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Vascular sonography
Vascular test 2 indirect testing
| Question | Answer |
|---|---|
| What are the different types of indirect testing? (5 types) | Segmental pressures, ABI, CW Doppler, PVR, Exercise stress test |
| What does PVR stand for? | Pulse Volume Recording |
| What is another word for PVR? | Plethysmography |
| What is the objective for indirect testing? | To identify normal and abnormal arterial waveforms, and detect the presence/severity of PAOD |
| What are the limitations of indirect testing? (3 of them) | Detects only hemodynamically significant disease (>60% stenosis) Usually cannot distinguish stenosis from occlusion Region, but not exact site of disease |
| What are the different types of pressure assessments? (2 types) | ABI, Segmental Pressures |
| What are the disadvantages of ABI/Segmental Pressure tests? | Calcified vessels |
| What is the disadvantage of using Spectral/analog waveform test (CW)? | Requires skill and practice |
| What is the advantage of PVR? (2) | Easy to perform, assesses limb perfusion |
| What is the disadvantage of PVR? | Patient movement can interfere |
| How should patients be positioned for indirect testing? | Supine with head raised slightly - extremities at same level as heart |
| Where should you place a pillow for support when using PVR? | Under the patient's heel |
| How long should you let a patient rest before beginning an exam? | 15-20 mins (Basal state) |
| What happens if cuff size is too NARROW? | Too NARROW= falsely elevated pressure |
| What happened is cuff size is too WIDE? | Too WIDE= falsely lower pressure |
| What should the width of the cuffs be? | 20 % (1.2 times) wider than the diameter of underlying limb |
| The typical size cuff for brachial, lower thigh is ______? | 12x40 cm |
| Where should you place the bladder of the cuff? | Over the medial portion of the leg/ area of the vessel |
| Where are cuffs placed for ABIs? | Upper arm (either brachial or radial artery), and Ankle |
| Where are cuffs placed for multilevel lower extremity segmental pressures? (4 areas) | upper arm, Thigh, Calf, Ankle |
| Where is doppler signal obtained when using the CW probe? | Distal to the cuff? |
| What angle yields the best signal for the CW probe? | 45-60 degrees |
| How much should the cuff be inflated? | 20-30 mmHg above the point where signal disappears |
| At what rate should the cuff be deflated? | 3 mmHg/second |
| The return of the first audible signal is the ______ pressure of the limb? | Systolic |
| If you must repeat a level during an ABI/ Segmental pressures, how long must you wait? | 1 minute to allow artery to rest |
| Where is the dorsalis pedis pressure site? | At the top of the foot |
| Which is easier to locate, the dorsalis pedis or the posterior tibial pressure site? | Posterior tibial |
| Where is the posterior tibial pressure site located? | Behind the medial ankle |
| Which is easier compressed, the dorsalis pedis or the posterior tibial? | Dorsalis pedis |
| What is an ABI ratio? | It is the Ratio of Doppler systolic pressures at the brachial level to those at the ankle (this indicates the overall severity of PAOD) |
| How is an ABI calculated? | By diving the higher the highest systolic ankle pressure by the higher of the 2 brachial pressures |
| What artery pressures are documented during an ABI? (3 of them) | Bilateral brachial, posterior tibial, and dorsalis pedis pressures |
| At what Ankle-Brachial Index does claudication occur? | 0.5-0.8 |
| At what Ankle-Brachial Index does ischemic rest pain occur? | <0.5 |
| What is the NORMAL range for an ABI? | 0.90-1.30 |
| What ABI signifies MILD PAOD? | 0.75-0.89 |
| What ABI signifies MODERATE PAOD? | 0.50-0.74 |
| What ABI signifies SEVERE PAOD? | <0.50 |
| What ABI signifies PAOD that is tissue threatening? | <0.35 |
| _____ pressure is normally the same or greater than higher ______ pressure | ANKLE pressure is normally the same or greater than higher BRACHIAL pressure |
| A change of _____ between serial studies is considered significant? | 0.15 |
| _____ ABI values correspond to _____ PAOD | LOWER ABI values correspond to WORSENING PAOD |
| Excessively high ABI values typically correspond to what? | Calcified arteries |
| Is systolic pressure invalid when underlying artery is calcified and incompressible? | YES, INVALID when the underlying artery is calcified and incompressible, it is falsely elevated (must rely on waveforms) |
| At what value is an ABI considered to be excessively high? | >1.3 |
| What are some pressure limitations? (3 of them) | Diabetes, Chronic steroid therapy, and renal dialysis |
| Do not inflate cuff over _____ mmHg above brachial pressure | 40mmHg |
| ABI indicates the overall severity of disease, but not what? | The site of disease |
| What can add additional information about disease location? | Segmental limb pressures |
| With the three cuff method where are the cuffs placed? | One around thigh, one around calf, and one around the ankle |
| With the four cuff method where are the cuffs placed? | Two around thigh (one at high thigh and one at low thigh), one arounf calf, and one around ankle |
| What is an advantage of the four cuff method? | Allows ability to further define level of disease by separating iliofemoral disease from superficial femoral artery disease Helps narrow down region of disease |
| A single large thigh cuff will result in a thigh pressure that is ____ the brachial pressure. | EQUAL TO |
| Cuffs that are above or below the knee are normally what to the brachial pressure? | Equal to or slightly greater than the brachial pressure |
| A narrower high thigh cuff results in what? | Higher thigh pressure (About 30 mmHg above brachial pressure) |
| A pressure drop of >20-30 mmHg indicates presence of what? | Proximal obstruction |
| Any reduction in distal pressure should be _____ between adjacent segments or it is suggestive of disease | <30 mmHg |
| What is the best indicator of disease? | Consecutive level differences in pressure |
| What are consecutive level differences in pressure? | Vertical difference (same limb) |
| What is pressure compared to contralateral limb also known as? | Horizontal differences |
| How many mmHg pressure gradient is considered significant compared to the contralateral limb (horizontal difference) | 20-30 mmHg or greater |
| Which is a better indicator for disease in a limb Horizontal or Vertical differences? | Vertical differences |
| Toe pressures of 30 mmHg or less are often present with that? | Non-healing foot or toe ulcers |
| What is a dicrotic notch and is it normal? | A dicrotic notch is a notch in the waveform, it is NORMAL |
| What type of waveforms exhibit a dicrotic notch? | Plethysmography waveforms |
| What are NORMAL characteristics of resting Doppler waveforms PROXIMAL to knee? | Triphasic/biphasic and bidirectional |
| What are the normal resting post-exercise toe brachial indices? | >0.80 |
| A single (wide) above-knee cuff systolic pressure is equal to what? | Higher brachial |
| All pulse waveforms have _____ systolic upstrokes. | Short (<135 ms, if able to be measured) |
| The normal difference between adjacent limb segments is what? | Less than or equal to 30 mmHg |
| Normal difference between brachial systolic pressures is what? | Less than or equal to 20 mmHg |
| Exercise testing is primarily used in patients who have what? | intermittent claudication that indicate normal or near normal ABI at rest |
| How can exercise stress be obtained? (3 ways) | Treadmill, walking at patients own pace in corridor, or heel raises (toe-ups) |
| What are the typical treadmill settings? | 10% grade, 1-2 mph, maximum walking time of 5 mins |
| What are the contraindications for treadmill testing? (8 of them) | Chest pain, arrhythmia, Post MI or cardiac procedure, SOB, Stroke, HTN, unsteadiness |
| When is an exercise test performed? | Following resting pressure measruements |
| How is an exercise test exam performed? | Patient walks on treadmill for 5 min, then ABI is obtained immediately for post-exercise ABI claudication. Pressures are repeated every 2 mins until they return to baseline. |
| How long can it take for pressures to reach pre-exercise pressures after an exercise test? | It can take up to 20 mins |
| The ______ value of post activity ABI categorizes functional severity of a limb | LOWEST |
| Is it normal or abnormal for pressures to increase after exercise? | NORMAL |
| What will pressures do in an ABNORMAL exercise test? | Pressure will decrease minimally or severely |
| What does the recovery time after an exercise test suggest? | Whether PAOD is single or multilevel |
| If an ABI returns to pre-exercise levels within 5 mins then it is associated with what? | Single-level disease |
| If an ABI returns to pre-exercise levels in greater than 6 mins then it is associated with what? | Multilevel disease |
| A post exercise ankle pressure of ______ mmHg or less indicates vascular etiology | 60 mmHg or less |
| What frequency CW transducer is typically used for indirect testing? | 8-10 MHz |
| During an indirect testing CW exam where are the Doppler waveforms taken from? (5 places) | Common Femoral Artery (groin level) Superficial Femoral Artery (mid thigh) Popliteal Artery (Knee fossa) Posterior Tibial Artery (Medial Malleolus) Dorsalis Pedis Artery (top of foot) |
| What angle should the CW transducer be held from the skin? | about 45-60 degrees |
| Interpretation of Doppler waveforms is limited to what? | Shape |
| What are the various doppler waveforms? (5 waveforms) | Triphasic Biphasic: Bidirectional Biphasic: Unidirectional Monophasic: Moderate/Severe Monophasic: Severe/Critical |
| What are the characteristics of a NORMAL doppler waveform? | Bidirectional and Triphasic |
| What does flow reversal relate to? | Greater resistance to flow (good thing) |
| PAOD reduces flow energy ____ to the lesion. | DISTAL |
| PAOD results in what? | reduction of peripheral resistance |
| PAOD reduces what? | Pheripheral resistance and the amount of flow reversal |
| What happens once PAOD reaches critical stage? | Anteriolar bed can no longer dilate to increase blood flow. Patient experiences pain |
| What does PVR measure? | Volume changes in limb |
| What does PVR stand for? | Pulse Volume Recording |
| What does VPR stand for? | Volume Pulse Recording |
| What is another name for PVR or VPR? | Plethysmography |
| For PVR how much is each cuff inflated? | 55-60 mmHg (just enough to squish off vein) |
| What type of outflow is restricted with PVR? | Venous outflow |
| With PVR changes occurring under cuff are from what flow? | Arterial inflow |
| What should normal PVR waveforms include? | Rapid upstroke with well-defined peak Dicrotic notch Return to baseline through remainder of diastole (bends toward baseline) |
| What would a waveform look like if there was moderate to severe disease? | Delayed onset to peak Round peak Diastolic phase becomes convex (bows out rather than toward to baseline) |
| What are some medical therapy interventions associated with arterial? | HTN medication and Medications to decrease blood viscosity |
| What are some behavior modifications associated with arterial? | Stop smoking, Exercise, and weight control |
| What are some surgical therapy interventions for arterial? | Endarterectomy Bypass grafts angioplasty stents |
Created by:
EmilyGriffin
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