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FRCR 2A (Crack The FRCR 2A) > 1. Vascular (Anatomy) > Flashcards

1. Vascular (Anatomy) Flashcards

1
Q

Aorta - regions (4)

A

Root (Aortic valve annuus to sino-tubular junction),
Ascending aorta,
Transverse aorta/arch,
Descending aorta.

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2
Q

Aorta - diameter (2)

A

Average is 3.6cm at root (largest point) and 2.4cm in distal descending.

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3
Q

Sinuses of Valsalva (3)

A

3 outpouchings above the annulus (right, left, posterior) which terminate at the ST junction.
Right and left coronaries come off right and left sinuses.
Posterior is often called non-coronary cusp

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4
Q

Aortic isthmus

A

Segment between left subclavian and ligamentous arteriosum

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5
Q

Ductus bump (2)

A

Contour bulge along the lesser curvature, distal to isthmus.
NORMAL structure, not a pseudoaneurysm.

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6
Q

Aortic arch variants (4)

A

Normal (75%)
Bovine (15%) - common origin of brachiocephalic artery and left common carotid.
Left common carotid coming off the brachiocephalic (10%)
4 separate origins (left vertebral artery originates separately from the arch, rather than the left subclavian)

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7
Q

Artery of Adamkiewicz (3)

A

Great anterior medullary artery (Artery of Adamkiewicz) comes off thoracic aorta.
Dominant feeding artery of spinal cord.
Comes off left side (70%) between T8-L1 (90%)

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8
Q

Inferior pancreatoduodenal artery comes off the…

A

…SMA (first branch of SMA)

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9
Q

Arc of Riolan

A

Made up from anastamosis of the left colic artery (comes off IMA) and middle colic artery (comes off SMA)

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10
Q

Marginal artery of drummond

A

Formed from terminal branches of SMA and IMA

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11
Q

Coeliac axis branches (5)

A

Coeliac axis branches into:
- Common hepatic artery
- Left gastric artery
- Splenic artery
Common hepatic artery
- Becomes proper hepatic artery after GDA (gastroduodenal artery)
This traditional anatomy only seen in 55%

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12
Q

Variant hepatic artery anatomy (3)

A

Right or left hepatic arteries may be replaced (come from other than proper hepatic) or accessory (duplicated).
Replaced - usually off left gastric or SMA.
Accessory - duplication of vessel, spare usually from left gastric or SMA.

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13
Q

Vessel in the ligamentum venosum?

A

Usually an accessory or replaced left hepatic artery (arising from left gastric)

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14
Q

Proper vs replaced right hepatic artery

A

Proper right hepatic artery is anterior to right portal vein.
Replaced right hepatic artery is posterior to main portal vein.
This positioning increases risk of injury in pancreatic surgeries.

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15
Q

Internal Iliac Artery Branches - posterior (4)

A

Iliolumbar,
Lateral sacral,
Superior gluteal,
Inferior gluteal (sometimes)

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16
Q

Internal Iliac Artery Branches - Anterior (8)

A

Umbilical (gives off superior vesicular),
Inferior vesicular
Obturator
Uterine (female),
Middle rectal,
Internal pudendal,
Inferior gluteal,

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17
Q

Ovarian artery origin

A

80-90% arise from anterior-medial aorta

18
Q

Persistent sciatic artery (4)

A

Anatomic variant, continuation of internal iliac.
Passes posterior to femur and anastamoses with distal vasculature.
Complications include aneurysms and early atherosclerosis.
Acute occlusion of external iliac, but still has foot pulses, think persistent sciatic artery.

19
Q

Coeliac to SMA - collateral pathways (3)

A

Conventional is Coeliac > Superior pancreatic duodenal > Inferior pancreatic duodenal > Gastroduodenal
Arc of Buhler (anatomic variant collateral from coeliac to SMA): Arch between SMA and Coeliac, independent of inferior pancreatic duodenal or gastroduodenal.
- This rare (4%) collateral can have an aneurysm, associated with coeliac axis stenosis.

20
Q

SMA to IMA collaterals (3)

A

Conventional: SMA > Middle colic > Left branch of middle colic > arc of Riolan > Left colic > IMA
- Arc of Riolan (aka meandering mesenteric artery): connects middle colic (SMA) and left colic (IMA)
- Marginal artery of drummond: Anastamosis of terminal branches of ileocolic, right colic and middle colic arteries of SMA with left colic and sigmoid branches of IMA, forms a continuous arterial circle along the inner border of the colon

21
Q

IMA to Ilaics - collaterals

A

Conventional: IMA > Superior rectal > Inferior rectal > Inferior pudendal > Anterior branch of internal iliac

22
Q

Winslow pathway - anatomy (3)

A

Seen in aorto-occlusive disease.
Subclavian artery > internal thoracic(mammary) artery > superior epigastric artery > inferior epigastric artery > external ilac artery.
Can be inadvertantly cut during transverse abdominal surgery.

23
Q

Corona mortis - anatomy/trivia (4)

A

Vascular connection between obturator and external ilaic.
Any vessel coursing over the superior pubic rim.
Can be injured in pelvic trauma or during surgery (notoriously difficult to ligate).
Can hypothetically cause a type 2 endoleak.

24
Q

Neck/Subclavian anatomy (3)

A

Sagittal view:
Scalene muscles make a triangle in the neck (triangle between anterior and middle scalene).
Subclavian vein runs anterior to said triangle.
Subclavian artery runs IN the triangle.

25
Q

Branches of the subclavian artery (5)

A

Vertebral,
Internal thoracic,
Thyrocervical trunk,
Costocervical trunk,
Dorsal scapular

26
Q

Continuation of subclavian artery (3)

A

Axillary artery: begins at first rib
Brachial artery: begins at lower border of teres major
Brachial artery: bifurcates to become ulnar and radial arteries

27
Q

Ulnar vs Radial artery on imaging (3)

A

Ulnar artery is usually bigger.
Ulnar artery usually gives off common interosseous.
Ulnar artery usually supplies the superficial planar arch, while the radial usually supplies the deep arch.

28
Q

Normal variants of upper extermety vasculature (2)

A

Anterior interosseous branch (median artery) persists and supplies deep palmar arch of hand.
High origin of radial artery - radial artery comes off either axillary or high brachial artery (normally comes off at level of radial head)

29
Q

External iliac becomes common femoral once…

A

…it has given off inferior epigastric artery (at the inguinal ligament)

30
Q

Common femoral artery - bifurcation (3)

A

Becomes superficial femoral and profunda femoris.
Profunda femoris courses posterior and lateral.
Superficial passes anterior and medial into adductor canal. When it emerges, it becomes popliteal artery

31
Q

Popliteal artery - continuation (3)

A

At level of distal border of popliteus muscle, popliteal artery becomes anterior tibial and tibioperoneal trunk.
Anterior tibial runs anterior and lateral, traverses interosseous membrane, down front of anterior tibia and terminates as dorsalis pedis.
Tibioperoneal trunk bifurcates into posterior tibial (most medial artery in leg, felt at medial malleolus) and peroneal (fibular) arteries.

32
Q

Venous collaterals - Gastric varices (5)

A

Portal HTN shunts blood away from liver and into systemic venous system.
Spontaneous portal-systemic shunts develop to decompress the system.
Most gastric varices formed by left gastric vein (coronary vein).
Isolated gastric varices are secondary to splenic vein thrombus.
Gastric varices (80-85%) drain into inferior phrenic vein, then left renal vein, forming gastro-renal shunt.

33
Q

Stomach venous supply (2)

A

Left gastric (coronary) vein = cardia
Posterior and short gastric = fundus

34
Q

Spleno-renal shunt.

A

Feature of portal HTN.
Abnormal collateral between splenic vein and renal vein.
Not associated with GI bleed, however, enlarged shunts associated with hepatic encephalopathy.
Imaging: Enlarged left renal vein with enlarged IVC at the level of the left renal vein.

35
Q

Caval variants (3)

A

Left SVC.
Duplicated SVC.
Duplicated IVC.

36
Q

Left sided SVC - features (3)

A

Can (rarely) result in right to left shunt.
Only seen in isolation in 10% (90% it’s duplicated).
Usually drains into the coronary sinus.

37
Q

Left SVC - trivia (3)

A

Commonest congenital venous anomaly in the chest.
Most common associated CHD is ASD.
Associated with unroofed coronary sinus.

38
Q

Duplicated SVC

A

Usually seen in scenario of left SVC with smaller, duplicated right SVC

39
Q

Duplicated IVC

A

2 IVCs seen either side of aorta.
Associated with renal pathology:
- Horseshoe and crossed fused ectopic kidneys
- Circumaortic renal collars

40
Q

Circumaortic venous collar (3)

A

Additional left renal vein that passes posterior to aorta.
Anterior limb is superior, posterior limb is inferior.
Important for renal transplant or IVC filter placement.

41
Q

Azygos continuation (5)

A

aka absence of hepatic segmen of IVC.
Hepatic veins drain straight into right atrium.
IVC often duplicated, left IVC terminates in left renal vein, which then crosses over to join right IVC.
Azygos vein is dilated.
Associated with polysplenia

FRCR 2A (Crack The FRCR 2A) (19 decks)

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