CCI Peripheral Arterial Evaluation 4 — Questions and Answers
Question 1: A patient presents with rest pain and a non-healing ulcer on the great toe. ABI is 0.30. What Rutherford classification does this represent?
- Category 1 — mild claudication
- Category 3 — severe claudication
- Category 5 — minor tissue loss (Correct answer)
- Category 6 — major tissue loss
Correct answer: Category 5 — minor tissue loss
Rutherford Category 5 describes ischemic rest pain with minor tissue loss such as a non-healing digital ulcer.
Question 2: Which velocity criterion on duplex ultrasound best identifies a native vessel stenosis of ≥50% in the iliac artery?
- PSV > 100 cm/s
- PSV ratio > 2.0 (Correct answer)
- EDV > 40 cm/s
- PSV < 50 cm/s
Correct answer: PSV ratio > 2.0
A PSV ratio greater than 2.0 compared to the adjacent normal proximal segment indicates ≥50% diameter reduction in the iliac artery.
Question 3: During pulse volume recording (PVR), what does a flat or nearly absent waveform at the ankle level indicate?
- Normal perfusion with low cardiac output
- Severe proximal occlusive disease (Correct answer)
- Venous hypertension artifact
- Improper cuff inflation
Correct answer: Severe proximal occlusive disease
A flat PVR waveform at the ankle indicates severe reduction in pulsatile blood flow from significant proximal occlusive disease.
Question 4: What is the primary advantage of CTA over duplex ultrasound in evaluating lower extremity PAD?
- No radiation exposure
- Better visualization of calcified vessels and runoff anatomy (Correct answer)
- Real-time hemodynamic assessment
- Lower cost and no contrast required
Correct answer: Better visualization of calcified vessels and runoff anatomy
CTA provides excellent visualization of the entire arterial tree including runoff vessels, even in heavily calcified arteries, superior to duplex for planning revascularization.
Question 5: A post-stent duplex scan of the superficial femoral artery shows a PSV of 350 cm/s within the stent. What is the most appropriate interpretation?
- Normal in-stent flow
- In-stent restenosis ≥50% (Correct answer)
- Stent thrombosis
- Hyperemia from recent intervention
Correct answer: In-stent restenosis ≥50%
An in-stent PSV greater than 300–350 cm/s with an elevated PSV ratio indicates significant in-stent restenosis of ≥50%.
Question 6: Which finding is most consistent with popliteal artery entrapment syndrome in a young athlete?
- Absent waveforms at rest bilaterally
- ABI dropping with plantar flexion or dorsiflexion maneuvers (Correct answer)
- Diffuse calcification throughout the popliteal artery
- High-thigh to above-knee pressure gradient at rest
Correct answer: ABI dropping with plantar flexion or dorsiflexion maneuvers
Popliteal artery entrapment causes dynamic compression during muscle contraction, detected by ABI or waveform changes with provocative foot maneuvers.
Question 7: In a patient with suspected Raynaud's phenomenon, digital photoplethysmography (PPG) is performed before and after cold provocation. Which response confirms vasospastic disease?
- No change in waveform amplitude after cold challenge
- Marked decrease or obliteration of waveform amplitude after cold challenge (Correct answer)
- Increase in waveform amplitude after cold challenge
- Development of retrograde flow after cold challenge
Correct answer: Marked decrease or obliteration of waveform amplitude after cold challenge
A marked reduction or loss of digital PPG waveform amplitude following cold provocation confirms vasospastic Raynaud's phenomenon.
CCI Peripheral Arterial Evaluation 4
A patient presents with rest pain and a non-healing ulcer on the great toe.
ABI is 0.30.
What Rutherford classification does this represent?