Abdominal Vasculature - Part 6 Flashcards
What does tardus parvus refer to?
A pattern of Doppler ultrasound spectral waveform resulting from arterial stenosis
Where is tardus parvus observed?
Downstream to the site of a stenosis
What does tardus mean?
Prolonged systolic acceleration
- eg. slow upstroke
What does parvus mean?
Small systolic amplitude and rounding of systolic peak
What does tardus parvus indicate?
An upstream significant renal artery stenosis
What does tardus parvus look like on US? (4)
- Slanted upstroke
- Delay in reaching the peak systole
- Diastolic flow
- Dampened waveform
When is there a risk of AAA rupture?
When the AAA is > 6cm
What are risk of AAA rupture (3)
- Significant mortality rate
- High blood pressure
- Current smoker
Where do you feel unusual pain if you have an AAA? (5)
- Back
- Groin
- Testicles
- Legs
- Buttocks
What does a periaortic hematoma suggest?
A rupture has occurred
EVAR
EndoVascular Aneurysm Repair
Endovascular aneurysm repair
Inserting graft components that are folded and compressed within a delivery sheath through the lumen of an access vessel, usually the common femoral artery
- treatment of an AAA
Where are grafts loacted?
On the outside
- form paths around the blockage
Where are stents located?
On the inside
- acts as a balloon to open up the vessel to allow movement through it
What happens upon deployment of the EVAR?
The endograft expands, contacting the aortic wall proximally and iliac vessels distally to exclude the aortic aneurysm sac from aortic blood flow and pressure
When do endoleaks occur?
When blood is allowed to flow into the aneurysmal sac
- continued blood flow into an excluded aneurysm after endovascular placement of a stent graft
What is the best modality for assessing post surgical leaks?
CT
What are the 4 classifications of endoleaks?
- Attachment site leak-improperly sealed at proximal or distal end
- Retrograde flow through collateral branches(lumbars or mesenterics)
- Flow into the aneurysm secondary to an inadequate seal between components of the device or a tear in the fabric of the graft
- Flow through the fabric of the graft secondary to graft porosity
What should you assess endoleaks?
Flow proximal and distal to the graft
Endoleak
Blood flow outside of the graft into the aneurysmal sac
When should you surveillance an endoleak in a postoperative year?
Every 3-6 month intervals
When should you surveillance an endoleak in the following year after the postoperative year?
Every 6-12 month intervals
- life long surveillance is necessary
FMD
Fibromuscular dysplasia
Fibromuscular dysplasia
Heterogeneous group of vascular lesions characterized by an idiopathic, non-inflammatory, and non-atherosclerotic angiopathy of small and medium-sized arteries
