Duplex Scanning & Color Flow of the Abdominal Vessels Flashcards
aneurysm diameter
> 3 cm
most aneurysms are true aneurysms which means
they involve all three layers of the blood vessel
most common shape of aneurysm
fusiform
most common location of aneurysms
infrarenal
most common cause of aneurysms
atherosclerosis
what is a mycotic aneurysm?
aneurysm caused by infection
AAAs have been associated with (4)
- Marfan syndrome
- syphilis
- familiar inheritance
- infection
what is renovascular hypertension?
secondary form of high BP often caused by renal artery stenosis or occlusion
2 things that occur in response to renovascular hypertension
- kidneys produce renin
- sodium and fluid retention
when evaluating the kidneys, PSV of the AO is obtained ____
just distal to the SMA
when evaluating the kidneys, PSV and EDV are obtained from (3)
- renal arteries ( prox, mid, dist )
- segmental arteries
- interlobar arteries ( upper & lower poles)
renal-to-aortic ratio (RAR) =
renal artery PSV / aortic PSV
normal RAR result
< 3.5
abnormal RAR result
≥ 3.5 which indicates a 60% greater diameter reduction
RAR may not be accurate in the presence of (3)
- AAA
- PSV of the AO are < 40 cm/sec
- PSV of the AO are > 90-100 cm/sec
PSV of AO ≥ 180-200 cm/sec with poststenotic turbulence is suggestive of ___
≥ 60% diameter reduction
significant stenosis will exhibit ____ turbulence and there will be ____ in the abnormal waveform
poststenotic turbulence
spectral broadening
normal kidney length
10 - 12 cm
end diastolic ratio (EDR) =
EDV / PSV
EDR is also known as (2)
parenchymal resistance ratio (PRR)
diastolic/systolic ratio (DSR)
normal ERD result
≥ 0.2
abnormal EDR result
< 0.2 which indicates an increase in resistance within the kidney
Pourcelot’s ratio is also known as
resistivity index (RI)
Pourcelot’s ratio/RI =
RI = ( PSV - EDV ) / PSV
Pourcelot’s ratio/RI is used to determine whether resistance is increasing in
transplanted kidneys
normal RI result
< 0.7
abnormal RI result
≥ 0.7
renal resistive-index value (RRIV) =
RRIV = ( 1 - EDV ) / PSV
in the RRIV equation, PSV and EDV are from the ___ arteries
segmental arteries
RRIV helps prospectively identify patients whose renal function of BP will improve after correction of ___
RA stenosis
RRIV < 0.75 suggests
improvement
RRIV ≥ 0.75 suggest
worsening
acceleration time (AT) is
time interval from the onset of systole to the initial peak
prox stenosis of ≥ 60% diameter will have a AT of ___
≥ 100 msec
acceleration index (AI) is ___
slope of the Doppler velocity waveform
AI =
( onset of systole velocity - PSV ) / AT
positive result is AI ≤ _____
291 cm/sec
mesenteric ischemia is also known as
mesenteric angina
mesenteric ischemia is
abdominal pain 15-30 mins after meals
chronic mesenteric ischemia is suggested when
there are abnormal findings for at least ⅔ of mesenteric vessels ( celiac, SMA, IMA )
mesenteric ischemia is difficult to diagnose, ____ is essential for diagnosis
arteriogram
in the presence of a ___, the patient is given a high calorie liquid meal after the fasting study
mesenteric bypass graft
after a high calorie liquid meal is given, what are the 3 things that should be documented?
- amount ingested and time it took to complete drinking liquid
- time the postprandial testing begins
- number of minutes between ingestion and onset of any symptoms
postprandial testing of the mesenteric arteries should be repeated ___ after the meal
20-30 mins
the fasting state determines ___
the presence of significant prox stenosis
the postprandial state evaluates ___
the function of a mesenteric bypass graft
fasting SMA is ___ resistance
high
postprandial SMA is ____ resistance
low
the ___ is not affected posprandially
celiac artery
fasting SMA
PSV -
EDV -
flow reversal -
PSV - high
EDV - low
flow reversal - yes
fasting celiac artery
PSV -
EDV -
flow reversal -
PSV - high
EDV - high
flow reversal - no
postprandial SMA
PSV -
EDV -
flow reversal -
PSV - marked increase
EDV - marked increase
flow reversal - yes
postprandial celiac artery
PSV -
EDV -
flow reversal -
PSV - no change
EDV - no change
flow reversal - n/a
normal PSV of SMA
110-177 cm/sec
normal PSV of celiac artery
50-160 cm/sec
PSV of SMA that predicts ≥ 70% diameter reduction
PSV ≥ 275 cm/sec
PSV of celiac artery that predicts ≥ 70% diameter reduction
PSV ≥ 200 cm/sec
what is celiac band syndrome?
extrinsic compression of the celiac artery by the median arcuate ligament of the diaphragm
celiac band syndrome
high-velocity signals of stenosis improve with ___ and return with ___
improve with deep inspiration
return with expiration
celiac band syndrome
an audible ___ can be auscultated
bruit
2 possible collateral connections between the SMA and IMA
- arc of Riolan
- marginal artery of the colon (aka marginal artery of Drummond)
preoperative duplex evaluation of candidates for liver transplant include (3)
- document patency of PV, splenic vein, SMV, HVs, IVC, and HA
- observe for abnormalities and/or other vasculature
- determine status of biliary tree
postoperative duplex evaluation of liver transplants include (2)
- document patency of PV, splenic vein, SMV, HVs, IVC, and HA
- document PV flow direction and vessel size
PV size should be
≤ 1 cm up to 1.5 cm
postoperative liver transplant complications (4)
- allograft rejection
- pseudoaneurysm
- hepatic infarction
- thrombosis of PV, IVC, and/or HA
most renal transplants are found in the ___
right iliac fossa
3 renal transplant anastomosis used
- RA end to side with EIA
- RA end to end with IIA
- RA end to side with EIV
in a renal transplant, the donor ureter is usually implanted into ___
the bladder directly
postoperative follow up of renal transplant include Doppler spectral analysis of (7)
- AO
- EIA or IIA
- EIV
- donor RA and RV
- allograft vessels
- PSVs and EDVs of all vessels
- flow resistance
B-mode signs of renal transplant rejection (3)
- increased allograft size
- increased cortical echogenicity
- hypoechoic regions in the parenchyma
___ is the most reliable method for rejection diagnosis
biopsy
duplex scanning can help diagnose (4)
- RA stenosis
- RV thrombosis
- arteriovenous fistula
- pseudoansurysms
