Nonimaging Physiologic Tests

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Nonimaging Physiologic Tests

• Assessment of Lower Extremity Arterial Disease

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Understanding the Anatomy, Physiology and
Pathophysiology
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Understanding the Equipment
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Knowing the Limitations
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Anatomy

1. Abdominal Aorta
2. Common Iliac
3. Internal and External Iliac
4. Common Femoral
5. Superficial Femoral
6. Profunda Femoris
7. Popliteal
8. Anterior Tibial
9. Posterior Tibial
10. Peroneal.
11. Doralis pedis

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Physiology

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

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Pathophysiology

• Ateriosclerosis Obliterans
• Most Common Site - SFA
• Next Most Common Site AI
• Diabetic Vs Nondiabetic
• Multiple Segments

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Clinical Symptoms

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

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Clinical Symptoms

1. Skin Changes
2. Ulcers
3. Gangrene

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Questions and Answers

1. Is there Disease?
2. Where is the Disease Located?
3. To what Extent is the Patient Disabled?
4. Is Collateralization adequate?
5. What is the Potential for Limb Loss?
6. How successful is Treatment?

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Instrumentation

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

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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

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Measurement of Systolic Blood Pressure

1. Ankle Pressure
2. Ankle Pressure Index
3. Values less than 1 indicate the presence of
   disease
4. Values gt 0.5 lt 1.0 Single-level occlusion
5. Values lt 0.5 Multiple levels of occlusion

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Ankle Pressure IndexDegree of Functional
Disability

• Intermittent Claudication
• 0.59
• Ischemic Rest Pain
• 0.26
• Gangrene
• 0.05

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Segmental Pressures

1. Location, Location, Location
2. Relative Significance
3. Cuff Placement HT, AK, BK, and Ankle
4. HTSP 30 to 40 mm Hg gt BSP
5. Thigh Pressure Index - gt 1.2
6. TPI gt 0.8 lt 1.2 Aortoiliac stenosis
7. TPI lt 0.8 Aortoiliac occlusion.

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Segmental Pressures

• Difference in SP between adjacent levels - lt 20
  mm Hg
• 2. Difference in SP between corresponding
  segments -
• lt 20 mm Hg
• Gradients
• HT AK - SFA Disease
• AK BK - PA Disease
• BK Ankle Tibial and Peroneal Artery
  Disease

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Toe Pressure

1. Obstructive Disease - Pedal Arch and Digital
   Arteries
2. API Spuriously high
3. Photoplethysmograph
4. Toe Pressure Index 0.80 0.90
5. TBI lt 0.66 is considered abnormal