Page 141 - Libro 2

PART 3 • PERIPHERAL ARTERIAL
8
Indirect Assessment of Arterial Disease
Terry Needham
OBJECTIVES
Describe the types of indirect testing including systolic pressure measurements, Doppler waveforms, and plethysmography
Identify normal and abnormal continuous wave and plethysmographic waveforms
Define the various signs and symptoms associated with peripheral arterial occlusive disease
List the indirect testing techniques employed in an upper extremity evaluation
KEY TERMS
ankle-brachial index | claudication | photoplethysmography | plethysmography | rest pain
GLOSSARY
Allen test a series of maneuvers testing
the digital perfusion of the hand while compressing and releasing the radial and ulnar arteries
ankle–brachial index the ratio of ankle systolic pressure to brachial systolic pressure
claudication pain in muscle groups brought on by exercise or activity that recedes with cessa- tion of activity; can occur in the calf, thigh, and buttock
photoplethysmography an indirect physiologic test that detects changes in back-scattered infrared light as an indicator of tissue perfusion
Indirect (nonimaging) testing modalities can be reli- able for detecting the presence of peripheral arterial occlusive disease (PAOD) affecting the extremities and for categorizing its overall severity. The most common symptom of PAOD affecting the lower ex- tremities is leg discomfort caused by activity, but
plethysmography an indirect physiologic test that measures the change in volume or impedance in a whole body, organ, or limb
Raynaud’s disease vasospasm of the digital arteries brought on by exposure to cold; can be caused by numerous etiologies
rest pain pain in the extremity without exercise or activity, thus “at rest”; can occur in the toes, feet, or ankle area
thoracic outlet syndrome compression of the bra- chial nerve plexus, subclavian artery, or subclavian vein at the region where these structures exit the tho- racic cavity and course peripherally toward the arm
which abates with cessation of the activity. This is termed intermittent claudication. Patients may de- scribe the sensation of intermittent claudication as fatigue, or as a cramping, aching, or tiredness sensation, usually starting in the calf and perhaps progressing to the thigh and/or buttocks, according
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