0800_Wiley.pdf

1、Jose M.Wiley,MD,MPH,FACC,FACP,FSCAIProfessor of MedicineChief,Section of CardiologyDepartment of MedicineTulane University School of MedicineTRADITIONAL NONINVASIVE TESTING AND TRADITIONAL NONINVASIVE TESTING AND INTERPRETATION:ARE ALTERNATIVE INTERPRETATION:ARE ALTERNATIVE METHODS USEFUL?METHODS US

2、EFUL?Disclosure Statement of Financial Disclosure Statement of Financial InterestInterestI have nothing to disclose0%5%10%15%20%25%30%35%29%PARTNERS5Age 70,or between 50-69 with diabetes or smoking11.7%San Diego2Mean Age=6619.8%Diehm4Age 6519.1%Rotterdam3Age 5514.5%NHANES1Age 704.3%DOCUMENTED PRESEN

3、CE OF PADWhen common risk factors were included,the prevalence of PAD was 1/3 of patients1.Selvin E,Erlinger TP.NHANES.Circulation.2004;110:738-743.2.Criqui MH,et al.Circulation.1985;71:510-515.3.Diehm C,et al.Atherosclerosis.2004;172:95105.4.Meijer WT,et al.Arterioscler Thromb Vasc Biol.1998;18:185

4、-192.5.Hirsch AT,et al.JAMA.2001;286:1317-1324.NHANES1Age 40Non-invasive testing for PAD1.ABIs(rest/exercise)/TBIs2.Segmental Pressures3.PVRs4.Arterial duplex5.CTA/MRADIAGNOSTIC ALGORITHM FOR PADHistory,Physical ExaminationSuggestive of PAD?No!Search for Alternate DiagnosisYes?0.9Still Suspicious?1.

5、40Vascular Lab Referral-Toe Brachial Index,segmental pressures,PVRgraded treadmill testAnatomic Assessment:DSA,CTA,MRAAnkle-Brachial IndexABI=Ankle and brachial systolic pressures taken using a hand-held continuous wave Doppler instrument The ABI is up to 72%sensitive,96%specific for PADEMPHASIZE SC

6、REENING:THE ANKLE-BRACHIAL INDEXHigher Ankle systolic pressure(DP/PT)Highest Brachial systolic pressureNormal1.00 1.40Borderline0.91 0.99PAD 0.90Pain/Ulceration 0.40Non-Compressible 1.40Adapted from Rooke,et al.Circulation,2011Circulation 2012;126:2890-909Ankle-Brachial Index(ABI)ABI=Higher ankle pr