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Nonimaging Physiologic Tests

Nonimaging Physiologic Tests. Assessment of Lower Extremity Arterial Disease. Understanding the Anatomy, Physiology and Pathophysiology. Understanding the Equipment. Knowing the Limitations. Anatomy. Abdominal Aorta Common Iliac Internal and External Iliac Common Femoral

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Nonimaging Physiologic Tests

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  1. Nonimaging Physiologic Tests Assessment of Lower Extremity Arterial Disease

  2. Understanding the Anatomy, Physiology and Pathophysiology

  3. Understanding the Equipment

  4. Knowing the Limitations

  5. Anatomy • Abdominal Aorta • Common Iliac • Internal and External Iliac • Common Femoral • Superficial Femoral • Profunda Femoris • Popliteal • Anterior Tibial • Posterior Tibial • Peroneal. • Doralis pedis

  6. Physiology • Blood Flow • Regulation of Blood Flow • Ventricular Contraction • Stroke Volume • Pressure Wave • Shape and Amplitude of Pressure Wave • Pressure Gradient • Peak Systolic Pressure

  7. Pathophysiology • Ateriosclerosis Obliterans • Most Common Site - SFA • Next Most Common Site – AI • Diabetic Vs Nondiabetic • Multiple Segments

  8. Clinical Symptoms • Ischemia – exercise and rest • Intermittent Claudication • Common Sites – calf, thigh, hip and buttock • Instep Claudication - TAO • Pseudoclaudication • Rest Pain

  9. Clinical Symptoms • Skin Changes • Ulcers • Gangrene

  10. Questions and Answers • Is there Disease? • Where is the Disease Located? • To what Extent is the Patient Disabled? • Is Collateralization adequate? • What is the Potential for Limb Loss? • How successful is Treatment?

  11. Instrumentation • Doppler Flowmeters • Plethysmographs - Pneumo, Strain Gauge, Impedance and Photo • Recording Devices

  12. Measurement of SystolicBlood Pressure • Wave amplification – Reflected waves, differences in • compliances • Peak Systolic Pressure • Critical Stenosis – degree of narrowing that produces • significant drop in distal pressure. • 4. Critical Stenosis – flow dependent

  13. Measurement of Systolic Blood Pressure • Ankle Pressure • Ankle Pressure Index • Values less than 1 indicate the presence of disease • Values > 0.5 < 1.0 – Single-level occlusion • Values < 0.5 – Multiple levels of occlusion

  14. Ankle Pressure IndexDegree of Functional Disability Intermittent Claudication 0.59 Ischemic Rest Pain 0.26 Gangrene 0.05

  15. Segmental Pressures • Location, Location, Location • Relative Significance • Cuff Placement – HT, AK, BK, and Ankle • HTSP – 30 to 40 mm Hg > BSP • Thigh Pressure Index - > 1.2 • TPI > 0.8 < 1.2 – Aortoiliac stenosis • TPI < 0.8 – Aortoiliac occlusion.

  16. Segmental Pressures • Difference in SP between adjacent levels - < 20 mm Hg • 2. Difference in SP between corresponding segments - • < 20 mm Hg • Gradients: • HT – AK - SFA Disease • AK – BK - PA Disease • BK – Ankle – Tibial and Peroneal Artery Disease

  17. Toe Pressure • Obstructive Disease - Pedal Arch and Digital Arteries • API – Spuriously high • Photoplethysmograph • Toe Pressure Index – 0.80 – 0.90 • TBI < 0.66 is considered abnormal

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