliac CFA popliteal artery
79
describe pseudoaneurysms
``` perivascular collection neck connection results to trauma compression therapy US guided thrombin injection ```
80
describe Takayasu's arteritis
pulseless diease diminished pulses non atherosclerotic treatment -- lifestyle modification, medications, surgery
81
review slides about grafts...
slides 126-142

Summer 2014 - Intro to Vascular ✔️ (7 decks)

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