Arterial

Question 1

Preferred order of dialysis access placement?

Answer 1

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

Question 2

For pre-op assessment for dialysis access, what arterial and venous diameters are required?

Answer 2

Arteries min 2 mm

Veins min 2 mm at wrist, 2.5 at elbow, or 4 mm for grafts.

Question 3

Four indications for duplex surveillance of AVF or graft.

Answer 3

Check fistula maturity
Check for graft stenosis
Check for pseudos
Check outflow issues

Question 4

What are the abnormal criteria for AVFs and dialysis grafts? (5)

Answer 4

Anastomoses PSV ratio > 3.0
Stenosis PSV ratio > 2.0
Depth > 0.5 cm
Volume flow < 500 ml/min
Vein diameter < 4 mm

Question 5

List the PSV and Velocity ratio for normal, moderate, and severe stenosis.

Answer 5

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

Question 6

Protocol for infrainguinal bypass grafts? (5)

Answer 6

Ask about ischemic symptoms.
Check fem and pedal pulses.
ABI
Color duplex of graft, inflow/outflow, anastomoses.
Calc Vr of any stenosis.

Question 7

What abnormalities may be found after CEA?

Answer 7

Intimal flaps
Myointimal hyperplasia
Progressive atherosclerosis

Question 8

What abnormalities may be found after CAS?

Answer 8

Stent malposition
Separation of stent from vessel wall
Myointimal hyperplasia and atherosclerosis

Question 9

List six arterial emergencies.

Answer 9

Ruptured AAA
Carotid artery stenosis
Carotid artery dissection
Acute lower extremity ischemia
Femoral pseudos
Penetrating arterial trauma

Question 10

AAAs are usually repaired when they reach what diameter?

Answer 10

5 - 5.5 cm

Question 11

When is carotid artery stenosis considered an emergency? (4)

Answer 11

Patient neurologically unstable
Crescendo TIAs
Stroke in evolution
Acute carotid thrombus

Question 12

Name four conditions associated with carotid artery dissection.

Answer 12

Type IV Ehler-Donles syndrome.
Marfan syndrome
FMD
Cystic medial necrosis

Question 13

What criteria define impending extremity graft failure? (2)

Answer 13

< 45 cm/sec average PSV

ABI falls >= 0.15 from previous test

Question 14

Arterial diameter norms (5)

Answer 14

Aorta: 30mm
Iliac: 15mm
CFA: 10mm
SFA: 8mm
Pop: 6mm

Question 15

Name three methods of lower extremity graft re-intervention following PTA.

Answer 15

Atherectomy
Dilation with larger balloon stent
Dilation with prolonged inflation

Question 16

Three classic symptoms of AAA?

Answer 16

Abdominal/back pain
Hypotension
Pulsatile abdominal mass

Question 17

Six causes of cardiac thromboembolis?

Answer 17

Rheumatic heart disease
MI
Endocarditis
Prosthetic valves
Arrhythmia (esp. A-fib)
Neoplasm

Question 18

Eight demographic factors of population more prone to penetrating arterial trauma?

Answer 18

Age
Gender
Race
Education
Socioeconomic status
Criminal record
Alcohol/Drug use
Gun ownership

Question 19

Thromoangiitis obliterans is also known as what?

Answer 19

Buerger’s disease

Question 20

List the four artery segments to and within the kidneys.

Answer 20

Renal arteries
Segmental arteries
Interlobar arteries
Arcuate arteries

Question 21

Define “thrill”

Answer 21

Vibration felt over an artery, caused by turbulent blood movement.

Question 22

Formula for Pulsatility Index?

Answer 22

(Systolic Peak - Diastolic Peak)/(mean across cycle)

Question 23

Is flow reversal a characteristic of venous flow?

Answer 23

No

Question 24

Which normally has lower resistance, the upper or lower extremities?

Answer 24

Upper

Question 25

If a patient with claudication has a normal ABI, what’s the next step?

Answer 25

Exercise testing.

Question 26

What is the normal effect of exercise on ankle pressure?

Answer 26

A slight increase or no change.

Question 27

If there is a drop in ankle pressure after exercise testing, what does that mean for the test results?

Answer 27

Postive test

Question 28

With a reactive hyperemia test, what is the immediate effect of cuff deflation on ankle pressure?

Answer 28

A transient drop in pressure.

Question 29

What effect will clenching the fist have on arterial resistance and pulsatility?

Answer 29

Greater resistance and increased pulsatility.