Abdominal Vascular

Question 1

Branches of the celiac axis include

Answer 1

hepatic, splenic, and gastric arteries. The celiac artery has three branches: the common hepatic, splenic, and left gastric arteries.

Question 2

The first branch of the abdominal aorta is the

Answer 2

celiac artery. The celiac artery also termed, celiac trunk or celiac axis, is the most cephalad visceral branch of the abdominal aorta. Followed by the superior mesenteric artery, the renal arteries, and the inferior mesenteric artery.

Question 3

The sonographic term “seagull appearance” refers to

Answer 3

celiac arteries. The celiac trunk and two of its branches: the common hepatic artery and the splenic artery, appear as a “seagull” or “T configuration” in the transverse plane of the real-time or color flow Doppler scan. These vessels lie superior to the superior mesenteric, renal, and gastroduodenal arteries.

Question 4

The splanchnic arteries comprises the

Answer 4

celiac, superior mesenteric, inferior mesenteric arteries. Splanchnic arteries refer to the vessels that supply the bowel with blood. They are primarily the celiac artery, the superior mesenteric artery, and the inferior mesenteric artery.

Question 5

The term fusiform refers to a type of

Answer 5

aneurysm. There are several types of aneurysms which include: saccular, fusiform, false, mycotic, and dissecting. Saccular and fusiform are shapes of true aneurysms (dilatation of the arterial wall) with different anatomical configurations. The false or pseudoaneurysm is caused by a hole in the wall of a vessel and is not confined to the arterial wall. A dissection is where blood enters the medial of the vessel and dissects the vessel into a true and false lumen. The micotic aneurysm develops secondary to a septic emboli lodging in the arterial lumen.

Question 6

A pulsating echogenic flap seen in the vessel lumen indicates

Answer 6

arterial dissection. Classically, the dissecting aneurysm has two lumens separated by an echogenic intimal flap that can be seen on the real-time scan pulsating toward the true lumen.

Question 7

The presence of a low resistance waveform in the SMA or IMA in a fasting patient indicates

Answer 7

mesenteric ischemia. In the normal fasting state, the superior mesenteric artery and inferior mesenteric arteries have a high resistance flow pattern. After the ingestion of a meal, the blood flow increases, and the high-resistance flow pattern changes to a low-resistance flow pattern. This is not true for the celiac artery, which the low-resistance pattern remains constant.

Question 8

Stenosis of the renal arteries is indicated if the peak systolic velocity is

Answer 8

three and one-half times the aortic peak systolic velocity. Renal artery stenosis is diagnosed by Doppler ultrasound when the peak systolic velocity in the stenosis is 180-200 cm/s or greater or when the peak systolic velocity of the renal artery is 3.5 times the peak systolic velocity of the aorta. This is the primary criterion. Other criteria include: damping of the distal waveform, and the acceleration index.

Question 9

The radiology procedure recommended for diagnosing occlusion of the splanchnic arteries and demonstrating the collateral circulation is

Answer 9

mesenteric angiogram with selective visceral views. Angiography is not only important to provide a definitive diagnosis for occlusion of the splanchnic arteries but also an important part of the successful management of acute intestinal ischemia. Angiography demonstrates the obstructing lesions as well as the collateral flow patterns and can provide such interventional procedures as thrombolytic therapy.

Question 10

The most common pathological condition of the inferior vena cava is

Answer 10

thrombosis. The most common pathological condition of the inferior vena cava is thrombosis followed by neoplasia or tumor.

Question 11

What vessel supplies 75% of the blood to the liver?

Answer 11

portal vein. The portal vein supplies 75-80% of the blood supply to the liver and 50% of the oxygen. The hepatic artery supplies the remainder of the blood supply to the liver. In cases of portal hypertension where the portal venous flow is compromised, there is usually an increase in the hepatic artery flow to the liver.

Question 12

The portal vein is formed by the confluence of the

Answer 12

splenic and superior mesenteric vein and, sometimes, the inferior mesenteric vein. The splenic and superior mesenteric veins and, in some cases, the inferior mesenteric vein join to form the portal vein posterior to the neck of the pancreas.

Question 13

The portal triad is comprised of

Answer 13

portal vein, hepatic artery, and bile duct. The portal triad also termed the hepatic triad, which is defined as a group of three entities, objects, or associations, includes the hepatic artery, portal vein, and bile duct, seen on the real-time image in the porta hepatis region.

Question 14

Mycotic aneurysms occur secondary to

Answer 14

infectious processes. Mycotic or infected aneurysm are caused by a growth of microorganisms in the vessel walls. They occur in multiple sites and are often seen as a complication of bacterial endocarditis.

Question 15

The predominate etiology for cirrhosis of the liver in the western hemisphere is

Answer 15

alcoholism. Alcoholism is the most common cause of cirrhosis in the western hemisphere. Cirrhosis is one of the ten leading causes of death and the most common cause of cirrhosis in the United States. Cirrhosis is the end-stage manifestation of hepatocyte injury leading to tissue necrosis, fibrosis, and attempted regeneration of liver tissue.

Question 16

A prominent venous collateral seen coursing along the abdominal wall from the portal vein to the umbilicus via the ligamentum teres and the falciform ligament is the

Answer 16

paraumbilical. The umbilical or paraumbilical vein collateral is indicative of portal hypertension. It communicates with the superficial veins of the abdominal wall and connects freely with the superior and inferior epigastric veins. In advance stages, it is called caput Medusae.

Question 17

The resistive index (RI) in the renal arteries should not exceed

Answer 17

0.70. The renal artery spectral waveform exhibits a low-resistance flow pattern with continuous forward flow in diastole. A resistive index of 0.70 has been considered the upper limit of normal in adults.

Question 18

The most common vascular pathway for tumor extension is the

Answer 18

inferior vena cava. The common vascular pathway for tumor or thrombus extension is the inferior vena cava. Extrinsic tumors can compress or invade the inferior vena cava and include renal cell carcinoma, hepatocellular carcinoma, and a variety of other neoplasms that metastasize to the paracaval lymph nodes.

Question 19

Occlusion of the hepatic veins is termed

Answer 19

Budd-Chiari. Budd-Chiari disease or syndrome is defined as symptomatic obstruction or occlusion of the hepatic veins. It can be either acute or chronic with an unknown etiology. Possibly arising from neoplasms, strictures, liver disease, trauma, systemic infections, and hematologic disorders.

Question 20

Reversal of flow in the common hepatic artery indicates

Answer 20

occlusion of the celiac artery origin. In patients with celiac artery occlusion at the origin, the collateral flow may be sufficient to produce normal Doppler signals in the hepatic and splenic arteries; however, the flow is reversed in the gastroduodenal and common hepatic arteries.

Question 21

A collateral circulation for the splanchnic arteries include

Answer 21

pancreaticoduodenal arcade, arch of Riolan, artery of Drummond. Stenosis or occlusion of the splanchnic arteries can cause bowel ischemia. This is often prevented by collateralization through three main collateral channels: the pancreaticoduodenal arcade, the arch of Riolan, and the marginal artery of Drummond.

Question 22

Sonographic criteria for an abdominal aortic aneurysm is dilated to

Answer 22

3 cm or more or 1.5 times the normal segment. The majority of abdominal aortic aneurysms are located in the infrarenal portion of the aorta and may extend into the iliac arteries. However, the renal arteries along with the iliac arteries are included in the sonographic examination to assist in the type of surgical reconstruction required.

Question 23

Branches of the hepatic artery include

Answer 23

the gastroduodenal, right gastric, right and left hepatic branches, cystic, intrahepatic branches, and occasionally the supraduodenal arteries.

Question 24

Which artery of the celiac axis is usually not seen on the ultrasound examination?

Answer 24

gastric artery. The celiac artery has a right branch ( hepatic artery), a left branch (gastric artery), which is usually not seen on ultrasound, and splenic, which is a left branch. The hepatic artery and the splenic artery are identified as the “seagull appearance” or the “T configuration” on ultrasound.

Question 25

Which artery gives rise to the gastroduodenal artery?

Answer 25

hepatic artery. The first branch of the hepatic artery is the gastroduodenal artery, and it courses between the duodenum and the neck of the pancreas. The gastroduodenal artery is located anterolateral to the head of the pancreas; the common bile duct is posterolateral to the inferior portion of the head of the pancreas. This landmark has long been used to identify the location of the common bile duct.

Question 26

Tributaries of the portal vein include

Answer 26

splenic, superior mesenteric, left gastric, right gastric, paraumbilical, and cystic veins. Those routinely seen on ultrasound include the splenic and superior mesenteric veins.

Question 27

A patient in the supine resting position should have a portal vein measurement of no more than

Answer 27

13 mm in diameter. The diameter of the portal vein should not exceed 13 mm and should vary with inspiration and expiration.

Question 28

What veins enlarge as they approach the diaphragm?

Answer 28

hepatic veins. The hepatic veins enlarge as they approach the diaphragm, and the portal veins appear larger as they approach the porta hepatis. This has long been a method of differentiation of the hepatic veins and the portal veins.

Question 29

Hepatic veins demonstrate what type of Doppler spectrum?

Answer 29

chaotic, pulsatile phasic variations, and transmitted pulsations. The hepatic veins venous flow is chaotic, with phasic variations and transmitted pulsations. They differ from the collateral venous vessels with continuous high-pitched Doppler waveforms and the low phasic flow seen in other venous structures. The pulsatile pattern is a result of the transmission of right atrial pulsations into the veins.

Question 30

The gonadal veins drain the venous blood into the

Answer 30

renal veins. The testicular veins and the ovarian veins which constitute the gonadal veins drain into the renal veins and subsequently the inferior vena cava. This is an important concept when determining patency of the gonadal veins.

Question 31

Which of the following is not a surgical graft type for aortic aneurysms? simple aortic tube graft, aortoiliac graft, aortofemoral graft, or Brescia-Cimino

Answer 31

Brescia-Cimino. The Brescia-Cimino fistula is an autogenous dialysis access graft. The others are aortic aneurysm surgical grafts named according to location of the graft and the arteries involved.

Question 32

In a normal fasting patient, the SMA has what type of flow pattern?

Answer 32

high-resistance. The superior mesenteric has a high-resistance flow pattern in the fasting patient. It may be turbulent at the origin, and there may be absent or reverse flow in diastole. Blood flow increases after eating. The normal peak systolic velocity in the fasting patient is approximately 140 cm/s and does not exceed 156 cm/s.

Question 33

A venous collateral that arises from the portal vein approximately opposite of the superior mesenteric vein and seen on longitudinal images is the

Answer 33

coronary vein. The portosystemic collateral that arises from the portal at the level of the superior mesenteric is the coronary vein or left gastric vein. The normal coronary vein does not exceed 4 mm. In cases of portal hypertension, a search is made to identify this collateral vessel.

Question 34

Characteristics of the right renal artery are

Answer 34

it lies posterior to the renal vein. It is unique in that it passes posterior to the inferior vena cava as it coursed from the hilum to the aorta. It arises from an anterolateral aspect of the aorta and has a low resistance waveform.

Question 35

Which of the sonographic manifestations is not characteristic of rejection in a renal transplant?

• increased size of transplanted kidney
• prominence of renal pyramids
• decreased echogenicity of the renal sinus
• decreased flow resistance in the parenchymal arteries

Answer 35

decreased flow resistance in the parenchymal arteries. The classical gray scale characteristics of renal transplant rejection include: hypoechogenicity, enlargement of the renal pyramids, increased size of the transplant with diminished echogenicity of the renal sinus echo complex, and increased echogenicity of the cortex. The pulsatility index is greater than 1.8, and the resistivity index is greater than 0.9, indicating increased peripheral resistance.

Question 36

The most common vascular complication of the renal transplant is

Answer 36

renal artery stenosis. In the renal transplant, renal artery stenosis is the most common vascular complication, while occlusion of the renal artery is less common.

Question 37

A pulsating abdominal mass slightly to the left of the midline suggests

Answer 37

abdominal aortic aneurysm. A pulsating abdominal mass in the region of the aorta, slightly left of the midline would suggest an aortic aneurysm. In cases of stenosis or atherosclerosis, a systolic bruit is often heard. In cases of occlusion of the abdominal arteries, pain and necrosis are generally the manifestations.

Question 38

The most common autologous AV fistula of the upper extremity for dialysis is

Answer 38

Brescia-Cimino fistula. The Brescia-Cimino fistula is the most common autologous fistula for dialysis access. It is constructed between the cephalic vein and the radial artery. Other types are the antecubital between the basilica or cephalic veins and the brachial artery. For chronic dialysis, the most common type of dialysis access is the synthetic AV shunt grafts which may be loop or straight grafts, placed in the forearm or upper arm.

Question 39

One of the most reliable clinical signs of patency in the dialysis graft is

Answer 39

palpable thrill over the venous anastomosis and distal vein. Other clinical evaluations for patency include the listening of the machinery-type murmur with a stethoscope and checking the hand for any ischemic steal syndromes.

Question 40

Portal flow

Answer 40

increases with expiration. Portal venous flow has hepatopetal flow toward the liver that decreases with inspiration and increases with expiration. The normal velocity is approximately 20-30 cm/s. Flow also decreases with exercise and with chronic liver disease.

Question 41

Normal portal venous flow is

Answer 41

hepatopetal (toward the liver). Portal venous flow is toward the liver (hepatopetal); however, with chronic liver disease it may be reversed (hepatofugal) or bidirectional.

Question 42

Cavernous transformation of the portal vein is

Answer 42

thrombus in the extrahepatic portosystemic veins. Cavernous transformation of the portal vein occurs secondary to thrombosis of the extrahepatic portal vein. This leads to the formation of periportal collaterals in the porta hepatis around the obstructed portal vein.

Question 43

Characteristics of portal hypertension does not include:

• enlarged portal vein
• splenic enlargement
• portal flow may be reversed
• portal venous pressure less than 30 mm Hg

Answer 43

portal venous pressure less than 30 mm Hg.
Portal hypertension is defined as portal vein pressure of more than 30 mm Hg. Characteristics include: enlarged portal vein, splenic enlargement, reversed or bidirectional flow, patent venous collateral patterns, and decreased flow in the portal vein.

Question 44

The term caput medusa means

Answer 44

superficial multiple tubular anechoic structures in the umbilical region. Caput medusa is defined as dilated cutaneous veins around the umbilicus primarily seen in the newborn or patients with cirrhosis of the liver. This is a very striking clinical presentation. Usually, the patient with cirrhosis has a distended abdomen with multitudes of superficial collateral vessels seen around the belly button.

Question 45

Continuous venous flow indicates

Answer 45

collateral venous flow. Normally venous flow is phasic with respiration. Continuous venous flow is seen with venous collaterals. Collateral venous flow is often high pitched and does not change with respiration.

Question 46

Increased portal pressure with decreased flow in the portal vein attributable to portal hypertension will

Answer 46

increase collateral flow. In cases of portal hypertension, where flow is restricted through the liver, alternate routes or portosystemic collaterals develop to conduct the blood to the heart. As portal flow decreases and pressure increases, the collateral flow will increase.

Question 47

A shunt between the left splenic vein and the left renal vein is

Answer 47

splenorenal shunt. The splenorenal shunt is one of the portosystemic collaterals seen in portal hypertension.

Question 48

What hepatic vein divides the liver into two lobes?

Answer 48

middle hepatic vein. The middle hepatic vein divides the liver into two lobes. It runs in the main interlobar fissure. The right hepatic vein divides the right lobe of the liver into the posterior and anterior segments and the left hepatic veins divides the left lobe of the liver into medial and lateral segments.

Question 49

Transjugular intrahepatic portosystemic shunt (TIPS) is NOT

• surgical shunt for recurrent gastrointestinal bleeding
• a radiology interventional procedure
• treatment for recurrent gastrointestinal bleeding and refractory ascites in patients with portal hypertension
• placement of a metallic stent from the portal vein to the hepatic veins for reduction of venous pressure

Answer 49

surgical shunt for recurrent gastrointestinal bleeding. The TIPS procedure is a radiology interventional procedure that is an alternative to the surgically created shunt for treatment of the portal hypertensive patient.

Question 50

Which is NOT a renal artery?

• segmental
• interlobar
• arcuate
• peroneal

Answer 50

peroneal. The renal artery and its corresponding branches include: main, segmental, interlobar, arcuate, and interlobular arteries. The peroneal is a continuation or branch of the popliteal artery.

Question 51

The normal adult velocity range of the aorta is

Answer 51

70-140 cm/s.

Question 52

The normal renal artery spectral waveform exhibits

Answer 52

low impedance with continuous forward flow during diastole. The renal arteries have a low resistance flow pattern with continuous forward flow during diastole. This is caused by the low resistance in the renal vascular bed and will be seen throughout the kidney.

Question 53

The renal veins are best seen on ultrasound in what position and plane?

Answer 53

anterior in a transverse plane. The renal veins are best seen in the transverse plane from the anterior. In children, a coronal plane from the lateral position is often used.

Question 54

The renal veins are best seen on ultrasound in what position and plane?

Answer 54

anterior in a transverse plane. In children, a coronal plane from the lateral position is often used.

Question 55

A systolic blood pressure of 140 mm Hg or above is the definition for

Answer 55

hypertension. Hypertension is defined as persistent high arterial blood pressure. The criteria include 140 mm Hg systolic and 90 mm Hg diastolic, and these can vary somewhat according to various authors.

Question 56

If one kidney is much smaller than the other you would check for

Answer 56

renal artery stenosis. In cases of renal vein occlusion, the kidney tends to enlarge because of venous congestion. In cases of renal masses, depending on the size of the mass, the kidney will increase in size with respect to the size of the mass. In cases of hydronephrosis, the kidney will enlarge as the collecting system of the kidney becomes increasingly dilated.

Question 57

The acceleration time (AT) of the renal artery is defined as

Answer 57

the interval from the onset of systolic flow to the initial peak systolic velocity with the normal value 0.07-0.1 s.

Question 58

Tardus-parvus waveform refers to

Answer 58

small partial pulse caused by proximal stenosis or occlusion. Tardus-parvus is also referred to as a small pulse or partial, seen secondary to renal artery stenosis. It is seen distal to the renal artery stenosis in the intrarenal arteries. The “tardus” indicates a prolonged or delayed early systolic acceleration and the “parvus” means the diminshed amplitude and rounding of the systolic peak.

Question 59

In cases of renal artery stenosis the resistive index (RI)

Answer 59

increases. The resistive index as well as the acceleration time will increase with renal artery stenosis.

Question 60

The term retroaortic renal vein means

Answer 60

the left renal vein courses posterior to the abdominal aorta. The left renal vein courses anterior to the aorta and posterior to the SMA. However variants include: the left renal vein is circumaortic with separate veins passing anterior and posterior to the aorta and retroaortic where the renal veins courses posterior to the aorta.

Question 61

Clinical findings in cases of renal vein thrombosis DO NOT include
A. flank pain
B. hematuria
C. small sized kidney
D. pulmonary embolism

Answer 61

(C) small sized kidney. Clinical findings of renal vein thrombosis include pain, hematuria, and the possible complication of pulmonary embolism. The kidney is usually swollen due to the venous congestion. A small sized kidney is usually associated with renal artery stenosis or chronic renal disease.

Question 62

The spectral waveform in the aorta

Answer 62

rapid rise with a sharp systolic peak and rapid decline to the baseline during diastole. The aorta spectral waveform is a triphasic high resistant waveform characteristic of peripheral arteries. The waveform has a rapid rise with a sharp systolic peak and a rapid decline to the baseline during diastole. The velocity is normally in the range of 70-140 cm/s. The aorta is used as a standard by which other abdominal vessels are compared.

Question 63

Most of atherosclerotic aortic aneurysms occur at what level?

Answer 63

below the level of the superior mesenteric and renal arteries. The vast majority of atherosclerotic aneurysms are below the level of the renal arteries or infrarenal. The simplest and least expensive test to diagnose and measure the aortic aneurysm is ultrasound. It provides reliable measurement within 3-4 mm of the actual size. The anterior posterior diameter being the best plane to obtain the measurements.

Question 64

What visceral artery changes its patterna and velocity after eating?

Answer 64

Classically the superior mesenteric changes after eating (postprandial). After ingestion of a meal, the SMA blood flow is significantly increased with a broad systolic peak. There is also increased continuous flow in diastole.

Question 65

What is the best imaging plane to demonstrate the celiac axis and its respective branches?

Answer 65

A transverse plane slightly superior to the superior mesenteric artery will demonstrate the celiac artery arising from the aorta with its axis and respective branches; the common hepatic artery, and the splenic artery which are seen as a seagull appearance. The third branch, the gastric artery, is usually not seen by real-time imaging.

Question 66

Acute appendicitis would demonstrate

Answer 66

increased vascularity. Appendicitis is an inflammatory process and associated with increased vascularity. The vascular supply to the appendix arises from the appendicular artery via the ileocolic and superior mesenteric artery. In cases of acute appendicitis, the color flow Doppler will often show a ring of color around the inflamed appendix.

Question 67

Blood flow to the appendix is via the

Answer 67

superior mesenteric, ileocolic, and appendicular artery

Question 68

What renal transplant pathological condition has the same sonographic characteristics of rejection but differs in resistive index value?

Answer 68

acute tubular necrosis. Acute tubular necrosis has all of the sonographic characteristics of rejection but can be differentiated from rejection using Doppler and the resistive index. The RI will remain normal with acute tubular necrosis, but it will be abnormal with rejection.

Question 69

Other than dialysis, what is another treatment for end-stage renal disease?

Answer 69

transplantation. Transplantation is the preferred treatment for irreversible end stage renal disease. However, there is a limited availability of donor organs, thus limiting the number of transplants.

Question 70

If a high-velocity jet is present at the site of stenosis in the renal artery, the color Doppler will show

Answer 70

a mosaic color pattern representing turbulence and narrowing at the site of stenosis. Characteristics of any high-grade stenosis is narrowing of the vessel with a color jet of mosaic colors caused by turbulence and scattering; followed by poststenotic turbulence and a damping of the vessel. The spectral waveform in the area of the high-grade stenosis will have a dramatically increased peak systolic flow, with filling of the spectral window. Laminar flow is associated with normal flow profiles, and the absence of color would signify an occlusion.

Question 71

The anastomosis site of the main renal artery in a renal transplant demonstrates a spectral waveform that wraps around with the peak appearing at the baseline. This is

Answer 71

aliasing because of exceeding the Nyquist limit. The term aliasing refers to high velocity waveforms that exceed the Nyquist limit (1/2 of the pulse repetition rate, PRF). It is frequently noted with vessels that have a high-grade stenosis.

Question 72

An orthotopic liver transplant is

Answer 72

donor’s organ placed in the normal location. An orthotopic transplant is where the graft is placed in a normal position. A heterotopic transplantation is where the donor organ is placed in an ectopic location. the most common liver transplant is the orthotopic cadaveric transplant (OLTX).

Question 73

A complication of the liver transplant that is of critical importance is

Answer 73

hepatic artery thrombosis. Hepatic artery thrombosis and occlusion is of critical importance because it can mean loss of the liver transplant and even death of the patient. This is a primary cause of graft ischemia, hepatic infarction, sepsis, and ultimately graft failure. Angiography confirms the diagnosis.

Question 74

What type of dialysis access can be performed at home and is the least expensive

Answer 74

peritoneal access. Dialysis access can be performed at home via a peritoneal access. It is the easiest and least expensive method; however, the disadvantage is the possibility of developing peritonitis.

Question 75

Color flow Doppler of the arteriovenous shunts shows

Answer 75

mosaic pattern with turbulence throughout the graft. In the normal dialysis access graft, there is a turbulent mosaic pattern throughout the graft and increased color changes at the anastomotic sites caused by increased velocities. If the color pattern becomes monochrome or homogeneous throughout the graft it is an indication that it is malfunctioning.

Question 76

The synthetic dialysis access shunt in the arm will be located

Answer 76

superficially. The dialysis access shunt will be located in a superficial position in the arm or forearm. This makes it ideal for imaging with the linear array transducer, which provides excellent detail and resolution. It is also accessible for palpation for determining the type of graft and its patency.

Question 77

What provides the definitive diagnosis of a renal transplant perigraft mass or fluid collection?

Answer 77

aspiration/biopsy. Several of the perigraft masses seen on the renal transplant examination can mimic each other. For example, a hematoma and an abscess have similar ultrasound characteristics. Also, the fluid-filled perigraft masses, such as a lymphocele or urinoma, have similar characteristics. To provide a definitive diagnosis, an aspiration or biopsy is required.

Question 78

What is the most common cause of arteriovenous access shunt failure?

Answer 78

thrombosis. Thrombosis of the arteriovenous access shunt is the most common cause of access failure and is more frequent in synthetic arteriovenous shunt grafts.

Question 79

Absence of color in the arteriovenous access shunt indicates

Answer 79

occlusion. Occlusion of the AV shunt will show absence of color filling in the shunt with patency in the adjacent feeding vessels. There are usually echoes filling the shunt with no Doppler signal.

Question 80

Gray scale imaging of the normal functional AV graft shows

Answer 80

two parallel echogenic walls with a sonolucent center. The functioning AV graft access will be superficially located with two parallel echogenic lines representing the walls of the graft and a sonolucent center.

Question 81

What type of aneurysm typically has a “neck” with forward and reverse blood flow?

Answer 81

pseudoaneurysm. A pseudoaneurysm or false aneurysm results from an injury to the wall of the artery. It is an extraluminal collection of blood that maintains communication with the injured artery via the “neck” whereby blood flows in and out of the pseudoaneurysm with the cardiac cycle. Thus, the forward and reverse flow pattern in the neck.

Question 82

A noninvasive treatment for a pseudoaneurysm is

Answer 82

ultrasound-guided compression repair. Ultrasound guided compression repair is a safe and effective noninvasive technique for obliteration of the pseudoaneurysm.

Question 83

During an ultrasound-guided compression of the pseudoaneurysm, which lies adjacent to the common femoral artery, what vital sign is continuously monitored?

Answer 83

pedal pulse. The distal pedal pulse is continuously monitored to ensure distal peripheral flow during compression.

Question 84

In cases of acute arterial occlusion there is usually

Answer 84

absence of collateral flow. In cases of acute arterial occlusion, the blood flow is usually instantly interrupted by an emboli, trauma, or thrombi. This will be accompanied by severe pain often associated with numbness. Surgery or interventional procedures are immediately required to restore the blood supply. In cases of acute occlusion, there has not been time for the formation of collateral vessels that can supply the required blood flow. When arterial occlusion occurs over a long time span collateral vessels have time to form, and they provide blood flow patterns to circumvent the occluded vessels. This, in turn, eases the symptoms until the demand for blood exceeds the collateral capacity, as seen with exercise. Then, the symptoms will return, this is what we term claudication pain.

Question 85

The etiology of the majority of arterial diseases is

Answer 85

atherosclerosis. Although all the factors listed in the answers are contributors to arterial disease, the etiology for the majority of arterial diseases is atherosclerosis. Atherosclerosis is defined by the World Health Organization as “a combination of changes in the intima and media. These changes include focal accumulation of lipids, hemorrhage, fibrous tissue, and calcium deposits.”

Question 86

The greatest risk of aortic aneurysms is

Answer 86

rupture. Rupture of the aortic aneurysm the most threatening outcome. More recent data indicate that rupture risk escalates when the aneurysm exceeds 5 cm in size.

Question 87

An abdominal bruit suggests

Answer 87

arterial stenosis or occlusive disease. A stethoscope reveals bruits when there is significant occlusive disease or stenosis of the aorta or its branches.

Question 88

The most common correctable cause of renal hypertension is

Answer 88

renal artery stenosis. The most common correctable cause of hypertension is renal arterial disease. Genetic factors, environmental factors, and chronic renal disease are potential causes of renal hypertension; however, as stated, the most common correctable cause is renal arterial disease.

Question 89

The origin of the gastroduodenal artery is

Answer 89

hepatic artery. The common hepatic artery arises from the right branch of the celiac artery. It then gives off the gastroduodenal artery and the right gastric artery and becomes the proper hepatic artery and enters the liver at the porta hepatis. It further divides into the right and left hepatic arteries.

Question 90

Avascular is

Answer 90

absence of vascular flow. The definition of avascular is “not supplied with blood vessels.”

Question 91

The superior mesenteric artery is best seen on real-time examination in what plane?

Answer 91

longitudinal. The superior mesenteric artery (SMA) is best seen in the longitudinal axis just below the origin of the celiac axis. In the longitudinal plane, the origin of the SMA as well as the longest segment can be viewed. Spectral waveforms are also obtained in the longitudinal plane to ensure accuracy.

Question 92

The blood supply to the gallbladder is supplied by the

Answer 92

cystic artery. Cystic artery arises from the hepatic artery.