Davies Vascular Ch. 4-6 (E3 Material)

Spectral Analysis displays ____ on the vertical axis, ____ on the horizontal axis, and the ____ of backscattered signals at any given frequency and time.

Frequency (or Velocity); Time; Amplitude

With Analog vs Spectral, which method allows you to see frequencies?

Spectral

For the upper extremities, Doppler waveforms are recorded for the following arteries:

Subclavian, Axillary, Brachial, Radial, and Ulnar

For the lower extremities, Doppler waveforms are recorded for the following arteries:

Common femoral (CFA), Superficial Femoral (SFA), Popliteal, Posterior Tibial (PTA), Dorsalis Pedis (DPA), Peroneal (Per A)

Normal signals are ____ or ____ with a rapid upstroke, sharp peak, rapid downstroke, a short peak below the baseline representing reverse flow, and resumption of forward flow (above baseline). The upper and lower extremity arteries have higher-resistance flow patterns.

Triphasic, multiphasic

Abnormal signals of the extremities are ___, ____, or ___.

Monophasic, nonpulsatile, or absent

Flow distal to well-collateralized occlusion can appear similar to flow distal to a ____

Stenosis

A monophasic and dampened signal can be obtained ____ to an obstruction as well as ____ to it.

Proximal, Distal

_____ of the distal vessels can reduce the pulsatility of the arterial signal, causing it to assume the quality of low-resistance vessels

Vasodilation

Postexercise waveforms normally maintain or augment pre-exercise waveforms with all of the waveform components usually depicted above the baseline. Abnormally, the following changes can occur:

Slow upstroke with more rounded peak

Slow downstroke

No reverse component

Peripheral resistance is usually lower in the _____ (Upper/Lower) extremities

Upper

The ____ artery is normally characterized by multiphasic, high-resistance flow.

Subclavian

It is not uncommon to see continuous ___(High/Low) resistance Doppler signals in the brachial, radial, and ulnar arteries of a patient who is relaxed and warm.

Low

The _____ ____ is calculated by dividing the peak-to-peak frequency by the mean (average) frequency.

Pulsatility Index (PI)

A PI of ____ is normal for the CFA, while a normal PI for the popliteal artery is approximately ____.

>5.5; 8.0

A PI of ____ in the common femoral artery with a patient superficial femoral artery has a pretty good predictive value and indicates proximal aortoiliac occlusive disease. If the SFA is occluded, however, the same reduced PI finding is not diagnostic.

less than 5.0

____ ___ also helps to differentiate inflow from outflow disease. It is not prolonged when there is disease distal to the probe.

Acceleration Time

Regarding Doppler Segmental Pressures, if the cuff is too large, blood pressure is artifactually ____; if the cuff is too narrow, the blood pressure is artifactually ___.

Lower; Higher

It is essential that the patients has rested at least _____ prior to a segmental pressure test. Walking in for the test can reduce the amount of blood flow to the extremities if the patient does have vascular claudication

20 minutes

Disease is always located ____ to the cuff

Proximal

It is important to start at the ankle level and then to move more proximally one level at a time to eliminate the possibility of underestimating the ____ ____ measurement

Systolic Pressure

Complete cessation of blood flow should be accomplished by inflating the cuffs __ to __ mmHg beyond the last audible Doppler arterial signal

20 to 30

ABI: ?

Findings: Normal

>1.0

ABI: ?

Findings: Asymptomatic minimal obstructive disease (many consider this as within normal limits)

>0.9-1.0

ABI: ?

Findings: Mild arterial disease

0.8-0.9

ABI: ?

Findings: Claudication (moderate disease)

0.5-0.8

ABI: ?

Findings: Rest pain (severe arterial disease)

The ____ is calculated by dividing the ankle pressure by the higher of the two brachial pressure.

ABI (ankle/brachial index)

A decrease in pressure of ____mmHg between two consecutive levels is considered significant and would suggest significant obstruction.

>30mmHg (other sources indicate >=20)

A horizontal difference of ___ to ____mmHg or more suggests obstructive disease at or above the level in the leg with the lower pressure

20 to 30

____ pressure differences are no longer valid once proximal disease has been detected.

Horizontal

Toe pressures of ____mmHg or less are evident in case of foot and toe ulcers that fail to heal.

30

Ankle pressures that drop to low or unrecordable levels immeadiatley after exercise and then increase to resting levels in _____ to _____ minutes suggest obstruction at a single level.

2 to 6

When such ankle pressures remain reduced or unrecordable for more than ___ minutes, multilevel obstructions are usually present

6

Patients who have single-level disease experience a ___% drop in ankle pressure.

Patients with multilevel arterial disease experience a pressure drop ____%

>50%

If there is a >= ___ to ___mmHg difference from one brachial pressure to the other; then the lower side would suggest a >50% diameter reduction of the subclavian artery and/or the vessel under the cuff.

15 to 20

The radial and ulnar artery pressures are usually within __ to ___mmHg of each other. If there is a difference of >=20mmHg, the vessel with the lower pressure may be obstructed.

5 to 10

Standard Allent Test Interpretation:

Radial artery continues to be manually compressed

Reappearance of the normal skin color when the hand is relaxed indicating that the palmar arch is patent with the ulnar artery providing inflow

Normal or Abnormal?

Normal

Radial artery continues to be manually compressed

If the hand does not return to its normal color during relaxation, this would indicate an obstruction of either the distal ulnar artery or the palmar arch. This finding is described as being "radial artery dependent"

Normal or Abnormal?

Abnormal