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PVI > Arterial Hemodynamics > Flashcards

Arterial Hemodynamics Flashcards

1
Q

cuff size affects limbs pressures

A

too narrow - falsely high too wide - falsely low

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2
Q

ABI > 1.4

A

diabetes

chronic renal failure

medial calcification

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3
Q

significance of 15 mm difference PT and DP

A

proximal disease

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4
Q

ABI uses which pressures for brachial and DP/PT

A

highest brachial pressure

highest DP or PT

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5
Q

30 mm hg gradient btw segments

A

significant disease

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6
Q

pressures may not drop

A

due to compensation from collaterals

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7
Q

pressures reflect function

A

not anatomy

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8
Q

pressure difference arm and proximal thigh

A

20-30 mm

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9
Q

contraindications for exercise testing

A

recent coronary event

shortness of breath

arthritis

ABI < 0.5

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10
Q

key in exercise testing

A

drop in pressure 20% not ABI (may increase)

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11
Q

treadmill exercise

A

10-12 % incline - start 1 mph - increase to 2.5

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12
Q

significance of recovery from exercise < 5 min

A

good collateralization

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13
Q

PPG

A

photoelectric plesmothography

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14
Q

normal PVR

A

dicrotic notch

sharp systolic upstroke

narrow peak

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15
Q

dicrotic notch

A

reflected wave

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16
Q

PVR amplitude dependent on following

PVR measures cuff pressure changes due to cuff volume which reflects changes in limb volume

A

stroke volume

blood pressure

vasomotor tone

blood volume

limb size

limb position

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17
Q

PVR waveforms with obesity & edema

A

attenuate

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18
Q

pressures for PVR

A

65 mm limbs/ 40 mm digits

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19
Q

PVR (measure over 3-4 cycles)

A

measures global perfusion under cuff

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20
Q

abnormal PVR

A

dampened upstroke

peak round and delayed

no dicrotic notch

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21
Q

PPG

A

light sensitive diode detects RBC

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22
Q

toe brachial index

A

toe pressure over highest brachial pressure

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23
Q

severe disease toe index

A

0.11-0.34

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24
Q

mild moderate toe index

A

0.35-0.64

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25
Q

normal toe index

A

> 0.65

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26
Q

able to differentiate stenosis versus occlusion

A

NO

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27
Q

patients in which to measure toe index

A

diabetes

medial calcification

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28
Q

primary testing pitfalls

A

inflow stenosis

inability to distinguish stenosis and occlusion

noncritical stenosis

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29
Q

Normal ABI/waveforms but claudication

A

stress exam - if positive then duplex

30
Q

common iliac aneurysm

A

2.0 cm 1.7 cm per Pellerito 1,5 cm upper normal

31
Q

criteria for femoral or popliteal aneurysm

A

increase by 50%

32
Q

AAA rupture risk

A

43 % if > 6 cm

10-20 % risk of rupture

33
Q

characteristics of endoleak

A

spongy aneurysm sac areas of decreased echogenicity pulsations

34
Q

meaning of 20-49% stenosis

A

plaque without velocity elevation

35
Q

ratio for 50-75% stenosis

A

2:1 velocity ratio

36
Q

velocity ratio for >75% stenosis

A

3:1

37
Q

significance of tandem lesion on velocity

A

decreases velocity elevation

38
Q

popliteal and tibial velocities

A

60’s

39
Q

SFA velocity

CFA velocity

A

90 +/- 15 cm/sec

115 +/- 25 cm/sec

40
Q

criteria for occlusion

A

pre occlusive thump

internal echoes

prominent collaterals

no flow

41
Q

velocity criteria for bypass graft failure (lower extremity) (not for > 6 mm vein grafts) ****

A

45 cm/sec

42
Q

ischemia of extremities involving upper extremities

A

5% of disease

43
Q

wrist brachial index

A

0.9 - 1.1

44
Q

digit brachial index

A

>= 0.9

45
Q

significant brachial pressure difference

A

20 mm

46
Q

Allen test

A

PPG on 3rd digit intact arch if waveform reverses incomplete arch if waveform stops

47
Q

5% of UE disease is large vessel

A

90-95% UE disease is small vessel

48
Q

nipple or peak of top of waveform

A

vasospasm

49
Q

characteristics of arteritis

A

smooth circumferential

50
Q

popliteal entrapment

A

hyperextension of knee

passive dorsiflexion

active plantar flexion

51
Q

low thigh and calf pressures

A

fem pop disease

52
Q

low toe pressure

A

vasospasm versus small vessel disease

53
Q

difference between Doppler and PVR

A

direct versus global perfusion

54
Q

low pressures in foot ankle

A

use CW

55
Q

sonographic appearance of endoleaks

A

spongy

hypoechoic or anechoic area

56
Q

endoleak type I

A

attachment site high pressure poor apposition hyperdense on precontrast type IA - proximal type IB - distal iliac artery

57
Q

endoleak type II

A

most common retrograde from excluded aortic branch lumbar or IMA

58
Q

type III endoleak

A

high pressure

structural failure of graft

holes in fabric

junctional separations

leak through body of stent graft

poor apportion or separation of graft or

graft rupture or tear of graft

may see high velocity jet

59
Q

type IV endoleak

A

immediately after placement

ransient graft porosity

blush on angio at time of placement

diagnosis of exclusion

60
Q

type V endoleak

A

endotension

persistent growth without visible cause

61
Q

PPG waveform with double peak

(early anacrotic notch and high dicrotic notch)

means

A

Raynaud’s disease

62
Q

PPG in incomplete arch

A

after release of either radial or ulnar no bouncing waveform

63
Q

ratio for 76-99% stenosis

A

3:1

64
Q

ratio for 50-75%

A

2:1

65
Q

significance of pandiastolic flow

A

aortic insufficiency

66
Q

popliteal entrapment - plantar flexion

A

velocity elevates to 327 cm/sec

67
Q

CW

continuous wave Doppler

A

2 crystals

5-10 mHz

Doppler probe 45-60 degrees

68
Q

what is this waveform demonstrating

A

hyperemia

69
Q

exercise testing

recovery < 5 min

A

adequate collateralization

70
Q

exercise testing

recovery > 10 min

A

poor collateralization

71
Q

waveform finding

A

serrated margin

post stenotic turbulence

72
Q

popliteal velocity

A

69 +/- 15 mm

PVI (9 decks)

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