Class two Flashcards
What are some aorta-iliac indications?
- Abdominal pain
- Pulsatile Abdominal mass
- Abdominal bruit
- Family Hx of AAA
- Hx of HTN
- Hip/buttock claudication
- Decreased femoral pulse
- Blue toe syndrome
- AAA surveillance.
What are two aorta-iliac diseases?
Atherosclerosis & aneurysm.
What are some risk factors for aorta-iliac disease?
- Age
- SMoking
- HTN
- Family Hx of AAA
- Trauma
- Athersclerosis
- Hyperlipidemia
- Male
What are the signs and symptoms of AAA?
- Patients with AAA are often asymptomatic
- Abdominal pain
- Body pain
- Palpable pulsatile abdominal mass upon physical exam
What is the survival rate for a ruptured AAA?
10-25%
When does the risk of rupture increase with an AAA?
The risk of rupture increase with the size of the aneurysm.
An aneurysm of ____ have a higher incidence of rupture?
>5 cm
When is surgical repair recommended for an AAA?
It is usally recommended for aneurysms of >5 cm
Most AAA are _____
Infrarenal
How should you examine the aorta?
Examine the aorta from the diaphragm to the bifurcation.
Where should measurements be taken for the aorta?
- Anterior posterior
- Outer wall to outer wall.
- Perpendicular to the long axis of the aorta.
What is the AAA duplex protocal?
- Measure from diapgragm to bifurcation
- Determine the location of AAA
- Measure
- Examine and measure iliac arteries
What should the angle be in a doppler for an aorto-iliac duplex?
60°
What is the criteria for an occlusive disease duplex?
- Focal increase in velocity of 2 or more times the proximal adjacent segment.
- Post-stenotic turbulence
- Presence of plaque
- Presence of a thrombus
- Abnormal doppler signal at CFA
What is the critera for a NORMAL duplex?
- Aortic diameter is approx. 2 cm
- Aortic tapers distally
- No intreluminal echoes detected within aort and iliac arteries
- Color fills vessel lumen
- Multi-phasic spectral waveforms
- Uniform PSV
What are the 3 main treatment options for aorto-iliac disease?
- Medical treatments
- Surgical treatments
- Endovascular treatments
What does medical treatment conists of?
- Medication
- Follow-up imaging
What does a surgical treatment conist of?
Open repair
What does endovascular treatment consist of?
- Percutaneous transluminal angioplasty
- Stent
- Endovascular aortic stent graft repair
What criteria qualifies for a AAA diagnoses?
- Focal increase in caliber of artery
- Dilated segment is at least 1.5 to 2x greater than the adjacent unaffected.
- >3cm=AAA
What does ectatic mean?
It refers to an abdominal aorta measuring >2 cm and <3 cm of an aorta that doesn’t taper distally.
IVC, iliac veins, and abdominal aorta are located where?
The retroperitoneum.
What is the retroperitoneum?
It is space between abdominal cavity and posterior abdominal wall.
Where does the IVC receives blood from?
It receives blood from all organs and tissues inferior to the diaphragm.
What are the risk factors for IVC/iliac vein disease?
- Age
- Immobility
- Cancer
- Hx of DVT
- Smoking
- Family Hx
- May-Thurner disease
- Clotting disorder
- Trauma
What are some exam indications for a IVC/iliac veins?
- LE pain
- LE swelling
- SOB
- Chest pain
- Hemopytsis
- Guided filter insertion
- Pre and post filter placement
What are normal IVC/iliac vein doppler waveforms characteristic?
- Proximal IVC: Cardiac pulsatility, phasic with respiratory variation
- Distal IVC & Iliac veins: Phasic with respiratory variation
What happens to the IVC/iliac respiration variation during inhalation?
Deep inhalation decreases venous signal
What happens to the IVC/iliac respiration variation during exhalation?
Exhalation increases venous signal
Why does the venous signal increase and decrease?
Due to intrathoracic changes during respiration
What is the most common cause of obstruction in the IVC/ IV?
Thrombosis.
Thrombosis most often propagates from lower extremity venous thromboembolism.
What should you observe in an IVC/IV assessment?
- OBSERVE FOR MASSES AND EXTRINSIC COMPRESSION OF THE VEIN.
- OBSERVE FOR VENOUS DILATION, VISIBLE THROMBUS
What should you evaluate in an IVC/IV assessment?
- EVALUATE LENGTH OF THE ILIAC VENOUS SYSTEM WITH COLOR.
- EVALUATE AND COMPARE DOPPLER SIGNALS FROM SIDE TO SIDE.
What is IVC & Iliac Vein Assessment critera for diagnosing a thrombosis?
- Dilated IVC or iliac vein
- Presence of echogenic material within vessel lumen
- Lack of color fill
- Absent Doppler signal in total occlusion
- Continuous, non-phasic Doppler signal may indicate partial obstruction
What is some other pathology in the IVC/IV?
- Neoplastic Obstruction
- Extrinsic or intraluminal tumors that invade or compress the IVC
- May-thurners syndrome
What are some examples of extrinsic or intraluminal tumors that invade or compress the IVC?
- Renal cell carcinoma
- Hepatocellular carcinoma
What is May-Thurner syndrome also known as?
Iliac vein compression syndrome (IVCS)
What is May-Thurner syndrome?
It is when the left common iliac vein is compressed by right common iliac artery
How is May-Thurner’s syndrome seen on duplex?
- At compression point, increased velocities and/or stenotic flow may be detected
- Continuous (non-phasic) Doppler signal noted distal to compression site
What can May-Thurners syndrome cause?
- Left iliofemoral DVT
- CVI, which may cause chronic LLE pain and edema
What are some 3 IVC anomalies?
- DUPLICATION OF THE INFRARENAL IVC
- LEFT-SIDED IVC
- CONGENITAL ABSENCE OF THE INTRAHEPATIC PORTION OF THE IVC
Where should an IVC filter be placed?
FILTERS SHOULD BE PLACE IN THE IVC DISTAL TO THE RENAL VEINS
