Hemodynamic Assessment of the CLI Patient

Written by Cynthia Laufenberg, MA

Presented by Abigail Mize, BS, RDCS, RVT

At Wednesday’s session, “What We All Need to Know About Wounds in the CLI Patient: Modern Core Wound Principles for the CLI Practitioner,” Abigail Mize, Clinical Research Coordinator/Interventional Sonographer at ACV Centers in Grand Rapids, Michigan, presented on “Hemodynamic Assessment of the CLI Patient. She reviewed both anatomic diagnosis and anatomic assessment and, once a diagnosis of CLI is reached, hemodynamic assessment.

“The goal of hemodynamic assessment is to assess location and extent of disease within the leg,” she noted. “ABI is often first diagnostic tool and can indicate single level vs multilevel disease based on severity.” The hemodynamic assessment should include toe-brachial index (TBI) for pedal disease, arterial duplex ultrasound to directly visualize arteries, and angiogram to further evaluate the extent of occlusion and better define pedal/plantar flow.

Ms. Mize also reviewed some of the downfalls of ABI. “ABI is a great first-line tool for assessing compromised arterial flow," she said, "but it should always be performed with limitations in mind.”

“Clinical assessment of anatomical CLI symptoms should be performed at every visit, and assessing the feet is a must,” she emphasized. Arterial duplex ultrasound provides direct visualization of the arteries from the groin to the foot, but it can be limited in pedal/plantar and digital flow. “Angiogram is the best tool for evaluation of the entire arterial tree as well as for revascularization planning,” she concluded. “Multi-modality assessment should be performed for the best anatomical and hemodynamic diagnosis and treatment for CLI patients.”