Module - Peripheral Arterial Screening and Microvasculature Diagnostics (SPS131)

STP

Aim of this module

This module provides trainees with the knowledge that underpins this third year specialist module in Vascular Science. It will provide trainees with the knowledge, understanding and practical skills to safely contribute to the diagnosis and screening of peripheral arterial disease (macro and microvascular), abdominal aortic aneursyms and intracranial lesions (for sickle cell). This module will provide trainees with the knowledge, understanding and practical skills to safely contribute to the screening of patients with suspected abdominal aortic aneursym (AAA) and peripheral arterial disease (ABPIs). It will also provide trainees with the knowledge, understanding and practical skills to obtain transcranial Doppler (TCD) images and measurements of the peripheral microvascular system.

Work-based learning outcomes


1. Perform ultrasound scans on patients with suspected abdominal aortic aneurysm (AAA).
2. Perform resting and post-exercise Doppler assessment of patients with suspected peripheral arterial disease.
3. Obtain transcranial Doppler (TCD) spectra of the intracranial cerebrovascular circulation.
4. Obtain measurements of the microvascular system.

Work-based Competencies


Learning outcome Title Knowledge
1 1

Perform an ultrasound scan using B Mode to identify and measure a normal abdominal aorta.

  • Anatomy of aorta and ultrasound landmarks.
  • Examination technique, patient positioning and scanning protocol.
  • NAAASP.
  • Artefacts and limitations associated with images and measurements acquired.
2 1

Perform an ultrasound scan using colour Doppler and spectral Doppler to demonstrate the haemodynamics of a normal carotid and vertebral arteries.

 

 

Haemodynamics and normal physiology of the aorta.

3 1

Perform ultrasound scans to identify and measure an AAA.

  • Aorta pathology and ultrasound characteristics.
  • Effects of aneurysm on flow patterns.
  • Correct measurement planes.
4 2

Obtain and fully interpret resting Doppler signals from all pedal pulses, measure blood pressure and calculate resting ABPI.

  • Relationship between haemodynamics and continuous-wave Doppler signals.
  • Effect of disease on Doppler signals, particularly atherosclerosis and infection.
  • Relationship between severity of atherosclerosis and pedal blood pressure.
  • Limits of interpretation, particularly in calcified vessels or oedematous legs.
5 2

Exercise the patient obtaining and fully interpreting resting and post- exercise ABPI measurements.

  • Safe exercise techniques.
  • Effect of exercise on lower limb haemodynamics.
  • Effect of exercise on Doppler signals and pedal pressure.
  • Limits of interpretation.
6 3

Obtain transcranial Doppler spectra of the intracranial cerebrovascular circulation identify the middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA).

  • Anatomy of intracranial arteries.
  • Examination technique, patient positioning and scanning protocol.
  • NHS Sickle Cell and Thalassaemia Screening Programme.
  • Haemodynamics and normal physiology of the intracranial arteries.
7 4

Obtain measurements of the microvascular system using thermography, laser Doppler, transcutaneous O2 or nailfold

  • Scientific principles of thermography, laser Doppler, transcutaneous O2 and nailfold capillaroscopy.
  • Examination technique, patient positioning and scanning protocol.
  • Haemodynamics and normal physiology of the microvascular circulation.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS Perform and interpret a complete AAA screening B Mode scan on a new patient
DOPS Perform and interpret a resting ABPI on a new patient
DOPS Obtain and measure Doppler TCD spectra of the intracranial cerebrovascular circulation.
DOPS Obtain measurements of the microvascular system using one technique.
DOPS Perform and interpret a complete diagnostic scan on a AAA surveillence patient, including assessment of the iliac and common femoral arteries.
DOPS Perform and interpret resting and exercise ABPIs on a new patient referred for claudication.
DOPS Perform and interpret a microvascular investigation on a new patient
DOPS Perform and interpret a complete AAA diagnostic scan on patient referred from the screening programme for non visualisation of aorta.
DOPS Perform and interpret an ABPI on a patient with critical ischaemia.
DOPS Perform and interpret an ABPI on an immobile patient with leg ulcers on the ward.
OCE Explain the AAA scan procedure and purpose to the patient
OCE Explain the ABPI procedure and purpose to the patient
OCE Obtain patient consent for the AAA scan
OCE Obtain the relavant clinic history and symptoms pertinent to the ABPI test.
OCE Prepare and position a mobile patient for a microvascular investigation.
OCE Prepare and position a patient for a TCD scan.
OCE Communicate with the patient during the exercise testing to ensure safe compliance and elicit clinical information.
OCE Explain the ABPI findings findings to the patient.
OCE Explain the microvascular scan findings to the patient
OCE Explain what happens with the AAA scan results