Peripheral vascular disease testing

Details Peripheral vascular disease testing Peripheral vascular disease testing

1996-03-05

1998-09-08

Yu, Mickey

Surgery

Diagnostic testing

Via monitoring a plurality of physiological data, e.g.,...

600483, 600485, 600488, 600490, 600500, 600501, 600502, 600507, 600526, A61B 502

Patent

active

058039074

DESCRIPTION:

BRIEF SUMMARY
The present invention relates to peripheral vascular disease testing and particularly to an apparatus and method for (1) screening patients for further study, and (2) investigating in greater detail, and more accurately, patients who are known to have peripheral vascular disease and may be either under observation or have had angioplasty or an operation.
It is an ongoing problem that patients present to General Practitioners with symptoms of their limbs which could indicate either an orthopaedic, neurological, or a vascular problem. For example, arterial problems of the lower limb can present as walking pain, rest pain, cold feet, skin changes and weak or absent pulses. Some of these features can well be due to orthopaedic, or neurological problems and it is difficult for the General Practitioner, or specialists in other branches of medicine to know to whom to refer the patient in such circumstances.
Decisions regarding the treatment of peripheral arterial disease of the lower limb, while based on the clinical features, may be clarified by non-invasive investigations. Absent pulse(s) in the leg, alone, are enough to determine the presence of arterial disease, and non-invasive tests are not necessary to make the a diagnosis. They may be used however to document the presence and extent of a disease. If pedal pulses are weak, a non-invasive tests are also unnecessary but they can provide objective quantitive confirmation. The ankle pressure at rest is simple to measure, confirms the clinical impression, and is particularly useful in obese patients or if there is ankle oedema that makes the pulses difficult to feel. If the pulses are normal, however, and the patient has had pain on walking, further tests are necessary. In such patients the ankle pressure should be measured at rest and after exercise because in the presence of a non-occlusive stricture, there may be normal ankle pressures at rest, and a fall in ankle pressure after exercise.
The use of doppler and doppler wave form analysis is now a standard investigation technique for patients with possible circulatory disorders of the limbs. Investigation is performed before and after exercise; which exercise has always been standardised by using a treadmill or similar apparatus.
There are a number of disadvantages for the utilisation of the treadmill in addition to cost and these may be characterised without limitation as follows: the limb, e.g. osteo-arthritis of the hip; output etc. which can significantly alter the results. Also by exercising the "whole patient" those with cardiac disease (manifested by previous M.I., angina or asymptomatic) are at risk of over-exercising and consequent stress. before leg pain occurs. partially sighted or who would otherwise experience problems utilising a treadmill. with vertebrabasilar disease with a treadmill since they are unable to perform dynamic assessments (angiograph duplex). occasioned by the time it takes the patient to return to the couch for testing. This means that accurate testing of old and infirm patients becomes problematic.
Since the onset of vascular disease tends to occur in the elderly, and since the elderly are likely to have at least one of the conditions referred to above, the treadmill, even if available, is of limited use in diagnosis in these cases.
The applicant has now discovered that the blood flow rate measurable in the distal circulation, utilising for example, a Doppler probe, remains normal or elevates after exercise in a limb with a normal blood flow. However, blood pressure falls, or even reaches zero, in a limb with abnormally impaired blood flow. It will be appreciated that by exercising just the group of muscles associated with the limb concerned, the overall heart rate is not much affected (up to about 20%) and hence not only can the diagnostic method be carried out upon the frail and elderly more easily, but the results obtained relate more directly to the limb under test. Similarly, by exercising one limb, measurement can be made in the non-exercised limbs.
The applicant has devi

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