Peripheral Arterial Physiologic Testing Flashcards

Which statement CORRECTLY describes the relationship between ankle-brachial index (ABI) values and cardiovascular risk?

Answer: Both low ABI (1.3) are independently associated with increased cardiovascular mortality

Both low ABI (reflecting atherosclerosis) and high ABI (reflecting arterial stiffness from calcification) are independently associated with increased cardiovascular morbidity and mortality.

During PVR testing, a thigh waveform shows a rounded, tardus-parvus morphology bilaterally. What proximal lesion should be suspected?

Answer: Significant aortoiliac inflow disease or aortic stenosis

Bilateral tardus-parvus (delayed, diminished) waveforms at the thigh level indicate disease proximal to both femoral arteries, pointing to aortoiliac or aortic inflow obstruction.

A patient has an ABI of 0.55 at rest. After a standard treadmill test, the patient stops at 2 minutes due to bilateral calf pain and the ankle pressure is unobtainable. The MOST likely diagnosis is:

Answer: Severe bilateral lower extremity PAD with exercise-limiting claudication

An already low resting ABI (0.55) with inability to complete treadmill testing and unobtainable post-exercise pressures indicates severe hemodynamically significant bilateral PAD.

What is the primary advantage of pulse volume recordings (PVR) over segmental limb pressures in patients with calcified vessels?

Answer: PVR assesses volume changes rather than compressibility, making it reliable despite vessel calcification

PVR measures limb volume changes with each cardiac cycle using air plethysmography, which is not affected by vessel wall stiffness or calcification, unlike pressure-based measurements.

A 55-year-old male runner presents with exertional leg pain. Resting ABI is 1.0 bilaterally. Post-exercise ABI drops to 0.6 bilaterally and recovers in 3 minutes. He has no risk factors for PAD. Which diagnosis should be considered FIRST?

Answer: Popliteal artery entrapment syndrome

Popliteal artery entrapment syndrome classically presents in young, athletic males with normal resting ABIs and significant post-exercise ABI drops due to muscular compression of the popliteal artery.

Which parameter obtained during peripheral arterial physiologic testing BEST predicts primary amputation healing at the below-knee level?

Answer: Below-knee or ankle systolic pressure >70 mmHg or toe pressure >30 mmHg

Below-knee amputation healing is most reliably predicted by adequate perfusion pressure, with ankle or BK pressures >70 mmHg and toe pressures >30 mmHg associated with successful primary healing.

When evaluating a patient for upper extremity arterial disease, a blood pressure difference greater than how many mmHg between arms is clinically significant?

Answer: 10 mmHg

An inter-arm pressure difference >10 mmHg suggests subclavian or axillary artery stenosis and warrants further evaluation; >15-20 mmHg is considered diagnostic of subclavian steal syndrome.