Unit 3 Peripheral Arterial Evaluation part 2

The 6 P’s of PAD: ACUTE

1. Pain*

2. Pallor

3. Polar (poikilothermia) (cool to touch)

4. Pulselessness

5. Paresthesia(tingling)

6. Paralysis

Reasons for noninvasive arterial testing -

• Evaluate pulsatile masses

• Evaluate suspected arterial trauma

• Evaluate angioplasty/stent placement

• Baseline study before operative reconstruction

• post-op

noninvasive arterial testing provides -

documentation of severity of arterial disease

noninvasive arterial testing aids in diagnosis of -

exercise-induced pain caused by occlusive arterial disease

noninvasive arterial testing supplements clinical judgement regarding -

healing of foot ulcers and amputation sites

indirect imaging limitations -

• detects only hemodynamically significant disease (> 60% stenosis)

• usually, cannot distinguish stenosis from occlusion

• region, but not site of disease

patient preparation for indirect imaging includes -

• verify patient and exam

• Obtain relevant history

relevant patient history includes -

• signs/ symptoms, onset, duration, etc.

• coexisting conditions such as stroke/TIA, CAD, hypertension, diabetes, lipid disorders

• smoking history

• family cardiac/ peripheral vascular history

• exercise activity

indirect imaging patient positioning -

• patient should be supine with head raised slightly

• legs should be externally rotated with knees flexed depending on vessels being interrogated

doppler waveforms examination technique -

continuous wave (CW) doppler transducer typically used

doppler waveforms are recorded from -

• common femoral

• superficial femoral

• popliteal

• posterior tibial

• dorsalis pedis

when using doppler and approximately -

45-degree angle to the skin should be used

normal doppler waveforms in the peripherals -

• triphasic

• biphasic (bidirectional)

PAOD -

Peripheral Arterial Occlusive Disease

PAOD reduces -

• flow energy distal to the lesion

• amount of flow reversal

PAOD results in -

reduction of peripheral resistance

Other PAOD characteristics -

• volume flow is maintained in this wat until PAOD reaches critical stage

• arteriolar bed can no longer dilate to increase blood flow

• patient experiences rest pain

pulse volume recordings measure -

changes in segmental limb volume with each cardiac cycle

With pulse volume recordings patient is examined in supine positions and -

BP cuffs are placed in arms, thighs, calves, ankles, and feet

during a pulse volume recording each cuff is inflated to preset -

pressure (usually 65 mm Hg) to maintain adequate contact between cuff bladder and limb

pulse volume waveforms are recorded on -

analogue chart recorder

Plethysmography is also known as -

• Air plethysmography

• pulse volume recording (PVR)

• Volume pulse recording (VPR)

plethysmography cuff is used to -

measure volume changes in limb

plethysmography reflects the -

total perfusion in the underlying arterial segments (does not identify specific arteries)

plethysmography can be used in -

patients with calcified arteries

plethysmography exam technique -

like segmental pressures, can use either one or two cuffs on the thigh plus one calf cuff and one ankle cuff

during a plethysmography each cuff is inflated to -

55 to 65 mm Hg

during plethysmography when cuff is inflated -

• venous flow is restricted

• changes occur under cuff are from arterial inflow

• volume in limb changes with cardiac cycle

• pressure change is converted to a waveform

Normal Plethysmography wave forms should include -

• rapid upstroke with well-defined peak

• notch on downstroke in early diastole (dicrotic notch)

• high resistance

plethysmography; moderate to severe disease spectral doppler -

• delayed onset to peak

• rounded peak

• diastolic phase becomes convex (bows out rather than toward the baseline)