Chapter 16 - Visceral Artery Duplex Flashcards
If a patient comes in with Dull achy or crampy abdominal pain 15 to 30 minutes after eating, what is this highly suspicious for?
Mesenteric ischemia
This is due to stenosis limiting blood flow necessary for digestion
Does a patient need to be fasting for a mesenteric evaluation?
Yes
When doing a mesenteric study, what vessels will you image?
Aorta celiac artery (hepatic +splenic) SMA and IMA (Prox, mid, distal)
During a food challenge in a mesenteric study, have the patient eat then scan again in 20-30 min, then image what vessel?
SMA
Where is the inferior mesenteric artery located in relation to the aortic bifurcation
1-3 cm proximal to sorta biff
Usually the SMA is small…if we see that it is in large what should we suspect?
Collateralization
Important!!
what are the two possible connections between SMA and IMA
Marginal artery of the colon (Drummond)
Arc of Riolan
The IMA may serve as a collateral to the iliac arteries via the internal iliac artery
True or false
True
What is the normal range for the celiac artery?
<200 cmsec
What is the normal range for the SMA?
<275 cm/sec
A range of >200 cm/sec with post-stenotic turbulence within the celiac artery indicates??
> 70% stenosis within the celiac artery
What is the criteria for >70% stenosis in the SMA??
> 275 cm/sec with post stenotic turbulence
When we see retrograde common hepatic artery flow, what should we suspect?
Why is the flow reversed?
This is often seen in an occluded celiac artery. It is reversed because it is supplying the spleen.
The celiac artery supplies what two organs?
Spleen and liver ( hence the celiac bird sign that has the hepatic artery and splenic artery)
The celiac artery is affected by the food challenge.
True or False
false. The flow stays low-resistive both pre/postprandial.
The SMA goes from ____ resistive before eating to ____ resistive after eating..
High/Low resistive
Pre-prandial- high resisitve ( gut not needing constant flow)
Post-prandial- low resistive (gut needs flow to digest food).
compression of the celiac artery origin by the medial arcuate ligament of the diaphragm
Arcuate ligament compression syndrome (celiac axis compression syndrome)
What is the clinical finding of arcuate ligament compression syndrome?
Abdominal bruit that disappears during deep inspiration
When the patient lets out their breath, the median arcuate ligament compresses the ventral aspect of the celiac artery creating the __ -shaped vessel
S shaped.
Renal artery stenosis is often caused by the release of ____,
Renin
The release of renin causes RAS, which then causes the blood vessels to constrict and that causes high blood the “high blood pressure”. This is called
Renovascular hypertension
If a patient comes in with a sudden onset of uncontrolled/controlled hypertension, what should we suspect?
Renal Artery Stenosis
RAS can often lead to what disease?
renal ____
Failure
What position is best for looking at the kidneys?
LLD or RLD
Which vein is the landmark of helping identify the renal arteries?
What is this landmark nicknamed?
The Left Renal Vein,
The banana peel view
The most common location of disease in a RAS is
the origin.
What is the normal peak systolic velocity (PSV) when evaluating for a Renal Artery Stenosis?
<180 cm/sec
If you see a peak systolic velocity greater than 180-200 cm/sec, you should suspect 60% or more RAS.
True or False
True
What are the ways to calculate a RAS?
Peak systolic velocity and the Renal Aortic Ratio (RAR)
How do you calculate the Renal Aortic Ratio?
Divide the highest renal artery PSV by the aorta PSV
What is a normal RAR (Renal Aortic Ratio)
less than (
What is an abnormal RAR (Renal Aortic Ratio)
more than (>) 3.5
How do you calculate the RI (Resistive Index)?
Divide the PSV - EDV by the PSV
Usually the computer does this, but still know.
What is a normal RI?
less than 0.8
What is an abnormal RI?
Greater than 0.8
What is the normal and abnormal range of the end diastolic ratio?
Normal is greater than 0.2 and abnormal is less than 0.2
A delayed systolic upstroke can indicate?
proximal stenosis
Where in a RAS study would we document the acceleration time (AT)
Distal renal artery at the hilum or segmental arteries
What is a normal Acceleration time?
Normal is less than (
What is an abnormal Acceleration time?
Abnormal is more than > 100 milliseconds
What should the cortex of the kidney measure?
GREATER THAN 1 cm
Less could be cortical thinning
When imaging a liver transplant, what vessels should we evaluate?
Portal vein, hepatics, IVC , and hepatic artery.
In a renal transplant patient,
The renal artery is anastomosed to the ___ or ___ ____ artery
internal or external artery
Low resistive flow is normally seen in a renal transplant patient.
True
