Arterial Imaging Flashcards by Pedro Garay

A PT has history of previous l. Femoral to posterior bypass 6 mo ago, symptoms now, pain after walking blocks, small ulceration on L lateral ankle, L ABI’s = 0.74, Doppler wave forms are monophasic, these are findings of:

ABI’s fit in claudication twanged, decrease in ABI’s of less than 0.15, Doppler wave changes from biphasic to monophasic, no pain at rest

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A PT has pain after 20 mins after eating for a couple of months, PT has lost 10 lbs, SMA & celiac artery have PSVs of less than 300 cm/sec, elevated EDVs & post-stenotic turulance, what are findings?

SMA stenosis is less than 75%, Doppler fits stenosis profile, elevated PSV’s of both vessels, not celiac stenosis over 70%

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Radial artery mapping is currently being used to determine if the radial artery can be used for which of the following?

Coronary artery bypass graft

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What is the most frequent complication of a peripheral artery aneurysm?

Embolization

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What complication of an aorta stent graft can cause the aneurysm to increase in size?

Endoleaks

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A PT is in lab to evaluate her right arm dialysis access graft baca use the dialysis department is having trouble using it, what’s the problem?

Normal triphasic arterial signals throughout the arterial side of fistula. Fistula is working properly is elevated diastole in artery flow, fistula not working arterial flow pattern high resistant

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With respect to renal duplex findings, all are considered normal findings:

RAR= 3.0. PRR= 0.3. RI= 0.5. Not normal kidney EDR= 0.10 abnormal over 3.5 for RAR, renal to aortic ratio

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True about angiography:

Complications for neurologic symptoms, puncture at hematoma is possible, obtaining more than one view during procedure is standard. Contrast agent can not be used in PT’s allergic contrast or have kidney failure cannot have contrast

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As you evaluate a PT with a synthetic graft, what is the biggest reason for graft failure?

Problems at the anastomotic sites

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How to calculate RAR( renal to aortic ratio)?

Divide highest renal artery PSV on each side by the aorta PSV

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The TRAM flap procedure is utilized for one of the following?

Autogenous breast reconstruction. Tram means transverse rectus abdominis myoctaneous flap

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During a Doppler exam on aorto-iliac system, a velocity combo that indicates that stenosis in the aorta is closer to a 50% diameter reduction. In order for stenosis to be 50% or greater:

The stenosis PSVs must be al least twice the pre-stenosis PSV’s, the higher the ratio, the higher stenosis

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A PT has uncontrollable hypertension. The left side w/ 20cm/s on renal kidney arteries, the right side renal kidney arteries are normal, what could this indicate?

Proximal renal artery pre-occlusive disease, proximal high grade stenosis will dampen arterial signals, but not change resistance(diastolic flow same)

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What effect does eating have on SMA flow patterns?

when fasting flow has low end diastolic velocities, high resistance

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All of the following veins can be mapped for suitability used as extremity bypass grafts:

Cephalic vein, small saphenous vein, basilic vein, great saphenous vein, can not use gastrocnemius vein

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Duplex imaging evaluates anatomical findings as well as blood flow characteristics. What vessel has little to no flow in end diastole?

External carotid artery

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True about liver transplants?

All major liver vessels evaluated w/Doppler, b-mode evaluation required, posts-op complications include: PV or IVC or hepatic artery thrombosis, also acute rejection will cause liver dysfunction.

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A PT had a dialysis access graft for 2 yrs, he has hand pain on exertion, associated w/ pallor & coolness of skin, what’s the cause?

Steal syndrome

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All of the following determine the amount of blood flow that moves thru artery:

Resistance, volume & pressure. Hydrostatic energy not a factor

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What is considered the best landmark to help identify the left renal artery?

Left renal vein

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All is true about Doppler flow patterns related to arterio-venous fistulas:

Flow thru fistulas has lower resistant & higher velocities, venous outflow is more pulsatile, distal arterial flow may is reduced. Not higher resistance proximal(lower resistance).

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Possible complications of a renal artery transplant?

Tubular necrosis, infection, increased cortial echogenicity, renal vein thrombosis, increased arterial resistance sign of rejection, and increased renal transplant size

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A PT has an aortic occlusion, what route would most likely be used for a bypass graft?

Axillary to bifemoral

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Statement most accurate about in-situ bypass grafts?

Complications usually related to AVF formation and/or retained valve cusps

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What is the most commonly used for an in-situ bypass graft?

Non reversed saphenous vein

A PT w/ uncontrollable hypertension come in for renal artery duplex exam, aorta PSV and the highest PSV's for R & L arteries, what is the correct RAR calculation?

Renal to aortic ratio: divide highesti renal artery PSV on each side by the aorta PSV

What disease process can result in rupture, embolization and/or stenosis?

Abdominal aneurysm

Conditions evaluated by an UE duplex study?

Subclavian artery stenosis, dialysis access graft stenosis, AVF. Not, Native atherosclerosis is rarely found

The parenchymal resistance ratio(PR) can be applied to the Doppler data obtained from segmental arteries in the kidney, what is the reason this if done?

To determine the presence/absence of increased resistance, normal would be low resistance, if high resistance, would suggest disease distal

Causes of mesenteric angina:

Stenosis/occlusion of IMA, SMA, celiac artery, not gastric artery

True about angiographic interpretation:

Normal flow fills the vessel lumen, atherosclerosis plaque appears as irregular or smooth, extent & location of filling defects are determined. Not a Primarily functional study

A distinct difference between magnetic resonance(MR) angio & CT angio?

MRA uses radio-frequency energy, CT employs ionizing radiation

Evaluating a PT w/ a duplex imaging exam, what is the ideal Doppler angel?

60 degrees

Blue toe syndrome caused by? Blue toe is due to a small piece of plaque that breaks loose, travels distally to smaller digital vessel

Atherosclerotic lesion, arteritis, abdominal aneurysm, not regular plaque(vasospastic disorder).

Medical treatment includes lifestyle modifications:

Protect & prevent injury/inflection, stop smoking, control weight, & maintain exercise, not pharmacological(meds)

Most common cause of aortic aneurysm?

Atherosclerosis

A PT undergoes a in-situ bypass, what post-operative complication compared to other forms is bypass operations?

A fistula formation

A PT had both of the great saphenous veins have been harvested, unfortunately all of the UE veins are inadequate size, what alternative vein could be used?

The small saphenous vein

What factor has the greatest influence on resistance blood flow?

Size of the vessel lumen

Hemodynamically significant of 50% diameter reduction, what equates reduction area?

75% area reduction

During duplex exam, woman's PSV's of 350+cm/sec associated w/ turbulence throughout access graft, the PSV's of the inflow artery was 150 cm/sec, what is her situation?

There is no standard stenosis criteria, these findings are most likely in normal limits

The following describes the flow direction in a normal portal vein?

Hepatopetal is a term for flow moving into the liver

True about Doppler flow patterns related to arterio-venous fistula:

Distal arterial flow maybe reduced, venous outflow is more pulsatile, flow thru fistula has lower resistance & high velocities, proximal arterial flow is lower resistance

Following is important for a successful bypass graft:

Good arterial in/out flow, continuity of the bypass conduit, collateral a not required for a successful bypass graft

Another term for stent:

Scaffold To maintain the intraluminal patency, it holds the artery wall in place

In the presence of celiac artery stenosis, what vessel can have retrograde flow?

Hepatic artery

A PT w/ arortic occlusion, what route would most due for bypass graft?

Axillary to bifemoral

What non-invasive finding is associated with potential graft failure?

Reduced flow velocities

After a graft surveillance exam, what might prompt surgeon to order angiogram?

Peak systolic velocities are reduced from 70 cm/sec in previous study to 40 cm/sec now

Why is the PT referred to vascular lab for performance if s radial artery mapping?

Determine viability of use for coronary bypass

A PT w/ pain occurring about 20 mins after eating for a couple of months & list 10 'pounds, celiac & SMA arteries have PSV's of > 300 cm/sec, elevated EDV's & post-stenotic turbulence, what are these findings?

Elevated PSVs of both vessels, SMA stenosis is >70%, Doppler fits stenosis profile. Not celiac stenosis of

Another term for poor quality, weak yet, low resistant Doppler signal is?

Tardus-parvis

The structure stretching from anterior superior border of the iliac crest to the pubic bone, also landmark when external iliac artery changes name to common femoral artery:

Inguinal ligament

If a PT is scheduled for a right lower extremity bypass other than in-situ bypass, which graft material would most likely be used?

Ipsilateral great saphenous vein

Normal findings are considered following a renal duplex exam:

RAR= 3.0. RI= 0.5. PRR=0.3. Not kidney EDR= 0.10

What vessel in normal flow characteristics do you expect to have little or no flow in end diastole?

External carotid artery, high resistant

A PT is examined for a potential in-situ bypass graft, what is likely to occur because of that procedure?

true: problems are possible within the body of the graft as well. The great saphenous vein will be used, after bypass expect valves to be broken during operation, vessels stay in same anatomical location before/after operation

Frequent complication of a peripheral artery aneurysm?

Embolization

True about abdominal aortic aneurysm:

Embolization & rupture are the most frequent complications, PT prior aneurysm have higher incidence of more aneurysms, this type is called a true aneurysm, most common location is?

In addition to atherosclerosis another cause of significant stenosis of the main renal artery(s) is?

Fibromuscular dysplasia

Blood flow patterns based on spectal analysis is important of any noninvasive study, what vessels normally have a lot of flow throughout diastole?

Hepatic artery

A PT had a left femoral to posterior tibial bypass 6 mo ago, PT has calf pain walking 2 blocks, small ulceration on left lateral ankle, ABI = 0.74, Doppler wave is monophasic. All of the following meet criteria:

ABI's fit into claudication range, decrease in ABI's of > 0.15, Doppler wave changed from biphasic to monophasic. Rest pain not present

What artery does not directly branch off the aorta?

Splenic artery. Arteries directly branch off aorta are: renal art, superior mesenteric art, common iliac artery

A PT had a dialysis access graft 2 yrs ago, symptoms of his c/o hand pain on exertion, associated w/ pallor & coldness, what is this likely cause?

Steal syndrome

A PT has pain about 20mins after eating for 3 months, lost 10 pounds, SMA & Celiac artery have PSV's of >300 cm/sec, elevated EDV's & post stenotic turbulance, what's correct?

Doppler info fits stenosis profile, SMA stenosis > 70%, elevated PSVs of both vessels of celiac & SMA arteries

A PT has a R LE bypass other than an in-situ bypass, what graft material would be used?

Ipsilateral great saphenous vein

Limitations to performing a complete or successful abdominal duplex scan:

Bowel gas, previous abdominal surgery, shortness of breath and size of PT. Not, whether or not they fast or if PT is in pre-prandial state not a limitation

When evaluating the arterial system for stenosis, where would you expect to see high velocities w/ an hemodynamically significant lesion?

Just proximal to, through and distal to the stenosis. Important to sample throughout

During renal art exam finds Kinsey measuring 9cm, w/ tardus parvus flow in the interlobar arteries, this is consistent w/ what type of pathology?

Proximal ipsilateral renal artery stenosis

A PT has a little abdominal pain & cramping that occurs 15-20 mins after eating meals, this pain is known as mesenteric angina, May due to stenosis/occlusion in what vessels?

SMA, IMA or celiac

Best choice for transducer frequency for abdominal vessels would be?

2-4 MHz

The following are branches off the celiac artery:

Splenic art, haptic art, left gastric art. Not right gastric artery

Arteriovenous fistulas & retained valve cusps can be a problem w/ this surgical procedure?

In-situ saphenous vein bypass(non-reversed)

Evaluating flow patterns of lower extremity arteries, what characteristics normally expected?

Sharp upstroke, period of forward flow, & phased flow reversal. Not a round peak

All of the following veins can be mapped for suitability & used for bypass grafts:

Small & great saphenous vein, cephalic & basilic vein, not gastrocnemius vein

Radial artery mapping is currently used for:

Tram flap reconstruction, palmar artery bypass & lower extremity bypass. Not coronary bypass

All can be considered causes of mesenteric angina:

Stenosis possible in celiac art, SMA, IMA or occlusion of celiac art. Not possible in left gastric artery

The number 2 represents in measuring Doppler shift frequency(Df)?

Doppler shifts, red blood cells act as stationary field then as wave source

A PSV Doppler velocity(PSV) info during a renal exam indicates 60 % or more diameter reduction?

Aorta PSV =50 cm/sec & left renal art PSV = 200 cm/sec

Using color Doppler the portal vein(PV) & hepatic artery(HA) are visualized in long axis side by side in normal flow:

Same Color, both vessels take blood to liver

A PT has PSV's of 350+ cm/sec w/ turbulance, PSVs if the inflow artery was 150 cm/sec, based on this what would be correct?

Although there is no standard stenosis criteria, these are most likely on normal limits

Significant stenosis of 50% diameter reduction equates to which of the following area reductions?

75% area reduction

What graft material is most commonly used for an in-situ bypass graft?

Non-reversed saphenous vein

A PT had. Left femoral to posterior tibial bypass 6 months ago, hams pain walking & sm ulceration on L ankle laterally, L ABI's =0.74, wave forms monophasic, PT won't have?

Rest pain, all others fit into claudication range

A PT with a left iliac obstruction, where would be the bypass graft?

R fem-L femoral bypass graft

Post-prandially, what happens to the PSV from the normal fasting celiac artery?

No change, celiac art flow pattern is unchanged after eating

What is the ideal angle for Doppler in a duplex image?

Do not exceed over 60 degrees

Claudication range is

.5-.9. Most abnormal ABI's is from LDPA(110 divided by highest brachial BP of 160 yields a L ABI of .66)

Changing from a 40 to a 60 degrees angle, how would that change the calculated velocity?

The calculated velocity would increase

Lifestyle modifications include:

Stop smoking, control weight, maintain exercise & prevent injury/infection, not med's that is pharmacology not modification

Most common sites where stenosis occurs in the hemodialysis access grafts?

Venous anastomosis & venous outflow vein

True about angiographic interpretation:

Primary anatomic study, normal anatomy seen as contrast fills vessel luman, extent & location of filling defects, atherosclerosis plaque appears irregular/smooth, not a functional study

Reasons for post insertion surveillance of stent grafts?

Leaks, migration or intimal hyperplasia. Least likely reason for surveillance is plaque formation

What occurs when a PT has an angioplasty?

Dilates focal plaque formation, percutaneous transluminal angioplasty(PTLA) used to dilate focal plaque formation

Why a PT is in lab for performance of radial artery mapping?

Determine viability of radial art for use for coronary bypass

Important for a successful bypass graft:

Good arterial inflow & outflow, continuity of the bypass conduit. Collateral routes not required for successful bypass graft

True about in-situ bypass grafts:

Complications usually related to AVF formation &/or retained valve cusps

Flow direction in the normal portal vein?

Hepatopetal, term meaning into liver

R ABI is 160, L ABI is 160, LPTA is 120, LDPA is 110 , based on this, what disease type does the abnormal ABI's fit into?

Claudication, .5-.9 is the claudication range. Most abnormal ABI's come from LDPA, calculated: 110 divided by the highest brachial BP of yeilds a L ABI of .66

A PT having a renal duplex ordered not to eat, smoke or exercise prior to exam, Doppler signal displays in what artery?

Renal, on the sentence

During a renal duplex exam, what indicates a 60% or greater diameter reduction?

Aorta= PSV 50 cm/sec. L renal artery= PSV 200 cm/sec

A PT is being arterial mapped prior to a TRAM procedure, during work up a bruit is auscultated over L supraclavicular region, doc is worried about breast reconstruction procedure possible or not?

Because the internal mammary artery is a branch of the subclavian artery

A tech having trouble using dialysis access graft on the right arm, what could be a problem?

Normal triphasic arterial signals throughout the arterial side of fistula, when fistula is working the arterial flow is elevated diastole, if not working properly arterial flow would be normal(high resistant pattern)

A PT has pain 20mins after eating for 2months, lost 10lbs, SMA & celiac artery have PSV's of >300 & EDV's of post stenotic turbulence, what's true:

Elevated PSVs in both vessels, fits stenosis profile, SMA stenosis is >70%, celiac does not have stenosis

True about abnormal interpretation criteria for a lower exam: any drop of ABI's >0.15 compared to previous numbers is considered abnormal

Also decrease of 30 cm/sec in any graft segment, Doppler change( tri to biphasic or if an AV fistulas or valve leaflet present

In addition to atherosclerosis, another cause of main renal artery(s) is ?

Fibromuscular dysplasia

A PT is scheduled for a right fem-left fem bypass, what would make this the bypass choice?

Left iliac obstructions is the reason

Best landmark to identify the left renal artery?

Left renal vein

A PT w/ dull, crampy abdominal pain occurs 15-20 mins after meals, known as mesenteric angina, may be stenosis/occlusion in what vessels?

IMA, SMA, celiac art, not left gastric

Resistance is inversely proportional to what variable in denominator?

Radius

Most common cause of aortic aneurysm is?

Atherosclerosis

What anatomic structure stretching from the anterior, superior border of iliac crest to pubic bone?

Inguinal ligament, also landmark for external iliac art changes to common femoral art.

Most common sites where stenosis occurs in the hemodialysis access graft?

Venous anastomosis and outflow vein

Why is a PT referred to lab for performance of a radial artery mapping?

Determine viability of use for coronary bypass graft

When a PT is fasting for evaluation of SMA?

Fasting will produce low end diastolic velocities

A tech changes from 30 degrees to 60 degrees, how does that change the calculated velocity?

Calculated velocity will increase

Do not exceed 60 degrees when obtaining?

Doppler info for velocity measurements

Spectral analysis shows blood flow patterns, what vessels would normally have a lot of flow throughout diastole?

Hepatic artery