Peripheral Arterial system 2 Flashcards
What is a pseudoaneurysm?
Pulsating encapsulated hematoma that communicates with an adjacent artery
What is a pseudoaneurysm confined by?
Surrounding tissue (not arterial wall)
What may pseudoaneurysms lead to?
Compression of an adjacent deep vein
In terms of pseudoaneurysms, most result from what?
An arterial puncture but may be caused by violent trauma or infection
When we see pseudoaneurysm, there must be what?
A communicating channel
What are some sonographic features of a pseudoaneurysm? 3
- Swirling of colour, “ying yang” appearance, communicating tract and possible intraluminal thrombus
- Spectral tracing of the tract has high velocities with spectral broadening. To and fro flow
- Spectral tracing within the hematoma demonstrates turbulent flow (low velocity)
What is the size of a pseudoaneurysm?
Varies but is typically between 1-5 cm
What does this image demonstrate?
Pseudoaneurysm
In terms of treatment of pseudoaneurysms, the size and location of the communicating channel is important why?
It is important to determine if it is a candidate for compression
What are some uncomfortable risks in determining if the communicating channel is a good treatment option?
Arterial occlusion and venous thrombosis
The treatment that revolves around compression as a treatment of pseudoaneurysm may take how long?
Up to 1 hour and if it is not successful then it is likely the patient will need surgery
Besides compression what is a treatment option of pseudoaneurysm?
Inject thrombin
What is arteritis?
Inflammation of the arterial wall often involving and immunologic condition
In terms of arteritis, media of cell walls do what?
Infiltrates with white blood cells
In terms of arteritis, muscular and elastic portions of the wall do what?
Erode and fibrosis develops
What is the end result of the arteritis process?
Overall weakening of the vessel and necrosis within the wall
Arteritis may produce what?
Thickening, stenosis and even occlusion
Who is most often affected by takayasu arteritis?
- <40 years old
- Most often female
What does Takayasu’s Arteritis affect?
- The aortic arch and great vessels
- All three layers of the vessel wall
What does Takayasu’s Arteritis look like on ultrasound?
Thickened walls with concentric narrowing, adjacent segments appear normal
Who is most likely affected by giant cell arteritis?3
- Elderly
- > 70 Y/P
- Female
What does giant cell arteritis affect?
Larger arteries
Who is mainly affected by Thromboangitis obliterans (TAO) Buerger’s disease? 3
- Mainly in men
- <45 y/o
- Smoking history
What does Thromboangitis Obliterans (TAO) Buerger’s disease affect?
Small and medium sized arteries of the upper and lower extremities
What is aorta coarctation?
Congenital narrowing of the thoracic aorta that may also affect the abdominal aorta
What might aorta coarctation may result in?
Lower extremity ischemia
What is Raynaud’s syndrome?
Intermittent ischemia in the fingers or toes in response to cold exposure or emotional stimuli
What does colour duplex help with in terms of Raynaud’s syndrome?
Helps rule out obstructive disease or emboli in the larger vessels as the cause of the symptoms
What is a more appropriate in assessing for Raynaud’s syndrome?
Indirect testing
What is primary Raynaud’s syndrome (idiopathic)?
Intermittent digital ischemia caused by arterial spasm
Who is most affected by primary Raynaud’s syndrome (idiopathic)?
Common in women and present bilaterally
What are some S/S with Primary Raynaud’s syndrome (idiopathic)?
Pain accompanied by pallor, followed by cyanosis (Blue), and hyperemia (red) as they warm up
What is the prognosis for Primary Raynaud’s Syndrome (idiopathic)?
Does not progress and has good prognosis
What is secondary Raynaud’s Disease? 6
Underlying disease is present, such as:
1. Scleroderma (most common)
2. Mixed connective tissue disease
3. Systemic lupus erythematosus
4. Rheumatoid arthritis
5. Drug induced vasospasm
6. Malignancy
In terms of Secondary Raynaud’s disease it is rare to have what?
Digital occlusion secondary to embolization from a proximal source (proximal aneurysms or stenotic lesions)
Secondary Raynaud’s Disease develops what?
Occlusive lesions of the upper extremity digital arteries and can cause tissue necrosis
What kind of condition is Secondary Raynaud’s disease and what is constantly present?
Chronic condition with ischemia constantly present
What is a duplex Raynaud’s syndrome?
Digital artery occlusion
What does Duplex Raynaud’s syndrome look like on spectral and colour doppler?
- Diminished digital waveforms on spectral doppler
- Poor or no colour filling of digital vessels
What does this demonstrate?
Raynaud’s syndrome
What is compression/ entrapment syndromes caused by?
Swelling within osteofascial compartments of the upper and lower extremities
What happens with compression/ entrapment syndromes?
Pressures increases and compromises blood flow to the tissue
What should we do if we suspect compression/ entrapment syndromes?
Assess the arteries that lie within or next to the site with doppler to determine if blood flow is present or diminished
What is a treatment option for compression/ entrapment syndromes?
Fasciotomy
What is popliteal entrapment?
Compression of the popliteal artery by the medial head of the gastrocnemius muscle or adjacent tendons as a result of a congenital deformity
How does popliteal entrapment happen?
Repeated extrinsic compression of the popliteal artery produces trauma to the vessel wall may result in an aneurysm, arterial thrombosis, and thromboembolism
What are some S/S for popliteal entrapment?
Claudication symptoms in young patients with no risk factors for atherosclerosis
In terms of popliteal entrapment, patients may have normal pressures, pulses, and waveforms at rest, but they will decrease significantly with what?
Passive plantarflexion of the foot
Popliteal entrapment is indicated when there is what?
A decrease arterial diameter when the patient points their foot downward resulting in a visualized stenosis or loss of pulse
Duplex testing to diagnosis popliteal entrapment syndrome is controversial as some believe what?
The decreased arterial diameter is a normal response when pointing the foot downward
What is adventitial cystic disease (ACD)?
Focal stenosis or occlusion of the popliteal artery and seeing the arterial lumen compressed by the cyst
What is the thoracic outlet?
Superior opening of the thoracic cavity that is bordered by the clavicle and first rib
What is thoracic outlet syndrome?
Compression/ impingement of subclavian arteries/ vein/ nerves as they emerge from the thoracic outlet
What are some signs and symptoms of thoracic outlet syndrome
- Hand and arm ischemia and pain or weakness, depending on what is compressed
- Pain when the arm is held in certain positions
In terms of thoracic outlet syndrome, Duplex scanning of the subclavian and axillary arteries or veins may be used to do what?
- Detect compression while the arm is held in various positions
- Assess for vessel damage (stenosis, Post-stenotic aneurysmal degeneration, subclavian artery occlusion). All can be a source of distal embolization which can lead to occlusion
What does arterial thoracic outlet syndrome look like on 2D? 5
- Subclavian artery aneurysm
- Stenosis
- Ulceration
- Thrombus
- Occlusion
What does Arterial thoracic outlet syndrome look like on spectral?
- Focal increased PSV in subclavian artery or no flow seen with occlusion
- Spectral waveform changes with provocative maneuvers
What does colour doppler look like with Arterial thoracic outlet syndrome?
Reduced lumen or no colour filling with occlusion
What does this image demonstrate?
Thoracic outlet syndrome
What are some causes of AV fistulas?
- Congenital
- Traumatic
In terms of AV fistula, communication between an artery and an adjacent vein features what? 4
- Colour bruit
- High- diastolic flow in an artery proximal to AVF
- High velocity turbulent flow (arterialized venous flow) in the vein near the fistula connection
- Slowly loses its pulsatility more distally
What is the most common AV fistula?
CFA/CFV post catheterization
AV Fistula may also be constructed for what?
Hemodialysis in the upper extremity
Label the images
What is blue toe syndrome?
Toe ischemia due to micro-emboli released from proximal atherosclerotic lesions, lodging in small arteries and arterioles
What is the treatment for blue toe syndrome?
Removal of emboli
What can cause extrinsic compression?
Tumors, Hematomas, etc
What can extrinsic compression result in?
Stenosis or occlusion by applying pressure on the arterial walls and comprising blood flow
What does Extrinsic compression use colour doppler for?
Colour doppler use to evaluate masses to determine their vascularity
What is power doppler used for in terms of extrinsic compression?
Power doppler is used to detect low flow states in suspect tumor masses
