Duplex Upper and Lower Extremities Flashcards
Localize stenosis/ occlusion/aneurysm is a capability of what
duplex upper extremity
A connection between an artery and vein is what type of graft
Hemodialysis Access graft
Name the 2 types of grafts and describe them
1) autologous= brescia-cimino (radial artery and cephalic vein)
2) synthetic= straight or looped (brachial artery to axillary vein)
Having the arm extended laterally and 45 degrees to the body describes what position
Pledge position
Normal native arteries for a hemodynamic access graft should be
a) high resistance
b) low resistance
a) high resistance
A stenosis should be
a) qualitative
b) quantitative
a) qualitative
- no velocity criteria
Focally elevated velocities and PST =
stenosis
What should a normal hemodialysis waveform of the proximal artery (inflow) be like
Low resistance and increased EDV
What should a normal hemodialysis waveform of the distal artery be like
back to normal high resistance (triphasic)
What should a normal hemodialysis waveform of a fistula be like
low resistance and high PSV and EDV
What should a normal hemodialysis waveform of a proximal vein (outflow) be like
pulsatile
Thumping high resistance in proximal artery or graft would be an abnormal finding of
graft occlusion
Low velocity dampened and continuous is a abnormal finding of
proximal inflow problem
A focal elevated velocity is an abnormal finding of
graft stenosis
Where is the most common location for focal elevated velocities
outflow vein
Evaluates location and severity of stenosis vs occlusion/ aneurysm is a capability of
Duplex lower extremity
A connection between an artery to an artery describes what type of graft
Bypass graft
what is the purpose of a bypass graft
Reroute blood flow in presence of significant extensive arterial obstruction
Name the 3 types of arterial bypass grafts
1) synthetic
2) in situ saphenous vein graft
3) reversed saphenous vein graft
What type of graft uses a PTFE
synthetic
What type of graft is used when the vein is kept in place, is removed from venous and connected to arterial and the branches must be ligated and valves removed
In situ saphenous vein graft
For an In situ saphenous vein graft where do you evaluate it
The body due to risk of AFV from branches
What type of graft is used when the vein is removed and flipped upside down, the branches are ligated, and valves kept in place
Revered saphenous vein graft
Where would you evaluate a reversed saphenous vein graft
Proximal anastomosis due to small size
Where would you evaluate a synthetic bypass graft
Anastomosis sites for possible leakage
A 2:1 ratio is what percentage diameter reduction
50%
- PSV doubles at stenosis
A 4:1 ratio is what percentage diameter reduction
75%
- PSV quadruples at stenosis
Any velocity greater than ______ cm/sec is a 75% diameter reduction
400 cm/sec
Retrograde flow in the native artery at distal anastomosis is
a) normal
b) abnormal
a) normal
An aneurysm would be considered an increase in what % diameter
50%
An aneurysm that has increase in diameter of 50% peripherally is most likely seen where
In the popliteal
When measuring the aorta to get AP measurement you must be
a) parallel
b) perpendicular
a) parallel
In the transverse view of the aorta you must scan in what plane to the aorta
a) parallel
b) perpendicular
b) perpendicular
What is the correct way to measure the true lumen of the aorta
outer to outer
How many cm is a AAA
> 3 cm
For a dissection you must be able to visualize what
An intimal flap
A RAR of 3.5 is what percentage of diameter reduction
60%
During a RAR tardus parvus is seen distally in what artery
segmental artery
A RAR cant be used if the Aorta is < ______ cm/s or >______ cm/s
<40 cm/s
>90 cm/s
Renal disease =
Nephrosclerosis
A normal kidney should be
a) high resistance
b) low resistance
b) low resistance
In a normal kidney the EDR should be
> 0.2
In a normal kidney the RI should be
<0.7
An abnormal kidney would have _______ resistance which = ________
increased resistance, nephrosclerosis
Abdominal pain and cramping 15-30 minutes after eating is what condition
mesenteric ischemia
Name the 3 vessels that are considered splanchnic vessels
1) Celiac
2) SMA
3) IMA
A normal celiac should be _____ resistance with _____ EDV
low resistance
high EDV
A celiac with a PSV of _____ cm/s is what % diameter reduction
> 200 cm/s
70% diameter reduction
A fasting SMA should have _____ resistance and ____ EDV
high resistance and low EDV
A post-prandial SMA should have ______ resistance and _____ EDV
low resistance and increased EDV
The SMA PSV of _____ cm/sec is what % diameter reduction
> 275 cm/sec
70%
Which splanchnic vessel is not easily visualized
IMA
If the IMA is imaged and the velocity is high this is considered to be
a) normal
b) abnormal
b) abnormal
2 out of 3 abnormal sphlanchnic vessels is what condition
Chronic mesenteric ischemia
Compression of the celiac by the median arcuate ligament of the diaphragm describes what syndrome
Celiac band syndrome
What syndrome is most often seen in young athletic women and is only compressed during expiration
Celiac band syndrome
During a renal transplant the donor vessels are connected to what vessels
External iliac vessels
During a liver transplant what 3 vessels are evaluated
1) hepatic artery
2) portal vein
3) hepatic veins
Normal transplants should have what type of flow pattern
a) high resistance
b) low resistance
b) low resistance
During a liver transplant what should the flow be in the portal vein
a) hepatopedal
b) hepatofugal
a) hepatopedal
During rejection of a transplant what happens to the EDV
decreases of loss of EDV
Name the 3 indications of organ transplant rejection
1) organ will increase in size
2) altered echogenicity
3) possible thrombosis of veins
For preoperative mapping the epigastric artery using what type of flap
TRAM
What type of flap for the epigastric artery is used in breast reconstruction
TRAM flap
What is another name for the internal mammary artery
Internal thoracic artery
Before the radial artery can be used for a coronary artery bypass graft what test must be peformed first
Modified Allens Test
For vein mapping what is the minimum mm that can be considered
2 mm
What type of fistula has communication between an artery and vein
Arteriovenous fistula
What type of atypical disorder is acquired usually from post procedure and has 1 connection
Traumatic
What type of atypical disorder is a malformation that you are born with and has numerous connections
Congenital
Closer to the heart that is larger has an increase risk of
CHF
What syndrome is swelling within fascial compartments causing compression and increased pressure to capillary vascular beds
Compartment syndrome
What syndrome compresses the tibial artery and causes a decrease in arterial perfusion
Anterior compression syndrome
What would indicate a total occlusion of the hemodialysis access graft
a) thumping patterns in the proximal vein
b) retrograde flow in the distal artery
c) high velocity, turbulent flow at its origin
d) little or now diastolic flow in the proximal artery
d) little or no diastolic flow in the proximal artery
What is the expected flow pattern in the artery proximal to the Brescia-Cimino fistula
a) low resistance
b) triphasic or biphasic
c) retrograde
d) high velocity and high resistance
a) low resistance
What describes the reversed saphenous vein graft
a) the proximal end is larger and the distal end is smaller
b) a valvutome must be used to remove the valves
c) the most common location for graft stenosis is the distal anastomosis
d) the distal end is larger and the proximal end is smaller
d) the distal end is larger and the proximal end is smaller
What is the most common location for arterial obstruction in the lower extremities
a) tibeoperoneal trunk
b) distal SFA
c) common femoral artery
d) bifurcation of the popliteal
b) distal SFA
Disease in which of the following can cause monophasic, continuous waveforms documented at the common femoral artery
a) SFA
b) common iliac artery
c) deep formal artery
d) internal iliac artery
b) common iliac artery
What is the normal doppler waveform pattern of the pre-prandial SMA
a) low end diastolic velocity
b) triphasic
c) low resistance
d) increased end diastolic velocity
a) low end diastolic velocity
What is the criteria for the renal artery to aorta ratio
a) normal is < 3.5
b) abnormal is <3.5
c) normal is less than 2:1
d) abnormal RAR is <1.0
a) normal is <3.5
The post prandial SMA is noted to have a PSV of 108 cm/s and EDV of 2 cm/s. What is the significance of these findings
a) prominent SMA collaterals
b) distal SMA obstruction
c) proximal SMA stenosis
d) normal hemodynamic pattern
b) distal SMA obstruction
In order to calculate the renal artery to aorta ratio, how should the aorta velocity be obtained
a) proximal to the SMA and distal to the celiac trunk
b) At the level between the take off of the SMA and renal arteries
c) inferior to origin of the renal arteries
d) at any location of the abdominal aorta avoiding aneurysm if present
b) At the level between the take off of the SMA and renal arteries
What sonographic finding most likely indicates renal transplant rejection
a) increased diastolic flow
b) increased organ size
c) perirenal fluid
d) absent diastolic flow
d) absent diastolic flow
When obtaining ankle blood pressures, what is the primary reason for having the patient in a flat, supine position
a) patient comfort
b) venous pressure reduction
c) easier doppler placement
d) reduce/eliminate hydrostatic pressure
d) reduce/eliminate hydrostatic pressure
Which of the following ankle/brachial indices is most consistent with the symptom of ischemic rest pain
a) 0.3
b) 0.5
c) 0.8
d) 1.0
a) 0.3
Which of the following conditions would cause an abnormal PVR at the high-thigh location
a) SFA occlusion
b) Internal iliac artery stenosis
c) popliteal artery occlusion
d) significant aortoiliac disease
d) significant aortoiliac disease
The reported advantage of a 4 cuff segmental pressure test over a 3 cuff method is differentiating which of these diseased segments
a) aorta disease from iliac disease
b) femoral artery from popliteal artery disease
c) aortoiliac from femoral artery disease
d) common femoral artery from profunda femoris disease
c) aortoiliac from femoral artery disease
Photoplethysmography uses which of the following modalities for blood flow evaluation
a) pulse volume recording
b) ultrasound
c) ultraviolet
d) infrared
d) infrared
Which of the following lower arterial test modalities provides diagnostic quantitative information
a) segmental pressures
b) continuous-wave doppler waveforms
c) photoplethysmography
d) pulse volume recording
a) segmental pressures
For accurate blood pressure determination, the cuff bladder should be ______ of the limb circumference
a) 10%
b) 20%
c) 30%
d) 40%
40%
PRV is a form of which of the following methods/techniques
a) impedance plethysomography
b) pneumo-plethysomography
c) photoplethysmography
d) segemental pressures
b) pneumo-plethysomography
While performing segmental pressures on a lower extremity, you note a pressure gradient between 2 cuffs to equal 15 mmHg. What does this finding indicate
a) normal result, no big deal
b) stenosis in the arterial segment proximal to the lowest cuff
c) total occlusion of the arterial segment
d) stenosis in the arterial segment distal to the lowest cuff
a) normal result, no big deal
Leg pain with exercise that is not due to arterial occlusive disease is often referred to as
a) buergers disease
b) pseudo-claudication
c) rest pain
d) arteritis
b) pseudo-claudication
The most common vein used for “in situ” bypass grafts is
a) SSV
b) popliteal vein
c) basilic vein
d) GSV
d) GSV
Which of the following is not a potential complication of a reversed femoro-popliteal vein graft
a) neointimal hyperplasia
b) graft aneurysm
c) fistula via non-ligated perforator vein
d) graft kink
c) fistula via non-ligated perforator vein
The radial artery terminates in which vessel
a) palmar arch
b) ulnar artery
c) brachial artery
d) interosseous artery
a) palmar arch
In which bypass graft procedure is a valvulotome used
a) in situ vein bypass
b) radial artery harvest
c) reversed vein bypass
d) aorto-bifemoral
a) in situ vein bypass
A hyperemic waveform existing in the PTA weeks status-post a femoral to distal vein bypass is most likely due to which of these conditions
a) graft occlusion
b) vasoconstriction
c) graft stenosis
d) chronic vasodilation
d) chronic vasodilation
What is the most common cause of in situ vein bypass graft stenosis
a) atherosclerosis
b) intimal hyperplasia
c) collagen vascular disease
d) arteritis
b) intimal hyperplasia
A potential complication of a EVAR is back-bleeding into the aneurysm sac from the IMA or lumbar arteries. This endoleak is classified as which of the following types
a) type 1
b) type 2
c) type 3
d) type 4
b) type 2
The left brachial pressure is 20 mmHg lower than the right brachial pressure. Whats up?
a) stenosis of the brachiocephalic artery
b) stenosis of the subclavian artery
c) stenosis of the brachial artery
d) its a normal pressure gradient
b) stenosis of the subclavian artery
Buergers disease is an arterial disorder involving which of the following vessels
a) renal arteries
b) coronary arteries
c) pelvic arteries
d) digital arteries
d) digital arteries
What is cold or vibration induced digital vasospasm
a) marfan syndrome
b) arteritis
c) buergers disease
d) raynauds syndrome
d) raynauds syndrome
Which of the following is the standard recovery time following a cold immersion test for Raynauds
a) 2 minutes
b) 5 minutes
c) 7 minutes
d) 10 minutes
b) 5 minutes
Which of the following best describes the Brescia-Cimino procedure
a) a brachial artery to median cubital vein fistula
b) a straight Teflon graft from radial artery and the basilic vein
c) a radial artery to cephalic vein fistula
d) an indwelling hemodialysis catheter
c) a radial artery to cephalic vein fistula
In a patient with a hemodiaylsis access forearm loop graft, digital ischemia can result from which of the following conditions
a) thrombosed hemodialysis access graft
b) incomplete palmar arch
c) pseudoaneurysm
d) venous outflow obstruction
b) incomplete palmar arch
Which of the following grafts is impenetrable by ultrasound
a) gore-tex
b) bovine
c) atrium
d) vectra
d) vectra
Reverse flow detected in the distal radial artery of an ipsilateral radial artery to basilic vein graft indicates which of the following conditions
a) impending graft failure
b) occluded ulnar artery
c) incompetent palmar arch
d) patent palmar arch
d) patent palmar arch
Which of the following vessels is not usually used in hemodialysis access grafts or fistulas
a) cephalic vein
b) brachial vein
c) basilic vein
d) median cubital vein
b) brachial vein
Antegrade, triphasic flow in a radial artery distal to a brachial artery to basilic vein loop hemodialysis access graft indicates which of the following
a) normal radial artery flow
b) venous outflow obstruction
c) pseudoaneurysm at anastomosis
d) graft failure
a) normal radial artery flow
Which access graft does not require maturation time
a) vectra (polyurethane)
b) gore-tex
c) atrium
d) imptra PTFE
vectra (polyurethane)
The post-prandial SMA is noted to have a PSV of 108 cm/s and EDV of 2 cm/s. What is the significance of these findings?
a) Normal hemodynamic pattern
b) Proximal SMA stenosis
c) Prominent SMA collaterals
d) Distal SMA obstruction
d) Distal SMA obstruction
-The normal post-prandial SMA would show an increased EDV. An abnormally high resistance waveform when it should be low resistance means there is a problem distally (in other words, blockages is upahead)
In order to calculate the renal artery to aorta ratio, how should the aorta velocity be obtained?
a) Proximal to the SMA and distal to the celiac trunk
b) At the level between the take off of the SMA and the renal arteries
c) Inferior to origin of the renal arteries
d) At any location of the abdominal aorta avoiding aneurysms if present
b) At the level between the take off of the SMA and the renal arteries
-This should be obtained between the renal arteries and the SMA. The doppler should be placed proximal to the renal artery origin and just distal to the SMA
What sonographic finding most likely indicates renal transplant rejection?
a) Increased diastolic flow
b) Increased organ size
c) Perirenal fluid
d) Absent diastolic flow
d) Absent diastolic flow
What is the threshold diameter for the popliteal artery to be considered aneurysmal?
a) 0.5 cm
b) 1.0 cm
c) 2.0 cm
d) 3.0 cm
b) 1.0 cm
In the presence of an SFA occlusion, what vessel usually provides collateral flow?
a) popliteal artery
b) common femoral artery
c) greater saphenous vein
d) deep femoral artery
d) deep femoral artery
The most important tibial vessel to assess pre-operatively for a femoral to distal bypass is the
a) Gastrocnemius artery
b) Peroneal artery
c) Anterior tibial artery
d) Posterior tibial artery
d) Posterior tibial artery
A hyperemic waveform existing in the posterior tibial artery 3 weeks status-post a femoral to distal vein bypass is most likely due to which of these conditions
a) Graft occlusion
b) Vasoconstriction
c) Graft stenosis
d) Chronic vasodilation
d) Chronic vasodilation
Antegrade, triphasic flow in a brachial artery proximal to a radial artery to basilic vein hemodialysis access graft indicates which of the following?
a) Normal radial artery flow
b) Venous outflow obstruction
c) Pseudoaneurysm at anastomosis
d) Graft failure
d) Graft failure
While scanning a renal transplant patient you observe low resistance in segmental arteries this is
a) rejection
b) stenosis of the donor renal artery
c) renal vein thrombosis
d) normal
d) normal
