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Vascular > Chapter 29: Intraoperative Duplex Ultrasound > Flashcards

Chapter 29: Intraoperative Duplex Ultrasound Flashcards

1
Q

self-produced, or from the same organism. In the case of bypass, using the patient’s own tissue

A

autologous/autogenous

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2
Q

Removal of plaque intima and part of the media of an artery to restore normal flow through the diseased segment

A

endarterectomy

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3
Q

Below the inguinal level. In the case of bypass, procedures from the groin down. (Outflow procedures)

A

infrainguinal

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4
Q

A device replacing an absent or damaged part. In the case of bypass, procedures done using a man-made tube.

A

prosthetic

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5
Q

Restoration of blood flow to an organ or area by way of bypass, endarterectomy, or angioplasty and stening.

A

revascularization

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6
Q

means by which a surgical field is isolated from nonsterile or contaminated materials

A

sterile technique

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7
Q

keeping a watch over. In the case of revascularization, it suggests periodically monitoring patency and functioning by some means.

A

surveillance

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8
Q

pertaining to the viscera; in this case, kidneys or intestines

A

visceral

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9
Q

anatomy examined during carotid endarterectomy

A

CCA
ICA
ECA

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10
Q

potential complications of carotid endarterectomy

A

intimal flap
residual plaque
platelet aggregate
suture line abnormalities
dissection

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11
Q

anatomy examined during infrainguinal revascularization

A

inflow artery
outflow artery
anastamotic regions
entire conduit

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12
Q

potential complications of infrainguinal revascularization

A

retained valves
AV fistulae
platelet aggregate
anastamotic or suture line abnormalities

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13
Q

Anatomy examined during renal and mesenteric artery bypass

A

anastamotic regions
renal artery
celiac artery
mesenteric artery

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14
Q

Potential complications of renal and mesenteric artery bypass

A

residual plaque
platelet aggregate
dissection
anastamotic or suture line abnormalities

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15
Q

hyperechoic plaque projecting into the vessel lumen; may display an abrupt edge

A

“shelf” lesion/residual lesion

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16
Q

small projection into vessel lumen usually less than 1 cm; disturbed flow or aliasing may be present

A

intimal flap

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17
Q

linear object seen extending for several centimeters, parallel to vessel walls; turbulent or disturbed flow present

A

dissection

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18
Q

hypoechoic or anechoic material adjacent to vessel wall; focal elevation in PSV, Increaesed velocity ratio

A

platelet aggregate

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19
Q

Stenosis: carotid or lower extremity bypass graft

A

PSV > 180cm/s
Velocity ration >2.5

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20
Q

Stenosis: renal or celiac artery

A

PSV >200 cm/s

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21
Q

Stenosis: superior mesenteric artery

A

PSV >250 cm/s

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22
Q

patent branch may be seen arising from an in situ bypass graft; turbulence and aliasing present in area of side branch; elevated diastolic velocities in bypass graft proximal to side branch

A

arteriovenous fistula

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23
Q

hyperechoic structure protruding into lumen of vein bypass graft; may be associated with slight dilation of valve sinus; turbulence of aliasing may be present

A

retained valve

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24
Q

turbulence or aliasing may be present; kink or wall irregularity may be present

A

suture line/ anastomotic problem

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25
Q

Injection of ______ during an infraguinal bypass can minimise the effects of vasospasm

A

papaverine

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26
Q

One of the most frequent operations performed by vascular surgeons

A

carotid endarterectomy

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27
Q

After a carotid endarterectomy the stroke rates drop below __%

A

3

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28
Q

most commonly used assessment during carotid endarterectomy

A

continuous-wave Doppler interrogation

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29
Q

plaque remaining in proximal CCA or distal ICA that appears as an abrupt edge or outcropping

A

shelf lesion

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30
Q

If a shelf lesion is more than __ mm thick, revision should occur

A

2

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31
Q

moving plaque within the bloodstream

A

residual plaque

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32
Q

If residual plaque is seen following a carotid endarterectomy, what is the next step

A

prompt revision

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33
Q

If an intimal flap is above __ mm, a revision is needed.

A

2

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34
Q

Result of vascular clamp injury; most common technical defects involve ECA

A

dissection

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35
Q

If the PSV of the ICA exceeds ___ cm/s or the ICA to CCA PSV ratio is greater than ______ cm

A

> 180 cm/s
2.5

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36
Q

Infrainguinal revascularization is performed for:

A

claudication
cranial limb ischemia

37
Q

Infrainguinal revascularization is performed via:

A

percutaneous endovascular means
open surgical bypass using with autogenous (vein) or a prosthetic material

38
Q

The choice of an appropriate conduit depends on:

A

level of bypass
available autogenous material

39
Q

The _____ approach is more prone to abnormalities

A

autologous

40
Q

Methods of assessing bypasses

A

palpation
continuous wave Doppler
angiography
angioscopy
duplex ultrasound scanning

41
Q

What was the gold standard for infrainguinal revascularization?

A

arteriography

42
Q

drawbacks of arteriography

A

inability to assess inflow
difficulty in visualizing the entire length of conduit
lack of physiological information provided

43
Q

Findings that prompt revision in infrainguinal revascularization

A

PSV greater than 180 cm/s
velocity ratio greater than 2.5

44
Q

may form at site of vessel wall injury

A

platelet aggregate

45
Q

may be identified with in situ grafts; turbulent flow present in region of fistula with elevated diastolic flow velocities proximal to fistula

A

arteriovenous fistula

46
Q

A velocity of more than ___ cm/s in a renal bypass is indicative of revision

A

200

47
Q

Normal celiac artery PSV

A

less than 200 cm/s

48
Q

Normal superior mesenteric artery PSV

A

less than 275 cm/s

49
Q

Which of the following is considered the “gold standard” for intraoperative assessment of any type of revascularization?
a. duplex ultrasound
b. arteriography
c. CW Doppler only
d. palpation

A

a

50
Q

Which duplex ultrasound system requirements would be best suited for intraoperative assessment?
a. portable systems with high-frequency transducers
b. high end systems with large array transducers
c. grayscale only systems with high frequency transducers
d. large systems with a variety of transducers

A

d

51
Q

What is the primary role of the vascular technologist during intraoperative procedures?

A

operation of the ultrasound system as the vascular surgeon manipulates the transducer

52
Q

In general, when performing an intraoperative assessment, which of the following imaging techniques is best?
a. grayscale imaging only
b. spectral Doppler analysis only
c. combination of grayscale, color, and spectral Doppler
d. color Doppler assessment only

A

c

53
Q

What is NOT a benefit of angiography in the intraoperative assessment of carotid endarterectomy?
a. ability to visualize the intracranial carotid artery
b. ability to visualize the extracranial internal carotid artery
c. the use of contrast is not needed
d. It offers physiologic data as well as anatomic data

A

c

54
Q

During intraoperative assessment of carotid endarterectomy, spectral Doppler demonstrated velocities of 200 cm/s in the internal carotid artery, whereas velocities in the common carotid artery were 70 cm/s. Based on these findings, which of the following is likely to occur?
a. closure of the surgical site with no further investigation
b. closure of the surgical site with duplex assessment performed 1 day postoperatively
c. repeat intraoperative duplex assessment 30 minutes later
d. revision of the surgical site with repeat duplex assessment after revision

A

d

55
Q

Which of the following duplex ultrasound findings is NOT associated with platelet aggregation?
a. hypoechoic or anechoic material adjacent to vessel wall
b. focal elevation in peak systolic velocities
c. increased velocity ratios
d. linear object visualized parallel to vessel walls

A

d

56
Q

Upon duplex assessment of a carotid endarterectomy site, shadowing is noted in the proximal internal carotid artery. What is the most likely cause of this shadowing?

A

artifact from the prosthetic patch at the endarterectomy site

57
Q

Which of the following can lead to complications or failure of an infrainguinal bypass graft?
a. inadequate arterial flow
b. use of prosthetic material below the knee
c. significant disease in the outflow vessels
d. all of the above

A

d

58
Q

Which of the following is a main advantage of intraoperative duplex assessment of infrainguinal bypass grafts?
a. complete anatomic evaluation of the graft
b. identification of retained valves
c. physiologic information is gathered as well as anatomic
d. shadowing caused by prosthetic material will enhance the image

A

b

59
Q

What is the preferred bypass conduit for infrainguinal revascularization?
a. Dacron material
b. PTFE material
c. autologous material
d. all materials are equally preferred

A

d

60
Q

What may abnormally low graft velocities in an infrainguinal bypass graft indicate?

A

poor outflow vessels

61
Q

Which criterion is used most often when assessing whether to revise an infrainguinal bypass graft during intraoperative assessment?

A

PSV greater than 180 cm/s and velocity ratio greater than 2.5

62
Q

During intraoperative duplex assessment of a lower extremity bypass graft, turbulent flow is noted in the mid-thigh with elevated diastolic flow in the proximal thigh. What are these findings consistent with?

A

arteriovenous fistula

63
Q

Why may intraoperative duplex assessment of renal artery bypass be preferred over angiography?

A

Duplex ultrasound avoids the use of contrast in a renal compromised patient

64
Q

Why is intraoperative duplex ultrasound NOT used in aortoiliac reconstruction?

A

small defects are not as patency-threatening in these large vessels

65
Q

What velocity is typically used as an indication to revise a renal artery bypass during intraoperative assessment?

A

200 cm/s

66
Q

During a superior mesenteric artery bypass intraoperative evaluation, an intimal flap is discovered and velocities were 300 cm/s. What would likely occur with this graft?

A

graft failure is imminent even with intervention

67
Q

What is a common venous procedure in which intraoperative monitoring is routinely used?

A

endovenous laser therapy

68
Q

What is an evolving ultrasound technology used for guidance of endovenous interventions?

A

IVUS

69
Q

A typical transducer used during an intraoperative procedure would be a(n) _____ frequency, linear arry.

A

multi

70
Q

During an intraoperative procedure, a sterile _____ is placed over the transducer once filled with sterile gel, and bubbles are removed to reduce interference.

A

sheath

71
Q

In duplex assessment of intrainguinal revascularization, injection of papaverine into the bypass is helpful in minimizing the effects of ______

A

vasospasm

72
Q

Because prosthetic materials absorb _____, intraoperative scanning of these materials is virtually impossible, however, prosthetic _____ in carotid endarterectomy can usually be worked around.

A

air
patch

73
Q

For the vascular technologist to assist in the operating room, they must have familiarity with ____ technique.

A

sterile

74
Q

Carotid endarterectomy is one of the most common operations performed by vascular surgeons and typically has stroke rates below ____%, however, there remains some value of intraoperative assessment to minimize residual ____.

A

3
residual

75
Q

Continuous-wave Doppler is probably the most commonly used assessment during cartoid endarterectomy; however, _____ wave Doppler or _____ imaging is being shown to be effective for intraoperative assessment.

A

pulsed
B-mode

76
Q

During duplex assessment of carotid endarterectomy, velocities are obtained from all the carotid arteries, and B-mode images are closely examined for wall ______

A

irregularities

77
Q

Plaque remaining in the proximal internal carotid artery or distal common carotid artery after endarterectomy, which appears as an abrupt edge or outcropping, is oftern referred to as a(n) ______

A

shelf lesion

78
Q

A(n) ______ is another complication of endarterectomy and is often revised if in excess of ___ mm.

A

intimal flap
2

79
Q

Infrainguinal revascularization can be performed for claudication or _______

A

critical limb ischemia

80
Q

While carotid endarterectomy is fairly standardized, issues are common with infrainguinal revascularization because there are many _____ in the performance of the procedure

A

variations

81
Q

The so-called “_____” veins are more prone to abnormalities that can result in failure of an infrainguinal bypass graft

A

alternative

82
Q

To identify retained valves, scarred areas, arteriovenous fistula, or platelet aggregation, duplex scanning during lower extremity bypass allows the ______ of the bypass to be evaluated.

A

entire length

83
Q

Findings the prompt revision of lower extremity bypass grafts include a peak systolic velocity greater than ____ cm/s and a velocity greater than ____.

A

180
2.5

84
Q

On duplex assessment of infrainguinal bypass, an increased velocity was noted; however, the lumen of the conduit appears anechoic– this could be the result of ______

A

platelet aggregation

85
Q

Duplex sonography has distinct advantages over angiography in the assessment of visceral revascularization, including the ability to visualize small vessels and the lack of the need for _____, particularly for patients with poor renal function./

A

contrast

86
Q

In renal bypass assessment, velocities of ____ cm/s by duplex scanning were an indication for revision.

A

200

87
Q

Abnormal intraoperative duplex studies of mesenteric bypass grafts have been associated with early _____, graft ____, and even death

A

reintervention
failure

88
Q

Criteria for normal results of a mesenteric bypass graft include peak systolic velocities below ___ cm/s for the celiac artery and _____ cm/s for the superior mesenteric artery, a velocity ratio less than ____ and no technical defects

A

200
275
2.0

89
Q
A

Vascular (33 decks)

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