Duplex Scanning & Color Flow of the Abdominal Vessels

Question 1

aneurysm diameter

Answer 1

> 3 cm

Question 2

most aneurysms are true aneurysms which means

Answer 2

they involve all three layers of the blood vessel

Question 3

most common shape of aneurysm

Answer 3

fusiform

Question 4

most common location of aneurysms

Answer 4

infrarenal

Question 5

most common cause of aneurysms

Answer 5

atherosclerosis

Question 6

what is a mycotic aneurysm?

Answer 6

aneurysm caused by infection

Question 7

AAAs have been associated with (4)

Answer 7

1. Marfan syndrome
2. syphilis
3. familiar inheritance
4. infection

Question 8

what is renovascular hypertension?

Answer 8

secondary form of high BP often caused by renal artery stenosis or occlusion

Question 9

2 things that occur in response to renovascular hypertension

Answer 9

1. kidneys produce renin
2. sodium and fluid retention

Question 10

when evaluating the kidneys, PSV of the AO is obtained ____

Answer 10

just distal to the SMA

Question 11

when evaluating the kidneys, PSV and EDV are obtained from (3)

Answer 11

1. renal arteries ( prox, mid, dist )
2. segmental arteries
3. interlobar arteries ( upper & lower poles)

Question 12

renal-to-aortic ratio (RAR) =

Answer 12

renal artery PSV / aortic PSV

Question 13

normal RAR result

Answer 13

< 3.5

Question 14

abnormal RAR result

Answer 14

≥ 3.5 which indicates a 60% greater diameter reduction

Question 15

RAR may not be accurate in the presence of (3)

Answer 15

1. AAA
2. PSV of the AO are < 40 cm/sec
3. PSV of the AO are > 90-100 cm/sec

Question 16

PSV of AO ≥ 180-200 cm/sec with poststenotic turbulence is suggestive of ___

Answer 16

≥ 60% diameter reduction

Question 17

significant stenosis will exhibit ____ turbulence and there will be ____ in the abnormal waveform

Answer 17

poststenotic turbulence
spectral broadening

Question 18

normal kidney length

Answer 18

10 - 12 cm

Question 19

end diastolic ratio (EDR) =

Answer 19

EDV / PSV

Question 20

EDR is also known as (2)

Answer 20

parenchymal resistance ratio (PRR)
diastolic/systolic ratio (DSR)

Question 21

normal ERD result

Answer 21

≥ 0.2

Question 22

abnormal EDR result

Answer 22

< 0.2 which indicates an increase in resistance within the kidney

Question 23

Pourcelot’s ratio is also known as

Answer 23

resistivity index (RI)

Question 24

Pourcelot’s ratio/RI =

Answer 24

RI = ( PSV - EDV ) / PSV

Question 25

Pourcelot's ratio/RI is used to determine whether resistance is increasing in

Answer 25

transplanted kidneys

Question 26

normal RI result

Answer 26

< 0.7

Question 27

abnormal RI result

Answer 27

≥ 0.7

Question 28

renal resistive-index value (RRIV) =

Answer 28

RRIV = ( 1 - EDV ) / PSV

Question 29

in the RRIV equation, PSV and EDV are from the ___ arteries

Answer 29

segmental arteries

Question 30

RRIV helps prospectively identify patients whose renal function of BP will improve after correction of ___

Answer 30

RA stenosis

Question 31

RRIV < 0.75 suggests

Answer 31

improvement

Question 32

RRIV ≥ 0.75 suggest

Answer 32

worsening

Question 33

acceleration time (AT) is

Answer 33

time interval from the onset of systole to the initial peak

Question 34

prox stenosis of ≥ 60% diameter will have a AT of ___

Answer 34

≥ 100 msec

Question 35

acceleration index (AI) is ___

Answer 35

slope of the Doppler velocity waveform

Question 36

AI =

Answer 36

( onset of systole velocity - PSV ) / AT

Question 37

positive result is AI ≤ _____

Answer 37

291 cm/sec

Question 38

mesenteric ischemia is also known as

Answer 38

mesenteric angina

Question 39

mesenteric ischemia is

Answer 39

abdominal pain 15-30 mins after meals

Question 40

chronic mesenteric ischemia is suggested when

Answer 40

there are abnormal findings for at least ⅔ of mesenteric vessels ( celiac, SMA, IMA )

Question 41

mesenteric ischemia is difficult to diagnose, ____ is essential for diagnosis

Answer 41

arteriogram

Question 42

in the presence of a ___, the patient is given a high calorie liquid meal after the fasting study

Answer 42

mesenteric bypass graft

Question 43

after a high calorie liquid meal is given, what are the 3 things that should be documented?

Answer 43

1. amount ingested and time it took to complete drinking liquid 2. time the postprandial testing begins 3. number of minutes between ingestion and onset of any symptoms

Question 44

postprandial testing of the mesenteric arteries should be repeated ___ after the meal

Answer 44

20-30 mins

Question 45

the fasting state determines ___

Answer 45

the presence of significant prox stenosis

Question 46

the postprandial state evaluates ___

Answer 46

the function of a mesenteric bypass graft

Question 47

fasting SMA is ___ resistance

Answer 47

high

Question 48

postprandial SMA is ____ resistance

Answer 48

low

Question 49

the ___ is not affected posprandially

Answer 49

celiac artery

Question 50

fasting SMA PSV - EDV - flow reversal -

Answer 50

PSV - high EDV - low flow reversal - yes

Question 51

fasting celiac artery PSV - EDV - flow reversal -

Answer 51

PSV - high EDV - high flow reversal - no

Question 52

postprandial SMA PSV - EDV - flow reversal -

Answer 52

PSV - marked increase EDV - marked increase flow reversal - yes

Question 53

postprandial celiac artery PSV - EDV - flow reversal -

Answer 53

PSV - no change EDV - no change flow reversal - n/a

Question 54

normal PSV of SMA

Answer 54

110-177 cm/sec

Question 55

normal PSV of celiac artery

Answer 55

50-160 cm/sec

Question 56

PSV of SMA that predicts ≥ 70% diameter reduction

Answer 56

PSV ≥ 275 cm/sec

Question 57

PSV of celiac artery that predicts ≥ 70% diameter reduction

Answer 57

PSV ≥ 200 cm/sec

Question 58

what is celiac band syndrome?

Answer 58

extrinsic compression of the celiac artery by the median arcuate ligament of the diaphragm

Question 59

celiac band syndrome high-velocity signals of stenosis improve with ___ and return with ___

Answer 59

improve with deep inspiration return with expiration

Question 60

celiac band syndrome an audible ___ can be auscultated

Answer 60

bruit

Question 61

2 possible collateral connections between the SMA and IMA

Answer 61

1. arc of Riolan 2. marginal artery of the colon (aka marginal artery of Drummond)

Question 62

preoperative duplex evaluation of candidates for liver transplant include (3)

Answer 62

1. document patency of PV, splenic vein, SMV, HVs, IVC, and HA 2. observe for abnormalities and/or other vasculature 3. determine status of biliary tree

Question 63

postoperative duplex evaluation of liver transplants include (2)

Answer 63

1. document patency of PV, splenic vein, SMV, HVs, IVC, and HA 2. document PV flow direction and vessel size

Question 64

PV size should be

Answer 64

≤ 1 cm up to 1.5 cm

Question 65

postoperative liver transplant complications (4)

Answer 65

1. allograft rejection 2. pseudoaneurysm 3. hepatic infarction 4. thrombosis of PV, IVC, and/or HA

Question 66

most renal transplants are found in the ___

Answer 66

right iliac fossa

Question 67

3 renal transplant anastomosis used

Answer 67

1. RA end to side with EIA 2. RA end to end with IIA 3. RA end to side with EIV

Question 68

in a renal transplant, the donor ureter is usually implanted into ___

Answer 68

the bladder directly

Question 69

postoperative follow up of renal transplant include Doppler spectral analysis of (7)

Answer 69

1. AO 2. EIA or IIA 3. EIV 4. donor RA and RV 5. allograft vessels 6. PSVs and EDVs of all vessels 7. flow resistance

Question 70

B-mode signs of renal transplant rejection (3)

Answer 70

1. increased allograft size 2. increased cortical echogenicity 3. hypoechoic regions in the parenchyma

Question 71

___ is the most reliable method for rejection diagnosis

Answer 71

biopsy

Question 72

duplex scanning can help diagnose (4)

Answer 72

1. RA stenosis 2. RV thrombosis 3. arteriovenous fistula 4. pseudoansurysms