Arterial Interventions and Peripheral Arterial Disease (PAD)

Session: Educational Exhibit Presentations - Station 1: Arterial Interventions and Peripheral Arterial Disease (PAD)

An Overview of Noninvasive Evaluation of Peripheral Artery Disease

Monday, March 6, 2023

5:50 PM – 5:55 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Kevin Zhou, BA

Medical Student
Kaiser Permanente School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Anthony R. Zamary, MS

Medical Student
Kaiser Permanente School of Medicine
Alexander Andrew Argame, BSN, RN (he/him/his)

Medical Student
Kaiser Permanente Bernard J. Tyson School of Medicine
WG

William Gombrich, BS

Medical Student
Kaiser Permanente School of Medicine
GV

Geogy Vatakencherry, MD, FSVM,FSIR

Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
AB

Alok Bhatt, MD

Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente Los Angeles

Disclosure(s):

Kevin Zhou, BA: No financial relationships to disclose

Anthony R. Zamary, MS: No financial relationships to disclose

Alexander Andrew Argame, BSN, RN: No financial relationships to disclose

Geogy Vatakencherry, MD FSIR: No financial relationships to disclose

Learning Objectives:

To review noninvasive modalities commonly used to assess peripheral arterial disease including arterial duplex, ankle-brachial index, pulse volume recordings, segmental pressures, toe photoplethysmography (toe PPG), transcutaneous oximetry (TcPO2), and skin perfusion pressure (SPP) measurement.

Background:

Physiologic testing in patients with lower extremity peripheral arterial disease is an essential component in the workup and management of these patients. Non-invasive physiologic testing helps determine if anatomic findings on cross-sectional imaging (CTA, MRA) are physiologically significant. The available testing methods can also serve as stand-alone tests to diagnose peripheral arterial disease, stratify the severity of disease, help prognosticate the likelihood of wound healing post-intervention, identify failure of previous intervention, and highlight the need for reintervention. We present here a review of various non-invasive testing modalities available.

Clinical Findings/Procedure Details: This exhibit will:

Provide a review of common non-invasive physiologic testing modalities for evaluating patients with PAD. This review will include the arterial duplex, ankle-brachial index, pulse volume recordings, segmental limb pressures, toe photoplethysmography (toe PPG), transcutaneous oximetry (TcPO2), and skin perfusion pressure (SPP) measurement.

Describe how to perform bedside ABI.

Illustrate how segmental pressures, pulse volume recordings, toe PPGs, TcPO2, and SPP are obtained and interpreted.

Describe how to use arterial duplex, ABIs, PVRs, and segmental pressures to determine the distribution of disease using a case-based review.

Highlight specific advantages and limitations of each non-invasive testing modality.

Conclusion and/or Teaching Points:

Knowledge of updated noninvasive evaluative methods for peripheral arterial disease is critical to identifying hemodynamically significant lesions, assessing the next steps of care, and determining the success of prior interventions. Proficiency in these techniques along with an understanding of their advantages and limitations is significant in determining patient outcomes.