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*detects presence of PAOD

*identifies general location

*categorizes it's severity

Indirect Testing

*distinguishes between true PAOD and mimics

Doppler Tracings

1.3

0.75 - 0.89

PVR

0.51 - 0.74

Segmental Pressures

Physiological study, rather than anatomical

Locations

*Common femoral

*Femoral (superficial)

*Popliteal

*Posterior tibial

*Dorasalis pedis

Doppler Tracing Locations

Tips

*Hold Pedoff Probe at 45 degree angle towards arterial flow

*No cuffs needed for this portion

*May need to use a glob of gel for thru transmission on ankle tracings

Doppler Tips

Notes

*Popliteal is 2nd most common site for aneurysms

*A lot of malignancies cause blood to clot

*Normal/desired tracing result is

a Tri-phasic flow pattern -->

Doppler Notes

Categorizations

Dorsalis Pedis

0 - Don't feel it

1 - Barely there

2 - Normal

3 - Bounding (suspect an aneurysm)

Categorizations

Reminders

*There is no imaging, you must find the arterial flow blindly.

*Hit 'space bar' to freeze image; 'enter' to save it.

*Posterior tibial is most important pulse to find. (behind medial malleolus) Remember to switch from the 4MHz to 8MHz probe for this location. (machine will remind you)

Doppler Tracing Reminders

Locations

*Measures limb volume with arterial inflow and venous outflow, using gentle squeezes to stop venous flow

*Bilateral readings, at 3-4 locations

*Gives tracings like waveforms

Pulse Volume Recordings

Tips

*Applies only ~55 mmHg of pressure

*Can be beneficially used even if arteries are calcified

*Orient the tubes on the cuffs cephalic

*Do PVR before segmental pressures as

these are easier to withstand

PVR Tips

Notes

*Normal tracings will have a brisk upstroke, well defined peak, and a dicrotic notch (from the closure of aortic valve) in diastole

*PVR tracings are used to compare

with results of segmental pressures

and Doppler tracings

PVR Notes

Categorizations

*Loss of dicrotic notch = Mild occlusion

*Moderate occlusion = additional loss of rapid upstroke

*Additional loss of well-formed peak = Severe occlusion

PVR Categorizations

Reminders

*As for segmental pressures, use cuffs that are at least 20% wider than limb diameter.

*In lab we use 10cm cuffs for 4 lower-leg positions and 12 cm cuffs for 4 upper-leg positions. Or, use a 3-cuff method for shorter or larger legs.

PVR Reminders

*4 cuff technique

*alternate use of 3 cuffs

Locations

*Tight pressure squeezes (~200 mmHg!) to stop arterial flow and determine systolic pressures, segmentally. These are used to calculate the Ankle-Brachial Index (ABI).

*Peripheral artery values are compared to

arm pressure values to determine where, if

at all, there is any possible occlusion.

Segmental Pressures

Tips

*Patient is supine for all 3 parts of this total exam, to eliminate any hydrostatic pressure interference.

*Use 8MHz Pedoff Probe to obtain the strongest ankle pulse. (either the DPA or PTA) Stay on it the entire time on one leg while the machine does

the segmental pressures unilaterally. Also, use

mobile keypad to operate the controls.

Segmental Pressures Tips

Notes

To calculate the ABI, find the brachial pressures

and use the one highest value of the 2 for both right and left calcs. Also, find the ankle pressures for each ankle, using the highest of the values from either the dorsalis pedis or posterior tibial arteries. Use the left value for the left and right value for the right. Divide the appropriate

ankle value by the one arm value

to get the ABI.

Segmental Pressures Notes

Categorizations

Consecutive values can be compared for PAOD. Any leg value that is directly horizontal or directly vertical should be not more than 30 mmHg different than its neighboring value, or else it signifies possible occlusion proximal to the

large pressure drop.

Segmental Pressures Categorizations

Reminders

Segmental Pressures Reminders

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