Segmental Pressure

Question 1

What is the primary purpose of segmental pressures?

Answer 1

To determine location of an obstruction.

Question 2

What is an obstruction?

Answer 2

Stenosis or occlusion.

Question 3

What are the three locations where a segmental pressures can locate an obstruction?

Answer 3

• Aorto-illiac
• Femero-popliteal
• Infrapopliteal

Question 4

How big should the cuff width be?

Answer 4

> 20% of limb diameter.

Question 5

Where should you keep the bladder of the cuff?

Answer 5

Medial.

Question 6

Where are the 5 cuff locations?

Answer 6

• Upper thigh
• Lower thigh
• Calf
• Ankle
• Brachial

Question 7

Where should use the CW doppler?

Answer 7

Dorsalis pedis and posterial tibialis.

Question 8

Once you inflate the cuff, and the pulse signal disappears, you should inflate the cuff how much more?

Answer 8

30 mmHg

Question 9

When you deflate, how fast should you deflate?

Answer 9

2-4 mmHg and note when the first pulse is heard.

Question 10

If the pedal artery isn’t audible, what should you do?

Answer 10

You should listen higher up to obtain the calf pressure or use the popliteal to obtain thigh pressure.

Question 11

What are some ways to help aid the patient during segmental pressures?

Answer 11

• Have the patient relax muscles as much as possible to avoid pain.
• If patient experiences severe pain, stop and indicate patient intolerance of the pressure cuff.

Question 12

What is the “normal” pressure gradient between levels?

Answer 12

<20 mmHG

Question 13

What is the “borderline” pressure gradient between levels?

Answer 13

20-30mmHg

Question 14

What is the “abnormal” pressure gradient between levels?

Answer 14

> 30 mmHg

Question 15

Are calf pressures occasionally greater than thigh pressures?

Answer 15

Yes.

Question 16

In OUR class, what is our pressure gradient going to be in order to indicate a “hemodynamically significant obstruction”

Answer 16

30 mmHG

Question 17

Does ABI’s tell you the location of an obstruction?

Answer 17

No.

Question 18

Should ankle pressure be higher than brachial?

Answer 18

yes.

Question 19

Why does cuff pressure decrease from upper thigh to ankle?

Answer 19

It decreases due to cuff artifact at the upper thigh level.

Question 20

What is the upper thigh/brachial ratio normally?

Answer 20

> 1.15

Question 21

What is the lower thigh, calf, and ankle/brachial ratios normally?

Answer 21

> 1.5

Question 22

How should the cuff width be in order to create an accurate pressure measurement?

Answer 22

> 120%

Question 23

A proximal obstruction is indicated with what ratio?

Answer 23

<1.15

Question 24

What is considered “proximal disease”?

Answer 24

It may be aorto-iliac, iliac, CFA, or proximal SFA.

Question 25

If segmental pressure drops, what does this indicate?

Answer 25

It typically indicates the obstruction is either at the cuff or proximal to it.

Question 26

What are the advantages of segmental pressures?

Answer 26

- Quantitative - Segmental location of obstruction can be determined. - Absolute pressure measurements are useful to determine level of amputation.

Question 27

What are some of the limitations that segmental pressures has?

Answer 27

- Calcification - Obesity - Patient discomfort. - Cannot discern stenosis from occlusion. - Significant obstruction with good collaterals may result in a normal pressure.

Question 28

What should you do if a cardiac arrhythmia are present?

Answer 28

Drop the pressure slowly to catch the first pulse.