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MIDS 237 > Ch 16 IVC + iliac veins > Flashcards

Ch 16 IVC + iliac veins Flashcards

1
Q

What is a confluence?

A

Union of 2 or more veins to form a larger vein (same as a bif in the arterial system)

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2
Q

What is an IVC filter?

A

-Cone shaped medical device that prevents pulmonary embolism
-Placed in IVC to trap embolisms from the lower extremities before they travel to the heart + lungs

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3
Q

What is a pulmonary embolus?

A

An obstruction of the pulmonary arteries, due to detached fragments of a blood clot that travels from the LEVs

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4
Q

What is the retroperitoneum?

A

Space b/w abdo cavity + the muscles/bones of posterior abdo wall

(includes IVC, iliac veins + abdo Ao)

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5
Q

Is the abdominal IVC in the peritoneal cavity?

A

No, retroperitoneal cavity

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6
Q

The IVC begins at what level of the spine?

A

L5: at the confluence of the RT + LT CIVs

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7
Q

The IVC ascends to the right or left of the Ao?

A

RT

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8
Q

The IVC passes through the diaphragm at what level of the spine?

A

T8

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9
Q

The EIVs is a continuation of the ___ veins?

A

Common femoral veins

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10
Q

___ joins the EIVs to form the CIVs?

A

IIVs

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11
Q

The left CIV passes superficial or deep to the right CIA at the level of the Ao bif?

A

Deep

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12
Q

___ veins join to form the IVC?

A

LT + RT CIVs

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13
Q

What veins drain into the IVC?

A

Hepatic, adrenal, renal, gonadal + lumbar veins

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14
Q

The diameter of the IVC depends on what?

A

The hydration status of the pt

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15
Q

What is the average IVC diameter at the level of the renal veins?

A

17-20mm

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16
Q

What defines mega cava?

A

-Enlarged IVC >28mm
-Occurs in pt’s with a large stature or with congestive heart failure

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17
Q

When does a duplicated IVC + left-sided IVC terminate?

A

Duplicated: terminates when the LT IVC drains into the LRV

Left-sided: terminates in the LRV or extends cranially to drain into the azygos vein in the chest

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18
Q

List 3 normal variants of the IVC?

A

-Duplicated IVC
-Left sided IVC
-Absence of intrahepatic portion of IVC

(these have normal doppler signals)

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19
Q

How does blood get returned to the heart if there is an absence of the intrahepatic portion of the IVC?

A

Via the azygos or hemiazygos veins

20
Q

SF of an absent intrahepatic IVC?

A

HVs are seen draining directly into the RA

21
Q

IVC protocol?

A

IVC: prox, mid, dist, CIV confluence + EIVs

Also: assess hepatic + renal veins

22
Q

Course of the LRV?

A

Anterior to Ao, posterior to SMA

23
Q

What is the nutcracker syndrome?

A

Compression of LRV

24
Q

Where does blood flow during inspiration + expiration?

A

Inspiration: to chest
Expiration: to abdomen

25
Q

Waveform for prox + dist IVC?

A

Prox: pulsatile (near RA)

Dist: phasic

26
Q

SF of a partial IVC obstruction?

A

Loss of normal respiration + cardiac variation in IVC + iliac veins

27
Q

What does a loss of respiratory phasicity + inability to augment with compression indicate?

A

Prox obstruction with iliac vein thrombosis

28
Q

What is the m/c pathologic finding?

A

Thrombosis resulting from propagation of a lower extremity venous thromboembolism

29
Q

SF of a thrombosis?

A

-Distended IVC or iliac vein with echogenic materal in lumen

-Acute thrombus can be anechoic + is hard to detect in 2D

30
Q

Differentiate b/w a fully + partially occlusive thrombus?

A

Fully:
-Distended vein with echogenic material in lumen
-Absent flow
-No doppler signal

Partially:
-Echogenic material is partially free floating + attached to vessel wall
-Flow is present but diminished
-Continuous doppler signal (loss of respiratory + cardiac variation)

31
Q

Is neoplastic obstruction of the IVC + iliac veins rare?

A

Yes!

32
Q

Intraluminal tumors arise from what veins?

A

Hepatic or renal veins (can obstruct IVC)

33
Q

SF of tumors?

A

Moderately echogenic + will have CD flow within the mass

34
Q

What does extrinsic tumors result in?

A

Dilated collateral veins + distention of distal IVC + iliac veins (can completely obstruct)

35
Q

What is iliac vein compression syndrome (aka may thurner syndrome)?

A

When the CIV gets compressed b/w the iliac artery above + the vertebral body below

36
Q

May thurner syndrome m/c affects with CIV?

A

LT

37
Q

How does may thurner appear on spectral doppler?

A

-Increased velocity at point of compression
-Monophasic flow w/o respiratory variation distal to compression

38
Q

Treatment for may thurner?

A

Balloon angioplasty + stent placement

39
Q

What is a caval fistula?

A

Abnormal connection b/w IVC + other vessels

Spontaneous: aortocaval
Surgical: portocaval

40
Q

Where is an IVC filter placed?

A

Just below level of renal veins

41
Q

SF of an IVC filter?

A

SAG: echogenic line in lumen (near renal veins)
TRV: central echogenic dot

42
Q

How does a physician put in an IVC filter?

A

Maintains SAG IVC image with the RRA in view, the tip should be just below the RRA

43
Q

Benefits to intravascular u/s (IVUS)?

A

-Can diagnose iliac vein stenosis
-Accurately measure vein diameter
-Evaluate the effect of endovascular intervention

44
Q

What is IVUS?

A

-Real time imaging of vein lumens, with more detail + accuracy than duplex u/s or contrast venography

-Helps differentiate the flow lumen from the vessel wall

45
Q

Flexible IVUS catheters have u/s ___ embedded at their tip?

A

Crystals (they emit sound waves covering 360 degrees of the vessel)

46
Q

IVUS has high sensitivity in detecting ___ + ___ vein segments?

A

Stenotic + obstructed

MIDS 237 (23 decks)

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