Misc. DI tests and Tx Flashcards
what is arteriography
anatomic study that looks for filling defect
interpretation of arteriography study
hemodynamically significant stenosis =50% diameter reduction
extent and location of filling defect is noted
Misc findings of arteriography
atherosclerotic lesions
occlusions and collaterals
vasospasm -severe swelling
fibromuscular dysplasia (medial hyperplasia)
what is contraindicated with arteriography
allergic to contrast
kidney problems
what is MRA ,
what is it used for
what is contraindicated
magnetic resionance arterography
uses radio waves and magnetic field
can quantify blood flow and distinguish soft tissue
bad for
metal
overestimating stenosis due to slow flow turbulance
expensive
pt are usually opposed to MRI / MRA
CT is what
used for
contraindicated by
ionizing radiation to obtain cross sectional images
identifies aorta size and extent of aneurysm as well as relational anatomy
used mostly for preop eval of Aortic repair
bad for PAD due to small vessels
pt motion
one plain is used
types of medical treatment
lifestyle changes
pharmacologic
pharmacologic treatment
asprin - antiplatelet
statins -cholestrol
antiHTN meds
meds that decrease blood viscosity
surgical treatment
endarterectomy _rotorooter
bypass graft
stent
good bypass graft has what three things
good
inflow, conduit, outflow
name 4 common bypass grafts
aorta -to- iliac arteries (also used for AAA)
Aorta to bi-femoral (also used for AAA)
femoral to pop
femoral to PTA / ATA/ Peroneal
vessels used to make autogeneous bypass grafts
GSV
renal artery
SMA
Endovascular treastment
3
Angioplasty (PTLA) (Tx of choice)
Intravascular Ultrasound ( IVUS)
stent/ stent graft
Angioplasty brief
fluoroscopy used with catheter balloon inflated to push plaque against artery walls
not effective on all vessels or lesions
good on focal stenosis eg. renal iliac femoral pop
usually procedure is followed by stent placement
risk of catheter intervention is ___-
low
less than 5% have complilcations which is usually thrombus
Intravascular Ultrasound brief
+ indications
images vessels from inside out
IVUS
used to eval plaque formation stent placement id aortic dissection venous-- chronic iliocaval obstruction
Angioplasty has a high rate of what
re stenosis
so stent graft is used
EVAR
EndoVascular Aneurysm Repair
stent graft is what
graft inside the artery
what should you expect with a stent graft
higher velocities
EVAR is treatment of choice for what
AAA
what probllems occur due to stent graft
re-stenosis due to intimal hyperplasia stent migrtation graft limb compression twisting dislodgment
ENDOLEAK
type of endoleaks
I - attachment sites (prox or dist) *most common
II- Branch vessels (IMA-lumbar) flow reverses in patient branch the reversed flow goes into the aneurysmal sac
III- graft defect: modular connections/ graft tear
IV- transgraft poracity – flow through the graft itself
V- Endotension - enlarging aneurysmal sac with no detectable leak
which types of endoleaks are commonly observed with ultrasound
I, II and III
attachment sites/ retrograde patient branch/ graft defect
