Duplex/color flow imaging ABD Flashcards
Arteries imaged?
Celiac, SMA, renal arteries, aorta, common iliacs, externally iliacs (prox, mid, distal), and internal iliac artery
An aneurysm is classified when?
Dilation > 3 cm or 50 % increase in diameter of original artery
The majority of AAA are?
atherosclerotic and infrarenal
Most frequent complications of an AAA?
rupture or embolization of the peripheral aneurysms
Many patients who have hypertension have?
renovascular hypertension
Renal artery stenosis can be secondary to what?
atherosclerosis or fibromuscular dysplasia
Renal artery protocal:
a) celiac and SMA velocity data
b) aorta PSV near SMA level
c) evaluate kidneys
d) PSV and EDV of prox, mid, distal renal artery
e) PSV and EDV of upper and lower pole of kidney in seg arteries
f) observe for secondary or accessory renal arteries
Renal arteries, kidney arteries, celiac, hepatic, and splenic arteries are all what resistance?
low
The aorta and fasting SMA and IMA are what resistance?
higher
Renal to aortic ratio
highest renal artery PSV/ AO PSV
Normal RAR:
less than 3.5
Abnormal RAR:
> 3.5 suggests > 60 % diameter reduction
When can an RAR not be used?
If AAA detected
If aortic PSV > 90cm/s or
End Diastolic Ratio (EDR) or the parenchymal resistance ratio for kidney:
EDV/PSV
normal: > 0.2
abnormal: less than 0.2
Resistivity index for kidney:
PSV-EDV/PSV
normal= 0.75
Abnormal calculations indicate an increase in distal resistance:
nephrosclerotic disease
With a PSV of 45 cm/s and an EDV of 5 cm/s, what is the EDR and the RI?
EDR= 0.1 RI= 0.88
What is tardus parvus?
Dampened, weak doppler signals with low resistance quality
Patients with a history of dull, achy or crampy abdominal pain 15-30 minutes after eating?
mesenteric ischemia
mesenteric ischemia (angina) may be due to a stenosis or occlusion of?
SMA, celiac, or IMA
Protocol for mesenteric arteries?
Fasting patient
PSV and EDV of celiac, SMA (p, m, d), IMA, and aorta
After eating (post-prandially) PSV and EDV of the SMA are obtained
For the food challenge test, have patient drink high caloric liquid (Ensure) and repeat the exam within how much time?
20-30 minutes
hyperemic response begins after about 10 min, max response time about 30 min
What is not influenced by the post-prandinal state?
Liver and spleen have fixed metabolic requirements
Celiac artery
If IMA is easily observed, often suggests?
SMA occlusion
In most cases how many mesenteric vessels have to be abnormal to be consistant with chronic mesenteric ischemia?
2 of 3
Extrinsic compression of celiac artery origin by what is frequently seen?
median arcuate ligament of the diaphragm
Pre and post operative evaluation of liver transplant includes documenting patency of?
portal vein, hepatic vein, IVC, and hepatic artery
post-op liver transplant complications can include thrombosis of vessels such as?
portal vein, IVC, and/or hepatic artery leading to hepatic infarction
Acute rejection will cause liver dysfunction and many suggest rejection is a?
cellular process
Transplanted RA anastomosed to what arteries?
Transplanted RV to what vein?
RA: external iliac artery or internal
RV: external iliac vein
post-op renal artery transplant includes?
renal artery doppler evaluation and kidney examination checking for hematoma and parenchymal echogenicity
Signs of renal transplant rejection?
increased transplant size and increased cortical echogenicity
acute rejection often increases arterial resistance
What method for rejection diagnosis for kidneys do many consider to be most reliable?
biopsy
others use the indicator of increased arterial resistance
