Term
| ARTERIAL ANATOMY OF THE UPPER LEG |
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Definition
| THE CFA ARISES INFERIOR TO THE INGUINAL LIGAMENT. IT THEN DIVIDES INTO THE DEEP FEMORAL ARTERY (PROFUNDA FEMORIS) AND THE SUPERFICIAL FEMORAL ARTERY. THE PROFUNDA ARTERY LIES POSTERIOR AND LATERAL TO THE SFA. IT SUPPLIES BLOOD TO THE THIGH MUSCLES AND HIP JOINT. THE PROFUNDA IS DEEP TO THE SFA AND MAY ACT AS A PATHWAY FOR COLLATERAL CIRCULATION WHEN BLOOD FLOW IN THE SFA IS REDUCED. THE SFA RUNS THE LENGTH OF THE THIGH. IT TERMINATES AFTER IT PASSES THROUGH AN OPENING IN THE TENDON OF THE ADDUCTOR HIATUS (AKA HUNTER’S CANAL). THE PROXIMAL SFA IS SUPERFICIAL, BUT DIVES DEEP AS IT TRAVELS INTO THE DISTAL PORTION OF THE THIGH |
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Term
| ANATOMY OF ANTERIOR TIBIAL ARTERY |
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Definition
| THE ANTERIOR TIBIAL ARTERY IS THE FIRST MAJOR ARTERY ARISING FROM THE DISTAL POPLITEAL ARTERY. THIS ARTERY PASSES SUPERFICIAL TO THE INTEROSSEOUS MEMBRANE AND RUNS DEEP IN THE ANTERIOR PORTION OF THE CALF ALONG THE ANTERIOR SURFACE OF THE INTEROSSEOUS MEMBRANE. THE DISTAL PORTION OF THE ANTERIOR TIBIAL ARTERY COURSES TO THE ANTERIOR ASPECT OF THE TIBIA. IT THEN PASSES IN FRONT OF THE ANKLE AND BECOMES THE DORSALIS PEDIS ARTERY ON THE TOP OF THE FOOT. |
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Term
| ANATOMY OF TIBEOPERONEAL TRUNK |
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Definition
| DISTAL TO THE TAKE OFF OF THE ANTERIOR TIBIAL ARTERY IS A SHORT SEGMENT KNOWN AS THE TIBEOPERONEAL TRUNK. THIS SHORT REGION IS SOMETIMES REFERRED TO AS THE PROXIMAL PORTION OF THE POSTERIOR TIBIAL ARTERY. IT QUICKLY GIVES RISE TO THE PERONEAL ARTERY AND THE POSTERIOR TIBIAL ARTERY. |
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Term
| ANATOMY OF PERONEAL ARTERY |
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Definition
| THE PERONEAL ARTERY BIFURCATES FROM THE TIBEOPERONEAL TRUNK ALONG WITH THE POSTERIOR TIBIAL ARTERY. THIS ARTERY SUPPLIES STRUCTURES IN THE LATERAL SIDE OF THE CALF AND CALCANEAL (HEEL) REGION OF THE FOOT WITH BLOOD. THE ARTERY RUNS ADJACENT TO THE FIBULA AND TERMINATES AS THE EXTERNAL CALCANEAL ARTERY. |
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Term
| ANATOMY OF POSTERIOR TIBIAL ARTERY |
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Definition
| THE POSTERIOR TIBIAL ARTERY RUNS SOMEWHAT OBLIQUELY DOWN THE MEDIAL POSTERIOR PART OF THE CALF. IT RUNS POSTERIOR TO THE TIBIA AND TERMINATES POSTERIOR TO THE MEDIAL MALLEOLUS. THE ARTERY THEN TERMINATES AS THE MEDIAL, LATERAL, AND PLANTAR ARTERIES OF THE FOOT. |
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Term
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Definition
| THE PLANTAR ARCH IS COMPOSED OF THE DEEP PLANTAR ARTERY (BRANCH OF THE DORSALIS PEDIS ARTERY) AND THE LATERAL PLANTAR ARTERY (BRANCH OF THE POSTERIOR TIBIAL ARTERY). THE ARTERIES OF THE PLANTAR ARCH GIVE RISE TO THE DORSAL METATARSAL ARTERIES WHICH FEED THE DIGITAL ARTERIES OF THE TOES. |
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Term
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Definition
Vast network of tiny vessels
Exchange of nutrients and gasses
No more than 1 mm long
8-10 microns in diameter |
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Term
| MECHANISMS CONTROLLING BLOOD FLOW |
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Definition
CARDIAC OUTPUT
WALL RESISTANCE
COMPLIANCE OF ARTERIES
VASOCONSTRICTION
VASODILATION |
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Term
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Definition
Arteries and arterioles are constricted at rest
High resistance flow below the renal arteries |
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Term
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Definition
Arteries and arterioles dilate with exercise
Low resistance flow pattern after exercise |
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Term
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Definition
AKA: MULTIPHASIC FLOW
HSYSTOLE: flow toward feet
EARLY DIASTOLE: flow toward heart
LATE DIASTOLE: flow toward feet
AS THREE PHASES |
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Term
| LOWER EXTREMITY FLOW POST EXERCISE |
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Definition
VASODILATION
RESISTANCE DECREASES
FLOW IS ANTEGRADE THROUGH CARDIAC CYCLE |
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Term
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Definition
A reproducible symptom complex brought on by same level of activity
Predictable
Patient may complain of muscle tiredness or pain with muscle weakness and cramping |
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Term
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Definition
ARTERIAL SPASM
ATHEROSCLEROSIS
ARTERIOSCLEROSIS
ARTERIAL OCCLUSION
* DIFFERENTIAL DIAGNOSIS IS NEUROGENIC OR MUSCULOSKELETAL INJURY |
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Term
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Definition
BUTTOCK CLAUDICATION - suggests aortoiliac disease
THIGH CLAUDICATION - suggests distal external iliac or common femoral artery disease
CALF CLAUDICATION - suggests superficial femoral artery or popliteal artery disease
REST PAIN CLAUDICATION - worse with limb elevation; relieved by dependency |
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Term
| PATIENT SIGN AND SYMPTOMES OF CHRONIC ARTERIAL DISEASE |
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Definition
HAIR LOSS
TROPHIC NAIL CHANGES
SKIN CHANGES
DECREASED PULSES
SENSATION CHANGES
DEPENDENT RUBOR |
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Term
| MILD CHRONIC ARTERIAL DISEASE SYMPTOMS |
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Definition
No symptoms
Decreased pedal pulses
Decrease in ankle blood pressure with exercise |
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Term
| MODERATE CHRONIC ARTERIAL DISEASE SYMPTOMS |
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Definition
No symptoms at rest
Intermittent claudication
Significant decrease in ankle blood pressure with exercise |
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Term
| SEVERE CHRONIC ARTERIAL DISEASE SYMPTOMS |
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Definition
Rest pain in feet and toes
Arterial ulcers
Tissue death / gangrene |
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Term
| CHRONIC ARTERIAL DISEASE WAVEFORM CHANGES |
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Definition
With severe disease the arteries will vasodilate at rest
Resistance will decrease distally and produce a monophasic waveform
Delayed systolic rise time |
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Term
| 5 P s OF ACUTE ARTERIAL OCCLUSION |
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Definition
PAIN
PALLOR
PULSELESSNESS
PARALYSIS
PARESTHESIAS |
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Term
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Definition
NECROSIS (DYING) OF TISSUE
TWO TYPES
WET GANGRENE
DRY GANGRENE
MAY OCCUR WITH SEVERE CHRONIC ARTERIAL DISEASE
MAY OCCUR AS A RESULT OF ACUTE ARTERIAL OBSTRUCTION DUE TO TRAUMA OR INJURY |
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Term
| INDIRECT PHYSIOLOGIC TESTING |
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Definition
PURPOSE: To detect arterial disease in the lower extremity arteries that is hemodynamically significant
Often used as a screening process to differentiate between true claudicators and those with neuropathy
Can assess graft patency
Provides follow up assessment for patients with arterial disease |
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Term
| LIMITATIONS IN INDIRECT TESTING |
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Definition
CANNOT DISTINGUISH BETWEEN STENOSIS AND OCCLUSION
ONLY DETECTS STENOSIS OF 60% OR MORE (HEMODYNAMICALLY SIGNIFICANT)
CANNOT PRECISELY LOCATE THE OCCLUSIVE DISEASE
DIFFICULT TO DIFFERENTIATE COMMON ILIAC FROM CFA STENOSIS
MAY SHOW FALSELY ELEVATED PRESSURES IN DIABETIC PATIENTS |
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Term
| THE ANKLE BRACHIAL INDEX (ABI) |
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Definition
AKA: ANKLE ARM INDEX
PURPOSE: often used as screening process to differentiate true claudicators from pseudo claudicators
RESULTS USUALLY COMBINED WITH DOPPLER VELOCITY WAVEFORM ANALYSIS |
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Term
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Definition
Patient placed in supine position
A BP of arm taken using brachial pulse
Record systolic pressure
A BP of ankle taken using posterior tibial pulse and dorsalis pedis pulse
Record systolic pressure using the highest of two
Calculate ratio by dividing the ankle systolic pressure by the arm systolic pressure |
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Term
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Definition
DORSALIS PEDIS
Easily compressed
HPOSTERIOR TIBIAL
Harder to compress
Easier to locate
arder to locate |
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