Vascular Assessment of Peripheral Arterial Disease

Details

Title

Vascular Assessment of Peripheral Arterial Disease

Type

Stage One

Module code

HPS132

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST will be able to apply their knowledge, skills and experience in the clinical setting to undertake the arterial assessment of the lower and upper limb including: 

• aneurysms;
• acute ischemia;
• chronic ischemia;
• intermittent claudication;
• popliteal entrapment syndrome;
• thoracic outlet syndrome;
• subclavian steal syndrome;
• pulsatile mass and trauma;
• inflammatory vascular disorders. 

Clinical Scientist in HSST will apply their expert knowledge, skills and experience to assess and follow up therapeutic interventions such as bypass grafts, endarterectomy, angioplasty or stents. They will also be able to recognise, deliver, report and interpret the appropriate physiological test/s to address the findings from initial clinical assessment. They will also use their expert knowledge of management options available to discuss management plans with the patient and/or supervising clinician based on the investigative findings. They will be expected to critically evaluate their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Vascular Scientist.

Knowledge and understanding

By the end of this module, the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the peripheral arterial assessment of a range of patients, including those with complex problems including: 

Anatomy, Physiology and Pathology

• typical anatomy and common variants (aorta to plantar arch and aorta to palmar arch)
• range and variety of pathology including:
  • aneurysmal disease.
  • stenotic or occlusive disease (including athersclerosic, thrombotic, embolic disease).
  • inflammatory disease (including Buerger’s disease, giant cell arteritis and Takayasu’s Arteritis.)
  • popliteal entrapment syndrome.
  • thoracic outlet syndrome.
  • subclavian steal.
  • arterial assessment prior to flap formation for reconstructive surgery.
• normal physiology and pathophysiological haemodynamics.

History Taking and Clinical Examination

• presenting signs and symptoms and identification of possible alternative diagnoses.

Diagnostic Procedures

• the appropriate equipment setup required to obtain high quality B-mode, colour flow imaging and spectral Doppler waveforms from peripheral arteries.
• the range of vascular ultrasound diagnostic techniques used to assess peripheral arterial disease.
• selection of the appropriate technique for each patient.
• alternative imaging techniques to assess peripheral arterial assessment e.g. angiography, Computer Tomography,(CT), Contrast enhanced CT and Magnetic Resonance Angiography(MRA).
• clinical sequelae of the diagnosis.

Management

• medical, interventional and surgical management options (see Medical and Surgical Management module for further details).
• how the diagnosis affects patient’s management pathway.
• the potential impact of peripheral arterial disease on the quality of life of the patient including long term complications.
• how to measure quality of life.

Bypass Grafts:

• the variety of locations of peripheral arterial bypass grafts e.g. axillo-bifemoral, aorto- iliac,femoro-popliteal, femoro-distal and upper limb bypass grafts.
• the graft conduits used e.g. synthetic, vein and hybrid grafts.
• pre-surgical assessment and identification of suitable autologous bypass graft options.
• the range and variety of pathology that may affect a bypass graft e.g. intimal hyperplasia, retained valve cusps, stenosis, occlusion, entrapment, aneurysm formation and fistulae.
• normal and pathological haemodynamics.
• presenting signs and symptoms and identify possible alternative diagnoses.
• the range of medical, interventional and surgical management options on diagnosing a problem with a graft.
• diagnostic techniques used by clinical vascular scientists to assess the range of grafts.
• selection of the appropriate technique for each patient and type of graft.
• complementary use of angiography, CT and M R A in the diagnosis and management.
• the clinical sequelae of the diagnosis and when urgent intervention is appropriate
• the range of medical, interventional and surgical management options on diagnosing a problem with a graft.
• how diagnosis affects management pathway.
• the potential impact of bypass grafts on the patient.the range of medical, interventional and surgical management options on diagnosing a problem with a graft.
• surveillance intervals.

Technical and clinical skills

By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance, adaptation and mastery of the following technical skills:

• Continuous Wave Doppler assessment of waveform shapes from lower and upper limb arteries.
• Lower limb exercise testing using Ankle Brachial Pressure measurement.
• Bilateral Brachial artery pressure assessment.
• B-mode identification of arteries and differentiation of acute and chronic occlusion.
• Lower and upper Limb arterial colour flow imaging and spectral Doppler assessment.
• Abdominal aorta assessment.
• Popliteal entrapment assessment.
• False aneurysm assessment.
• Reactive hyperemia testing.
• Thoracic outlet assessment.
• Subclavian Steel syndrome assessment
• Upper limb arterial assessment post exercise e.g. to provoke subclavian steal.
• Allens test for hand blood flow
• Digital Doppler including toe pressures and imaging assessment.
• Photoplethysmography
• Microvascular techniques

By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals and will:

• take a clinical history.
• provide expert opinion on the most appropriate diagnostic test and technique for the clinical presentation.
• perform the ultrasound imaging or physiological measurement diagnostic test, optimising the equipment to acquire images, physiological waveforms and measurements.
• analyse and interpret images, physiological waveforms and measurements.
• identify sources of error and artefact and correct appropriately.
• formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report results and conclusion, emphasising the key findings.
• communicate with the multi-disciplinary team and participate in MDTs.
• co-ordinate and where appropriate lead bypass graft surveillance programme
• obtain urgent medical review on the diagnosis of significant findings during a bypass graft scan.
• reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
• act on the findings.

Attitudes and behaviours

By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations. They will also consistently demonstrate the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:

• communicate appropriately with the patient and place the patient at the centre of care.
• prioritise the safety of the patient.
• consistently work to high standards of clinical practice applying knowledge and evidence, making decisions and evaluating the impact of those decisions.
• monitor, evaluate and maintain clinical practice standards.
• share data on clinical practice standards with service users and managers to encourage dialogue and debate.
• recognise the importance of the multidisciplinary clinical team and will take responsibility for ensuring appropriate and effective decision making processes are in place.
• support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities.
• be committed to and support continuous improvement of vascular services, with particular reference to auditing practice, evidence based practice, innovation, new and improved technologies.