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Vascular I & Physics I > Ch. 7 Vascular > Flashcards

Ch. 7 Vascular Flashcards

1
Q

What are the indications for an extracranial duplex exam

A 
asymptomatic neck bruit
TIAs
stroke
screening for surgery
f/u after a stent ot carotid endarterectomy
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2
Q

How many bruits are related to high grade stenosis

A

1/3

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3
Q

What is an emboli

A

piece of plaque that breaks off

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4
Q

Neurological deficits that occur intermittently, lasting from several minutes to a few hours

A

TIA

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5
Q

When do symptoms for TIA resolve

A

within 24 hours

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6
Q

Fixed or permanent neurologic deficits

A

CVA or completed stroke

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7
Q

Neurological deficits that last between 24 and 72 hours

A

Reversible Ischemic neurological deficit (RIND)

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8
Q

Symptoms of Carotid Artery Lesions

A

paralysis
paresthesia on one side (opposite side of affected)
Dysphasia/aphasia
Amaurosis fugax

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9
Q

What is paralysis

A

focal weakness

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10
Q

What is paesthesia

A

numbness usually on one side of the body

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11
Q

What is dysphasia or aphasia

A

difficulty speaking

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12
Q

What is Amaurosis fugax

A

(same side as responsible carotid lesion) is a TIA of the eye that produces blindness “shade” being pulled down over one eye

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13
Q

Symptoms of vertebrobasilar Insufficiency

A

doziness
diplopia
ataxia

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14
Q

What is diplopia

A

double vision

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15
Q

What is ataxia

A

loss of full control of bodily movement

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16
Q

What does the physical exam require

A

bilateral blood pressures
palpation of pulses for strength and symmetry
auscultation for bruits

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17
Q

What transducer and frequency is used for this exam

A

linear 7-14MHz

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18
Q

Vessels should be evaluated in both transverse and longitudinal planes and with

A

b-mode imaging
color
spectral doppler

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19
Q

A mobile appearing white line echo in the CCA is most likely

A

reverberation artifact from the IJV

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20
Q

What does speckling indicate

A

bruit

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21
Q

What is pulsed wave spectral doppler used for

A

measure flow velocities

document waveform contours

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22
Q

Differences between the ICA and ECA

A

ECA has multiple branches /
ECA will oscillate with “temporal tap” /
ICA is larger /
ICA has a low resistance wave form

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23
Q

Where do you perform the “temporal tap”

A

superficial temporal artery anterior to the ear

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24
Q

The ECA spectral waveform will have a

A

high resistance waveform and low diastolic component

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25
Q

How does the ICA typically lay in relation to the ICA

A

posterior

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26
Q

ICA has a

A

low resistance waveform and high diastolic

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27
Q

Where is flow reversal located in the bulb

A

along outer wall of bulb

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28
Q

What indicates normal flow within the bulb

A

yin yang sign

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29
Q

Is velocity measurement needed on bulb

A

no

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30
Q

Documented for flow separation in bulb:

A

flow reversal

yin yang sign

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31
Q

Sweeo doppler sample volume from

A

CCA into proximal ICA

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32
Q

What is PSV

A

peak systolic velocity

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33
Q

What is EDV

A

end diastolic velocity

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34
Q

What does isonate mean

A

to image with ultrasound

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35
Q

Where do you place the transducer to evaluate the vertebral artery

A

anteromedial aspect of midneck on long axis

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36
Q

Where do you want to obtain doppler signal for subclavian artery

A

as far proximal as possible

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37
Q

What are a few pitfalls

A

vessels high/low in the neck /
patients with thick short necks /
beam steering and angle correction with different transducers

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38
Q

Normal B-Mode characteristics

A

smooth vessel walls /
intima media clearly visible /
lumen is anechoic

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39
Q

Where does plaque most commonly occur

A

CCA bifurcation

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40
Q

What are the early stages of plaque

A

appears as thickened areas of intima media layers /

fibrous cap may form between plaque and lumen

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41
Q

How is plaque usually classified

A

smooth, irregular, homogeneous, heterogeneous

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42
Q

What term is discouraged to use by a sonographer

A

ulcerated because it is diagnostic

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43
Q

What is homogeneous plaque

A

uniform appearance and low echogenicity (high lipid content)

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44
Q

What is heterogeneous plaque

A

mixed echogenicity (fatty material and calcium)

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45
Q

What are some intraluminal defects identified by b-mode imaging

A

arterial dissection
carotid artery thrombosis
iatrogenic injury

46
Q

What is iatrogenic injury

A

any adverse condition that is induced by a healthcare provider

47
Q

What is arterial dissection

A

separation of layers that creates a second/false lumen

48
Q

What is crucial with arterial dissection

A

to differentiate a dissection from an internal jugular vein wall artifact (use multiple views)

49
Q

Signs of arterial dissection (CCA)

A

absence “yin yang” color flow pattern in transverse /
absence “wall thump” in doppler waveform /
may still see a uniform doppler waveform

50
Q

What dpes spectral doppler do

A

provides the most reliable means for assessing vessel patency and classifying degree of stenosis

51
Q

Doppler waveform contour is related to

A

cardiac output
vessel compliance
peripheral resistance (status of distal vascular bed)

52
Q

Normal doppler waveform contour (CCA, ICA, ECA)

A

brisk systolic acceleration
sharp systolic peak
clear spectral waveform

53
Q

On spectral doppler, ICA has

A

highest diastolic velocities

lowest peripheral resistance

54
Q

On spectral doppler, ECA has

A

lowest diastolic velocities

highest peripheral resistance

55
Q

On spectral doppler, CCA has

A

intermediate diastolic velocities

characteristics of both ICA and ECA

56
Q

What do bulb baroreceptors to

A

assist in blood pressure control

57
Q

what do bulb chemoreceptors do

A

involved in control of respiratory rate

58
Q

Carotid bulb doppler waveform

A

normal flow separation along outer wall /
more laminar flow near flow divider /
absence of flow reversal can be considered abnormal

59
Q

What happens as plaque starts to develop in the bulb

A

it can fill the bulb, reducing flow separation

60
Q

Abnormal doppler waveform contour distal to stenosis

A

decreased flow velocity
delayed acceleration
rounded peak
“tardus-parvus”

61
Q

What is “tardus-parvus”

A

low velocity flow with delayed acceleration

62
Q

In an abnormal doppler waveform contour, spectral broadening generally represents

A

turbulent flow

63
Q

In abnormal doppler waveform contour, proximal to stenosis, with very significant stenosis

A

proximal waveform will display a more high resistance pattern (decreased or absent diastolic flow)

64
Q

What is a steal waveform contour

A

where one vascular bed draws blood away or steals from another

65
Q

Degree of steal depends on

A

severity of stenosis

resistance offered by the venous downstream vascular beds

66
Q

What is a latent steal

A

flow that is beginning to show signs of reversal but not completely retrograde

67
Q

Waveform characteristics of a hesitant waveform

A

antegrade flow with deep flow reversal notch /

alternating or bilateral

68
Q

Hesitant doppler waveform contour sign

A

vertebral bunny sign

69
Q

What is a complete steal

A

complete retrograde flow of vessel involved

70
Q

What is string sign

A

blunted, resistive waveform that precede complete occlusion

71
Q

Where is string sign most commonly found

A

ICA

72
Q

How to detect string sign

A

use low scale and high gain doppler settings /

use power doppler to evaluate distal flow

73
Q

Appearance of distal ICA stenosis or occlusion

A

decreased diastolic flow /
high resistance flow pattern indicates severe stenosis or occlusion distal to the segment evaluated /
blunted appearance

74
Q

High resistance flow pattern indicates severe stenosis or occlusion ______ to the segment evaluated

A

distal

75
Q

ECA stenosis _____ tend to involve origin and proximal segments

A

lesions

76
Q

ECA stenosis associated with

A

focal velocity increase
post-stenotic turbulence
dampened distal waveform

77
Q

In ECA stenosis, watch for _____ in velocity as a result of collateralization

A

diffuse increase

78
Q

CCA stenosis can occur in the

A

proximal, mid or distal segments

79
Q

Significant stenosis in CCA is associated with

A

focal velocity increases
poststenotic turbulence
dampened distal waveforms in both the ICA and ECA

80
Q

May result in retrograde ECA to supply ICA

A

choke lesion

81
Q

Aortic valve and root stenosis will generate

A

symmetrically abnormal doppler waveform contour in the bilateral carotid systems

82
Q

In aortic valve or root stenosis, dampened waveforms are ______ carotid artery systems

A

throughout both

83
Q

AV or RS may also have _____ brachial systolic pressures

A

bilateral low

84
Q

Brachiocephalic stenosis will _____ affect the right carotid system

A

only

85
Q

Special considerations for AV or RS

A 
low cardiac output or poor EF / 
aortic valvular disease / 
hypertrophic obstructive cardiomyopathy / 
arrhythmias / 
cardiac assist devices
86
Q

What is the primary criterion for classification of stenosis severity

A

doppler flow velocity

87
Q

doppler flow velocity depends on

A

correct doppler angle 60 degrees or less and parallel to vessel wall

88
Q

doppler flow velocity may require doppler beam

A

steering or “heel toe” to get proper alignment

89
Q

Pulsed wave doppler sample volume should be

A

“swept” through all vessels

90
Q

Criteria for classification of disease has validated for the

A

ICA only

91
Q

Criteria for classification of disease was developed by comparing duplex results with

A

“gold standard” imaging modalities (angiography)

92
Q

Classification for disease for CCA and ECA stenosis criteria are

A

focal velocity increase
poststenotic turbulence
distal waveform changes

93
Q

Changes in CCA and ECA for stenosis correlate with a

A

<50% stenosis in these vessels

94
Q

Smooth, single color in the low to medium tone range indicates

A

laminar flow

95
Q

Aliasing occurs with

A

higher flow velocities

96
Q

______ produces a “mosaic” color doppler pattern

A

turbulent flow

97
Q

Always use ______ waveforms to classify severity of disease

A

pulsed wave spectral doppler

98
Q

Power doppler displays flow based on _____ rather than ______ shift

A

amplitude

frequency

99
Q

_______ has no direction information and is independent of angle

A

power doppler

100
Q

Power doppler is extremely helpful in detecting ______ velocities such as “string sign”

A

extremely low flow

101
Q

What is helpful with power doppler

A

high color gain
low color scale (PRF)
low wall filter

102
Q

Proximal vertebral artery usually evaluated during routine

A

carotid duplex scan

103
Q

Normal vertebral artery flow has same pattern as

A

ICA

104
Q

Normal flow in vertebra artery is

A 
low resistance
antegrade
brisk systolic acceleration
sharp peak
high diastolic flow
105
Q

PROXIMAL vertebral artery stenosis will produce

A

abnormal antegrade dampened waveforms distally with delayed acceleration and rounded peaks

106
Q

Proximal vertebral artery stenosis occurs at origin from

A

subclavian artery

107
Q

What waveforms indicate DISTAL stenosis or occlusion

A

resistive or blunted

108
Q

Hemodynamically significant stenosis in the proximal subclavian artery causes changes to

A

vertebral artery flow

109
Q

Subclavian stenosis results in ______ decrease on affected side more than ______ lower than contralateral arm

A

brachial blood pressure

15 mmHg

110
Q

Subclavian stenosis will show

A

elevated flow velocity with post stenotic turbulence /

abnormal vertebral artery waveform contour

111
Q

What are the steps to vertebral artery flow changes as obstruction progresses

A
  1. normal antegrade flow
  2. antegrade with deep notch mid cycle
  3. alternating or bidirectional flow
  4. complete reversal fully retrograded flow
112
Q

What is reactive hyperemia

A

proactive test used to augment a subclavian steal from “latent” to “complete”

Vascular I & Physics I (19 decks)

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