1. Peripheral Vascular Disease

2. Peripheral Vascular Disease
Peripheral Artery Disease
Peripheral Venous Disorders
Thrombophlebitis
Varicose Veins
Chronic Venous Insufficiency
Carotid Artery Disease
Peripheral Artery Disease
Peripheral Renal Disease
Abdominal Aortic Aneurysm
Raynaud Syndrome
Buerger Disease
Polyarteritis Nordosa
The second type of peripheral vascular disease is peripheral venous disorders, which refer to problems in the peripheral veins. There are a number of different peripheral venous disorders, which include the following:
Thrombophlebitis (including superficial vein thrombosis and deep vein thrombosis). An obstructing blood clot (a thrombus) has formed, causing the surrounding veins to become inflamed (phlebitis). For more information, see Thrombophlebitis.
Varicose veins. Abnormally widened veins that are swollen, dark and frequently twisted or contorted instead of straight. They usually occur in the legs, and may cause swelling (edema), inflammation and a dark color around the ankles. For more information, see Varicose Veins.
Chronic venous insufficiency. An advanced stage of leg vein disease in which the veins become incompetent, causing blood to pool in the legs and feet, and sometimes to leak backwards. For more information, see Chronic Venous Insufficiency.

3. Arteries

4. Technique
Measure highest systolic reading in both arms
Record first doppler sound as cuff is deflated
Record at the radial pulse
Use highest of the two arm pressures
Measure systolic readings in both legs
Cuff applied to calf
Use doppler ultrasound device
Record dorsalis pedis pressure
Record posterior tibial pressure
Use highest ankle pressure (DP or PT) for each leg
Calculate ratio of each ankle to brachial pressure
Divide each ankle by highest brachial pressure
Interpretation
Ankle-Brachial ratio >0.95: Normal
Ankle-Brachial ratio <0.95: Peripheral Vascular Disease
Ankle-Brachial ratio <0.6: Intermittent Claudication
Ankle-Brachial ratio <0.5: Multi-level disease
Ankle-Brachial ratio <0.26: Resting ischemic pain
Ankle-Brachial ratio <0.2: Gangrenous extremity
False Negative Test: Diabetes Mellitus
Vessels in diabetics are poorly compressible
Results in falsely elevated ankle pressure
Management
Segmental Arterial Pressure indicated for ratio < 0.9
Consider angiography or Magnetic resonance angiography
References
Hirsch (2002) Lecture, Fairview Lakes RMC
Carman (2000) Am Fam Physician 61(4):

5. The AHA recommends the cuff bladder size be 20% wider that the limb diameter.
Generally, a 10 cm cuff is fine for use at both the ankle and arm sites.
Use a 12 cm cuff for patients with larger limbs or a 6.5 cm cuff for smaller limbs. Be sure to use the same size cuff on both the arms and ankles

6. In the left column of the ABI chart, find the brachial pressure closest to the one you selected. The in the row at the top of the ABI chart, find the closest right ankle pressure. The box where the column and row intersect shows the ABI for the right side

7. PAIN-FREE WALKING DISTANCE
Girolami, et al. Archives of Internal Medicine 159: , 1999

8. TOTAL WALKING DISTANCE
Girolami, et al. Archives of Internal Medicine 159: , 1999

9. PHYSICAL WORK CAPACITY
Hiatt et al Circulation 90: , 1994

10. CLAUDICATION THRESHOLD
Hiatt et al Circulation 90: , 1994

11. DAILY PHYSICAL ACTIVITY
Regensteiner et al Journal of Vascular Surgery 23: , 1996.

12. PHYSICAL FUNCTIONING
Regensteiner et al Journal of Vascular Surgery 23: , 1996.

13. Energy expenditure is greater Long leg:
Above
Below
Energy expenditure is greater
Long leg:
24% energy expenditure
14% higher ventilation

14. Exercise Reduce Risk Factors Increase Physical Work Capacity
Increase Collateral Circulation
Increase oxygen capacity of muscle
Decrease Claudication Threshold