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Atlas of the Diabetic Foot - part 2

Thượng bảng điều khiển bên trái: một dạng sóng hai pha của động mạch chày sau bên trái ở cấp mắt cá chân. Vận tốc đỉnh tâm thu giảm (27,4 cm / s) và có mở rộng cửa sổ quang phổ trong tâm thu, trong khi tốc độ cao trong thời gian tâm trương. Đường kính động mạch bình thường như đã thấy trong một hình ảnh màu song công trên bên trái của các dạng sóng quang phổ | 18 Atlas of the Diabetic Foot Figure 1.17 Upper left panel a biphasic waveform of the left posterior tibial artery at ankle level. The peak systolic velocity is reduced 27.4 cm s and there is widening of the spectral window during systole while velocity is high during diastole. The artery diameter is normal as seen in a color duplex image on the left of the spectral waveform. These findings suggest the presence of a proximal stenosis of about 40 . Right upper panel the same artery at another site after a stenosis. The low peak systolic velocity 14.5 cm s biphasic waveform and spectral widening during systole as well as the high velocity during diastole are notable features. These findings suggest the presence of a proximal stenosis of more than 50 . Left lower panel duplex scan of the left anterior tibial artery from the same patient and the recorded spectral waveform. An even lower peak systolic velocity 12.1 cm s significant widening of the systolic spectral window and high diastolic velocity are shown. The diameter of the artery is normal lower right panel . The above findings signify the presence of a proximal stenosis of about 50-60 . Courtesy of C. Revenas critical limb ischemia gangrene ulcer skin changes or ischemic rest pain . If such signs are present the patient should be referred for specialist vascular assessment. In addition intensive management of co-existent cardiovascular risk factors should be initiated. Palpation of the dorsalis pedis and posterior tibial artery as well as auscultation for femoral artery bruits should be performed on an annual basis for all adults with diabetes. If one pedal artery is absent or diminished or if bruits are audible ABI determinations should be carried out annually. If the ABI value is below 0.9 intensive management of co-existent cardiovascular risk factors should be initiated. Patients for whom ABI monitoring is recommended a all those with type 1 Who is the Patient at Risk for Foot Ulceration 19 Figure 1.18 Lower