LEA and penile doppler

what is defined as an exercise induced muscular discomfort due to the lack of arterial muscle perfusion

claudication

claudication is induced by ___

walking

claudication can be relieved by resting for _____

2-5 minutes

what is the main function of the arterial system

transport oxygen rich blood from the heaty to perfuse organs and tissues

what layers make up the walls of an artery (outer to inner)

tunica adventitia, tunica media, tunica intima

what layer supplies the vessel with support and structure

media

at what level does the external iliac artery become the common femoral artery

inguinal ligament

the profunda femoral artery is located ____ and _____ to the superficial femoral artery

posterior; lateral

what does the popliteal artery terminate into

anterior tibial artery and tibioperoneal trunk

vessel diameter has the greatest affect on _______

flow volume

a decrease in the artery diameter causes an _____ of the arterial resistance

increase

an increase in ____ can be a marker for arterial pathology

PSV

PAD an arterial occlusive disorder causes a reduction in arterial lumen leading to an increase in ____

PSV

what is the primary disease process that leads to PAD

atherosclerosis

what is characterized as the buildup of atherosclerotic plaque on the arterial endothelium as a result of excess lipids present in the blood

atherosclerosis

atherosclerosis can cause a _____ that occurs when plaque dislodges from the arterial wall and propagates distally in the arterial system and can eventually go to the brain and cause a stroke or cause ischemia by occluding arteries

arterial embolism

how can we stop the progression of atherosclerosis through management of our life / medical

no Tabaco use, eating healthier, exercise and medications

what is the treatment for PAD that involves the use of a catheter in the artery at the site of the atherosclerotic lesion where percutaneous transluminal angiography, endograft, atherectomy, and thrombin injections can be done

endovascular treatments

what is the most common surgical treatment for PAD

making a bypass graft - making an alternative route for the blood

in severe causes of atherosclerosis what is typical done for treatment

limb amputation

as PAD progresses the amount the patient can walk before having symptoms ________

decreases

with PAD what is rest pain

when the muscles of the legs do not get enough the amount of oxygenated blood needed even at rest

what is the type of pain that causes discomfort when lying down until the patient gets in a dependent position to let gravity assist the blood going to the toes

ischemic leg pain

what are signs of peripheral occlusive arterial disease

elevation pallor, dependent rubor, ischemic ulcers, gangrene, bruit, decreased peripheral pulses

what information is given during a segmental doppler of pressures

a quantitative value that offers physiologic info from the segment of the vessel under the cuff

how long should a patient result before having a segmental doppler pressure performed

15 minutes

why would a pressure cuff not be placed on a certain part of the limb

they cannot be placed on grafts or stents

what position is the patient when getting segmental pressures taken

supine

why is the patient in a supine position with the legs at the same level as the heart for a pressure to be taken

to prevent hydrostatic pressure artifact

how much more should a cuff be inflated above the systolic before it is slowly deflated

20-30 mmHg

when getting the segmental doppler pressures the CW transducer should insonate at an angle of ____ of the best signal

45-60 degrees

to get the best pressures the cuff must have a width ___ greater than the diameter of the limb

20%

if the width of the cuff is too small this might cause a ____ of the values

elevation

in a healthy patient the pressure measurements will ____ going from ankle to proximal thigh

increase

if there is a difference of >20 mmHg between the arm pressures what does this mean

arterial obstruction of the innominate, subclavian, axillary, or proximal brachial artery is suspected on the side with a lower value

how much higher should a proximal thigh pressure be compared to a brachial pressure due to cuff size artifact

30 mmHg

if the proximal thigh pressure is equal to or less than the brachial pressure what does this mean

suggest disease at or proximal to the femoral artery

when comparing values within the same limb there should be a difference of a value no greater than ___ between two adjacent segments

20 mmHg

if there is a greater then 20 mmHg difference between two adjacent segments of the leg what does this suggest

intercurrent disease

pressure measurements obtained at the same level of both the limbs should not have a difference in value grater than _____

20 mmHg

are segmental pressure gradients able to distinguish between arterial stenosis and occlusion

no

how do we get the pressure index

dividing the values at each level by the highest brachial value

what is the normal level of an ABI

1 - 1.40

what is the ABI value that suggest arterial calcification and vessel no compressibility

> 1.40

what are the borderline values for an ABI

0.91 - 0.99

what are the ABI values that are considered abnormal and are suggestive of disease

less than .90

what value of an ABI has a high risk of amputation

less then .50

what can be caused by medial calcinosis or medial sclerosis that results in not being able to compress the arteries during an ABI (mostly seen in diabetic patients)

values that are falsely elevated

what tests are not affected by a noncompliant arterial wall

toe pressures

what is a three cuff pressure not able to do

discriminate between inflow and FA disease

what are the reasons that segmental pressures in the lower extremity are underestimated

1. narrowing of arterial lumen must be significant enough to cause a pressure change

2. proximal disease may mask distal disease

3. calcified vessels may falsely elevate pressures

without occlusive arterial disease blood perfusion will ____ to muscles during exercise to meet elevated oxygen demands

increase

in patients with intermittent claudication increased perfusion to muscles used during ambulation is _____ which might cause no symptoms at rest

not done

a collateral vessel development can cause a ____ ABI

normal

when do collateral vessels form

when perfusion is inadequate

can collateral vessel give adequate perfusion to the leg during rest

yes

when a patient is found to have collaterals when getting an ABI done with a normal value what testing should be done

arterial stress test

arterial stress testing is done with a ____ grade institution on a treadmill

10-20%

during an arterial stress test how long should the patient walk on the treadmill before taking the AMI measurements again

5 minutes or until symptoms begin that prevent further exercise

during an arterial stress test what brachial pressure is taken the second time (after exercise)

the brachial pressure that was highest at rest

during an arterial stress test what ankles pressures are taken the second time (after exercise)

they are taken bilaterally using the artery that was highest during rest in each limb

during an arterial stress test when should the post exercise pressures be taken

with 2 minutes of exercise

during an arterial stress test how often after the initial pressure is taken after exercise should pressures be taken

every 2 minutes for 10 minutes or until they return to resting value

during an arterial stress test what reflects the severity of the underlying arterial disease

ankle pressures that fall after exercise and return to baseline in 5 minutes suggest

single segment occlusive disease

ankle pressures that persist for greater than 10 minutes after exercise suggest

multisegment arterial disease

what is suggested if the patients ankle pressures are unchanged or improved (elevated) after exercise

no underlying arterial disease is causing the patients symptoms (can still be present)

what is the more accurate method for evaluating distal limb and foot perfusion in individuals with falsely elevated limb pressures

toe pressures

toe pressures are also used to help determine if there is obstructive disease of the ___ and ____ arteries

pedal arch; digital

how is the pressure obtained on the toes

placing a photoplethysmography sensor on the distal portion of the toe

what is the normal measurement for a TBI (Toe-brachial index)

>0.80

what is a plethysmography

it measures the changes in blood volume as a method to obtain arterial waveform

what is pneumoplethysmography commonly known as

pulse volume recording (PVR)

what does a PVR measure

changes in segmental limb volume that occurs during each cardiac cycle

during a PVR each cuff is inflated between ____ and ____ above the systolic pressure before deflating

20; 30 mmHg

what is the normal PVR waveform

a rapid rise (acceleration) to a sharp peak during systole followed by a slower fall (deceleration) during diastole, with a cardiac notch showing the retrograde flow that occurs during diastole

a PVR waveform shows progressive occlusive arterial disease

the loss of a dicrotic notch followed by a delayed upstroke and downslope time

what PVR waveform suggests severe arterial occlusive disease

no pulse amplitude (flatline)

the PVR waveform of the calf should be ____ compared to the waveform of the thigh dur to cuff artifact

higher amplitude

what should be done when segmental pressures are taken and show noncompressible vessels

PVR waveforms

what is a photoplethysmography PPG test done for

detecting cutaneous microcirculation arterial pulses by showing the PPG waveform

what is PPG testing normally done on

digits or in situations of severe arterial disease like wound healing and ischemia

ankle pressures less than _____ suggest the presence of of significant ischemia and yeild a low probabilty of wound healing