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51 Cards in this Set
- Front
- Back
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Pseudo-Claudication |
•Arthritis or LBP that mimics claudication |
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Basal State |
•Steady state in metabolism of systemic blood pressure |
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Arterial Physiologic Test Goals |
•Find evidence of occlusion •Cause of symptoms •Severity/progression |
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Advantages of Physiologic Tests |
•Simple, fast, inexpensive •Accurate for significant disease •Objective, quantitative info |
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Indirect Tests |
•Pressure, plethysmography, doppler wave analysis, exercise test |
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Pressure Assessment |
•ABI and/or segmental pressures |
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Plethysmography |
•Pulse volume recording •Photophlethysmography(PPG) |
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Pertinent Questions |
•Leg pain, both or one sided •Location of worst pain •Walking distance, pain ceases •Vascular surgery/bypass |
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Physical Signs of Disease |
•Pallor, pain, paresia, puleless •Coldness, ulceration, wounds •Dependent rubor |
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Claudication |
•Progressive pain with exercise •Calf, thigh, buttock, hip •Relieved by rest |
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Arterial Symptoms |
•Progressive, intermittent, no swelling, pallor, cool, rest pain |
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Venous Symptoms |
•Acute, persistent pain, swelling, cyanosis, warmth, tenderness |
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Normal Supine Patient |
•Ankle systolic pressure is >/= brachial |
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Pressure Acquisition |
•Patient in basal state in warm room |
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BP Cuff Size |
•Bladder 20% wider than limb |
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PPG |
•Infrared emitting/receiving diode detects cutaneous blood flow |
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PPG Advantages |
•Less operator dependent •Simultaneous sampling •Convenient |
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PPG Disadvantages |
•No audible signal •Ineffective for severe disease •Motion/ambient light artifact |
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Oscillometric Pressures |
•Convenient but error prone •Overestimate pressures |
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Doppler vs PPG |
•Doppler is time consuming but more reliable |
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ABI |
•Ankle pressures/highest brachial •Highest ankle pressure reported |
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Segmental Pressures |
•Snug cuffs, warn patient •Inflate 20 mmHG above systole •Pause then release |
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Toe/Brachial Index |
•>0.75 is normal •<0.66 is abnormal |
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ABI Exception for Normals |
•Brachial systole below 100 or above 200 •Ankle may be 25% lower than brachial |
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Arm Pressures |
•20 mmHg gradient between pressures = subclavian stenosis/occlusion in lower side |
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Segmental Pressure Interpretation |
•Compare to contralateral side, adjacent segment, brachial pressure |
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30 mmHg Pressure Drop |
•Significant in the presence of abnormal ABI |
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Calcification Clues |
•Non comp, can't get pressure •ABI > 1.35 •Distal pressure high compared to proximal |
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Pressure Advantages |
•Quantitative info on limb perfusion •Easy, substantial validation |
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Volume Plethysmography |
•Measures volume change in limb or organ |
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PVR |
•Limb volume changes w/ systole •Air displaced in cuff •Instant pressure change recorded |
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Normal Thigh 4 Cuff |
•>/= 20 mmHg above brachial |
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PVR Limitations |
•Tremors, distal disease with prox occlusion, subjective, atrial fib |
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PVR Advantages |
•Easy to learn/perform •Global limb perfusion •Metatarsal/toe evaluated •Fast, not affected by calcified arts |
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Waveforms Obtained |
•CFA, SFA, Pop, PTA, DPA |
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Doppler Technique |
•Basal state, warm room •4-8 MHz CW Doppler •45-60° angle to skin |
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Doppler Limitations |
•Obesity, scars, occlusion = junk •Venous interference •High skill required |
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Exercise Purpose |
•Differentiate true/pseudo clauds •Differentiate bordline normal •Determines what limits walking |
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Exercise Stress Test |
•Treadmill: 1.5-2 mph, 5-10% grade for 5 minutes •Ankle pressures ASAP |
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Exercise Candidates |
•Intermittent claudicators •ABI 0.85 - 0.5 •Claudication but resting study is normal |
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Contraindications for Treadmill |
•Questionable cardiac, resting ischemia(<0.3), rest pain, severe pulmonary disease, poor movers |
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Exercise to Define Extent of Disease |
•Use treadmill, toe raises |
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Exercise to Separate True from Pseudo |
•Use treadmill |
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Post Exercise Method #1 |
•One bilateral ABI from both ankles and one arm •Efficient |
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Post Exercise Method #2 |
•Serial ABIs until ankles return to pre exercise levels |
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Claudication Criteria |
•Post exercise ankle pressure of 60 or less confirms vascular etiology |
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Stress Testing Caveats |
•Record symptom onset/nature •Record walking time •If pressures normal post, no need to take more |
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PORCH |
•Post Occlusive Reactive Hypermia |
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PORCH Method |
•Occlude distal thigh 3 mins •Occlude pressure 20 above limb •Record post occl ankle pressure |
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PORCH Limits |
•Painful, poor patient acceptance •Learn, don't do |
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Physiologic Test Limits |
•Only finds hemodynamically significant disease(>60%) •Can't tell stenosis from occlusion •Tells region, not site of disease |
