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Exercise testing in peripheral arterial disease
Published in R. C. Richard Davison, Paul M. Smith, James Hopker, Michael J. Price, Florentina Hettinga, Garry Tew, Lindsay Bottoms, Sport and Exercise Physiology Testing Guidelines: Volume II – Exercise and Clinical Testing, 2022
Amy Harwood, Edward Caldow, Gabriel Cucato
PAD diagnosis is established via patient history and general, clinical and lower-limb examinations. It is confirmed via Doppler assessment of the ankle brachial pressure index (ABPI or ABI). The ABPI is defined as the ratio of systolic blood pressure measured in the ankle to that in the arm (brachial artery). The ABPI has good sensitivity and specificity and can provide information regarding disease severity (Aboyans et al., 2012). In addition to Doppler assessment, there are a number of imaging modalities that can provide anatomical localisation of disease. Duplex ultrasound assessment is widely regarded as the ‘gold-standard’ imaging modality (Anderson et al., 2013). Other imaging modalities such as magnetic resonance or computerised tomographic angiography are often used prior to surgical intervention rather than for diagnostic purposes. To classify patients, a combination of clinical examination, diagnostic testing and exercise testing can be utilised (Table 5.7.1).
Principles of wound care
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
All individuals presenting with a leg ulcer should be screened for arterial disease by Doppler ultrasound measurement of ankle brachial pressure index (ABPI) by competent staff alongside a thorough clinical investigation within 2 weeks (Wounds UK 2016). Often a specific leg ulcer assessment chart is used to record this assessment, which includes documenting assessment of factors affecting wound healing (e.g. smoking, nutritional status). The ABPI is calculated by dividing the brachial systolic blood pressure by the ankle systolic blood pressure. A normal ABPI reading is about 1 and if the reading is 0.8 or above (up to 1.3), compression therapy can usually be applied following a full holistic lower limb assessment (Wound UK 2019; Mitchell and Elbourne 2019). Compression therapy aims to provide graduated compression, with the highest pressure at the ankle and the lowest at the knee, thus returning blood from the lower limb and preventing pooling in distended lower leg veins. An arterial ulcer is caused by an inadequate arterial blood supply to the area, and a person suspected of having an arterial ulcer may require vascular surgery.
Arterial Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
Chronic limb-threatening ischaemia (CLTI) represents the severe end of the arterial disease spectrum. The definition of CLTI is ischaemic rest pain or tissue loss (ulceration or gangrene) for 2 weeks or more in the presence of atherosclerotic peripheral arterial disease. These patients normally present with rest pain in the forefoot and with severe night pain in the forefoot that prevents them from sleeping. They often report having to sleep with the leg hanging out of bed (such that gravity can be used to help improve the foot blood supply and relieve their ischaemic pain). The diagnosis should also be associated with one or more abnormal hemodynamic parameters, e.g., a reduced ankle-brachial pressure index (ABPI) (<0.4).
Pembrolizumab related Guillain barre syndrome, a rare presentation in a patient with a history of lupus and bladder cancer
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Vikram Sangani, Mytri Pokal, Mamtha Balla, Ganesh Prasad Merugu, Sreedhar Adapa, Srikanth Naramala, Venu Madhav Konala
Hospital course: Due to lower back pain and weakness in the lower extremities, he underwent computed tomography (CT) of the cervical, thoracic and lumbar spine which revealed multiple bony sclerotic lesions consistent with metastasis and multifocal lymphadenopathy. The patient received 10 mg of dexamethasone initially. Magnetic resonance imaging (MRI) was not done due to pacemaker placement 2 months ago. Neurosurgery recommended no indication for surgical decompression. With a history of Peripheral arterial disease and associated chronic skin discoloration in lower extremities, arterial ultrasound was ordered, which showed occlusion of left distal superficial femoral and left dorsalis pedis arteries with extensive plaque formation bilaterally. Vascular surgery was consulted who reviewed the ankle-brachial pressure index (ABPI), which is more specific for lower extremity ischemia, which was negative. They concluded that the weakness is unrelated to arterial insufficiency.
Peripheral vascular changes in the lower limbs following cocaine abuse
Published in Journal of Addictive Diseases, 2020
N. Camilleri, A. Mizzi, A. Gatt, N. Papanas, C. Formosa
Measurement of ankle brachial pressure index (ABPI) was performed using a portable hand held Doppler and blood pressure cuffs. Pedal spectral waveform analysis of the dorsalis pedis and the posterior tibial were acquired from all recruited subjects utilizing a Huntleigh® Dopplex Assist vascular package (Cardiff, UK) with an 8 MHz probe. The probe was held steadily on the anatomical artery location at an angle between 45 and 60°against the flow of arterial blood. Interpretation of arterial pressure waveforms results was based on standards from the literature7. Waveforms were classified as triphasic, biphasic, monophasic discontinuous and monophasic continuous. The triphasic waveforms were considered as normal, whereas the biphasic and monophasic discontinuous and monophasic continuous waveforms were interpreted as abnormal3. Measurements were carried out after a 5-ankle brachial pressure index (ABPI) rest in supine position with the upper body as flat as possible, with all tight clothing around the waist and the arm undone.
Role of rivaroxaban in the prevention of atherosclerotic events
Published in Expert Review of Clinical Pharmacology, 2019
Marcelo Sanmartín, Sergi Bellmunt, Juan Cosín-Sales, Xavier García-Moll, Antoni Riera-Mestre, Manuel Almendro-Delia, José Luis Hernández, Francisco Lozano, Pilar Mazón, Carmen Suarez Fernández
It has been estimated that among adults aged >40 years, the prevalence of peripheral artery disease (PAD) with ankle-brachial pressure index <0.9 reaches 7%, but only around 10% of patients have clinical intermittent claudication [1,6]. PAD increases the risk of future cardiovascular events. In addition, patients with PAD are more likely to have advanced atherosclerosis in other vascular beds. The overall age-adjusted death rates for this condition are 15.5 per 100 000 and hospitalization for critical limb ischemia remains stable in the last years despite current treatments [1,6].