Lower Extremity Physiologic Testing

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Last updated 4:21 PM on 9/9/26
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16 Terms

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Normal CW Doppler Signal in Lower Extremity

Multiphasic - high resistance, two beats in the antegrade direction

Strong late systolic forward flow

Reversal of flow in early diastole (peripheral resistance)

Forward flow in late diastole (compliance)

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Dicrotic Notch

Recoil/contraction of distended arterial walls

Size of notch determined by level of arterial compliance

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Incisura

Downward pressure contour on waveform

Start of ventricular diastole

Results in velocity decrease in forward flow

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Multiphasic With High Resistance

2 phases

2 forward antegrade beats

Normal

<p>2 phases</p><p>2 forward antegrade beats</p><p>Normal</p>
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Monophasic with Low Resistance

Mild disease

<p>Mild disease</p>
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Monophasic without Diastolic Flow

Moderate disease

<p>Moderate disease</p>
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Monophasic with Low Resistance - Tardus Parvus

Severe proximal disease

<p>Severe proximal disease</p>
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Pulse Volume Recordings (PVR)

Assesses overall limb perfusion based on pressure changes

Records change in volume of blood in a limb as blood moves through

Used to measure limb volume related to cardiac cycle-pulsing changes in limb volume - girth of limb increases and air in the cuff is displaced

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Normal PVR Waveform

Biphasic - always above baseline

Rapid upstroke in systole

Sharp & defined peak

Delayed downstroke

Flat dicrotic notch - on downstroke

<p>Biphasic - always above baseline</p><p>Rapid upstroke in systole</p><p>Sharp &amp; defined peak</p><p>Delayed downstroke</p><p>Flat dicrotic notch - on downstroke</p>
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PVR Waveform of Mild Disease

Monophasic flow (looks like tardus parvus)

Loss of dicrotic notch

Slightly delayed upstroke

Downstroke bows away from baseline

Sharp peak

May decrease in amplitude

<p>Monophasic flow (looks like tardus parvus)</p><p>Loss of dicrotic notch</p><p>Slightly delayed upstroke</p><p>Downstroke bows away from baseline</p><p>Sharp peak</p><p>May decrease in amplitude</p>
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PVR Waveform of Moderate Disease

Delayed upstroke

Rounded

Decreased amplitude

<p>Delayed upstroke</p><p>Rounded</p><p>Decreased amplitude</p>
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PVR Waveform of Severe Disease

Significant delay in upstroke

Absent or low-amplitude

Equal upslope and down slope time

<p>Significant delay in upstroke</p><p>Absent or low-amplitude</p><p>Equal upslope and down slope time</p>
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PVR Waveform of Critical Disease

Almost becomes flat line

Seen in severe dz or acute arterial occlusion

Differentiate from increased venous flow

<p>Almost becomes flat line</p><p>Seen in severe dz or acute arterial occlusion</p><p>Differentiate from increased venous flow</p>
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Where is disease on an abnormal PVR waveform?

Above the cuff

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PPG Techniques

Attached with tape, clip, or pressure cuff

Use same amount of pressure from site to site

LED surface needs to be flat against skin surface

Reseat probe if abnormal signal is seen

<p>Attached with tape, clip, or pressure cuff</p><p>Use same amount of pressure from site to site</p><p>LED surface needs to be flat against skin surface</p><p>Reseat probe if abnormal signal is seen</p>
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