Vascular Ultrasound-Arterial Physiologic Testing: legs
Chapter 10 Daigle Questions with Correct Answers
Indirect physiologic test methods: Correct Answer-~Pulse Volume
Recordings (PVR) or Volume Pulse Recording (VPR)
~Doppler analog waveform analysis or Doppler spectral analysis.
~Segmental Limb Pressures (SLP) & Calculated Ankle-Brachial Indices
(ABI) & Toe Brachial Indices (TBI)
Exercise stress test (or post-reactive hyperemia)
Advantages of Indirect Physiologic Testing: Correct Answer-~Simple to
perform & requires only a short learning curve.
~ Testing time is short; 20-45 min for bilateral exam
~Accurate for hemodynamically significant disease.
~Objective, quantitative physiologic info.
~Instrumentation inexpensive compare to ultrasound.
Goals of Lower Extremity Physiologic Testing: Correct Answer-~To
determine objective evidence for arterial disease.
~To determine if arterial disease is causing patient's symptoms.
~ In patient's with combined neuropathy & arterial obstruction,
physiologic testing may be the only OBJECTIVE way to determine
which condition is causing the patient's symptoms. Limb pressures are
useful in predicting whether sufficient perfusion exists to heal ulceration
& wounds.
,Limitations of Indirect Testing: Correct Answer-~Inability to identify
precise location of disease
~Diagnoses tend to be generalized in regard to region & to disease
severity.
~Will not detect minor levels of diffuse atherosclerotic disease.
Palpation of pulses Correct Answer-are subjective information.
Pulses may be obtained at: Correct Answer-~Groin - distal EIA or CFA
~Popliteal fossa - Popliteal artery.
~Ankle - DPA & PTA.
Rating/gradation method of limb pulses: Correct Answer-0 = no pulse
1 = weak pulse
2 = normal pulse
3 = very strong pulse or aneurysmal pulses.
Segmental Systolic Limb Pressures Correct Answer-Compare limb
blood pressures to systemic pressures obtained in the arms.
~Systolic pressures in each limb segment should be equal to or greater
than arm pressure in normal patients.
~Significant drops between segments = presence of occlusive disease in
that region.
2 types of Segmental pressure testing: Correct Answer-1. 3 cuff
technique - One large 17 cm air bladder thigh cuff, plus calf & ankle
cuffs.
2. 4 cuff technique (best at differentiating inflow disease from femoral
artery disease.) - Two smaller thigh cuffs (12 cm), as well as two cuffs
below the knee.
The patient should be supine for _______ minutes prior to a Segmental
Systolic Limb Pressure test. Correct Answer-5 - 10 minutes
Cuff sizes Correct Answer-~ Upper arms 10 or 12 cm
~Upper thighs 12 cm
~Lower thighs or above knee 12 cm
~ Proximal calf (AKA, below the knee) 10 cm or 12 cm
~ Ankles 10 or 12 cm
~ Optional: metatarsal 6-8 cm, great toe 2.0 - 2.5 cm.
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