Podcast
Questions and Answers
What does a drop in ankle pressure greater than 50% during an arterial exam indicate?
What does a drop in ankle pressure greater than 50% during an arterial exam indicate?
- Multiple level disease (correct)
- Single level disease
- Aortic disease
- Normal arterial function
Which pressure change indicates significant disease between two adjacent segments?
Which pressure change indicates significant disease between two adjacent segments?
- A drop of 15 mmHg
- A drop of 50 mmHg
- A drop of 20 mmHg
- A drop of 30 mmHg (correct)
If a patient shows a triphasic waveform in the proximal femoral artery but a monophasic waveform in the mid-segment of the femoral artery, what is suspected?
If a patient shows a triphasic waveform in the proximal femoral artery but a monophasic waveform in the mid-segment of the femoral artery, what is suspected?
- Normal arterial flow
- Aneurysm in the femoral artery
- Mid Superficial Femoral Artery stenosis or occlusion (correct)
- Peripheral artery disease in the lower leg
What is indicated by an ankle pressure drop of less than 35% that returns to baseline within one minute?
What is indicated by an ankle pressure drop of less than 35% that returns to baseline within one minute?
Considering the pressure readings of upper thigh 175 mmHg and distal thigh 120 mmHg, what can be inferred if there is a significant drop in pressures?
Considering the pressure readings of upper thigh 175 mmHg and distal thigh 120 mmHg, what can be inferred if there is a significant drop in pressures?
What is the ABI value for the right leg?
What is the ABI value for the right leg?
Why is it essential to calculate ABI values?
Why is it essential to calculate ABI values?
What is the left leg's ankle pressure measured by DPA?
What is the left leg's ankle pressure measured by DPA?
Based on the provided pressures, what could be a consequence of an improperly conducted resting arterial exam?
Based on the provided pressures, what could be a consequence of an improperly conducted resting arterial exam?
Which formula is used to calculate ABI?
Which formula is used to calculate ABI?
What could cause the overestimation of disease severity identified in the resting exam?
What could cause the overestimation of disease severity identified in the resting exam?
What does a lower ABI value indicate regarding peripheral artery disease?
What does a lower ABI value indicate regarding peripheral artery disease?
What is a characteristic finding of coarctation of the aorta?
What is a characteristic finding of coarctation of the aorta?
In a patient with coarctation of the aorta, which of the following is likely to be observed?
In a patient with coarctation of the aorta, which of the following is likely to be observed?
Why is atherosclerotic vascular disease unlikely in a 9-year-old?
Why is atherosclerotic vascular disease unlikely in a 9-year-old?
What would indicate severe arterial insufficiency in the case presented?
What would indicate severe arterial insufficiency in the case presented?
What should be the initial step for an exam if a patient appears slightly short of breath?
What should be the initial step for an exam if a patient appears slightly short of breath?
Which condition involves blood flow reversal in the vertebral artery?
Which condition involves blood flow reversal in the vertebral artery?
Which clinical clue is essential when diagnosing coarctation of the aorta in a child?
Which clinical clue is essential when diagnosing coarctation of the aorta in a child?
What happens to blood pressure in the arms and legs in coarctation of the aorta?
What happens to blood pressure in the arms and legs in coarctation of the aorta?
What is indicated by a pressure drop of more than 30 mmHg between the low thigh and calf with an absent dicrotic notch on the PVR waveform?
What is indicated by a pressure drop of more than 30 mmHg between the low thigh and calf with an absent dicrotic notch on the PVR waveform?
Which of the following options is consistent with right mild femoral popliteal and mild tibial artery occlusive disease?
Which of the following options is consistent with right mild femoral popliteal and mild tibial artery occlusive disease?
Why is option A (Aorta and bilateral severe iliac occlusive disease) deemed not consistent with the provided data?
Why is option A (Aorta and bilateral severe iliac occlusive disease) deemed not consistent with the provided data?
What does a pressure drop and absent dicrotic notch suggest regarding vascular health?
What does a pressure drop and absent dicrotic notch suggest regarding vascular health?
Which condition is not implied by a pressure drop of more than 30 mmHg between the low thigh and calf?
Which condition is not implied by a pressure drop of more than 30 mmHg between the low thigh and calf?
Which vascular condition accounts for a severe pressure drop consistent with the given statement?
Which vascular condition accounts for a severe pressure drop consistent with the given statement?
What is likely if a patient shows no evidence of severe iliac disease based on a pressure waveform analysis?
What is likely if a patient shows no evidence of severe iliac disease based on a pressure waveform analysis?
What characterization does NOT match the pressure drop over 30 mmHg between the low thigh and calf?
What characterization does NOT match the pressure drop over 30 mmHg between the low thigh and calf?
What principle does photoplethysmography utilize to detect changes in venous volume in the leg?
What principle does photoplethysmography utilize to detect changes in venous volume in the leg?
How does hemoglobin affect the measurement in photoplethysmography?
How does hemoglobin affect the measurement in photoplethysmography?
What indicates severe disease in the waveform of photoplethysmography?
What indicates severe disease in the waveform of photoplethysmography?
Why can photoplethysmography safely be used on diabetic patients?
Why can photoplethysmography safely be used on diabetic patients?
What should be ensured when preparing to perform a photoplethysmography exam?
What should be ensured when preparing to perform a photoplethysmography exam?
Which of the following conditions may limit the accuracy of PPG measurements?
Which of the following conditions may limit the accuracy of PPG measurements?
What change in blood flow would you expect in a patient with mild arterial disease during a PPG examination?
What change in blood flow would you expect in a patient with mild arterial disease during a PPG examination?
When is it advised to obtain digital PPG tracings if the ABI findings do not correspond?
When is it advised to obtain digital PPG tracings if the ABI findings do not correspond?
Which statement about the waveforms resulting from photoplethysmography is true?
Which statement about the waveforms resulting from photoplethysmography is true?
What is a notable effect of medial calcification on the ABI reading?
What is a notable effect of medial calcification on the ABI reading?
What condition is indicated by a slight decrease in high thigh pressure on the right side?
What condition is indicated by a slight decrease in high thigh pressure on the right side?
Which description fits the right moderate disease identified in the analysis?
Which description fits the right moderate disease identified in the analysis?
What symptom is associated with the left mild disease according to the data?
What symptom is associated with the left mild disease according to the data?
What is the overall finding regarding the segmental pressures and pulse volume recordings?
What is the overall finding regarding the segmental pressures and pulse volume recordings?
What dysfunction is suggested by the absence of the dicrotic notch?
What dysfunction is suggested by the absence of the dicrotic notch?
How do the findings on the right side compare to the left mild disease?
How do the findings on the right side compare to the left mild disease?
Which of the following conditions has a specific drop in pressure between low thigh and calf?
Which of the following conditions has a specific drop in pressure between low thigh and calf?
What does a reduction in pulse volume recordings suggest regarding vascular health?
What does a reduction in pulse volume recordings suggest regarding vascular health?
What condition is indicated by a normal ABI calculation despite the presence of monophasic flow in the popliteal and calf arteries?
What condition is indicated by a normal ABI calculation despite the presence of monophasic flow in the popliteal and calf arteries?
What does a decrease in ABI during exercise testing typically indicate?
What does a decrease in ABI during exercise testing typically indicate?
Which testing method can provide better evaluation of lower extremity pressures in cases of suspected arterial disease, especially when ABI values are over 1.0?
Which testing method can provide better evaluation of lower extremity pressures in cases of suspected arterial disease, especially when ABI values are over 1.0?
What does a consistently high ABI value above 1.0 suggest about the vascular condition of a patient with diabetes?
What does a consistently high ABI value above 1.0 suggest about the vascular condition of a patient with diabetes?
In the context of ABI tests, what finding would most likely lead to an erroneous classification of a patient's vascular health?
In the context of ABI tests, what finding would most likely lead to an erroneous classification of a patient's vascular health?
What condition is the most common cause of pseudoclaudication?
What condition is the most common cause of pseudoclaudication?
How should arterial pressures in the toes be evaluated to eliminate the effects of hydrostatic pressure?
How should arterial pressures in the toes be evaluated to eliminate the effects of hydrostatic pressure?
What should be done before repeating a blood pressure measurement?
What should be done before repeating a blood pressure measurement?
Which of the following symptoms is NOT typically caused by neurogenic thoracic outlet syndrome?
Which of the following symptoms is NOT typically caused by neurogenic thoracic outlet syndrome?
What should be the position of the patient when conducting arterial pressure assessments?
What should be the position of the patient when conducting arterial pressure assessments?
Which anatomical structure is commonly compressed in neurogenic thoracic outlet syndrome?
Which anatomical structure is commonly compressed in neurogenic thoracic outlet syndrome?
What occurs when the spaces between the vertebrae in the lower back narrow?
What occurs when the spaces between the vertebrae in the lower back narrow?
What type of pressure reading may be inaccurate if the system is not allowed to normalize after the first measurement?
What type of pressure reading may be inaccurate if the system is not allowed to normalize after the first measurement?
What should be done if a normal ABI does not correlate with the Doppler evaluation results?
What should be done if a normal ABI does not correlate with the Doppler evaluation results?
What result can medial calcification lead to regarding ABI readings?
What result can medial calcification lead to regarding ABI readings?
What is the primary purpose of digital plethysmography?
What is the primary purpose of digital plethysmography?
Which statement is true about the impact of medial calcification on digital arteries?
Which statement is true about the impact of medial calcification on digital arteries?
Under which circumstance is it advisable to use digital plethysmography?
Under which circumstance is it advisable to use digital plethysmography?
What could be a reason for a diabetic patient to undergo digital pressures and PPG evaluation?
What could be a reason for a diabetic patient to undergo digital pressures and PPG evaluation?
What can the presence of monophasic flow in calf arteries indicate despite a normal ABI?
What can the presence of monophasic flow in calf arteries indicate despite a normal ABI?
What does it indicate if a patient presents with a normal ABI but has a discrepancy in Doppler evaluation?
What does it indicate if a patient presents with a normal ABI but has a discrepancy in Doppler evaluation?
What level of disease is identified on the patient's right side?
What level of disease is identified on the patient's right side?
Which indicator aligns with the presence of right mild iliac disease?
Which indicator aligns with the presence of right mild iliac disease?
What does the presence of an absent dicrotic notch suggest?
What does the presence of an absent dicrotic notch suggest?
How does the pressure behave between low thigh and calf in cases of right moderate femoral popliteal occlusive disease?
How does the pressure behave between low thigh and calf in cases of right moderate femoral popliteal occlusive disease?
What other condition may be inferred if dicrotic notch is absent on the PVR waveform?
What other condition may be inferred if dicrotic notch is absent on the PVR waveform?
In the context of the findings, which statement about right side conditions is accurate?
In the context of the findings, which statement about right side conditions is accurate?
What does a slight pressure drop in high thigh pressure on the right side imply?
What does a slight pressure drop in high thigh pressure on the right side imply?
Which aspect is NOT consistent with the findings of mild femoral popliteal occlusive disease?
Which aspect is NOT consistent with the findings of mild femoral popliteal occlusive disease?
What does the reduced pressure in the left 3rd digit compared to the right 3rd digit indicate?
What does the reduced pressure in the left 3rd digit compared to the right 3rd digit indicate?
Why are the brachial, radial, and ulnar pressures considered normal bilaterally?
Why are the brachial, radial, and ulnar pressures considered normal bilaterally?
What should be the next step in evaluation after finding an abnormal pressure in the left 3rd digit?
What should be the next step in evaluation after finding an abnormal pressure in the left 3rd digit?
What might the abnormal pressure in the left 3rd digit indicate?
What might the abnormal pressure in the left 3rd digit indicate?
What waveform finding is expected in the proximal femoral artery for normal flow?
What waveform finding is expected in the proximal femoral artery for normal flow?
How does the normal bilateral measurements of brachial, radial, and ulnar pressures affect the interpretation of localized disease?
How does the normal bilateral measurements of brachial, radial, and ulnar pressures affect the interpretation of localized disease?
What does a drop in pressure greater than 30 mmHg between two adjacent segments of the artery indicate?
What does a drop in pressure greater than 30 mmHg between two adjacent segments of the artery indicate?
What is the significance of the pressure measurement of 110 mmHg in the left 3rd digit?
What is the significance of the pressure measurement of 110 mmHg in the left 3rd digit?
If a patient presents with leg pain and the segmental pressures are significantly lower at the upper thigh compared to the distal thigh, what condition may be suspected?
If a patient presents with leg pain and the segmental pressures are significantly lower at the upper thigh compared to the distal thigh, what condition may be suspected?
Which of the following best describes the intended follow-up after discovering the reduced pressure in the left 3rd digit?
Which of the following best describes the intended follow-up after discovering the reduced pressure in the left 3rd digit?
Calculate the ABI for the right leg using the provided arm and ankle pressures. What is the correct ABI value?
Calculate the ABI for the right leg using the provided arm and ankle pressures. What is the correct ABI value?
Based on the observed left 3rd digit pressure, what implication does it have regarding disease distribution?
Based on the observed left 3rd digit pressure, what implication does it have regarding disease distribution?
What condition can explain a duplex examination showing medium velocity triphasic flow with minimal atherosclerosis in the bilateral arteries?
What condition can explain a duplex examination showing medium velocity triphasic flow with minimal atherosclerosis in the bilateral arteries?
Which segmental exam pressure is most consistent with a significant drop that indicates a possible mid-SFA stenosis?
Which segmental exam pressure is most consistent with a significant drop that indicates a possible mid-SFA stenosis?
In a segmental pressure exam, what does the presence of a monophasic waveform in the mid-segment of the femoral artery indicate?
In a segmental pressure exam, what does the presence of a monophasic waveform in the mid-segment of the femoral artery indicate?
What is the significance of measuring pressures at different levels during a four-cuff segmental exam?
What is the significance of measuring pressures at different levels during a four-cuff segmental exam?
What does a pressure gradient greater than 30 mmHg between the thigh and calf suggest?
What does a pressure gradient greater than 30 mmHg between the thigh and calf suggest?
What is the first component lost in a PVR waveform when arterial disease is present?
What is the first component lost in a PVR waveform when arterial disease is present?
What is likely indicated by a pressure reading of 155 mmHg in the thigh compared to 90 mmHg in the calf?
What is likely indicated by a pressure reading of 155 mmHg in the thigh compared to 90 mmHg in the calf?
What is a potential consequence of significant pressure gradients observed in patients with intermittent claudication?
What is a potential consequence of significant pressure gradients observed in patients with intermittent claudication?
What does the absence of a dicrotic notch in a PVR waveform typically indicate?
What does the absence of a dicrotic notch in a PVR waveform typically indicate?
In the context of the examination data provided, what does bilateral intermittent claudication suggest?
In the context of the examination data provided, what does bilateral intermittent claudication suggest?
Which statement accurately describes one possible implication of a significant drop in pressures between the low thigh and calf?
Which statement accurately describes one possible implication of a significant drop in pressures between the low thigh and calf?
What can be inferred if a patient exhibits a drop in calf pressure during a physical examination?
What can be inferred if a patient exhibits a drop in calf pressure during a physical examination?
What condition is suggested by a significant pressure drop from the thigh to the calf on the right side?
What condition is suggested by a significant pressure drop from the thigh to the calf on the right side?
What does the pressure reading of 95 mmHg at the thigh level on the left side indicate?
What does the pressure reading of 95 mmHg at the thigh level on the left side indicate?
In photoplethysmography, what is the primary function of the infrared light?
In photoplethysmography, what is the primary function of the infrared light?
Which of the following pressure readings indicates a likely vascular obstruction on the left side?
Which of the following pressure readings indicates a likely vascular obstruction on the left side?
How is the pressure index assessed between the thigh and the calf on the right side?
How is the pressure index assessed between the thigh and the calf on the right side?
Which of the following statements corresponds to the interpretation of the right side's biopsy findings?
Which of the following statements corresponds to the interpretation of the right side's biopsy findings?
If there is a significant drop in systolic pressure from the thigh to calf on the right side, what is the differential diagnosis most likely?
If there is a significant drop in systolic pressure from the thigh to calf on the right side, what is the differential diagnosis most likely?
What does an index of 0.80 at the ankle (DPA) indicate in terms of vascular health?
What does an index of 0.80 at the ankle (DPA) indicate in terms of vascular health?
What does the segmental pressure reading of 210 mmHg on the left side represent?
What does the segmental pressure reading of 210 mmHg on the left side represent?
Which finding suggests mild iliac disease on the right side?
Which finding suggests mild iliac disease on the right side?
What does an ankle pressure reading of 85 mmHg indicate?
What does an ankle pressure reading of 85 mmHg indicate?
What does a segmental/brachial index value of 1.79 on the left side imply?
What does a segmental/brachial index value of 1.79 on the left side imply?
What condition is indicated by a pressure drop greater than 30 mmHg between the low thigh and calf?
What condition is indicated by a pressure drop greater than 30 mmHg between the low thigh and calf?
What does the notation of 'slight rounding and decrease in amplitude' in pulse volume recordings suggest?
What does the notation of 'slight rounding and decrease in amplitude' in pulse volume recordings suggest?
Which finding supports the conclusion of left mild femoral popliteal occlusive disease?
Which finding supports the conclusion of left mild femoral popliteal occlusive disease?
What does an absent dicrotic notch on the PVR waveform indicate?
What does an absent dicrotic notch on the PVR waveform indicate?
What does the right side show in terms of occlusive disease?
What does the right side show in terms of occlusive disease?
Which option describes a consistent characterization of left mild femoral popliteal occlusive disease?
Which option describes a consistent characterization of left mild femoral popliteal occlusive disease?
Which of the following is NOT a finding associated with the analysis of mild iliac disease?
Which of the following is NOT a finding associated with the analysis of mild iliac disease?
How would one best characterize right mild iliac and moderate femoral disease?
How would one best characterize right mild iliac and moderate femoral disease?
What could be a potential misinterpretation regarding the findings of femoral popliteal occlusive disease?
What could be a potential misinterpretation regarding the findings of femoral popliteal occlusive disease?
What is suggested by the presence of mild disease on the right side compared to the left?
What is suggested by the presence of mild disease on the right side compared to the left?
Which of the following findings would likely indicate the need for further examination?
Which of the following findings would likely indicate the need for further examination?
Which characterization is least likely to match the analysis of right mild femoral popliteal disease?
Which characterization is least likely to match the analysis of right mild femoral popliteal disease?
Which condition is likely if mild iliac disease is present on the right side?
Which condition is likely if mild iliac disease is present on the right side?
What does a relatively close pressure reading between the upper forearm and brachial pressure suggest?
What does a relatively close pressure reading between the upper forearm and brachial pressure suggest?
What do abnormal digit tracings alongside normal ankle-brachial indices indicate?
What do abnormal digit tracings alongside normal ankle-brachial indices indicate?
What is the recommended sample size for PW Doppler evaluation of an artery?
What is the recommended sample size for PW Doppler evaluation of an artery?
What does significant drop in pressure between the upper forearm and wrist-radial measurements suggest?
What does significant drop in pressure between the upper forearm and wrist-radial measurements suggest?
Why might the pressure measurements at the upper forearm and wrist be significant in diagnosis?
Why might the pressure measurements at the upper forearm and wrist be significant in diagnosis?
What could be the interpretation of close pressure readings at the upper forearm and brachial pressure?
What could be the interpretation of close pressure readings at the upper forearm and brachial pressure?
In the evaluation of peripheral arterial disease, what does a discrepancy between digit and ankle-brachial indices imply?
In the evaluation of peripheral arterial disease, what does a discrepancy between digit and ankle-brachial indices imply?
What does it indicate if the pressure at the upper forearm is similar to the brachial pressure?
What does it indicate if the pressure at the upper forearm is similar to the brachial pressure?
What does the pressure drop between the upper forearm and wrist-radial measurement indicate?
What does the pressure drop between the upper forearm and wrist-radial measurement indicate?
Why could a pressure drop at the radial measurement site imply an obstruction?
Why could a pressure drop at the radial measurement site imply an obstruction?
Which factor suggests a localized issue affecting blood flow through the radial artery?
Which factor suggests a localized issue affecting blood flow through the radial artery?
What anatomical consideration supports the interpretation of a pressure drop at the radial site?
What anatomical consideration supports the interpretation of a pressure drop at the radial site?
What implication does a pressure drop of 10 mmHg from the upper forearm to the wrist-radial reading suggest?
What implication does a pressure drop of 10 mmHg from the upper forearm to the wrist-radial reading suggest?
How could the observed pressures help inform clinical decisions?
How could the observed pressures help inform clinical decisions?
What might a 5 mmHg pressure drop specifically at the radial artery suggest about blood supply?
What might a 5 mmHg pressure drop specifically at the radial artery suggest about blood supply?
What is the potential interpretation of the pressure gradient observed between different limbs during measurements?
What is the potential interpretation of the pressure gradient observed between different limbs during measurements?
Flashcards
Photoplethysmography (PPG)
Photoplethysmography (PPG)
A non-invasive test that measures blood flow by shining infrared light onto the skin and monitoring the changes in reflected light. Hemoglobin absorbs the light, so as blood volume in the leg decreases, more light is reflected.
How PPG Works: Light Reflection
How PPG Works: Light Reflection
Red blood cells reflect the light emitted by the PPG device. The amount of reflected light is measured by photocells to assess changes in blood volume.
What Does PPG Measure?
What Does PPG Measure?
PPG detects changes in cutaneous (skin) blood flow and volume, giving insights into arterial health.
Normal PPG Waveform
Normal PPG Waveform
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PPG Waveform in Mild Disease
PPG Waveform in Mild Disease
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PPG Waveform in Severe Disease
PPG Waveform in Severe Disease
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PPG Advantage: Medial Calcification
PPG Advantage: Medial Calcification
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PPG for Confirmation
PPG for Confirmation
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PPG and Medial Calcification
PPG and Medial Calcification
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Limitations of PPG
Limitations of PPG
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What does a change from triphasic to monophasic waveform indicate during arterial Doppler?
What does a change from triphasic to monophasic waveform indicate during arterial Doppler?
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Pressure Drop Significance
Pressure Drop Significance
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Suspected Mid SFA Stenosis/Occlusion
Suspected Mid SFA Stenosis/Occlusion
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What constitutes a NORMAL ABI result?
What constitutes a NORMAL ABI result?
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What does an Ankle Pressure Drop of 35-50% indicate?
What does an Ankle Pressure Drop of 35-50% indicate?
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Coarctation of the Aorta
Coarctation of the Aorta
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Ankle-Brachial Index (ABI)
Ankle-Brachial Index (ABI)
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Normal ABI Range
Normal ABI Range
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Normal ABI Response to Exercise
Normal ABI Response to Exercise
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Single-Level Disease (ABI)
Single-Level Disease (ABI)
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Rest Before Vascular Exam
Rest Before Vascular Exam
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What is the ABI test?
What is the ABI test?
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How is the ABI calculated?
How is the ABI calculated?
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What do ABI values of 0.98 and 0.94 indicate?
What do ABI values of 0.98 and 0.94 indicate?
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What do different ABI values indicate?
What do different ABI values indicate?
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What's a limitation of a resting ABI test?
What's a limitation of a resting ABI test?
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What is a normal ABI value?
What is a normal ABI value?
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What should you do if your ABI is consistently low?
What should you do if your ABI is consistently low?
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Why is early treatment of PAD important?
Why is early treatment of PAD important?
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What does a pressure drop of over 30 mmHg between the low thigh and calf, with an absent dicrotic notch on the PPG waveform, indicate?
What does a pressure drop of over 30 mmHg between the low thigh and calf, with an absent dicrotic notch on the PPG waveform, indicate?
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What does a change from a triphasic to a monophasic waveform during arterial Doppler indicate?
What does a change from a triphasic to a monophasic waveform during arterial Doppler indicate?
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What does a pressure drop of over 30 mmHg between two adjacent segments suggest?
What does a pressure drop of over 30 mmHg between two adjacent segments suggest?
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What does a significant pressure drop between the two thigh cuffs suggest?
What does a significant pressure drop between the two thigh cuffs suggest?
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Is Option A (Aorta and bilateral severe iliac occlusive disease) consistent with the case data?
Is Option A (Aorta and bilateral severe iliac occlusive disease) consistent with the case data?
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Pressure Drop
Pressure Drop
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Level of Disease
Level of Disease
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Thigh Pressure
Thigh Pressure
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Calf Pressure
Calf Pressure
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Peripheral Artery Disease (PAD)
Peripheral Artery Disease (PAD)
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Bilateral Disease
Bilateral Disease
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What are normal ABI values?
What are normal ABI values?
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What does a pressure drop of over 30mmHg between adjacent segments indicate?
What does a pressure drop of over 30mmHg between adjacent segments indicate?
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Why is exercise testing used in evaluating PAD?
Why is exercise testing used in evaluating PAD?
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Triphasic Waveform
Triphasic Waveform
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Monophasic Waveform
Monophasic Waveform
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Significant Pressure Drop
Significant Pressure Drop
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Four-Cuff Segmental Exam
Four-Cuff Segmental Exam
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Mid Superficial Femoral Artery (SFA) Stenosis or Occlusion
Mid Superficial Femoral Artery (SFA) Stenosis or Occlusion
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Pressure Drop from Upper Thigh to Distal Thigh
Pressure Drop from Upper Thigh to Distal Thigh
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When is Digital Plethysmography used?
When is Digital Plethysmography used?
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How does Medial Calcification affect ABI results?
How does Medial Calcification affect ABI results?
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What assessment measures should be used for a diabetic patient with a non-healing toe wound?
What assessment measures should be used for a diabetic patient with a non-healing toe wound?
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How does Digital Plethysmography work?
How does Digital Plethysmography work?
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Why are digital pressures more accurate than Doppler measurements in this scenario?
Why are digital pressures more accurate than Doppler measurements in this scenario?
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What action should be taken when ABI and Doppler results are inconsistent?
What action should be taken when ABI and Doppler results are inconsistent?
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Why is PPG useful in cases of Medial Calcification?
Why is PPG useful in cases of Medial Calcification?
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What makes PPG unique?
What makes PPG unique?
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What is pseudoclaudication?
What is pseudoclaudication?
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What is the most common type of Thoracic Outlet Syndrome (TOS)?
What is the most common type of Thoracic Outlet Syndrome (TOS)?
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In what position should arterial pressures in the toes be measured?
In what position should arterial pressures in the toes be measured?
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How long should you wait before repeating a blood pressure measurement?
How long should you wait before repeating a blood pressure measurement?
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Can a normal ABI rule out medial calcification?
Can a normal ABI rule out medial calcification?
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How can PPG be used to confirm findings when ABI is normal but Doppler shows inconsistencies?
How can PPG be used to confirm findings when ABI is normal but Doppler shows inconsistencies?
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What does a pressure gradient exceeding 30 mmHg between the thigh and calf indicate?
What does a pressure gradient exceeding 30 mmHg between the thigh and calf indicate?
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What is the first component lost on a PVR waveform in arterial disease?
What is the first component lost on a PVR waveform in arterial disease?
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What does a significant pressure drop between the two thigh cuffs indicate?
What does a significant pressure drop between the two thigh cuffs indicate?
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What does a pressure drop exceeding 30 mmHg between two adjacent segments indicate?
What does a pressure drop exceeding 30 mmHg between two adjacent segments indicate?
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What does an ABI of 0.98 on one leg and 0.94 on the other leg indicate for the patient?
What does an ABI of 0.98 on one leg and 0.94 on the other leg indicate for the patient?
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What does a change from a triphasic to a monophasic waveform indicate during arterial Doppler?
What does a change from a triphasic to a monophasic waveform indicate during arterial Doppler?
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When is digital PPG used?
When is digital PPG used?
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What is ABI?
What is ABI?
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Peripheral Artery Disease
Peripheral Artery Disease
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What indicates arterial disease in a segmental pressure exam?
What indicates arterial disease in a segmental pressure exam?
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What does a pressure drop between the two thigh cuffs indicate?
What does a pressure drop between the two thigh cuffs indicate?
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What is Digital Plethysmography (PPG)?
What is Digital Plethysmography (PPG)?
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What does a pressure drop between the thigh and calf indicate?
What does a pressure drop between the thigh and calf indicate?
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What should you do if ABI and Doppler results are inconsistent?
What should you do if ABI and Doppler results are inconsistent?
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Digital Plethysmography (PPG)
Digital Plethysmography (PPG)
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Medial Calcification
Medial Calcification
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Pseudoclaudication
Pseudoclaudication
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Neurogenic TOS
Neurogenic TOS
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How does Medial Calcification Affect ABI?
How does Medial Calcification Affect ABI?
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Assessment Measures for Diabetic Foot Ulcer
Assessment Measures for Diabetic Foot Ulcer
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Study Notes
Thoracic Outlet Syndrome (TOS)
- TOS is a condition where a muscular band, cervical rib, or fibrous band compresses the brachial plexus.
- Many patients are asymptomatic.
- Symptoms include dull aching pain, radiating from the compression point, numbness (paresthesia), pain, and increased symptoms with arm/neck movements or exercise. Swelling can also occur with venous TOS.
- The location of compression can vary.
Examination Techniques for TOS
- PPG exam can be performed with the sensor placed on the 2nd digit of the radial artery.
- Doppler exam can be performed with the transducer placed on the radial artery.
Types of TOS
- Neurogenic TOS (most common type, >90%): Compression of the brachial plexus from cervical ribs, anterior scalene muscles, and ligaments. Symptoms include paresthesia, numbness, and pain.
- Arterial TOS (least common, ~1%): Compression of the subclavian artery from the head of the humerus. Symptoms may not be identified by ultrasound if only the nervous system is involved.
- Venous TOS (also called Paget-Schroetter syndrome or effort thrombosis): Compression of the subclavian vein against the first rib and scalenus anticus muscle with abduction of the arm. Symptoms include paresthesia, numbness, pain, increased symptoms with arm/neck movements or exercise, swelling with venous TOS, and intermittent symptoms that vary with patient position.
Exam Techniques
- General Procedure: Evaluate the patient first for atherosclerosis; establish normal flow patterns, then evaluate flow changes with position changes. The patient sits with palms up and resting on thighs.
- PPG & PVR: Perform PPG tracings of the second digit (index finger) at rest and with maneuvers, and PVR tracings with a brachial cuff at rest and with maneuvers. Note any changes in flow or waveforms with position changes.
- Doppler Evaluation (Arterial): Evaluate the radial artery at the wrist. Obtain Doppler samples, and perform TOS maneuvers. Repeat Doppler samples.
- Doppler Evaluation (Venous): Evaluate the distal subclavian vein. Establish baseline flow with Doppler, perform TOS maneuvers and repeat Doppler samples. Record any changes in flow velocities with maneuvers.
TOS Maneuvers
- Neutral Position: Used for baseline tracing before maneuvers to initiate symptoms. Record positions used to evaluate patient. Note any symptoms or changes in waveforms with this position.
- 90 Degree Abduction: Raise the arm up with hand at the same height as the shoulder, palm up. Turn the head toward the affected arm and then away, while recording waveforms. Note any symptoms or waveform changes.
- 180 Degree Abduction: Raise the arm straight up with the palm turned towards the head. Turn the head toward the affected arm and then away, while recording waveforms. Note any symptoms or waveform changes.
- Adson Maneuver: Patient sits tall with chest forward, takes a deep breath, and turns their head to the affected side, extends the arm, and raises it slightly. Evaluate with head turned to the unaffected side. Note symptoms and waveform changes, and any changes in pressure values.
- Costoclavicular Maneuver: Patient pushes elbows back, shoulders down, and sticks chest out. Face forward with chin level. Turn head to affected side and away. Record waveforms. Note any symptoms or waveform changes.
Abnormal Findings
- PPG/PVR: Significantly reduced amplitude or absent signal with patient maneuvers.
- Arterial Doppler: Significantly reduced or absent signal with patient maneuvers. Evaluation may not identify symptoms if only nervous system is involved. Note any changes in waveform morphology or flow velocities with each maneuver.
- Venous Doppler: Venous signal becomes continuous or disappears. Note changes in flow with different maneuvers.
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Description
Test your knowledge on interpreting various outcomes from arterial exams, focusing on ankle pressure changes and waveform analysis. This quiz covers indications of significant disease states and pressure fluctuations in different segments of the arteries. Enhance your understanding of vascular assessments and their implications for patient health.
