wrist brachial index interpretation

The identification of vascular structures from the B-mode display is enhanced in the color mode, which displays movement (blood flow) within the field (picture 5). Although stenosis of the proximal upper extremity arteries is most often caused by atherosclerosis, other pathologies include vasculitis, trauma, or thoracic outlet compression. Physiologic tests include segmental limb pressures and the calculation of pressure index values (eg, ankle-brachial index, wrist-brachial index), exercise testing, segmental volume plethysmography, transcutaneous oxygen measurements and photoplethysmography. Biphasic signals may be normal in patients older than 60 because of decreased peripheral vascular resistance; however, monophasic signals unquestionably indicate significant pathology. (See 'Segmental pressures'above.). Upper extremity disease is far less common than. A meta-analysis of 20 studies in which MDCT was used to evaluate 19,092 lower extremity arterial segments in 957 symptomatic patients compared test performance with DSA [49]. The ulnar artery feeding the palmar arch. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). It can be performed in conjunction with ultrasound for better results. A continuous wave hand held Doppler unit is used to detect the brachial and distal posterior tibial and dorsalis pedis pulses and the blood pressure is measured using blood pressure cuffs and a conventional sphygmomanometer. There are many anatomic variants of the hand arteries, specifically concerning the communicating arches between the radial and ulnar arteries. (See "Screening for lower extremity peripheral artery disease".). OTHER IMAGINGContrast arteriography remains the gold standard for vascular imaging and, under some circumstances (eg, acute ischemia), is the primary imaging modality because it offers the benefit of potential simultaneous intervention. Pressure gradient from the lower thigh to calf reflects popliteal disease. Principles of Pressure Measurements for Assessment of Lower-extremity 13.14 ). (See "Clinical manifestations and evaluation of chronic critical limb ischemia". Extremity arterial injury LITFL CCC Trauma

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