Podcast
Questions and Answers
Which pressure measurement indicates a significant decrease in the leg compared to the proximal thigh?
Which pressure measurement indicates a significant decrease in the leg compared to the proximal thigh?
What condition can be indicated by the decrease in blood pressure in the entire leg?
What condition can be indicated by the decrease in blood pressure in the entire leg?
An ABI of 0.77 suggests which condition?
An ABI of 0.77 suggests which condition?
Which characteristic does NOT belong to a normal arterial PPG waveform?
Which characteristic does NOT belong to a normal arterial PPG waveform?
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What could indicate intrinsic compression of the iliac artery?
What could indicate intrinsic compression of the iliac artery?
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The term 'catacrotic' in arterial waveforms typically refers to which aspect?
The term 'catacrotic' in arterial waveforms typically refers to which aspect?
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Which of the following measurements would be considered abnormal in a PPG waveform?
Which of the following measurements would be considered abnormal in a PPG waveform?
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What is the significance of an Ankle Brachial Index (ABI) measurement below 0.5?
What is the significance of an Ankle Brachial Index (ABI) measurement below 0.5?
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What does a Thigh/Brachial index greater than 1.2 indicate?
What does a Thigh/Brachial index greater than 1.2 indicate?
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Which of the following is a criterion for a normal exercise evaluation?
Which of the following is a criterion for a normal exercise evaluation?
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What is a critical ankle pressure difference that indicates severe arterial disease?
What is a critical ankle pressure difference that indicates severe arterial disease?
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What happens to ankle pressures in a normal patient post-exercise?
What happens to ankle pressures in a normal patient post-exercise?
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What Ankle Brachial Index (ABI) value indicates single vessel disease?
What Ankle Brachial Index (ABI) value indicates single vessel disease?
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Which of the following ABI values suggests multiple vessel disease?
Which of the following ABI values suggests multiple vessel disease?
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What is the normal range for Ankle Brachial Index (ABI)?
What is the normal range for Ankle Brachial Index (ABI)?
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What condition is associated with ankle pressures less than 80 mmHg?
What condition is associated with ankle pressures less than 80 mmHg?
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What is the acceptable difference in pressure in the same segment in both legs?
What is the acceptable difference in pressure in the same segment in both legs?
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What does an ABI value of 1.30 indicate?
What does an ABI value of 1.30 indicate?
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Which statement about peak systolic velocity (PSV) is correct?
Which statement about peak systolic velocity (PSV) is correct?
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What is the criteria for exercise evaluation to determine an issue?
What is the criteria for exercise evaluation to determine an issue?
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Which of the following ABI values is considered abnormal?
Which of the following ABI values is considered abnormal?
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What does an ABI value of 0.96 indicate in relation to peripheral arterial disease?
What does an ABI value of 0.96 indicate in relation to peripheral arterial disease?
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What is the significance of biphasic waveforms observed in the PTA and DPA?
What is the significance of biphasic waveforms observed in the PTA and DPA?
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Which vascular change is indicated by elevated velocities during exercise?
Which vascular change is indicated by elevated velocities during exercise?
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Why might there be no change in waveforms or ankle pressures with exercise?
Why might there be no change in waveforms or ankle pressures with exercise?
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In the four cuff method for obtaining segmental pressures, what is the expected difference between proximal thigh blood pressure and brachial systolic pressure?
In the four cuff method for obtaining segmental pressures, what is the expected difference between proximal thigh blood pressure and brachial systolic pressure?
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What might extensive collateral formation indicate regarding blood flow?
What might extensive collateral formation indicate regarding blood flow?
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What finding suggests the presence of adequate perfusion despite significant stenoses?
What finding suggests the presence of adequate perfusion despite significant stenoses?
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Which anatomical site is directly correlated with the assessment of stenosis using duplex ultrasound?
Which anatomical site is directly correlated with the assessment of stenosis using duplex ultrasound?
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What physiological mechanism does peripheral vasodilation during exercise involve?
What physiological mechanism does peripheral vasodilation during exercise involve?
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What condition is most likely present based on the arm and ankle pressure measurements?
What condition is most likely present based on the arm and ankle pressure measurements?
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What does a decrease in ankle pressures suggest in terms of peripheral arterial disease?
What does a decrease in ankle pressures suggest in terms of peripheral arterial disease?
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During reactive hyperemia testing, when are pressure measurements taken?
During reactive hyperemia testing, when are pressure measurements taken?
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What is indicated by a 30 mmHg drop in pressure between the right upper arm and the radial artery?
What is indicated by a 30 mmHg drop in pressure between the right upper arm and the radial artery?
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What is a key characteristic of the recovery time during reactive hyperemia compared to treadmill testing?
What is a key characteristic of the recovery time during reactive hyperemia compared to treadmill testing?
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What discrepancy is noted between the left and right arm pressure measurements?
What discrepancy is noted between the left and right arm pressure measurements?
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Which of the following is not a typical finding in patients undergoing upper extremity segmental pressure exams?
Which of the following is not a typical finding in patients undergoing upper extremity segmental pressure exams?
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What is the primary purpose of performing post-occlusive reactive hyperemia?
What is the primary purpose of performing post-occlusive reactive hyperemia?
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In the given measurements, what does a higher ankle pressure compared to the arm pressure suggest?
In the given measurements, what does a higher ankle pressure compared to the arm pressure suggest?
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Which statement is true concerning the relationship between arterial pressure and vascular disease?
Which statement is true concerning the relationship between arterial pressure and vascular disease?
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What does a normal arm pressure combined with a high ankle pressure indicate?
What does a normal arm pressure combined with a high ankle pressure indicate?
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What is the primary purpose of reactive hyperemia testing?
What is the primary purpose of reactive hyperemia testing?
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Which situation best illustrates reactive hyperemia?
Which situation best illustrates reactive hyperemia?
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When is reactive hyperemia testing particularly useful?
When is reactive hyperemia testing particularly useful?
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What triggers the initial phase of reactive hyperemia?
What triggers the initial phase of reactive hyperemia?
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What physiological mechanism is primarily responsible for the increase in blood flow during reactive hyperemia?
What physiological mechanism is primarily responsible for the increase in blood flow during reactive hyperemia?
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What is the correct procedure when performing the Adson maneuver?
What is the correct procedure when performing the Adson maneuver?
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What might indicate an abnormality in digit pressure assessment?
What might indicate an abnormality in digit pressure assessment?
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What does a positive Adson maneuver indicate?
What does a positive Adson maneuver indicate?
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Which factor is most critical when interpreting a positive Adson maneuver?
Which factor is most critical when interpreting a positive Adson maneuver?
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What clinical finding should lead to further evaluation of the palmar arch?
What clinical finding should lead to further evaluation of the palmar arch?
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What is the main purpose of the Adson maneuver?
What is the main purpose of the Adson maneuver?
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Which cuff size is typically used for measuring wrist pressure?
Which cuff size is typically used for measuring wrist pressure?
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What is the main advantage of using a 3 cuff method for thigh pressure assessment?
What is the main advantage of using a 3 cuff method for thigh pressure assessment?
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What is a common issue when utilizing smaller cuffs in the 4 cuff method for thigh assessment?
What is a common issue when utilizing smaller cuffs in the 4 cuff method for thigh assessment?
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Which cuff size is typically employed for assessing digit pressure?
Which cuff size is typically employed for assessing digit pressure?
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Which statement accurately describes the purpose of segmental pressure assessment?
Which statement accurately describes the purpose of segmental pressure assessment?
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Which factor is NOT an appropriate reason to terminate a treadmill exercise for a lower extremity arterial exam?
Which factor is NOT an appropriate reason to terminate a treadmill exercise for a lower extremity arterial exam?
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What is an inherent limitation of utilizing the smaller cuffs in measuring thigh pressure?
What is an inherent limitation of utilizing the smaller cuffs in measuring thigh pressure?
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What should be prioritized when performing a segmental pressure exam?
What should be prioritized when performing a segmental pressure exam?
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What is a primary characteristic of a digit pressure measurement using the 2.5 cm cuff?
What is a primary characteristic of a digit pressure measurement using the 2.5 cm cuff?
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In the context of performing a lower extremity arterial exam, what is most critical when evaluating cuff selection?
In the context of performing a lower extremity arterial exam, what is most critical when evaluating cuff selection?
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What condition is characterized by leg pain due to inadequate blood flow but will show a drop in ankle pressure with exercise?
What condition is characterized by leg pain due to inadequate blood flow but will show a drop in ankle pressure with exercise?
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Which of the following conditions is NOT associated with a normal response in the Ankle Brachial Index (ABI)?
Which of the following conditions is NOT associated with a normal response in the Ankle Brachial Index (ABI)?
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What describes the expected ABI response during an exercise-induced assessment in pseudoclaudication?
What describes the expected ABI response during an exercise-induced assessment in pseudoclaudication?
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How does the ankle pressure behave in claudication during exercise?
How does the ankle pressure behave in claudication during exercise?
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Based on the provided segmental pressures, what could potentially account for the differences noted in the ankle and thigh pressures?
Based on the provided segmental pressures, what could potentially account for the differences noted in the ankle and thigh pressures?
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What is a fundamental difference between claudication and pseudoclaudication?
What is a fundamental difference between claudication and pseudoclaudication?
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Which of the following best describes pseudoclaudication symptoms during physical activity?
Which of the following best describes pseudoclaudication symptoms during physical activity?
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Which statement accurately reflects the Ankle-Brachial Index (ABI) in the context of pseudoclaudication?
Which statement accurately reflects the Ankle-Brachial Index (ABI) in the context of pseudoclaudication?
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What might be indicated if there is no drop in ankle pressure during an exercise evaluation?
What might be indicated if there is no drop in ankle pressure during an exercise evaluation?
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What does a decreased pressure in the leg imply about potential vascular issues?
What does a decreased pressure in the leg imply about potential vascular issues?
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Which pressure reading is most notably lower when moving from the proximal thigh to the calf?
Which pressure reading is most notably lower when moving from the proximal thigh to the calf?
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How is the characteristic dicrotic notch of a normal arterial PPG waveform described?
How is the characteristic dicrotic notch of a normal arterial PPG waveform described?
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What might a notably slow upslope in a PPG waveform indicate?
What might a notably slow upslope in a PPG waveform indicate?
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What does an Ankle Brachial Index (ABI) of 0.77 typically signify?
What does an Ankle Brachial Index (ABI) of 0.77 typically signify?
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In evaluating arterial waveforms, what does the term 'anacrotic' describe?
In evaluating arterial waveforms, what does the term 'anacrotic' describe?
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How does a 30 mmHg pressure drop between the right upper arm and the radial artery typically present?
How does a 30 mmHg pressure drop between the right upper arm and the radial artery typically present?
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What does the term 'catacrotic' in the context of arterial waveforms refer to?
What does the term 'catacrotic' in the context of arterial waveforms refer to?
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Which statement regarding normal arterial PPG waveforms is accurate?
Which statement regarding normal arterial PPG waveforms is accurate?
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What is the minimum toe pressure considered normal if the systolic brachial pressure is 116 mmHg?
What is the minimum toe pressure considered normal if the systolic brachial pressure is 116 mmHg?
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Which factor is least likely to contribute to a false reduction in ankle pressure during assessment?
Which factor is least likely to contribute to a false reduction in ankle pressure during assessment?
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In the context of measuring arterial pressures, what is likely to happen if a cuff is too large?
In the context of measuring arterial pressures, what is likely to happen if a cuff is too large?
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What could extensive collateral formation suggest in a patient undergoing an exercise arterial exam?
What could extensive collateral formation suggest in a patient undergoing an exercise arterial exam?
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Under what condition should additional digit pressure be evaluated in a patient?
Under what condition should additional digit pressure be evaluated in a patient?
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When the brachial artery is obstructed, which statement regarding forearm arteries is TRUE?
When the brachial artery is obstructed, which statement regarding forearm arteries is TRUE?
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What clinical finding during the Adson maneuver indicates a positive test for thoracic outlet syndrome?
What clinical finding during the Adson maneuver indicates a positive test for thoracic outlet syndrome?
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Which measurement is most commonly used to assess digit pressure?
Which measurement is most commonly used to assess digit pressure?
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What should be suspected if reduced digit pressure is limited to a single digit?
What should be suspected if reduced digit pressure is limited to a single digit?
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What position should the patient adopt when performing the Adson maneuver?
What position should the patient adopt when performing the Adson maneuver?
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Which action is NOT part of the Adson maneuver procedure?
Which action is NOT part of the Adson maneuver procedure?
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What is the first step in the Adson maneuver process?
What is the first step in the Adson maneuver process?
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What is typically observed in PVR tracings with increased peripheral resistance?
What is typically observed in PVR tracings with increased peripheral resistance?
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Which condition would likely result in normal digital pressures in the upper extremity?
Which condition would likely result in normal digital pressures in the upper extremity?
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What does a loss of diacrotic notch in PVR tracings indicate?
What does a loss of diacrotic notch in PVR tracings indicate?
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In which situation would reactive hyperemia testing be most appropriate?
In which situation would reactive hyperemia testing be most appropriate?
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What underlying cause is typically associated with SVC syndrome?
What underlying cause is typically associated with SVC syndrome?
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Which of the following conditions could elevate the risk of developing abnormally low digit pressures?
Which of the following conditions could elevate the risk of developing abnormally low digit pressures?
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What does new onset left leg claudication primarily indicate?
What does new onset left leg claudication primarily indicate?
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What condition is NOT commonly associated with abnormal PPG tracing?
What condition is NOT commonly associated with abnormal PPG tracing?
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Which of the following is NOT a characteristic of symptomatic peripheral vascular disorders?
Which of the following is NOT a characteristic of symptomatic peripheral vascular disorders?
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What physiological change does peripheral vasodilation during exercise primarily facilitate?
What physiological change does peripheral vasodilation during exercise primarily facilitate?
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What is the disadvantage of using smaller cuffs in the 4 cuff method for thigh pressure assessment?
What is the disadvantage of using smaller cuffs in the 4 cuff method for thigh pressure assessment?
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Which of the following describes the primary purpose of a digit pressure assessment using a cuff?
Which of the following describes the primary purpose of a digit pressure assessment using a cuff?
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Which statement accurately describes the difference between the 3 cuff and 4 cuff methods for measuring thigh pressure?
Which statement accurately describes the difference between the 3 cuff and 4 cuff methods for measuring thigh pressure?
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What is a potential reason for terminating a treadmill exercise during a lower extremity arterial exam?
What is a potential reason for terminating a treadmill exercise during a lower extremity arterial exam?
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What critical information can be obtained from assessing thigh pressure during an arterial exam?
What critical information can be obtained from assessing thigh pressure during an arterial exam?
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In pressure assessments, why is the assessment of wrist pressure with a 7 cm cuff typically preferred?
In pressure assessments, why is the assessment of wrist pressure with a 7 cm cuff typically preferred?
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What is a significant limitation of using the smaller cuffs in arterial pressure measurements?
What is a significant limitation of using the smaller cuffs in arterial pressure measurements?
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What is the main reason to prefer a larger cuff in the 3 cuff method for thigh pressure assessment?
What is the main reason to prefer a larger cuff in the 3 cuff method for thigh pressure assessment?
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When using the 4 cuff method, what must be taken into account regarding cuff sizes?
When using the 4 cuff method, what must be taken into account regarding cuff sizes?
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What may be inferred if a patient exhibits bilateral rest pain relieved by dangling their legs?
What may be inferred if a patient exhibits bilateral rest pain relieved by dangling their legs?
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What is a key indicator of significant ischemia in the context provided?
What is a key indicator of significant ischemia in the context provided?
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Which measurement indicates a discrepancy in the adequacy of lower extremity evaluation using a smaller cuff?
Which measurement indicates a discrepancy in the adequacy of lower extremity evaluation using a smaller cuff?
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What implication does having an Ankle Brachial Index (ABI) measurement greater than 1.30 suggest in the context of medial calcification?
What implication does having an Ankle Brachial Index (ABI) measurement greater than 1.30 suggest in the context of medial calcification?
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Which assessment will yield more accurate information than ABI alone in cases of medial calcification?
Which assessment will yield more accurate information than ABI alone in cases of medial calcification?
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How might a history of diabetes affect the evaluation of a patient's vascular health?
How might a history of diabetes affect the evaluation of a patient's vascular health?
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What is a potential consequence of using a 10cm cuff on the thigh of a patient?
What is a potential consequence of using a 10cm cuff on the thigh of a patient?
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Which combination of symptoms could suggest a poor prognosis in a patient with vascular issues?
Which combination of symptoms could suggest a poor prognosis in a patient with vascular issues?
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Which anatomical measurement is crucial to fully evaluate lower extremity arterial disease?
Which anatomical measurement is crucial to fully evaluate lower extremity arterial disease?
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Which statement accurately reflects the condition of a patient with thickened toenails and dry skin?
Which statement accurately reflects the condition of a patient with thickened toenails and dry skin?
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What is the significance of obtaining at least one additional digital pressure measurement on the left hand during the examination?
What is the significance of obtaining at least one additional digital pressure measurement on the left hand during the examination?
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What would be the next step if the upper extremity segmental pressures indicate a significant discrepancy between the radial and digital readings?
What would be the next step if the upper extremity segmental pressures indicate a significant discrepancy between the radial and digital readings?
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If the digital pressures show a reduction but the arm pressures are normal, what might this imply?
If the digital pressures show a reduction but the arm pressures are normal, what might this imply?
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In a scenario where the second digit pressure readings are significantly lower than other upper extremity pressures, what is most likely the concern?
In a scenario where the second digit pressure readings are significantly lower than other upper extremity pressures, what is most likely the concern?
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Which combination of pressures suggests an issue with blood supply to the digits despite normal brachial readings?
Which combination of pressures suggests an issue with blood supply to the digits despite normal brachial readings?
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Why is it important to compare pressures between the right and left segments in upper extremity assessments?
Why is it important to compare pressures between the right and left segments in upper extremity assessments?
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If the radial pressure in the right arm is 144 mmHg while the left arm is 136 mmHg, how should this disparity be interpreted?
If the radial pressure in the right arm is 144 mmHg while the left arm is 136 mmHg, how should this disparity be interpreted?
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What is the primary physiological response during reactive hyperemia following ischemia?
What is the primary physiological response during reactive hyperemia following ischemia?
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When is reactive hyperemia testing particularly beneficial?
When is reactive hyperemia testing particularly beneficial?
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What is a key characteristic of the recovery time observed during reactive hyperemia testing?
What is a key characteristic of the recovery time observed during reactive hyperemia testing?
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Which situation best exemplifies reactive hyperemia?
Which situation best exemplifies reactive hyperemia?
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What could influence the results of reactive hyperemia testing in a patient with known arterial disease?
What could influence the results of reactive hyperemia testing in a patient with known arterial disease?
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What Ankle Brachial Index (ABI) range indicates mild to moderate disease?
What Ankle Brachial Index (ABI) range indicates mild to moderate disease?
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Which statement accurately describes appropriate protocols when managing a patient with DVT during a lower extremity examination?
Which statement accurately describes appropriate protocols when managing a patient with DVT during a lower extremity examination?
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What is the primary concern of performing cuff pressure measurements on a patient with a known DVT?
What is the primary concern of performing cuff pressure measurements on a patient with a known DVT?
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What should a sonographer do if a DVT was identified 2 days ago before performing an exam?
What should a sonographer do if a DVT was identified 2 days ago before performing an exam?
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Which of the following statements is false regarding DVT management post-admission?
Which of the following statements is false regarding DVT management post-admission?
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Which ABI classification defines a patient with severe disease?
Which ABI classification defines a patient with severe disease?
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What is the expected outcome if cuffs are improperly applied to a leg with DVT during pressure examinations?
What is the expected outcome if cuffs are improperly applied to a leg with DVT during pressure examinations?
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What is the significance of the range 0.9 - 1.0 in ABI measurements?
What is the significance of the range 0.9 - 1.0 in ABI measurements?
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In the context of DVT management, which statement is true regarding the role of anticoagulant therapy?
In the context of DVT management, which statement is true regarding the role of anticoagulant therapy?
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What ABI value would likely suggest patient status is unchanged from earlier assessments?
What ABI value would likely suggest patient status is unchanged from earlier assessments?
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What is a key difference in the ankle pressure response between claudication and pseudoclaudication during exercise?
What is a key difference in the ankle pressure response between claudication and pseudoclaudication during exercise?
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Which condition is associated with normal Ankle-Brachial Index (ABI) despite symptoms of leg pain?
Which condition is associated with normal Ankle-Brachial Index (ABI) despite symptoms of leg pain?
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In the context of segmental pressure measurements, what is indicative of a potential issue with vascular flow?
In the context of segmental pressure measurements, what is indicative of a potential issue with vascular flow?
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What type of cause is responsible for symptoms in pseudoclaudication?
What type of cause is responsible for symptoms in pseudoclaudication?
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Which of the following findings suggests a normal ankle pressure response during exercise?
Which of the following findings suggests a normal ankle pressure response during exercise?
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What does the absence of a drop in ankle pressure with exercise indicate?
What does the absence of a drop in ankle pressure with exercise indicate?
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Which statement accurately describes the ABI readings in a patient with pseudoclaudication?
Which statement accurately describes the ABI readings in a patient with pseudoclaudication?
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What abnormality could be indicated by a segmental pressure exam showing decreased ankle pressure compared to the proximal thigh pressure?
What abnormality could be indicated by a segmental pressure exam showing decreased ankle pressure compared to the proximal thigh pressure?
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During a segmental pressure exam, what expected difference should be noted between proximal thigh and brachial pressures?
During a segmental pressure exam, what expected difference should be noted between proximal thigh and brachial pressures?
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Which finding in an ABI measurement suggests severe arterial disease?
Which finding in an ABI measurement suggests severe arterial disease?
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What should be done immediately if a patient reports leg or chest pain during an examination?
What should be done immediately if a patient reports leg or chest pain during an examination?
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What is a likely complication when performing a segmental pressure exam using the arm with a hemodialysis graft?
What is a likely complication when performing a segmental pressure exam using the arm with a hemodialysis graft?
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In which situation might a patient with chronic renal failure undergo a segmental pressure exam seated rather than supine?
In which situation might a patient with chronic renal failure undergo a segmental pressure exam seated rather than supine?
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What physiological change might mediate an overestimation of ankle pressures in patients with diabetes?
What physiological change might mediate an overestimation of ankle pressures in patients with diabetes?
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Which factor may lead a patient with claudication to experience pseudoclaudication rather than classic claudication?
Which factor may lead a patient with claudication to experience pseudoclaudication rather than classic claudication?
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What critical measure should be taken during a segmental pressure exam for patients with a dialysis graft?
What critical measure should be taken during a segmental pressure exam for patients with a dialysis graft?
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During segmental pressure examinations, what should be prioritized when a patient feels discomfort?
During segmental pressure examinations, what should be prioritized when a patient feels discomfort?
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What symptom indicates the need for immediate cessation of an exercise evaluation in vascular assessments?
What symptom indicates the need for immediate cessation of an exercise evaluation in vascular assessments?
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When performing a segmental pressure examination, what is one critical point regarding blood pressure measurement in patients with renal disease?
When performing a segmental pressure examination, what is one critical point regarding blood pressure measurement in patients with renal disease?
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Study Notes
Physiological PT I
- An upper extremity segmental pressure exam produces specific pressures.
- Brachial pressures are measured on the right and left (e.g., right 140mmHg, left 132mmHg).
- Radial pressures are measured on the right and left (e.g., right 144mmHg, left 136mmHg).
- Ulnar pressures are measured on the right and left (e.g., right 138mmHg, left 138mmHg).
- The 2nd digit pressures are measured on the right and left (e.g., right 130mmHg, left 104mmHg).
Additional Information (Physical Exam Procedures)
- If arm pressures are normal, but digital pressure is abnormally reduced, examine one more digit on the left hand.
- If additional digital pressure is abnormal, likely disease in the palmar arch is the cause of decreased digit pressures.
- If additional digital pressure is normal, test remaining digits to ensure reduced pressure is isolated to a single digit and to check digital artery for disease.
Thoracic Outlet Syndrome
- The Adson maneuver evaluates flow changes with thoracic outlet syndrome.
- Palpate radial pulse on the affected side, and extend the elbow and neck.
- Have the patient rotate head to the side being tested.
- Have the patient abduct and laterally rotate the shoulder from this position.
- Have the patient take a deep breath and hold while assessing pulse response.
- A decreased pulse vigor from initial position to the final position is a positive test.
Segmental Thigh Pressure Exam
- The 4 cuff method uses two smaller cuffs to obtain separate thigh pressures.
- These cuffs are generally smaller than the larger cuff used in the 3 cuff method.
- Smaller cuffs tend to overestimate thigh pressure; the larger more accurately measures.
Lower Extremity Exam Termination
- If a patient reports pain in their leg or chest, terminate the exam.
- Record exercise duration, symptom location, and any changes in ankle pressure.
Segmental Pressure Exam Complication for Dialysis Patients
- Dialysis patients should be seated in a chair rather than lying down for more than a few minutes.
- The arm without the dialysis port should be the only arm measured in this case.
- Medial calcification can lead to overestimation of ankle pressures in some patients, and this needs to be considered during the diagnosis.
Response to Exercise in Patients with Pseudoclaudication
- Pseudoclaudication has a neurogenic or orthopedic cause and is not ischemic.
- The ABI will be normal and there will be no drop in ankle pressure with exercise in patients with pseudoclaudication.
Segmental Pressure Findings
- The right arm pressure is 142 mmHg.
- The right leg proximal thigh pressure is 140 mmHg; the right leg distal thigh is 126 mmHg, the right calf is 116 mmHg and the right ankle is 112 mmHg.
- Different results could indicate possible aortoiliac disease, or possible intrinsic compression of the iliac artery by the pelvic mass.
Normal Arterial PPG Waveform Characteristics
- A normal arterial PPG waveform has a dicrotic notch.
- It has a slow upslope and downslope.
- There is little difference between systolic and diastolic blood volumes.
ABI Interpretation and Implications
- ABI of 0.77 indicates disease.
- An ABI of 0.5-0.9 indicates mild-moderate disease.
- An ABI of < 0.5 indicates severe disease.
General Information
- Normal lower extremity arterial response to reactive hyperemia (35% drop in ankle pressures that return to normal in 1 minute following cuff release)
- A patient with leg pain but not with symptoms during exercise needs another form of examination.
Interpretation of Digit Tracings in PPG
- Normal waveforms are triphasic and show sharp systolic upstrokes, brief diastolic reversals, and final forward flow during late diastole.
- Abnormal waveforms, such as monophasic or absent waveforms, suggest impaired distal perfusion due to occlusion or obstruction of digital arteries.
- Abnormal digital tracing with normal ABI indicates adequate blood flow in larger arteries but obstruction in the digital arteries causing distal perfusion impairment.
- This scenario is often seen alongside thrombi or emboli obstructing the smaller digital arteries, though larger arteries retain adequate flow.
Additional Information
- When abnormal digit tracings are observed along with normal ABIs, it suggests adequate blood flow to larger arteries such as the femoral and popliteal arteries.
- One potential cause of embolic obstruction in digital arteries is the presence of abdominal aortic aneurysm (AAA).
- Aortic aneurysms can develop emboli, obstructing smaller distal arteries in digits.
- Evaluation for AAA is warranted when normal ABIs but abnormal digit tracings are noted to identify a possible source of emboli.
- This evaluation may involve imaging studies like ultrasound, CT angiography, or magnetic resonance angiography (MRA) of the abdominal aorta.
Popliteal Entrapment Evaluation
- PPG sensor evaluation to record flow changes during calf muscle contraction (active plantar or dorsiflexion of the foot).
Venous Photoplethysmography (PPG):
- Documents venous insufficiency
- Detects hemoglobin levels in legs
- Normal: tracing drops until dorsiflexions stop, then rises slowly as veins refill.
- Abnormal: tracing drops less significantly, rising quickly; venous reflux refills veins faster than arterial inflow.
Venous Refill Time (VRT):
- Measures time for veins to refill after emptying (dorsiflexion).
- Normal VRT is 20 seconds or greater.
- Short VRT (less than 20 seconds) indicates venous insufficiency.
Air Plethysmography (APG)
- Detects venous insufficiency
- Quantifies venous reflux
- Evaluates calf muscle pump function.
- Measures venous volume changes in different positions (legs elevated, supine, standing, toe-ups).
- This provides information about venous filling time, functional venous volume, ejection fraction of calf muscles, and residual venous volume.
Key Components of Air Plethysmography Chart
- Normal VRT suggests normal venous function, while abnormal VRT suggests venous insufficiency.
Segmental Pressure Exam for Lower Extremity Insufficiency
- A minimum of 30 seconds between augmentation maneuvers.
Doppler Ultrasound of Lower Extremities
- Doppler ultrasound is used to identify venous disease.
- Patients positioned in 60-degree reverse Trendelenburg position with contrast injection into the dorsal vein.
- Image monitored during breathing maneuvers to assess venous insufficiency.
Impedance Plethysmography
- Non-invasive
- Diagnoses abnormalities in venous/arterial systems, often in limbs.
- Used to detect deep vein thrombosis (DVT).
- Electrodes placed on skin to measure impedance changes due to blood flow changes in vessels.
Strain Gauge Plethysmography
- Measures blood flow through changes in limb circumference
- Non-invasive
- Detects abnormalities in circulatory system
- Evaluates venous function and detects issues like venous insufficiency or DVT
PPG Tracing and Size Control
- Use a constant size setting for the photoplethysmography (PPG) system to best demonstrate changes in blood volume between different toes or feet.
- Changes in the size setting must be documented on the tracing.
Post-Exercise ABI Recovery Time
- Normal post-exercise recovery is 2–6 minutes, indicating a single-level arterial issue like stenosis. -Recovery time >6 minutes suggests multi-level arterial disease.
Limitations of Segmental Pressure Exams Compared to Doppler
- Segmental pressure cannot differentiate between external and common iliac stenosis/occlusion.
- Segmental pressures help assess the level of problem within the extremity, but don't determine the exact extent of stenosis or obstruction.
- Without doppler, you can't determine if the obstruction is in the iliac or common femoral artery. -Without a Doppler ultrasound, you cannot find out if the obstruction is in the popliteal artery.
Using 12 cm Cuffs in Lower Extremity Exam
- 12 cm or larger cuffs overestimate the normal thigh pressure.
- When using larger cuffs, pressures are underestimated in the calf, ankle and arms.
Additional Information
- Normal venous refill time (VRT) should be at least 20 seconds.
Other Information
- A 30mmHg drop in pressure between the upper arm and radial artery at the forearm indicates radial artery disease.
- A 70 mmHg toe pressure is considered normal if the systolic brachial pressure is 116 mmHg.
- Toe pressures less than 30 mmHg or ankle pressures less than 50 mmHg are associated with non-healing wounds.
- 2 mph at a 12% grade is the standard treadmill speed for exercise testing.
- A patient experiencing rest pain and relief after sitting may have a single-level stenosis.
- A lower extremity PPG exam shows normal readings of 30 seconds and 23 seconds on the right and left legs, respectively, and the next step is repeating the VRT assessment with a tourniquet on the right leg.
- For a patient with a suspected Raynaud syndrome, place the PPG sensors on the finger tips before and after cold sensitivity testing to detect blood flow changes.
- If a patient has a prior history of untreated multilevel disease in the right leg, it may limit their treadmill tolerance for the left leg. Reactive hyperaemia testing is the best way to assess for new-onset left leg claudication.
- Using a tourniquet during a venous PPG exam on the leg helps to determine if venous insufficiency is superficial or deep. This is because, when the venous refill time (VRT) is initially less than 20 seconds, a tourniquet is placed at the groin to isolate superficial venous flow, and VRT is measured again. If VRT improves when the tourniquet is in place, insufficiency is likely in the superficial system only; otherwise, it is in the deep system.
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Test your knowledge on the Ankle Brachial Index (ABI) and its significance in diagnosing arterial conditions. This quiz covers key indicators, normal values, and interpretations of arterial waveforms. Perfect for medical students or healthcare professionals seeking to enhance their understanding of vascular assessments.
