Arterial+Testing+Summary

Here are the notes from our discussion in class:

ABI
 * The first step—done by a nurse or doctor in the vascular clinic or by you if not done already!
 * If normal with no claudication then you are done, patient doesn’t need to be examined further
 * If normal, with claudication à exercise ABI
 * Bracial Pressure (use highest)
 * Ankle Pressues
 * o Posterior tib
 * o Dorsalis pedi (ATA)
 * Ratio
 * o Normal is >.9
 * o Abnormal is <.9 à send to exercise
 * o If their ABI is >1.2, it is probably calcific arts and cant compress à PVR is best study
 * o <.5 Pain at rest, multi-level disease
 * o <.3 severe
 * o if they are .5, then it is already diagnosed and an exercise ABI will not add to the diagnosis.
 * o Depends on facility
 * o If you have abnormal ABI and you know it is significant <.5 à segmental pressures or Cw doppler or PVR

Ankle/brachial index >1.0 Normal (no symptoms) Ankle/brachial index 0.9 Minimal ischemic disease (minimal symptoms) Ankle/brachial index 0.5-0.89 Mild-to-moderate disease (symptoms of intermittent claudication) Ankle/brachial index 0.3-0.5 Moderate-to-severe disease (symptoms of ischemic pain in leg at rest) Ankle/brachial index <0.3 Severe disease (danger to the leg)

Exercise ABI
 * 10-12% incline
 * 5 mins of as long as they can make it
 * 1.5-2 mph
 * do both arms and both ankles (legs first)
 * ankle—take which ever you hear better
 * normal for blood pressure to increase after exercise
 * if they have disease, pressure will decrease after exercise

Segmental Pressures
 * To find out where the disease
 * Use PT or DP, whatever you feel is better
 * 4 cuff method
 * o high thigh
 * cuff artifact
 * cuff isn’t big enough to fit around the thigh so shows artifactually high on test
 * cuff needs to be 20% bigger than limb diameter
 * *believe low pressure but not high pressure (usually artifact)*
 * o blow up to higher than you think the pressure will be (you wont hear anymore)
 * o metatarsals
 * put the ppg probe on the end of the toe
 * o toe pressures
 * <.6 TBI is abnormal
 * **Difference of 15-30 side to side or superior to inferior indicates disease!**
 * o **Disease is when the pressure goes down**

PVR
 * Double check or for arteries you cant get accurate pressure (like calcific arts)
 * Automatically inflate bilaterally to 60 mmHg
 * Measures volume change during systole and diastole
 * recording how the artery changes
 * Waveform
 * [[image:PVR.jpg]]
 * Normal
 * o Short Acceleration time
 * o Dicrotic Notch
 * Disease
 * § Loss of notch
 * § “tardus parvus

CW Doppler
 * CFA
 * Mid SFA
 * Pop
 * DP
 * PTA