Peripheral Arterial Physiologic Testing Flashcards

A patient with claudication has an ABI of 0.62 at rest. After treadmill exercise, the ABI drops to 0.31 and takes 8 minutes to recover. What does this pattern indicate?

Answer: Moderate-to-severe arterial disease with poor collateral compensation

A post-exercise ABI drop >20% with prolonged recovery (>3 minutes) indicates hemodynamically significant arterial disease with inadequate collateral circulation.

Which waveform characteristic on PVR (pulse volume recording) is MOST consistent with proximal aortoiliac occlusive disease?

Answer: Flat, broad waveform with absent dicrotic notch throughout the limb

Aortoiliac disease produces diffusely flattened, broadened PVR waveforms throughout the entire lower extremity due to inflow obstruction affecting all segments.

During segmental pressure testing, a 30 mmHg pressure gradient is found between the proximal thigh and above-knee segments. Where is the disease most likely located?

Answer: Superficial femoral artery

A gradient >20 mmHg between proximal thigh and above-knee cuffs localizes disease to the superficial femoral artery in the mid-thigh region.

A diabetic patient has non-compressible tibial arteries with ABIs >1.3. Which alternative test is MOST reliable for assessing arterial perfusion in this patient?

Answer: Toe-brachial index (TBI)

The toe arteries are typically spared from medial calcification in diabetics, making the TBI the preferred non-invasive pressure index when ABIs are non-compressible.

What is the normal toe-brachial index (TBI) value in a healthy adult?

Answer: >0.60

A normal TBI is ≥0.70 in most references, with values below 0.60 generally considered abnormal and indicating significant digital arterial disease.

Which finding on continuous-wave Doppler examination is MOST indicative of a hemodynamically significant proximal stenosis?

Answer: Monophasic, low-velocity signal with loss of reverse flow component

A monophasic, damped signal distal to a significant stenosis results from loss of pulsatility as pressure energy is dissipated across the lesion.

A patient undergoing reactive hyperemia testing shows an ABI that falls from 1.0 to 0.55 after 3 minutes of cuff occlusion and takes 5 minutes to return to baseline. What does this indicate?

Answer: Hemodynamically significant arterial disease

In reactive hyperemia, an ABI drop >15-20% with slow recovery indicates significant arterial occlusive disease unable to meet increased metabolic demand.