Arterial Flashcards
Preferred order of dialysis access placement?
Non-dominant forearm cephalic fistula Dominant forearm cephalic fistula Either arm upper arm cephalic fistula Either arm basilic transposition Forearm loop graft Upper arm straight graft Upper arm loop graft
For pre-op assessment for dialysis access, what arterial and venous diameters are required?
Arteries min 2 mm
Veins min 2 mm at wrist, 2.5 at elbow, or 4 mm for grafts.
Four indications for duplex surveillance of AVF or graft.
Check fistula maturity
Check for graft stenosis
Check for pseudos
Check outflow issues
What are the abnormal criteria for AVFs and dialysis grafts? (5)
Anastomoses PSV ratio > 3.0 Stenosis PSV ratio > 2.0 Depth > 0.5 cm Volume flow < 500 ml/min Vein diameter < 4 mm
List the PSV and Velocity ratio for normal, moderate, and severe stenosis.
Normal: PSV < 125 cm/sec, > 40 cm/sec
Mod: PSV 125-200 cm/sec, Vr 1.5-2.5
Severe: PSV > 180, Vr > 2.5
Protocol for infrainguinal bypass grafts? (5)
Ask about ischemic symptoms. Check fem and pedal pulses. ABI Color duplex of graft, inflow/outflow, anastomoses. Calc Vr of any stenosis.
What abnormalities may be found after CEA?
Intimal flaps
Myointimal hyperplasia
Progressive atherosclerosis
What abnormalities may be found after CAS?
Stent malposition
Separation of stent from vessel wall
Myointimal hyperplasia and atherosclerosis
List six arterial emergencies.
Ruptured AAA Carotid artery stenosis Carotid artery dissection Acute lower extremity ischemia Femoral pseudos Penetrating arterial trauma
AAAs are usually repaired when they reach what diameter?
5 - 5.5 cm
When is carotid artery stenosis considered an emergency? (4)
Patient neurologically unstable
Crescendo TIAs
Stroke in evolution
Acute carotid thrombus
Name four conditions associated with carotid artery dissection.
Type IV Ehler-Donles syndrome.
Marfan syndrome
FMD
Cystic medial necrosis
What criteria define impending extremity graft failure? (2)
< 45 cm/sec average PSV
ABI falls >= 0.15 from previous test
Arterial diameter norms (5)
Aorta: 30mm Iliac: 15mm CFA: 10mm SFA: 8mm Pop: 6mm
Name three methods of lower extremity graft re-intervention following PTA.
Atherectomy
Dilation with larger balloon stent
Dilation with prolonged inflation
Three classic symptoms of AAA?
Abdominal/back pain
Hypotension
Pulsatile abdominal mass
Six causes of cardiac thromboembolis?
Rheumatic heart disease MI Endocarditis Prosthetic valves Arrhythmia (esp. A-fib) Neoplasm
Eight demographic factors of population more prone to penetrating arterial trauma?
Age Gender Race Education Socioeconomic status Criminal record Alcohol/Drug use Gun ownership
Thromoangiitis obliterans is also known as what?
Buerger’s disease
List the four artery segments to and within the kidneys.
Renal arteries
Segmental arteries
Interlobar arteries
Arcuate arteries
Define “thrill”
Vibration felt over an artery, caused by turbulent blood movement.
Formula for Pulsatility Index?
(Systolic Peak - Diastolic Peak)/(mean across cycle)
Is flow reversal a characteristic of venous flow?
No
Which normally has lower resistance, the upper or lower extremities?
Upper
If a patient with claudication has a normal ABI, what’s the next step?
Exercise testing.
What is the normal effect of exercise on ankle pressure?
A slight increase or no change.
If there is a drop in ankle pressure after exercise testing, what does that mean for the test results?
Postive test
With a reactive hyperemia test, what is the immediate effect of cuff deflation on ankle pressure?
A transient drop in pressure.
What effect will clenching the fist have on arterial resistance and pulsatility?
Greater resistance and increased pulsatility.
