Chapter 16 - Visceral Artery Duplex

Question 1

If a patient comes in with Dull achy or crampy abdominal pain 15 to 30 minutes after eating, what is this highly suspicious for?

Answer 1

Mesenteric ischemia

This is due to stenosis limiting blood flow necessary for digestion

Question 2

Does a patient need to be fasting for a mesenteric evaluation?

Answer 2

Yes

Question 3

When doing a mesenteric study, what vessels will you image?

Answer 3

Aorta celiac artery (hepatic +splenic) SMA and IMA (Prox, mid, distal)

Question 4

During a food challenge in a mesenteric study, have the patient eat then scan again in 20-30 min, then image what vessel?

Answer 4

SMA

Question 5

Where is the inferior mesenteric artery located in relation to the aortic bifurcation

Answer 5

1-3 cm proximal to sorta biff

Question 6

Usually the SMA is small…if we see that it is in large what should we suspect?

Answer 6

Collateralization

Question 7

Important!!

what are the two possible connections between SMA and IMA

Answer 7

Marginal artery of the colon (Drummond)

Arc of Riolan

Question 8

The IMA may serve as a collateral to the iliac arteries via the internal iliac artery

True or false

Answer 8

True

Question 9

What is the normal range for the celiac artery?

Answer 9

<200 cmsec

Question 10

What is the normal range for the SMA?

Answer 10

<275 cm/sec

Question 11

A range of >200 cm/sec with post-stenotic turbulence within the celiac artery indicates??

Answer 11

> 70% stenosis within the celiac artery

Question 12

What is the criteria for >70% stenosis in the SMA??

Answer 12

> 275 cm/sec with post stenotic turbulence

Question 13

When we see retrograde common hepatic artery flow, what should we suspect?
Why is the flow reversed?

Answer 13

This is often seen in an occluded celiac artery. It is reversed because it is supplying the spleen.

Question 14

The celiac artery supplies what two organs?

Answer 14

Spleen and liver ( hence the celiac bird sign that has the hepatic artery and splenic artery)

Question 15

The celiac artery is affected by the food challenge.

True or False

Answer 15

false. The flow stays low-resistive both pre/postprandial.

Question 16

The SMA goes from ____ resistive before eating to ____ resistive after eating..

High/Low resistive

Answer 16

Pre-prandial- high resisitve ( gut not needing constant flow)

Post-prandial- low resistive (gut needs flow to digest food).

Question 17

compression of the celiac artery origin by the medial arcuate ligament of the diaphragm

Answer 17

Arcuate ligament compression syndrome (celiac axis compression syndrome)

Question 18

What is the clinical finding of arcuate ligament compression syndrome?

Answer 18

Abdominal bruit that disappears during deep inspiration

Question 19

When the patient lets out their breath, the median arcuate ligament compresses the ventral aspect of the celiac artery creating the __ -shaped vessel

Answer 19

S shaped.

Question 20

Renal artery stenosis is often caused by the release of ____,

Answer 20

Renin

Question 21

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

Answer 21

Renovascular hypertension

Question 22

If a patient comes in with a sudden onset of uncontrolled/controlled hypertension, what should we suspect?

Answer 22

Renal Artery Stenosis

Question 23

RAS can often lead to what disease?

renal ____

Answer 23

Failure

Question 24

What position is best for looking at the kidneys?

Answer 24

LLD or RLD

Question 25

Which vein is the landmark of helping identify the renal arteries?

What is this landmark nicknamed?

Answer 25

The Left Renal Vein,

The banana peel view

Question 26

The most common location of disease in a RAS is

Answer 26

the origin.

Question 27

What is the normal peak systolic velocity (PSV) when evaluating for a Renal Artery Stenosis?

Answer 27

<180 cm/sec

Question 28

If you see a peak systolic velocity greater than 180-200 cm/sec, you should suspect 60% or more RAS.

True or False

Answer 28

True

Question 29

What are the ways to calculate a RAS?

Answer 29

Peak systolic velocity and the Renal Aortic Ratio (RAR)

Question 30

How do you calculate the Renal Aortic Ratio?

Answer 30

Divide the highest renal artery PSV by the aorta PSV

Question 31

What is a normal RAR (Renal Aortic Ratio)

Answer 31

less than (

Question 32

What is an abnormal RAR (Renal Aortic Ratio)

Answer 32

more than (>) 3.5

Question 33

How do you calculate the RI (Resistive Index)?

Answer 33

Divide the PSV - EDV by the PSV

Usually the computer does this, but still know.

Question 34

What is a normal RI?

Answer 34

less than 0.8

Question 35

What is an abnormal RI?

Answer 35

Greater than 0.8

Question 36

What is the normal and abnormal range of the end diastolic ratio?

Answer 36

Normal is greater than 0.2 and abnormal is less than 0.2

Question 37

A delayed systolic upstroke can indicate?

Answer 37

proximal stenosis

Question 38

Where in a RAS study would we document the acceleration time (AT)

Answer 38

Distal renal artery at the hilum or segmental arteries

Question 39

What is a normal Acceleration time?

Answer 39

Normal is less than (

Question 40

What is an abnormal Acceleration time?

Answer 40

Abnormal is more than > 100 milliseconds

Question 41

What should the cortex of the kidney measure?

Answer 41

GREATER THAN 1 cm

Less could be cortical thinning

Question 42

When imaging a liver transplant, what vessels should we evaluate?

Answer 42

Portal vein, hepatics, IVC , and hepatic artery.

Question 43

In a renal transplant patient,

The renal artery is anastomosed to the ___ or ___ ____ artery

Answer 43

internal or external artery

Question 44

Low resistive flow is normally seen in a renal transplant patient.

Answer 44

True