— a useful tool when assessing the existence of ischemia
Digit-Brachial Index (DBI) is the upper extremity equivalent of the lower extremity Ankle-Brachial Index. DBI < 0.75 are typically considered abnormal. Pressure assessment can be done on all digits or on selected digits with more pronounced problems.
Measurement of digit pressure and digit brachial index are useful tools when assessing the existence of ischemia. Laser Doppler measurements using the PF 6000 Pressure/ Combined system can easily be done. Simultaneous assessment of brachial pressure and finger pressures saves time and provides absolute pressures and DBI all automatically calculated in the generated report. By using preheated thermostatic laser Doppler probes the measurement can be standardized and digits heated to the same temperature during the entire examination.
Finger Pressures – Fistula
For some patients assessment of brachial pressure in both arms is contraindicated. Typical conditions is the presence of AV Fistula, patients undergone mastectomy etc. Brachial pressure is then determined from the other arm and used to calculate the finger pressure ratio both for fingers on the right and left hand.
Patients with arteriovenous (AV) graft or fistula can suffer from upper extremity ischemia of various degree. The diagnosis of ipsilateral ischemia in an extremity with an AV access has often been made on clinical criteria alone. Signs can be rest pain, neurologic deficit, or gangrene and ulceration. The diagnostic challenge arises when symptoms are less severe and the exam is unclear. The pathogenesis of AV access-induced hand ischemia is caused by low resistance of the access causing a reversal or stagnation of flow in the vessels distal to the AV anastomosis. The distal vascular bed is thereby deprived of its arterial supply.
Perimed provides customized examination plans for finger pressure assessment as well as for finger pressure assessment on patients fistula where measurement of brachial pressure in both arms is contraindicated.