Abdominal Vascular Studies Flashcards
The gonadal arteries arise from the aorta how?
Anterolaterally
Is the celiac axis part of the mesenteric arteries?
yes
Common iliacs typically measure:
<1.5cm
Saccular aneurysms occur more often in the:
thoracic aorta
Pseudoaneurysms involve all three layers
false
What measurement do they intervene with aneurysms?
> 5.5cm
What’s the preferred method of treatment for AAA?
EVAR – endovascular aneurysm repair. A stent is inserted via a groin vessel
What can be seen after an EVAR procedure?
endoleaks
What types of endoleaks are most common?
Type 1- flow is leaking proximally or distally at an attachment point due to a poor seal at one end
Type 2- retrograde flow is leaking into the aneurysmal sac via a branch vessel
If you see flow in what two vessels indicates an endoleak?
IMA and lumbar arteries
These should be occluded as a result of the graft
What disease makes one prone to thoracic aorta dissection?
Marfan’s
Which lumen is bigger, true or false?
False
Aorta measurements should be :
outer to outer
Aorta velocities?
40-100cm/s
Where does the SMA and IMA provide blood to?
SMA= small and large bowel IMA= large bowel
Mesenteric arteries aka
Splanchic
Most common form of mesenteric iscemia is? What are the main causes?
Chronic mesenteric ischemia – 2/3 vessels need to be severely occluded before symptoms arise. Atherosclerosis is main cause
Which is more serious, acute or chronic mesenteric ischemia?
Acute – is caused by thrombus, embolus or external compression, and mimics the same as Gb disease, etc. Mortality rate of 50%
In the mesenteric vessels, where is the most likely area for an aneurysm ?
splenic artery, usually found incidentally
Where does the celiac primarily supply blood to?
liver and spleen
Arterial perfusion relies on:
cardiac output
blood pressure
blood volume
Normal ICA/CCA PSV ratio
<2
The _______ in ankle systolic pressure after exercise is an indicator of severity of PAD
Fall
After a patient has been on the treadmill for 3 minutes, they come off an get pressures taken. They have a high fall in pressure, what does this indicate?
Severe PAD
What’s the alternative to the treadmill test?
Reactive hyperemia test
Plethysmography aka
pulse volume recording
In reactive hyperemia, a decrease of _____ or more indicates PAD
50%
When an occlusion occurs in the ICA, flow in the ophthalmic artery becomes ______ in order to supply the brain
retrograde
With penile Dopplers, PSV is an indicator of? and EDV?
PSV- arterial dysfunction
EDV- venous dysfunction
If patients are going through chemo or radiation, what can they experience?
Takayasus arteritiis: inflammation of vessel walls
Carotid body tumor aka
paraganglioma, highly vascular tumor
What’s the treatment for plaque in arteries?
endarterectomy
PSV is the first thing to be affected in a stenosis. In critical stenosis it’s EDV
True
The higher the stenosis, the ______ the EDV
higher
Normal flow velocities for SCA, CCA, ICA, ECA and vertebrals:
SCA: 140cm/s CCA: 80-100cm/s ICA: <125cm/s ECA: <120cm/s Vertes: 20-60cm/s
What bumps up stenosis from moderate to severe?
EDV
When we see an ICA waveform in the ECA, what does this mean?
Internalization – when the ICA is occluded, the ECA takes on the job
When do we see water hammer sign:
With aortic regurgitation – signifies that something is going on distally
Rapid forward flow, and then a little bit of reversal
Risk factors for atherosclerosis:
Smoking Obesity Hyperlipidemia Hypertension Diabetes Family hx Psychosocial factors Unhealthy diet Gender Age
HDL and LDL levels
HDL- >60mg/dl is good
LDL- >160mg/dl is too high
What’s the most devastating area of a stroke? Cerbellar, RT side, Brain stem or LT side
Brainstem
Within _____cm of the carotid bulb do most stenoses occur?
2cm
What are the gold standards for strokes?
MRA and CT
Stent’s can cause
an increase in velocity within. Gradual but not abrupt. Up to 150cm/s
What ratio indicates restenosis in a stent?
2:1
What is the criteria of stenosis for CAS and CEA?
> 50-99% stenosis for symptomatic
60-99% for asymptomatic
risk must be under 3%
But also the notes say they don’t put stents in asymptomatic pt’s rn?
Yin - yang appearance
Pseudoaneurysm
Where is aortic coaractation most common? Is it acquired or congenital?
Congenital – most often in aortic arch
Risk factors for DVT:
Hereditary – blood disorders
Acquired- age, obesity, malignany, pregnancy, OC use, trauma, immobilization, recent surgery
What is the Homan’s sign?
Pain on dorsiflexion of foot
What are the 3 main symptoms of DVT:
Swollen, warm and painful legs
+ Homan’s sign
What does D-dimer test measure? When is it not helpful?
D-dimer measures the fibrin that accumulate in the blood
Not helpful for pt’s over 80, pregnant, or hospitalized
It is the simplest, noninvasive way to monitor the percentage of hemoglobin that is saturated with oxygen
Pulse oximeter <95% is abnormal
Post thrombotic syndrome symptoms:
chronic leg swelling, ankle pigmentation and ulceration
What causes skin pigmentation?
Breakdown of hemoglobin
Difference in mobile vs immobile patients with clots:
mobile (mild) cases, the body’s normal thrombolytic mechanisms will clear it up
immobile patients, the clot will increase in size
If patients are obese and you cannot see the vein, what can help you with a diagnosis?
Loss of phasicity and poor augmentation response
What’s the most common cause of an upper extremitiy DVT?
placement of a central venous catheter or pacemaker lead
What are some symptoms of UEVT?
asymptomatic facial/arm edema neck/shoulder pain blurred vision (SVC) head fullness (SVC) vertigo/blurred vision (SVC)
If you see an abnormal signal in one vessel, what should you do?
Compare with the other side
Paget-Schroetter syndrome:
primary UEDVT= are PSS + TOS
Heavy exertion from activities such as wrestling, weight lifting, etc. causes microtrauma to vessel intima, which leads to coagulation issues. UEDVT in young healthy individuals
Secondary DVT:
Caused by VAD and/or cancer. Incorrectly placed catheters are the cause. central catheters should be placed in lower third of SVC by RA
Where are more central venous access devices placed? Which side is preferred?
SCV and IJV. Right IJV is preferred because of it’s straight course to the heart
What increases the pulsatility of the doppler waveform in the EIV and CFV?
Tricuspid valve regurgitation and/or right heart failure
Renals should measure:
<2cm
Superficial thrombophlebitis most commonly occurs in:
varicose veins
Clinical signs of superficial thrombophlebitis?
Severe pain and redness, inflammation, swelling, pyrexia and palpable cord
Lower limb artery stenoses criteria:
<1.5:1 - normal 1.5-2:1- 25-50% 2-4:1- 50-75% 4:1- >75% No flow: occluded
What’s a good predictor of renal artery disease? Is US the gold standard?
RI. No, CTA or MRA
Where does FMD most commonly affect the RA?
Mid to dst portion
Is FMD bilateral?
Yes
Do we use angle correct on RAR
Not on intrarenal vessels
What can cause RV thrombosis?
underlying diseases, dehydration, hyper-coagulability
tumors, extrinsic compression
What happens if FMD is left untreated?
Potential dissection
Most common organs for infarct
Spleen and kidney
After a transplant, what would likely occur first? Occlusion or stenosis?
Occlusion
Where do we measure the aorta in the RAR?
Just before renals
Resistant index aka
Pourcelot index
What vessels do we use for the RAR
Segmental or arcute in UP, mid and LP
RAR value? RI value?
RAR- >3.5
RI- >0.7
The most common location for a incompetent perforating vein?
2/3 down the thigh, Hunterian perforator
Is the valsalva a useful tool in the lower leg?
No
Abnormal calf & thigh perforator measurement
3mm calf
4mm thigh
