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8 — Indirect Assessment of Arterial Disease
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Critical Thinking Questions
1. What are two important concerns about patient position for physiologic exams?
2. You perform a segmental pressure evaluation on a patient with relatively short legs. There is not enough room to place both a high thigh and low thigh cuff. You use a single contoured thigh cuff. What effect do you think this will have on your results and why?
3. You have been asked to examine the status of the common femoral artery. You can perform a PVR, CW Doppler waveform, or segmental pressure examination. Which test would you select and why?
4. Digital evaluations are commonly used to evaluate patients with thoracic outlet syndrome and Raynaud’s disease. What vessels are impacted by these pathologies and why are digital studies used?
REFERENCES
1. LaPerna L. Diagnosis and medical management of patients with intermittent claudication. J Am Osteopath Assoc. 2001;100(10 su pt 2):S10–S14.
2. Edwards JM, Porter JM. Evaluation of upper extremity ischemia. In: Bernstein EF, ed. Vascular Diagnosis. 4th ed. St. Louis, MO: Mosby; 1993:630–640.
3. Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg. 2007;46(3):601–604.
4. Herrick AL. Pathogenesis of Raynaud’s phenomenon. Rheumatology (Oxford). 2005;44(5): 587–596.
5. Daigle RJ. Techniques in Noninvasive Vascular Diagnosis. 2nd ed. Littleton, CO: Summer Publishing; 2005:142.
6. Winsor TA. Influence of arterial disease on the systolic blood pressure gradients of the ex- tremity. Am J Med Sci. 1950;220:117–126.
7. Yao ST, Hobbs JT, Irvine WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg. 1969;56:676–679.
8. Baker JD, Dix DE. Variability of Doppler ankle pressures with arterial occlusive disease: an evaluation of ankle index and brachial-ankle pressure gradient. Surgery. 1981;89: 134–137.
9. Strandness DE Jr, Sumner DS. Hemodynamics for Surgeons. New York, NY: Grune & Stratton; 1975:228.
10. Stein R, Hriljac I, Halperin JL, et al. Limitation of the resting ankle-brachial index in symp- tomatic patients with peripheral arterial disease. Vasc Med. 2006;11(1):29–33.
11. AbuRahma AF. Segmental Doppler pressures and Doppler waveform analysis in peripheral vascular disease of the lower extremities. In: AbuRahma AF, Bergan JJ, eds. Noninvasive Vascular Diagnosis. London, England: Springer; 2000:213–229.
12. Gerhard-Herman M, Gardin JM, Jaff M, et al. Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr. 2006;19(8):955–972.
13. vanLangen H, vanGurp J, Rubbens L. Interobserver variability of ankle-brachial index mea- surements at rest and post exercise in patients with intermittent claudication. Vasc Med. 2009;14(3):221–226.
14. Scissons R, Comerota A. Confusion of peripheral arterial Doppler waveform terminology. J Diag Med Sonog. 2009;25(4):185–194.
15. Daigle RJ. Techniques in Noninvasive Vascular Diagnosis. 2nd ed. Littleton, CO: Summer Publishing; 2005:151.
16. Carter SA, Lezack JD. Digital systolic pressures in the lower limbs in arterial disease. Circulation. 1971;43(6):905–914.