Arterial evaluation Flashcards
(170 cards)
1
Q
what would be the significance of finding a low resistance waveform in a peripheral artery?
a. the arterioles of the distal vascular bed are vasoconstricted
b. the waveform is consistent with a distal occlusion
c. blood flowing into a low resistance vascular bed rather than the expected high resistance bed
d. the flow pattern suggests a prix arteriovenous fistula
A
c. blood flowing into a low resistance vascular bed rather than the expected high resistance bed
2
Q
your department includes auscultation as a part of your physical exam, what is true about that technique?
a. you can osculate the aorta, femoral, pop, and tibial arts
b. the absence of a bruit excludes disease
c. the presence of a bruit indicates turbulent flow
d. auscultation provides an objective evaluation of blood flow patterns
A
c. the presence of a bruit indicates turbulent flow
3
Q
Ms. Smith presents to the vascular lab for arterial testing because she has 6 months history of pain in her calf muscles when she walks. if she has vascular disease what is the most likely cause?
a. atherosclerosis
b. embolism
c. arteritis
d. thromboangiitis obliterans
e. raynauds phenomenon
A
a. atherosclerosis
pg 47. the thickening hardening and loss of elasticity of the walls of the arteries. most common arterial pathology
4
Q
Which of the following is an advantage with the four cuff method of obtaining segmental pressures?
a. the high thing pressure more accurately reflects the patients systemic blood pressure
b. the four pressure measurements are more reliable in the evaluation of diabetic patients
c. the technique is better tolerated in the morbidly obese patient
d. the method allows the ability to differentiate proemial superficial femoral artery disease from distal superficial artery disease
A
d. the method allows the ability to differentiate proemial superficial femoral artery disease from distal superficial artery disease
5
Q
with the three cut method how should the thigh pressures compare to the brachial pressures in the following situations?
a. you would expect the thigh pressures to be lower than the brachial pressures to exclude proximal disease
b. thigh pressures are expected to be at least 30mmHg higher than the highest brachial pressure to indicate the absence of inflow disease
c. thigh pressures are expected to be similar to the brachial pressures in the absence of aortoiliac occlusive disease
d. the three cuff method is not accurate in the exhalation of proximal disease she brachial pressures are high
A
c. thigh pressures are expected to be similar to the brachial pressures in the absence of aortoiliac occlusive disease
6
Q
after the brachial pressures have been obtained which of the following represents the proper order of obtaining the lower extremity pressures?
a. the order can vary depending on the patients comfort level
b. the proper order is proximal cuff to distal curd on each extremity
c. the proper order is distal cuff to proximal cuff on each extremity
d. the order can vary from one extremity to the other depending on the sonographers preference
A
c. the proper order is distal cuff to proximal cuff on each extremity
pg. 73 sgmental pressures are obtained bilaterally ( one leg at a time from ankle to high thigh
7
Q
when interpreting segmental pressures measurements, which of the following factors is the least helpful?
a. comparison of the most proximal pressures reading with the higher of the two brachial pressures
b. evaluation of the pressure gradient between adjacent cuffs
c. calculations of the ankle/brachial index
d. identification of the horizontal pressure differences at the ankle level
A
d. identification of the horizontal pressure differences at the ankle level
8
Q
35 yo male who complains of pain in his feel with discoloration of his toes which if the most significant of his risk factors?
a. he has high blood pressure
b. he smokes 3 packs a day
c. he has high cholesterol
d. he has family history of CVD
A
b. he smokes 3 packs a aday
9
Q
35 yo male who complains of pain in his feel with discoloration of his toes and smokes three packs a day , which of the following disease processes does he most likely have?
a. chronic arterial occlusive disease
b. acute arterial occlusion
c. thromboangiitis obliterans
d. vasospastic process e.g raynauds
A
c. thromboangiitis obliterans
the most common form of arteritis is burgers disease aka thromboangiitis obli. characteristics are: heavy smoking, men younger than 40, presents with occlusions of the fingers or toes, has rest pain and ischemic ulceration etc.
10
Q
The _______ artery gives off a branch in the hand to form the superficial palmar arch. it terminates in the deep palmar arch.
A
Radial artery
11
Q
the _____ artery gives off a deep palmar branch then terminates in the superficial palmar arch. it is the predominant source of blood flow in the hang
A
ulnar artery
12
Q
The _____ supplies the stomach, liver panc duodenum and spleen
A
celiac artery aka celiac trunk
13
Q
the acending aorta arises from the left ventricle and has two branches what are they?
A
the right and left coronary arteries
14
Q
the parietal branches of the abdominal aorta are ? 3
A
inferior phrenic artery, lumbar arteries, middle sacral artery
15
Q
what are the terminal branches of the abdominal ao?
A
right and left common iliac arteries.
16
Q
what is the first branch off the distal popliteal artery?
A
the anterior tibial artery
17
Q
what is the second branch of the distal pop art?
A
the tibioperoneal trunk
18
Q
what does the tibioperoneal trunk give rise to?
A
the posterior tibial and perineal arteries
19
Q
Low resistance=_______ flow rate
A
higher
20
Q
higher resistance= ______flow rate
A
Lower
21
Q
Increased Viscosity= ______ velocity
A
Decreased
22
Q
Decreased viscosity= _______ velocity
A
increased
23
Q
R= ———-
A
R=8nl/ ~ r4
24
Q
what law defines the relationship between volume flow and resistance?
A
poiseulles law
25
what is poiseulles equation?
Q=P/R or Q= (P1-P2) ~r4/ 8nl
26
the size of a vessel is _________ proportional to the velocity of blood flow
inversely
27
reynolds number should never exceed what?
2000
28
When reynolds number exceeds ____ laminar flow becomes what?
2000 disturbed
29
_____ equation shows that velocity and pressure are inversely related
bernoulli principle
30
proximal to a stenosis the pressure energy is _____ and the kinetic energy is ______ this region has the nights total energy sum
higher, lower
31
total energy in the stenotic segment is ______than that in the prestenotic segment because energy is lost
less
32
distal to the stenosis the kinetic energy ______ and the pressure energy__________.
decreases, increases
33
_____ is the difference in pressure between two points in a vessle
pressure gradient
34
during _______ diastole flow moves forward again as the reflective wave hits the proximal resistance of the next oncoming wave and reverses direction again
early
35
diastolic flow reversal is a hallmark of the vessels that supply __________ vascular beds
high resistance
36
with vasodilation of a vessel (ska for example) what happens to diastolic flow reversal
absent or decreases
37
a double systolic peak is sometimes referred to as what?
pulsus bisferiens
38
adam has decreased peak systolic velocity with rounded waveform that is unilateral what is the likely cause?
severe proximal occlusive disease
39
adam has decreased peak systolic velocity with rounded waveform that is bilateral what is the likely cause?
cardiomyopathy
40
______ flow alterations usually attributed to vessel disease and extrinsic compression
unilateral
41
bilateral flow alterations suggest what?
cardiac involvement
42
the most common finding suggestive of a cardiac abnormality is what in the lower extremities?
pulsatile venous doppler
43
exercise causes peripheral ______ in the microcirculation so that distal peripheral resistances dimish and blood flow markedly increases
vasodilation
44
_______ is the best single vasodilator of high resistance vessels within skeletal muscle
exercise
45
high resistance vessels ______ in response to inceased blood pressure and ______ in response to decreased blood pressure.
dilate or constrict
constrict, dilate
46
a stenosis usually becomes hemodynamically significant when the cross sectional area of the arterial lumen is reduced _____% which corresponds to a diameter reduction of _____%
75, 50
47
what is the relationship between velocity, flow and cross sectional area of a vessel? equation
V=Q/A
48
fluid movement needs two things:
a route and difference in energy between two points
49
The amount of blood ejected is ?
Stroke volume
50
as heart rate increases what happens to blood volume?
increases
51
as pressure goes up what happens to volume?
goes up
52
if the radius of a vessel decreases what happens to the volume
decreases
53
if the length of a tube doubles what happens to the resistance?
Doubles
54
as radius decreases what happens to velocity?
increases
55
Where there is high velocity there is ___ pressure
low... bernoulli law
56
what happens to pressure gradient across a stenosis when flow doubles?
flow also doubles ( direct relationship
57
distal to a stenosis the reversal of flow in a biphasic or triphasic high resistance signals ________
disappears
58
in a critical stenosis what happens to both pressured flow volume?
decreases
59
ratio of the change in fluid volume to a change in pressures is that?
compliance, i.e. the blood leaving the heart during systole the AO becomes distended
60
peripheral resistance affects what type of flow more than the other?
systolic or diastolic?
diastolic flow more than systolic flow
61
as a vessel radius decreases, resistance_______
increases
62
reynolds equation:
velocity x density x radius / viscosity
63
what is ABI?
access perfusion in legs, ankle brachial ratio
64
what is the thechique that measures volume changes in a limb or organ?
plethsmography
65
oxygen content in tissue- sound healing, what is the tool called
trancutanous oximetry
66
what is used for the healing potential to an area of skin
laser doppler
67
a patient arrives at the offie with discoloration of her right big tow. all pulses are palpable. she denies pain in her legs with activity or pain that wakes her at night. she has no risk factors associate with arterial disease. what do you suspect is the most likely cause of her problem?
a. atherosclerosis
b. aneurysmal disease
c. raynauds phenomenon
d. coarctation of the ao
e. thromboangiitis obliterates
b. aneurysmal disease
68
when calculating the ankle brachial index what number do you use for the brachial?
the highest of the two arms
69
patient complained of pain in his left calf every time he climbs stairs. because the ankle brachial indices are wnl you will have the patient complete some form of exercise. which of the following is the lease likely to affect the decision to utilize a constant load treadmill?
a. recent severe cardiac arrhythmias
b. history of hyperlipidemia
c. total hip replacement resulting in limping
d. walks with a cane
e. sever hypertension
b. history of hyperlipidemia
70
after completing the exercise study, you believe the patient has a single level arterial disease based on which of the following conclusions?
a. the patient takes 2-6 minutes to return to his pre exercise pressures
b. recovery time is 6-12 minutes
c. recovery time is greater than 12
d. your patient never returns to pre exercise pressures
a. the patient takes 2-6 minutes to return to his pre exercise pressure
ankle pressures that drop to low or unrecordable levels immediately after exercise then increase to resting levels in 2-6 minutes suggest obstruction at a single level pg 79
71
T/F:
after completing the exercise study, you believe the patient has a multi level arterial disease based on the ankle pressures remaining reduced or unrecordable for more than 6 minutes
true
72
if your patient cannot walk on the treadmill, your protocol is to complete reactive hyperemia. which of the following is true?
a. it provides the same stress on peripheral circulations as a constant load treadmill
b. 12 cm wide ankle cuffs are inflated to 30 mmHg above the higher brachial
c. the proximal cuffs are inflated per protocol and the higher pressure is maintained for 1-3 minutes. upon deflation of the cuffs the ankle/brachial indicies are obtained
d. an abnormal response is 50% or greater decreases in the ankle pressure following cuff deflation
d. an abnormal response is 50% or greater decreases in the ankle pressure following cuff deflation
pg 80.
patients who have a single level disease experiences <50% drop in a ankle pressure
patients with multi level arterial disease experience a pressure drop > 50%
73
T/F treadmill testing is considered by many to be the preferable test to reactive hyperemia because it produces a physiologic stress that reproduces a patients ischemia symptoms
true
74
T/F patency of the radial artery is the most important criterion determining its suitability as a bypass conduit. during compression of the radial artery you record pig wave forms of digits #2 and #4. complete cessation of flow to the digits is a normal finding and the radial artery can be harvested
false
75
T/F patency of the radial artery is the most important criterion determining its suitability as a bypass conduit. during compression of the radial artery you record pig wave forms of digits #2 and #4. maintenance of flow to the digits is the desired finding and allows the radial artery to be used for the bypass
true
76
T/F patency of the radial artery is the most important criterion determining its suitability as a bypass conduit. the most frequently performed test in this case is the modified allen tests which determines the potency of the radial artery
false
77
performing a plethysmography exam the patient complains of bilateral hip/thigh pain with activity, you notice the amplitudes of the waveform are normal but there is no notch (reflection) n the downslope at any level bilaterally. what does this suggest?
a. expected finding
b. the lack of reflection rules out vascular disease
c. the findings mean the vessel is incompressible
d. this finding is likely based on the result of collateral arterial branches
d. this finding is likely based on the result of collateral arterial branches
pg 105
although the waveform maintains its amplitude the loss of the reflection is highly suggestive that this waveform is produced by the presence of collateral vessels
78
what is claudication:
pain in muscles during exercise but subsiding with rest
79
what does buttock claudication suggest? what if symptoms are unilateral?
aortoiliac disease. if symptoms are unilateral this suggests iliofemoral disease
80
patient presents with left lower extremity claudication, the right lower plethysmographic waveforms and dipper pressure are normal. the left showed rounded, broad plethysmographic waveforms at the thigh level which are similar in quality at the fall and ankle. these finding suggest?
a. multilevel disease of the left lower
b. significant lesion of the aortoiliac system
c. suspected left iliofemoral arterial obstructive disease
d. suspected left tibial vessel arterial stenosis
c. suspected left iliofemoral arterial obstructive disease
| pg. 45
81
35 year old woman comes in with worsening bilateral finger pain, numbness and coldness which she experiences intermittent for the past 15 years. billet PPGpressures and waveforms are obtained both before and after cold stress. before the waveforms were wnl after cold stress the waveforms had a slow upstroke and downslope, rounded peaks and disappearance of reflection on the down. these finding remained for as long as 5 minutes after cold immersion. this is most consistent with?
a. embolic process
b. thromboangiitis obliterates
c. primary raynauds
d. phlegmasia cerulea dolens
e. Atherosclerosis
c. primary raynauds
the normal waveforms are to return in less than 5 minutes. if they are abnormal at 5+ minutes its likely cold sensitive pg 113
82
your patient is scheduled for a lower extremity bypass graft. which of the following choices would make the most suitable bypass material
a. small saphenous: 1.5mmx1.8mm
b. great saphenous:3.2mmx 3.4mm
c. cephalic vein that measures 1.9mmx 1.9mm
d. basilic vein 1.6mmx 1.8mm
b. great saphenous: 3.2mmx 3.4mm
| Vein should be between 2-3mm
83
What is transcutaneous oximetry?
helps determine wound healing and amputation level
84
what is normal transcutaneous oximetry PtcO2 on the foot?
>50mmg
85
what is critical limb ischemia (CLI) PtcO2 (rest pain, ulcer, gangrene)
<30mmHg and more often<20 mmHg
86
T/F
| its rather common for arteries in the upper extremity to become stenotic
false
87
Your patient is scheduled for a coronary artery bypass graft (CABG) and the surgeon wants to use the right radial artery. T/F
The most frequently peformed test in this case is the modified allen test which determines the patency of the radial artery
False
It is to determine the patency of the ulnar artery to make sure it supplies blood to the digits while the radial artery is being compressed
88
What is a normal ABI?
>1.0 wnl
| >.9-1.0 also wnl
89
If a patient has an ABI of .8-.9 what would you expect?
Mild arterial disease
90
If a patient had a ABI of .5-.8 what would you expect?
Claudication ( moderate disease) pain while exercising that subsides at rest
91
If a patient has a ABI of
Rest pain ( severe arterial disease)
92
how is ABI calculated?
Dividing the ankle pressure by the higher of the two brachial pressures
93
If you have a ABI of >1.3-1.5 or higher what is that considered?
result of incompressible vessel
94
T/F normally the Ankle systolic pressure is less than the higher brachial pressure
false
pg 75
Normally the ankle systolic pressure is the same as or greater than the higher brachial pressure
95
T/F a decrease in pressure of >30mmHg between two consecutive levels is considered significant and would suggest significant obstruction
true
96
a horizontal difference of __-__ mmHg or more suggests obstructive disease at or above the level in the leg with the lower pressure
20-30
97
when a ankle pressure drops to low or is unrecordable immediately after exercise and then increase to resting levels in 2-6 minutes this suggests what?
obstruction at a single level
98
when a multilevel obstruction is present what would you expect for the ankle pressures?
they would remain reduced or unrecordable for more than 6 minutes.
99
your male patient is being evaluated for impotency. which of the following non invasive studies is lease helpful in this situation?
a. obtain plethysmographic recording at the thigh, calf, ankle and toe bilaterally
b. document doppler waveforms of the common femoral artery, posterior tibial art and dorsal pedis art bilaterally
c. use the doppler to obtain ABI
d. obtain penile pressures with ppg or doppler
e. calculate the penile/ brachial index PBI
a. obtain plethysmographic recording at the thigh, calf, ankle and toe bilaterally
pg 74 for theABI part of the answers...
when a full extremity study is not required, the brachial and ankle pressures are obtained bilaterally. the posterior tibial artery and dorsal pedis after are used for the ankle pressures
100
Penile Doppler: male patient has a ABI of .8 bilaterally using both the posterior tibial art and dorsals pedis artery, with penile/brachial PBI of.38 what is your impression of these findings?
a. he has some large vessel disease, but the PBI is normal
b. he may be impotent due to vascular disease of his aortoiliac arteries
c. he has blockage of the vessels feeding the penis but can't exclude proximal disease
d. he has a vasculogenic impotence from internal iliac artery occlusive disease
b. he may be impotent due to vascular disease of his aortoiliac arteries
pg 94
101
the penile brachial index is calculated using the higher brachial.... whats normal pressure?
> or equal to .75
102
what is a abnormal PBI?
103
Which side is it common to find a varicocele on?
left
104
___________ of flow noted during valsavla id a diagnostic of a varicocele
reversal
105
regarding dialysis access grafts the venous anastomosis and outflow vein are the most common sties for what?
stenosis
106
______________ is when the distal arterial ( high pressure) blood flow is reversed into the low resistance (low pressure) venous side of the dialysis access
steal syndrome
pg 125 figure 12-9
with manual compression of the graft, thereby eliminating its influence on the digital flow, the waveform normalizes. this finding is consistent with steal, i.e. the dialysis access is stealing blood form the digits because of the altered pressure gradient
107
what is brachial artery reactive testing?
it asses the ability of the endothelium to regulate vasodilation by measuring the degree to which the brachial artery dilates in response to reactive hypermia
108
with reactive hypermia of the brachial artery what should the healthy endothemium increase by when the cuff is on the upper arm?
> or= 10% when the cuff is on the upper arm
109
with reactive hypermia of the brachial artery what should the healthy endothemium increase by when the cuff is on the lower arm?
increase by at least 6%
110
what is the doppler equation? what does Fo stand for?
^f=2FoVCos0/c; carrier frewuency ( trandsucer frequency)
111
what is the speed of ultrasound in tissue?
1540 m/sec
112
what is reversed saphenous vein graft?
saphenous vein is reversed prior to anastomosis to the proximal and distal portions of the artery ie small end of vein to prox end of art and larger end of vein to distal end.
113
once the vein is connected to the artery it becomes_______. shortly there after the vein becomes more__________
arterialized, consistant
114
what is in situ vein graft?
(GSV) is left in place with the prox and dist ends anastomosed to the required artery. prior to the anastomosis the valves are broken up
115
why is it crucial to evaluate anastomotic sites particularly in synthetic bypass grafts?
pseudoaneuryms
116
when evaluating stenosis of a native artery what 2 velocities are you comparing?
the stenotic peack systolic velocity is compared to the prestenotic peack velocity
117
with stenosis of a native artery what does an increase in veloicty >100% represent?
>=50% diameter reduction
118
a stenotic to prestenotic PSV ratie>4:1 suggests?
>=75% diameter reduction
119
a stenotic PSV of >= 400 cm/sec also suggests a?
>=75% diameter reduction
120
significant stenoses and occlusions commonly occur at the level of the ________ in the distal superficial femoral artery and pop artery
adductors canal ( hunters canal)
121
when performing a vein bypass graft a decrease of ___cm/sec from a previous study to the current study is considered a significant change
30
122
when performing a vein bypass graft a decrease of _____ in the ABI from a previous study to the current study is considered a significant change
>.15
123
the accepted criterion for diagnosis of an aneurysm is an increased in diameter of ______ or greater than the native artery
50%
124
T/F the "neck" and to and fro waveforms are diagnostic hallmarks of a pseudoaneurysm
true
125
in bypass grafts only the expected findings include a PSVs of _______ cm/sec and a lower resistance flow in the distal graft outflow artery
>45
126
abnormal findings in a stenosis or graft defect with a PSVs _____ cm/sec and a velocity ratio______
>180 cm/sec and velocity ratio of >2.5
127
abnormal findings with a graft is you find a low PSV what would you assess for?
inflow disease or for a systemic cause
128
When peforming a surveillance of lower extremity vein bypass graft, consider revision if:
* Focal PSV is ____cm/sec
* intrasetnotic to prestenotic systolic velocity ration (SVR) ___
* there is high outflow resistance( no diastolic flow)
* intervial decrease in ABI of ______
>200 cm/s
>30
>0.2
129
for the AO a dilatation of >____cm qualifies for designation as an aneurysm. in general an increase in diameter of ___% or more qualifies an artery as aneurysmal
3cm, 50%
130
the majority of AAAs are atherosclerotic and located ________
infrarenal
131
the most frequent complication and danger of a AAA is?
rupture
132
both ________ and ________ are considered primary complications of perpheral arterial aneurysms
embolism and thrombosis
133
__________ is a secondary form of high blood pressure and is often caused by what?
renovascular hypertension, renal artery stenosis or occlusion
134
when performing a renal artery kidney exam the examiner begins with what? state the protocol
obtain velocities from the celiac and superior mesenteric arteries, PSV of the AO just distal to SMA, Peak and end Diastolic renal artery PROX,MID, DST bilaterally, segmental arteries and interlobar arteries
135
Renal arteries are normally characterized by
low resistance
136
Celiac, hepatic and spelenic arteries are ______ resistance
low
137
Aortic flow is __________ resistance
high
138
a fasting SMA and IMA will have ____ resistance
high
139
renal to aortic ratio (RAR) is calculated how
dividing the highest peak systolic velocity of the renal artery by the PSV of the AO
140
Normal RAR is ?
<3.5
141
abnormal RAR is?
>= 3.5 this indicates a 60% or greater diameter reduction
142
Kidney arterial flow: the kidney artieries ( segmental, interlobar, arcuate) are normally characterized by their ______ resistance
low
143
ratios such as end diastolic ratio also know as parenchymal resistance ratio or diastolic/ systolic ratio ( DSR) can be applied if flow resistance has increased ( which is considered abnormal_ what is the equation?
end-diastolic velocity/ peak systolic velocity
144
what are normal results for end diastolic ratio? abnormal?
>= .2 ,
145
another ratio used for kidney arterial flow is Pourcelots ratio/ resistive index (RI)... what is the quation?
PSV-EDV/PSV
146
another ratio used for kidney arterial flow is Pourcelots ratio/ resistive index (RI). what is normal? abnormal?
< .7, >= .7
147
renal resistive index values ( RRIV) also uses peak systolic velocity and end diastolic velocities obtained from the segmental artieres. a lower resistance RRIV value of ______ is associated with improvement in both blood pressure and renal function after the correction of renal artery stenosis
148
a RRIV of >=.75 is a strong indicator of?
worsening renal function and lack of blood pressure improvement despite correction
149
patients who suffer from dull, achy, crampy abdominal pain 15-30 minutes after meals may suffer from?
mesenteric ischemia
150
post prandial testing is performed more often to evaluate the function of what?
mesenteric bypass graft
151
in a fasting state SMA blood flow should be ?
high resistance
152
after eating the SMA flow changes to ?
lower resistance
153
T/F the pattern of blood flow in the celiac artery is affected postprandially
false, it is not affected
154
which of the following choices is the most frequent complication from an abdominal aneurysm?
a. vasospasm
b. rupture
c. acute occlusion
d. compartment syndrome
b. rupture
155
patient is status post endovascular repair of aortic aneurysm. what post op finding requires attention?
a. peak systolic veloticy of 76 cm/sec in the aorta proximal to the endovascular graft
b. biphasic doppler signals throughout the endograft
c. unchanged amount and contour of mural thrombus in the aneurysmal sac
d. increasing size of the aneurysmal sac
d.increasing size of the aneurysmal sac
156
you are asked to document just the flow velocities in the dialysis graft, rather than performing a complete eval. what is the significance of a peak systolic velocity of 85 cm/sec?
a. this is normal flow
b. the patient has an arterial inflow problem
c. this is accelerated flow and consistent with graft stenosis
b. the patient has an arterial inflow problem
157
if peak systolic velocities are > 400 cm/sec in the femoral artery the probable diameter reduction is?
a. >50%
b. 50%
c. >= 75%
d. >= 90%
c. >= 75%
158
as you evaluate a reversed saphenous vein bypass graft which finding is within normal limits?
a. ABIs are reduced by>.15 compared to previous exam
b. some retrograde doppler flow in the native vessel at the distal anastomosis
c. peak systolic velocity of 384 cm/sec is evident at the proximal anastomosis
d. decreased PSVs that are evident at the smallest graft diameter
b. some retrograde doppler flow in the native vessel at the distal anastomosis
159
which of the following qualities is most consistent with an AAA?
a. diameter measurment of >3cm
b. increase in diameter of 25%
c. Longitudinal measurment of 5 cm
d. diameter measurment of <2 cm
a.diameter measurment of >3cm
160
high resistance flow patterns are expected in which of the following arteries?
a. preprandial SMA
b. postprandial celiac artery
c. renal arteries
d. preprandial hepatic artery
a. preprandial SMA
161
what would be the significance of finding PSVs of 48 cm/sec on the AO and 172 cm/sec in the left renal artery?
a. consistent with a 50% diameter reduction of the left renal artery
b. wnl
c. documents a >=60% diameter reduction of LRA
d. consistent with >= 75% diameter reduction of LRA
c. documents a >=60% diameter reduction of LRA
renal artery PSV/ PSV of the ao = 172/48=3.5
>= 3.5 indicates a 60% or greater diameter reduction
162
T/F when evaluating for flow accelerations in the celiac artery, you would compare peak systolic velocities with inspiration and exhalation
true
163
you are able to obtain four blood pressure measurements simultaneously, this method can be utilized in all but which of the following scenarios?
a. right finger,rt ankle, lt arm, penis
b. lt calf, rt arm, lt toe, rt thigh
c. penis, lt arm, left ankle, rt arm
d. rt forearm, rt calf, lt arm, lt ankle
b. lt calf, rt arm, lt toe, rt thigh
164
you are evaluating a endovascular repair of an AAA. if you were to detect flow in the aneurysmal sac at the distal/ inferior attachment site what would you have identifies?
a. type I endoleak
b. not a problem but expected
c. type ii endoleak
d. it is unexpected but not considered an endo leak
a. type I endoleak
| Type I: attachment endoleak at proximal and or distal attachment sites
165
if your patient had a type II graft leak what would you expect?
branch leaks, branches include lumbar artery and IMA
166
if your patient had a type III graft leak what would you expect
modular connect endoleak
167
if your patient had a type IV graft leak what would you expect
minute tears in the fabric or from changes in the pall porosity
168
T/F if an endoleak originates from the endograft itself ( attachment leak) then the waveforms sprctral quality will be similar to that with in the graft
T
169
T/F if a endoleak originates from branch vessels it will have the same spectral waveform from that with in the graft
False if a endoleak originates from branch vessels it will have the different spectral waveform from that with in the graft
170
if a patient has a status post endovascular repair of a AAA and there is flow in the aneurysmal sac which appears to be coming from the lumbar artery what do you think the significance of this finding is?
type II endoleak
