Parks 915-BL Operating & Service Manual page 36

OFFICE TECHNICS FOR VASCULAR TESTING -
FIG 3
Angiogram showing a large plaque in the common femoral
artery involving the orifice of the profunda.
Results of angiography confirmed the superficial femoral
artery obstruction and suggested severe stenosis of the deep
femoral orifice (Fig 3). Since the hemodynamically
significant lesions were confined to the thigh, it seemed
logical to increase the collateral circulation distal to
the occluded superficial femoral artery. Therefore,
a n e n d a r t e r e c t o m y o f t h e d i s t a l c o m m o n f e m o r a l
artery and deep femoral artery orifice was done.
It is significant to note that there were no changes
in the patient's physical examination after operation
and, without vascular testing, only his testimony could
be used to indicate a beneficial result. The preopera-
t i v e a n k l e / a r m r a t i o w a s 0 . 3 8 . A f t e r o p e r a t i o n , i t
r o s e t o 0 . 5 3 . I n a d d i t i o n , t h e p a t i e n t 's e x e r c i s e
tolerance increased nearly tenfold. These concrete
data should be used as the criteria for success or
failure.
C a s e 3 . A 5 4 - y e a r- o l d d e n t i s t w a s s e e n o n e y e a r
a f t e r b y p a s s g r a f t f o r s e v e r e a o r t o i l i a c o c c l u s i v e
d i s e a s e . T h r e e m o n t h s a f t e r o p e r a t i o n , h e w a s
evaluated in the laboratory. Brachial systolic pressure
was 108 mm Hg. Ankle systolic pressures were 114
m m H g o n t h e r i g h t a n d 111 m m H g o n t h e l e f t .
Both ankle pressures increased after exercise. There
w e r e n o s i g n s o r s y m p t o m s o f i s c h e m i a . H e w a s
studied again eight m o n t h s l a t e r. H i s p u l s e s w e r e
intact. The arm pressure was 114 min Hg, and the
ankle pressures were 126 mm Hg on the right and 96
mm Hg on the left. He walked 1000 yards on the flat
treadmill at 3 mph with no symptoms. There was a
24% decrease in the left ankle pressure after exercise.
C o m m e n t . T h i s p a t i e n t , t h o u g h a s y m p t o m a t i c , i s
exhibiting disease progression, which will require closer
follow-tip. This disease progression could not have
been detected on a clinical basis, but was readily
detectable using simple vascular testing technics.
SOUTHERN MEDICAL JOURNAL,Vol 68, No. 1
Hagood et al
Conclusions
Palpation of pulses and inspection of the limb are
subjective methods of evaluating complaints that
may be related to arterial insufficiency. Since the
physician whose practice includes patients with
many varying problems may feel insecure about
his ability to evaluate pulses, objective testing
m e t h o d s h a v e a r e a l p l a c e i n t h e d i a g n o s t i c
armamentarium. The Doppler ultrasonic velocity
detector may be thought of in the same manner as
one thinks of a stethoscope, as an instrument
which extends clinical perception. It is a rapid
and safe tool which can provide relevant, and at
times indispensable, information.
Measurement of ankle systolic pressure by the
Doppler ultrasonic technic has proven to be an
objective and repeatable test which correlates well
with the anatomic situation. Exercise testing
provides both a functional assessment of the
patient's complaints and a diagnostic challenge by
which small, resting pressure gradients can be
a c c e n t u a t e d . R e s t i n g p r e s s u r e m e a s u r e m e n t ,
exercise testing, and Doppler ultrasonic survey are
extremely simple methods of evaluation by which
even minor degrees of occlusive arterial disease
may be detected. The equipment necessary to
evaluate vascular problems can be purchased for
less than $1,000.
References
1 . Satomura S: Ultrasonic blood rheograph. J Acoust Soc
Japan 15:151-154
2 . Winsor T, Hyman C, Payne JH: Exercise and limb circulation
in health and disease. Arch Surg 78:184-192
3 . Strandness DE Jr, Bell JW: An evaluation of the hemo-
dynamic response of the claudicating extremity to exercise.
Surg Gynecol Obstet 119:1237-1242
4 . Yao ST, Hobbs IT, Irvine WT: Ankle systolic pressure
measurements for arterial disease affecting the lower
extremities. Br J Surg 56:676-679
5 . Strandness DE Jr, Schultz RD, Sumner DS, et al: UItrasonic
flow detection: a useful technique in the evaluation of
peripheral vascular disease. Am J Surg 113:311-320.
6 . Wi l d J J , R e i d J M : E f f e c t o f u l t r a s o u n d o n biological
tissues. J Acoust Soc Am 25:270-280
7. Strandness DE Jr: Management of Arterial Occlusive
Disease. Chicago, Year Book Publishers, Inc.
8 . Carter SA: Response of ankle systolic pressure to leg
exercise in mild or questionable arterial disease.
N Engl J Med 287:578-582
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