Ch 15 Ao + iliac arteries

Question 1

What is an endoleak?

Answer 1

The continued blood flow into an excluded aneurysm after endovascular placement of a stent graft

Question 2

What is an endovascular aneurysm repair?

Answer 2

Form of minimally invasive surgery where a stent graft is placed inside an aneurysm, providing a new channel for blood flow + excludes flow from the dilated walls of the artery

Question 3

Differentiate fusiform + saccular?

Answer 3

Fusiform: elongated + spindle shaped, circumferential widening of Ao (m/c)

Saccular: sac-like or pouch-like bulging of 1 wall, due to infection, trauma, or penetrating ulcer

Question 4

What is a stent?

Answer 4

Tube like structure placed inside a blood vessel to provide patency + support

Question 5

What are the branches off the descending thoracic Ao?

Answer 5

Bronchial, esophageal, phrenic, intercostal + subcostal arteries

Question 6

What level of the spine does the abdominal Ao begin at?

Answer 6

T12 - passes through aortic hiatus of diaphragm

Question 7

What are the 3 anterior branches of the abdominal Ao?

Answer 7

-Celiac artery (1-2cm long)
-SMA (1cm below CA)
-IMA (3-4cm above Ao bif)

Question 8

The celiac artery gives rise to which 3 arteries?

Answer 8

HA, SA + LGA

Question 9

What does the SMA supply + what course does it take?

Answer 9

-Supplies the small intestine + part of large
-Courses inferiorly, running parallel + anterior to the Ao

Question 10

What does the IMA supply?

Answer 10

Large intestine

Question 11

What is the seagull sign?

Answer 11

CA, HA, SA

(LGA not seen)

Question 12

List the lateral + paired branches of the abdominal Ao?

Answer 12

-Renal arteries (1-2cm below SMA)
-Gonadal arteries: testicular + ovarian arteries (branch off below RAs)

Question 13

List the posterior branches of the abdominal Ao?

Answer 13

-Lumbar arteries (4 pairs, sometimes 5)
-Middle sacral artery

Question 14

Which renal artery is longer + higher?

Answer 14

RT (courses posterior to IVC to get to RK)

Question 15

The renal arteries enter the kidneys posterior or anterior to the renal veins?

Answer 15

Posterior

Question 16

Course of lumbar arteries?

Answer 16

Lateral + posterior to lumbar vertebrae

Question 17

What is the middle sacral artery?

Answer 17

-Small branch that arises just above Ao bif
-Supplies sacrum, coccyx + lumbar vertebrae

Question 18

The abdominal Ao bifurcates at what level of the spine?

Answer 18

L4 (into the RT + LT common iliac arteries)

Question 19

The CIA’s bifurcate into what?

Answer 19

Internal + external iliac arteries

Question 20

What does the IIA + EIA supply?

Answer 20

IIA (aka hypogastric arteries): pelvic organs

EIA: continues distally to supply lower extremities

Question 21

___ arteries become the common femoral arteries once they cross the inguinal ligament?

Answer 21

EIA’s

Question 22

M/c location of a AAA?

Answer 22

Infrarenal (below renal arteries)

Question 23

AAAs are m/c in men or women?

Answer 23

Men

Question 24

___ aneurysms are associated with AAAs?

Answer 24

Common iliac, femoral or popliteal aneurysms

Question 25

___ increases the risk of having a AAA by 5x?

Answer 25

Smoking

Question 26

What is the AAA protocol?

Answer 26

Images of Ao + iliac arteries with b-mode + CD in both planes (protocols vary with each site)

Question 27

How do we measure the Ao?

Answer 27

Outer to outer

Question 28

If the AAA protocol includes spectral doppler, how should we set our doppler parameters?

Answer 28

SVB: 1.5-2mm Doppler Angle: 45-60 degrees

Question 29

U/s reports must include the diameter of the Ao + CIA if ___?

Answer 29

Ectactic/aneurysmal

Question 30

If a focal aneurysm is found, we must note its proximity to ___?

Answer 30

The renal arteries

Question 31

List 4 other findings associated with a AAA?

Answer 31

-Wall defects -Penetrating ulcers -Intimal tears -Dissections

Question 32

What is the normal infrarenal Ao diameter?

Answer 32

<2cm

Question 33

What is ectasia?

Answer 33

-Mild diffuse enlargement of Ao, secondary to degeneration of the wall -Use this term when Ao measures <3cm

Question 34

What is the measurement for a true Ao aneurysm?

Answer 34

When Ao dilates >3cm + involves all 3 layers of vessel wall

Question 35

What is the measurement for an ectatic + aneurysmal CIA?

Answer 35

Ectatic: >1.5cm Aneurysmal: >2cm

Question 36

What is an ABI + ABF graft?

Answer 36

ABI: aortobiliac graft ABF: aortobifemoral graft

Question 37

What is the AAA post-op protocol?

Answer 37

2D, CD + spectral doppler velocities obtained of the Ao, anastomosis, graft + CIAs (diameters taken prox + dist to graft to rule out pathologies)

Question 38

What is an EVAR?

Answer 38

-Endovascular aortic aneurysm repair -Stent graft device placed in AAA via catheter -Is anchored with stents in the non-aneurysmal arteries prox + dist to the AAA (reduces risk of rupture)

Question 39

SF of graft fabric?

Answer 39

Hyperechoic area along the ant + post walls of Ao lumen, just below RAs

Question 40

What is AIOD?

Answer 40

-Aortoiliac occlusive disease -Is stenosis in the Ao or CIAs due to atherosclerotic plaque (20% pt's with AAA have AIOD)

Question 41

AOID protocol?

Answer 41

-Image Ao + iliac arteries in 2D + CD in both planes -Measure prox/mid/dist Ao, CIAs + EIAs -Take velocities (if elevated, take another velocity prox + dist to that area)

Question 42

Occlusive disease often starts near what structure?

Answer 42

Ao bif, extends into CIAs + EIAs, then into femoral arteries

Question 43

How would an occluded area appear?

Answer 43

No CD flow + spectral doppler will show a thump artifact

Question 44

How to calculate aortoiliac stenosis?

Answer 44

PSV in stenosis/ PSV prox to stenosis (a doubling in velocity b/w these segments indicates 50-99% stenosis)

Question 45

What are we looking for distal to a stenosis?

Answer 45

Turbulence or tardus parvus waveform

Question 46

Waveform above renal arteries?

Answer 46

Low resistance (high diastolic flow) with antegrade flow in diastole

Question 47

Waveform of distal Ao?

Answer 47

Higher resistance with low end diastolic flow

Question 48

Waveform of common, external + internal iliac arteries?

Answer 48

Multiphasic with flow reversal below baseline in early diastole

Question 49

M/c type of open repair for a AIOD?

Answer 49

ABF graft

Question 50

PSV >300 cm/s in a stent with post-stenotic turbulance indicates what?

Answer 50

>50% stenosis

Question 51

EDV >150 cm/s in a stent with post-stenotic turbulance indicates what?

Answer 51

>80% stenosis