Ch. 8 Vascular Flashcards by Hope Spriggs

Winding and bending of the carotid artery

Tortuosity/kinking

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With tortuosity, up to _____ of adults will have some degree of _____

1/4 (25%), angulation

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Is tortuosity bilateral?

usually yes

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Signs and symptoms of tortuosity

usually asymptomatic, may cause stroke or TIA,

head turning can cause symptoms, pulsatile mass

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Color is a useful tool to appreciate the tortuous coarse of the _______ ICA

distal

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With tortuosity, evaluation can be challenging because aliasing is likely present along

outer edges of curve or as vessel becomes more vertical (creating 0 degree doppler angles)

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T/F: It is difficult to image entire tortuous vessel in one image

True

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With tortuosity, doppler waveforms should be taken from

straighter portions of vessel when possible

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Do you sample the area of the tightest curve in a tortuous vessel

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What do you do if the doppler waveform must be taken from curved portion

angle is set so that middle of angle correct cursor is parallel to vessel walls / sample volume is to remain small / keep sample volume center stream

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When doing doppler sample volume through the tortuous segment

pre and postcurve or kink velocities should be noted / flow changes may be documented with head rotation

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Strict velocity criteria _____ be applied to tortuous vessels

cannot

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_____ velocities _____ to curves and kinks are to be expected

increased, distal

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Significant stenosis in tortuosity will be followed by

post stenotic turbulence

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Separation of the layers of an artery due to intimal tear

dissections/intimal flaps

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Dissections may be associated with

pseudoaneurysm, thrombus and/or second intimal tear

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False lumen flow pattern variations include

antegrade flow with secondary tear /
antegrade flow into true lumen and out of the false lumen in a to-and-fro pattern / antegrade flow in the true lumen and retrograde flow in the false lumen

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Dissections and intimal flaps usually originate from

aorta and extend into CCA

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Dissections may be associated with other diseases such as

Marfan syndrome or ehler-danlos syndrome

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Dissections can be

spontaneous or traumatic

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Dissections associated with history of hypertension are

spontaneous

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Dissections that are subtle from head rotation or obvious like blunt trauma

traumatic

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______ may occur after endarterectomy

intimal flap

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Dissections/intimal flaps signs and symptoms

asymptomatic /
head, face or neck pain /
hemispheric stroke or TIA symptoms /
young patients with stroke symptoms

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Duplex findings associated with dissection include

unusual color flow pattern in an artery that shows no artherosclerosis / presence of thin white line in vessel lumen / may flutter with each pulse

(dissection) blind ended tear appearance

low resistance doppler signal in true lumen / if false lumen is thrombosed then stentotic flow in true lumen / false lumen will demonstrate high-resistance flow patterns unless thrombosed / reversed/retrograde flow may be present in false lumen

(dissection) secondary tear appearance

blood allowed back into lumen / true and false lumen may demonstrate antegrade flow with different waveform contours / reversal of flow in either lumen

Fibromuscular dysplasia (FMD) apearance

abnormal growth of smooth muscle cells and fibrous issue in artery walls / narrowing of arterial lumen in multiple sections / slight aneurysm dilation may be noted in between stenotic sections

FMD causes a __________ appearance of artery on arteriography

"string of beads"

FMD signs and symptoms

young caucasin females / most common in renal arteries causing hypertension / ICA second most common

FMD in ICA signs and symptoms

often does not cause symptoms / cervical bruit (most common / emboli may occur and cause TIA

FMD bilateral disease is typical. T/F

In FMD, doppler analysis is likely to show ______ and _______ past the ______ ICA segment

turbulence, high velocities, proximal

_____ frequency transducers and _______ are useful to identify _____ ICA flow

lower, power doppler, distal

Carefully examine ____ ICA with ____, _____ and _____

distal | color, doppler and b mode

What frequency probe may be needed to visualize most distal segments

lower

What additional images should be included for FMD

distal ICA w color / spectral of highest velocities mid to distal / any post stenotic turbulence / power doppler for string of beads / b mode of affected area for diameter changes

FMD should be suspected with the following

young patients / no evidence of artheroscleroic disease / marked turb in distal ICA with increases vel

Demonstration of "string of beads" appearance on

b mode, color, power doppler

Diagnosis of FMD is often confirmed with

angiography

Carotid body is a _______ structure in the _____ of the carotid bifurcation

1-1.5mm / adventitia

Carotid body tumors are classified as

paragangliomas

Carotid body tumor signs and symptoms

asymptomatic / small lump anterior to neck / discomfort / rarely cause headaches or change in voice

Carotid body tumors usually present as a well-defined mass located between the __________ at the bifurcation

ICA and ECA

Carotid body tumors cause ____ of the two vessels

splaying

CBT is a _______ tumor, demonstrating a ____ resistance waveform on spectral doppler

highly vascular, low

CBT diagnosis includes

identification of highly vascularized mass / splaying of ICA and ECA / low resistance wave forms in mass

Carotid aneurysm is

dilation of carotid involving all three walls / most commonly occur in CCA / atherosclerosis main cause / may be result of infection

Carotid aneurysm that is a result of an infection is called

mycotic aneurysm

CA signs and symptoms

pulsatile mass in neck / asymptomatic / TIA/stroke symptoms

In CA, rupture is ____ but can cause

rare, cranial nerve dysfunction

CA rupture and cranial nerve dysfunction may result in

patient hoarseness

CA diagnosis is

rare / difficult to differentiate from large bulb

Pseudoaneurysm is

perforation in arterial wall allowing blood to extravasate into surrounding tissue / false aneurysm

Pseudoaneurysm is uncommon is carotid arteries. T/F

true

PA is usually the result of

penetrating trauma or iatrogenic injury

PA may form at

endarterectomy site or at anastomotic site of carotid bypass graft

PA signs and symptoms

palpable/pulsatile neck mass / carotid bypass graft with mass

In PA, blood flow outside arterial wall creates _________ that is connected to artery by _____

mass in surrounding tissue, "neck"

Pseudoaneurysm mass appearance

thrombus / low velocity "yin yang pattern"

PA diagnosis

pulsatile mass with yin yang color filling is classic presentation for pseudoaneurysm

Radiation-induced arterial injury is

injury to vessel walls from therapeutic irradiation of various tumors

What vessels may be affected by RIAI and why

capillaries, arterioles and venules / radiation damages endothelial cells of walls

RIAI causes ______ due to injury to the _______ in the _____ layer of the vessel

fibrosis, vaso vasorum, medial

RIAI stenoses are ____ than most typical atherosclerosis lesions

longer

RIAI lesions ____ contain calcifications and may have ____ effect

do not, hypoechoic

Arteritis is

inflammation of the artery wall that breaks down parts of wall structure

Arteritis has to forms often encountered:

takayasu disease, temporal arteries

Takayasu disease affects

aortic arch and great vessels

Giant cell arteritis (temporal arteries) affects

medium and larger sized arteries

Arteritis signs and symptoms

autoimmune disease suspected / women affected more

Takayasu typically affects what age group

younger

Giant cell arteries typically affects what age group

elderly

Takayasu signs and symptoms

claudication of arms / no radial pulses / TIA/stroke symptoms / bruits

Temporal arteritis signs and symptoms

headaches / low grade fever / jaw claudication / tender temporal region / BLINDNESS

Takayasu disease lesions tend to appear as

long, smooth, homogenous narrowing (general wall thickening)

Giant cell arteries usually affects the

superficial temporal artery off the ECA

In GCA, the STA may have a ______ appearance surrounding the artery

halo

Takayasu technical considerations

doppler wf as far proximal as possible / bilateral brachial bp / subclavian wf

In TD, B Mode images in long and trans should be obtained to examine for areas of

arterial thickening

GCA technical considerations

entire STA examined in transverse / identify halos

In arteritis diagnosis, look for characteristic

long segments of thickened arterial walls in takayasu disease