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Vascular > Chapter 13: Duplex Ultrasound of Upper Extremity Arteries > Flashcards

Chapter 13: Duplex Ultrasound of Upper Extremity Arteries Flashcards

1
Q

a vasospastic disorder of the digital vessels

A

Raynaud’s syndrome

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2
Q

A form of large vessel vasculitis resulting in intimal fibrosis and vessel narrowing

A

Takaysu’s arteritis

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3
Q

The superior opening of the thoracic cavity that is bordered by the clavicle and first rib; the subclavian artery, subclavian vein, and brachial nerve plexus pass through this opening

A

thoracic outlet

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4
Q

A sudden constriction of a blood vessel that will reduce the lumen and blood flow rate

A

vasospasm

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5
Q

Upper extremity arterial disease occurs in only about __% of extremity ischemia.

A

5

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6
Q

Causes of upper extremity symptoms

A

mechanical obstruction at the thoracic outlet
embolism
trauma
digital artery vasospasm
digital artery occlusion

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7
Q

What percentage of extremity peripheral arterial disease do upper extremity arterial diseases represent?

A

5%

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8
Q

Which of the following is NOT a prominent etiology of arterial diseases in the upper extremities?
a. mechanical obstruction or compression at the thoracic outlet
b. embolism from various sources (including the heart)
c. vasoconstriction of digital arteries
d. diffuse atherosclerosis of the axillary or brachial artery

A

d

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9
Q

The right subclavian artery originates from the _______.

A

innominate artery

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10
Q

The left subclavian artery originate from the _____.

A

aortic arch

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11
Q

The first major branch of the aortic arch.

A

innominate artery

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12
Q

The innominate artery is also known as the ______.

A

brachiocephalic artery

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13
Q

The innominate artery divides into the ______ and the _____.

A

right common carotid artery
right subclavian artery

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14
Q

The retroesophageal subclavian artery is also known as the _____.

A

aberrant right subclavian artery

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15
Q

Right subclavian may originate directly from aorta distal to left subclavian artery and then pass posterior to esophagus to the right side

A

retroesophageal subclavian artery

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16
Q

arises from dilated segment of proximal descending aorta

A

Kommerells diverticulum

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17
Q

palsy of recurrent laryngeal nerve

A

Ortner’s syndrome

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18
Q

Second major branch from aortic arch

A

left common carotid artery

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19
Q

Third major branch from aortic arch

A

left subclavian artery

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20
Q

first major branches of both left and right subclavian arteries

A

vertebral arteries

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21
Q

Subclavian arteries exit through _____.

A

thoracic outlet

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22
Q

an extra rib as a result of an overdevelopment of a cervical spine vertebra transverse process; above first rib and just above clavicle

A

cervical rib

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23
Q

The subclavian artery turns into the _____ artery at the lateral margin of the first rib.

A

axillary

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24
Q

The axillary artery transitions into the _____ artery at level of inferior lateral border of teres major muscle.

A

brachial

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25
Q

Found in the upper arm passing posterior to the humerus

A

deep brachial artery

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26
Q

Most common upper extremity arterial anatomic variant

A

“high-takeoff”

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27
Q

radial artery originates in mid to upper arm instead of in or just distal to antecubital fossa

A

“high-takeoff”

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28
Q

The brachial artery divides into :

A

radial artery
ulnar artery
interroseus artery

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29
Q

continues at wrist deep to lateral flexor muscles of forearm

A

radial artery

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30
Q

The radial artery divides into two branches at the wrist

A

superficial palmar arch
deep palmar arc

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31
Q

gives origin to interosseous artery in proximal forearm before passing deep to medial forearm flexor muscles

A

ulnar artery

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32
Q

courses toward wrist adjacent to flexor carpi ulnaris tendon before crossing wrist where passes deep to hook of hamate bone

A

ulnar artery

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33
Q

trauma to ulnar artery in area of hamate bone
results in:
arterial degeneration
thrombus formation
potential occlusion

A

Hypothenar hammer syndrom

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34
Q

Give origin to metacarpal arteries

A

superficial and deep palmar arch

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35
Q

give origin to paired digital arteries

A

metacarpal arteries

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36
Q

What is a dilated segment of the proximal descending aorta which may give rise to the takeoff of an aberrant subclavian artery?

A

Kommerell’s diverticulum

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37
Q

Which of the following is NOT a common site for compression of the subclavian artery?
a. compression between the first rib and scalene muscle
b. compression between the clavicle and first rib
c. compression by the brachial plexus
d. compression by the pectoralis minor

A

c

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38
Q

Which of the following is/are a potential consequence(s) of compression of the subclavian artery at the thoracic outlet?
a. thrombosis
b. stenosis
c. aneurysm
d. all of the above

A

d

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39
Q

Injury of what artery may result in hypothenar hammer syndrome>

A

the ulnar artery at the wrist

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40
Q

intermittent digital ischemia from cold exposure or emotional stimuli

A

Raynaud’s syndrome

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41
Q

condition of abnormal digital artery vasospasm resulting in pain and a characteristic pallor of the digits followed by cyanosis and hyperemia upon rewarming

A

Primary Raynaud’s syndrom

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42
Q

also known as Raynaud’s phenomenon

A

Secondary Raynaud’s syndrome

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43
Q

Most common systemic condition of Secondary Raynaud’s syndrome

A

scleroderma

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44
Q

The majority of digital artery occlusive disease originates ____ to the wrist.

A

distal

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45
Q

compression of structures in thoracic outlet

A

thoracic outlet syndrome

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46
Q

symptoms of TOS

A

pain
weakness
muscle atrophy

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47
Q

TOS occurs primarily in _____ patients.

A

younger

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48
Q

Ulcerated lesions or aneurysm can cause _____ which serve as a source of _____ embolization

A

thrombus formation
distal

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49
Q

Unilateral digital artery occlusion is suggestive of ______ embolic source.

A

proximal

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50
Q

The _____ artery is the first major branch of the aortic arch and divides into the right common carotid artery and subclavian arteries.

A

innominate

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51
Q

On the left, the ______ artery arises directly from the aortic arch in 4% to 6% of patients.

A

vertebral

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52
Q

The artery resting between the biceps muscle anteriorly and triceps muscle posteriorly is the _____ artery.

A

brachial

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53
Q

The artery, which lies deep to the pectoralis major and minor, is the _____ artery.

A

axillary

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54
Q

A high takeoff occurs most commonly as a variant of the _____ artery.

A

radial

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55
Q

The interosseous artery commonly takes off from the _____ artery.

A

ulnar

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56
Q

Arterial duplex ultrasound rules out clinically significant injuries of the upper extremity arteries, ______ to the axillary crease.

A

distal

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57
Q

upper extremity atherosclerosis in absence of renal failure or diabetes

A

arterial occlusive disease

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58
Q

Arterial occlusive disease is generally confined to ___.

A

proximal subclavian artery

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59
Q

reversal or bidirectional flow in ipsilateral vertebral artery

A

subclavian steal syndrome

60
Q

stenosis or occlusion of subclavian artery as manifested by blunted proximal subclavian artery velocity waveforms along with reversed or staccato flow in vertebral artery

A

subclavian steal syndrome

61
Q

autoimmune disorder that affects arteries of aortic arch, visceral abdominal aorta, and pulmonary arteries

A

Takayasu’s arteritis

62
Q

Takayasu’s arteritis most commonly affects_____

A

women in 20s and 30s

63
Q

Type I Takayasu’s arteritis

A

branches of the aortic arch

64
Q

Type IIa Takayasu’a arteritis

A

ascending aorta
aortic arch and branches
thoracic descending aorta

65
Q

Type III Takayasu’s arteritis

A

thoracic descending aorta
abdominal aorta
renal arteries

66
Q

Type IV Takayasu’s arteritis

A

abdominal aorta
renal arteries

67
Q

Type V Takayasu’s arteritis

A

combined features of types IIb and IV

68
Q

acute phase symptoms of Takayasu’s arteritis

A

fever
malaise
arthralgias
myalgias
elevated erythrocyte sedimentation rate
elevated C reactive proteins

69
Q

Primary treatment of Takasayu’s arteritis

A

steroids
immunosuppressive medications

70
Q

Giant cell arteritis affects:

A

caucasion women over 40

71
Q

Giant cell arteritis can affect the ______, ______, and ______.

A

opthamolic
subclavian
axillary

72
Q

Ultrasound findings acute phase of axillary artery

A

thickened hypoechoic arterial wall due to edema; evidence of flow restriction

73
Q

Treatment for Giant Cell Arteritis

A

anti-inflammatory medications
immunosuppresant medications

74
Q

Buerger’s disease is also known as ______.

A

thromboangiitis obliterans

75
Q

primarily involves small vessels of hands and feet; seen in cigarette smokes under 50 years

A

Beurger’s disease

76
Q

Which arteries are visualized with the sternal notch window and the infraclavicular and supraclavicular approaches?

A

the subclavian arteries

77
Q

The evaluation of the axillary artery by duplex is often accomplished with the arm in the _______.

A

“pledge position”

78
Q

What arteries need to be examined during an upper arterial exam?

A

subclavian
axillary
brachial
radial
ulnar

79
Q

When irregularities are noted sonographer should use a ______ to document prestenotic PSV, PSV at stenosis, documentation of poststenotic turbulence.

A

stenotic profile

80
Q

windows of insonation of origin of subclavian artery

A

sternal notch
supraclavicular
infraclavicular

81
Q

crosses under clavicle and first rib

A

subclavian artery

82
Q

Using the sternal notch window, the origin of the subclavian artery is usually first identified with color Doppler in a _____ view.

A

transverse

83
Q

With Doppler, all arteries in the upper extremities should, under normal conditions, exhibit ____ resistance.

A

high

84
Q

Under normal conditions, what is the flow velocity range of the arteries in the forearm?

A

40 to 60 cm/s

85
Q

What is the normal upper extremity waveform?

A

multiphasic, sharp systolic peak, followed by a brief period of diastolic flow reversal and then minimal continued forward flow in diastole

86
Q

Upper extremity arteries are ____ resistance.

A

high

87
Q

Normal PSV range for subclavian arteries

A

80 to 120 cm/s

88
Q

Normal PSV range for forearm arteries

A

40 to 60 cm/s

89
Q

increased PSVs with loss of end systolic reverse flow
postenotic turbulence
dampened distal arterial waveforms

A

signs of stenosis in upper arm

90
Q

A greater than 50% stenosis in the upper arm, would cause the PSV ratio to be ____.

A

greater than 2

91
Q

What is indicated by a triphasic waveform distal to a high PSV?

A

falsely elevated proximal PSV

92
Q

What is indicated by a monophasic distal waveform

A

proximal lesion hemodynamically significant

93
Q

documented by demonstrating the absence of flow within the lumen of the artery by color and spectral Doppler

A

occlusions

94
Q

What can help increase blood flow in the upper extremity to help with an exam?

A

exercising or warming the extremity

95
Q

To assist in the visualization of the relative small caliber arteries in the forearm, the sonographer may use _______ of the arm to increase blood flow.

A

exercise or warming

96
Q

permanent localized dilation in an artery

A

aneurysm

97
Q

Aneurysms have to meet the criteria of ____ or greater increase in diameter of the artery.

A

50%`

98
Q

Subclavian artery aneurysms often occur with _____.

A

Arterial TOS

99
Q

Well known etiologies of aneurysms in the axillary, brachial, radial, and ulnar arteries.

A

atherosclerosis and trauma

100
Q

repeated use of palm of hand as a hammer

A

Hypothenar hammer syndrome

101
Q

The most common system condition resulting in secondary Raynaud’s syndrome is _____.

A

scleroderma

102
Q

Digital artery necrosis associated with Raynaud’s symptoms will rarely be seen with ______ Raynaud’s syndrome.

A

secondary

103
Q

Provocative maneuvers demonstrating subclavian artery compression at the thoracic outlet may occur in 30% of _____ individuals.

A

normal

104
Q

Unilateral digital ischemia should prompt the sonographer to look for a source of _______ from more proximal arteries.

A

embolization

105
Q

Duplex ultrasound has been shown to be an effective means of evaluating for upper extremity ______, even though computed tomographic arteriography or direct surgical exploration is currently the standard of car.

A

vascular injuries

106
Q

Clinically, significant stenosis or occlusion of upper extremity arteries from atherosclerosis is typicalled confined to the ______ artery.

A

proximal subclavian

107
Q

Symptoms of fever, malaise, arthralgia, and myalgia are not uncommon in the ____ phase of Takasayu’s disease

A

acute

108
Q

Immunosuppressant and anti-inflammatory medications are the primary treatement for several forms of ______.

A

Giant cell arteritis

109
Q

A definite diagnosis for Buerger’s disease is best achieved with _____.

A

angiography

110
Q

When evaluating an aneurysm, it is important to visualize the vessel in a true _____ plane to not falsely overestimate the diameter.

A

axial

111
Q

With what condition are aneurysms of the subclavian arteries often associated?

A

thoracic outlet syndrome

112
Q

What is the landmark that marks the transition from the axillary artery to the brachial artery?

A

inferolateral border of the teres major muscle

113
Q

How is primary Raynaud’s syndrome distinguished from,m secondary Raynaud’s syndrome or Raynaud’s phenomenon?

A

There are no underlying diseases

114
Q

Although rare, digital artery occlusion from embolization may occur. Which of the following is NOT a predominant source of embolization?
a. subclavian artery aneurysms
b. stenosis of proximal upper extremity arteries
c. fibromuscular diseases of arteries of the forearm
d. thromboangiitis obliterans

A

d

115
Q

To efficiently assess perfusion and/or vasospasm of digital arteries, how should one record waveforms obtained with PPG?

A

pre- and post- cold immersion

116
Q

Compression of structures at the thoracic outlet may happen with all of the following EXCEPT:
a. hypertrophy of the scalene muscle
b. hypertrophy of the pectoralis minor muscle
c. the presence of a cervical rib
d. the presence of abnormal fibrous bands

A

b

117
Q

Which statement regarding compression of the brachial plexus and vascular structures at the thoracic outlet is FALSE?
a. Compression of either will give similar symptoms
b. Compression of either cannot be easily confirmed by provocative maneuvers
c. compression of both often occurs concomitantly
d. Confirmation of neural symptoms is best done by electromyography

A

c

118
Q

How is “arterial minor” form of thoracic outlet syndrome defined?

A

intermittent compression of the subclavian when the arm is raised overhead

119
Q

Which condition is associated with significant stenosis or occlusion of arteries of the arm and/or forearm from atherosclerosis?
a. diabetes and/or renal failure
b. coronary artery disease
c. peripheral arterial disease
d. systemic diseases

A

a

120
Q

A 47-year old male smoker presents to the vascular lab with ulceration of his fingertips. What disease process should be suspected in this patient?

A

Buerger’s disease

121
Q

Which form or arterial inflammation can affect the ophthalmic artery as well as the subclavian or axillary?

A

Giant cell arteritis

122
Q

What is the most significant difference between giant cell arteritis and Takayasu’s disease when both affect the subclavian artery?

A

the age of the patient

123
Q

First major artery of the aortic arch

A

Brachiocephalic artery

124
Q

The brachiocephalic artery divides into _____ and _____ arteries.

A

right common carotid
right subclavian

125
Q

Arises directly from aortic arch as third major branch

A

left subclavian artery

126
Q

First major branch from both subclavian arteries

A

vertebral arteries

127
Q

Subclavian arteries exit chest through ______

A

thoracic outlet

128
Q

originates at the lateral margin of the first rib; lies deep to pectoralis major and minor muscles

A

axillary artery

129
Q

At elbow level, the brachial artery divides into _____, _____, and ______ arteries.

A

radial
ulnar
interosseous

130
Q

The radial artery branches into _____ and ______/

A

superficial and deep palmar arches

131
Q

Gives rise to interosseous artery; passes deep to forearm flexor muscles; courses toward wrist following ulnar; terminates as the superficial palmar arch

A

ulnar artery

132
Q

Upper extremity artery branches

A

subclavian
axillary
brachial
radial
ulnar

133
Q

Windows for insonation of the sublclavian arteries

A

sternal notch; supraclavicular; infraclavicular

134
Q

Normal upper extremity waveform

A

multiphasic
sharp systolic peak
brief period of diastolic flow reverasal
minimal continued forward flow in diastole

135
Q

Normal PSV varies from _____ cm/s in subclavian

A

80 to 120

136
Q

Normal PSV varies from ______ cm/s in brachial, radia, and ulnar arteries.

A

40 to 60

137
Q

Permanent localized dilation resulting in 50% increase in diameter of an artery compared to adjacent normal artery

A

aneurysm

138
Q

arterial degeneration of ulnar artery as it passes deep to hook of hamate bone; associated with repeated used of palm of hand as a hammer

A

Hypothenar hammer syndrome

139
Q

abnormal digital artery vasospasm; results in pain and color changes; anatomically, digital arteries appear normal; rarely results in tissue damage

A

Primary Raynaud’s syndrome

140
Q

underlying disease process responsible for symptoms; patients tend to develop occlusive lesions; associated with tissue necrosis

A

Secondary Raynaud’s syndrome

141
Q

Impingement of the neurovascular bundle at the thoracic outlet

A

thoracic outlet syndrome

142
Q

Significant atherosclerotic disease in the upper extremity involves the:

A

proximal subclavian artery

143
Q

Arterial occlusive disease occurs most often in the ___ subclavian artery.

A

left

144
Q

autoimmune disorder that affects the arteries of the aortic arch and visceral abdominal aorta

A

Takayasu’s arteritis

145
Q

Giant cell arteritis can involve _____, ______, ______, and ______ arteries.

A

opthalmic
subclavian
axillary
superifical temporal

146
Q

primarily involves small vessels of hands and feet; seen in smokers under 50

A

Buerger’s disease

147
Q
A

Vascular (33 decks)

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