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Vascular Term 3 > quiz 3 > Flashcards

quiz 3 Flashcards

1
Q

what is the gold standard for preoperative assessment of patients for carotid intervention?

A

arteriography

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2
Q

what are some non-invasive techniques?

A
  • MRA
  • Duplex and TCD combined
  • CT
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3
Q

discribe non-invasive techniques

A
  • No contrast used

- No catheter related complications

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4
Q

is arteriography invasive?

A

yes-catherdar based

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5
Q

what does arteriography assess?

A

the aortic arch,subclavian and carotid arteries(intracranial and extracranial vessels)

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6
Q

what are reported complications in arteriography?

A

Stroke and death are reported complications in 0.2- 0.7% of patients

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7
Q

plain CT

A

Provides 2 and 3 dimensional images to -identify silent infarcts

  • determining the timing of surgery
  • evaluating the risk of surgery
  • ruling out other causes of disease or symptoms
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8
Q

CTA

A
  • Invasive
  • Administration of contrast dye
  • Highlights the cerebrovascularity
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9
Q

Digital subtraction angiography

A

pre contrast image is taken and as dye is injected, it subtracts out the pre image and only filled vessels are seen

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10
Q

what is the method of choice for visualizing the entire cerebral arterial system?

A

Digital subtraction angiography

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11
Q

is MRA invasive?

A

no

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12
Q

what is MRA accurate at identifying?

A

carotid occlusion

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13
Q

is MRA or duplex dopper more reliable for categorizing stenosis in areas of moderate to severe narrowing?

A

duplex doppler and angiography

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14
Q

in MRA what can it overestimate?

A

where flow is turbulent

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15
Q

what s angioplasty?

A

technique of mechanically widening narrowed or obstructed arteries typically being a result of atherosclerosis

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16
Q

what is placed into narrowed locations in angioplasty?

A

An empty and collapsed balloon on a guide wire, known as a balloon cathete

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17
Q

how is the cathedar inflated in angioplasty?

A

inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure

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18
Q

what happpens to plaque in angioplasty?

A

The balloon forces expansion of the inner plaque deposits and the surrounding muscular wall, opening up the blood vessel for improved flow

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19
Q

if an artery is not strong enough to stay open after balloon is deflated and taken out, what is done?

A

a stent would be inserted at the time of ballooning to endure the vessel remains opens

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20
Q

what can placement of stent alter?

A

biochemical properties

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21
Q

what can a stent cause with flow?

A
  • increase in velocities
  • some turbulence
  • PSV can increase throughout the patent stent area up to 150cm/s
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22
Q

what is considered not norma for PSV in a stent?

A

Gradual PSV increase is expected,but an abrupt increase is not normal

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23
Q

what velocity in a stent identifies a degree of restenosis?

A

2:1 ratio

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24
Q

what must you obatin in a post stent assessment?

A

prestent, mid stent, post stent

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25
Q

what is the stent assessed for?

A
  • intimal thickening
  • plaque formation
  • thrombus to diagnose restenosis
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26
Q

what is gray scale useful for?

A

evaluate deformity in stent (kinks, buckling)

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27
Q

what do vascuar surgeons recommend as the first line treatment?

A

CEA (endartectomy)

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28
Q

when is CEA done on a patient?

A
  • For most symptomatic patients with stenosis of 50% to 99%

- And asymptomatic patients with stenosis of 60% to 99%

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29
Q

The perioperative risk of stroke and death in asymptomatic patients must be __________to ensure benefit for the patient

A

<3%

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30
Q

who should CAS (stenting) be reserved for?

A

symptomatic patients with stenosis of 50% to 99% at high risk for CEA for anatomic or medical reasons

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31
Q

who is CAS not recommended for?

A

asymtomatic patients

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32
Q

Asymptomatic patients at high risk for intervention or with _______ life expectancy should be considered for medical management as the first-line therapy

A

<3 years

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33
Q

what significantly reduces risk of major and fatal stroke in patients with symptomatic, high-grade (70-99%) carotid stenosis?

A

carotid endartectomy in addition to medical therapy

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34
Q

how is CEA done?

A

The surgeon will make a cut in the blocked part of the artery to remove the plaque, or will remove the inner lining of the artery around the blockage

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35
Q

what may a surgeon do in a CEA to block blood flow?

A
  • A clamp is placed on the artery to stop blood from flowing through it
  • A tube may also be used to shunt blood around the narrowed or blocked carotid artery
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36
Q

how does blood get to the brain during a CEA?

A

from the contralateral carotid artery or can be from a shunt

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37
Q

when may a patch be placed over a cut?

A

if the patient has small arteries or has already has a CEA

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38
Q

what does a patch do?

A

reduce the risk of stroke for some patients

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39
Q

post CEA what needs to be ruled out?

A

restonosis followung revascularization

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40
Q

where does PSV increase when doing a post CEA assessment?

A

pre CEA area and within stenosis

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41
Q

what is gray scale useful for in a post CEA stenosis?

A

evaluate for changes in the vessel wall consistent with sutures,patches,stent material,early intimal proliferation or late atherosclerotic plaque formation

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42
Q

what are complications associated with CEA?

A
  • Residual plaque at the end of the CEA site
  • intimal flap
  • dissection
  • occlusion
  • infected patch
  • hematoma
  • pseudoaneaursym
  • restenosis
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43
Q

Residual plaque at the end of the CEA site

A

Color and spectral Doppler may display turbulence or elevated PSV depending on severity

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44
Q

Intimal flap

A
  • Disruption along the vessel wall with moving material observed within the lumen
  • Disturbed color flow patterns and elevated PSV often present
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45
Q

dissection

A

Intimal layer separates from the wall and may stenose or occlude vessel

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46
Q

occlusion

A

No color fill in

  • no lumen detected
  • no spectral Doppler signal
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47
Q

Infected patch

A

Irregular buckling of patch material along the vessel wall;perivascular fluid accumulation

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48
Q

Hematoma

A

Nonvascular mass adjacent to the vessel;may appear cystic or contain various levels of echogenicity

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49
Q

Pseudoaneurysm

A

Dilated area attached to the vessel with flow demonstrated on color and doppler spectrum: to- and-fro pattern with a neck connecting to the vessel
-colour swirling (ying-yang appearance)

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50
Q

restenosis

A

Focal area of elevated velocities with poststenotic turbulence;hyperplasia along the wall in the stenotic zone

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51
Q

what does coarctation mean?

A

narrowing

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52
Q

what isAortic coarctation-CoA or COAo?

A

congenital condition whereby the aorta is narrow

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53
Q

where is Aortic coarctation-CoA or COAo most common?

A

aortic arch

  • usually in area where ductus arteriosus ((ligamentum arteriosum after regression) inserts
  • May be pre or post ductal
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54
Q

how do you detect an Aortic coarctation-CoA or COAo?

A

Difference of 70 mmHg or more between the brachial and ankle systolic pressures at rest

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55
Q

what could happen to patients with coarctation of the thoracic aorta?

A

may not have claudication and little or no change in ankle pressure following exercise

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56
Q

why may thoracic aorta coarctation have no change in ankle pressur following exercise?

A

This is due to the development of extensive
collateralization that provides
compensatory flow to the exercising muscles of the lower limbs

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57
Q

what is the repair of coarctation?

A

resection and end-to end anastomosis

angioplasty can be used

58
Q

when is resection and end-to end anastomosis technique used?

A

widely especially in older children and older adults

59
Q

describe the repair of coarctation?

A

The aorta is transected proximal to the coarctation at a level that ensures removal of any narrowed portion of the isthmus as well as the coarctation

60
Q

what is a stroke caused by?

A
  • atrial fibrillation
  • hardening of arteries
  • high blood pressure
61
Q

what are some rare causes of a stroke?

A
  • vasospasm
  • FMD
  • radiation induced vasculopathy
62
Q

what is an ischemic stroke?

A

strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain`

63
Q

what is the underlying condition for ischemic stroke?

A

atherosclerosis-fatty deposits lining the vessel walls

64
Q

what are 2 types of obstruction that may occur with ishemic stroke?

A
  • cerebral thrombosis

- cerebral embolism

65
Q

cerebral thrombosis

A

thrombus(blood clot) that develops at the clogged part of the vessel in the brain- from atherosclerosis

66
Q

what is a cerebral embolism?

A

Refers generally to a blood clot that forms at another location in the circulatory system
- a portion of the blood clot breaks loose,enters the bloodstream and travels through the brains blood vessels until it reaches a vessel too small to let it pass

67
Q

where does the blood clot in cerebral embolism come from?

A

usually from heart or larger arteries of the neck such as carotids

68
Q

what is a vasospasm?

A

blood vessel spasms or contracts causing less blood flow

69
Q

when may cerebral (brain) vasospasm happen?

A

after an operation for a bleed that occurs between the brain and the thin tissue covering the brain (subarachnoid hemorrhage)

70
Q

what increases the risk of an ischemic stroke?

A

cerebral vasospasm

71
Q

when does vasospasm typically occur?

A

4-10 days after subarachnoid hemorrhage

`

72
Q

what is arteriovenous malformations (AVMs)

A

When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins
`

73
Q

how many people usualy get a AVM?

A

1% (200-500 people)

74
Q

who are AVM’s more common in?

A

males

75
Q

what are the symtoms to a AVM in more than 50% of patients?

A

intracranial hemorrhage

76
Q

what are the symtoms of a AVM in 20-25% of patient?

A

focal or generalized seizures

77
Q

what is a symtoms wit the head that patients with AVM have?

A

localized pain in the head due to increased flow around an AVM

78
Q

what may 15% of patients have difficutly with for an AVM?

A

difficulty with movement, speech, or vision

79
Q

what are the chances of having an AVM bleeding?

A

1% to 3% percent each year

80
Q

what is a cerebral aneurysm?

A

a weak or thin spot on a blood vessel in the brain that balloons out and fills with blood

81
Q

what can a bulging aneurysm put pressure on?

A

a nerve or surrounding brain tissue

82
Q

who does brain aneurysms occur in?

A

anyone, at any age but more common in adults than children

83
Q

where os cerebral aneurysms more common in?

A

women

adults (30-60)

84
Q

who is at a higher risk for cerebral aneurysm?

A

people with certain inherited disorders

85
Q

what do all cerebral aneruyms have a potential of?

A

rupture and cause bleeding within the brain

86
Q

what are the risk factors for cerebral aneurysms?

A
  • hypertension
  • alcohol abuse
  • drug abuse (mainly cocaine)
  • smoking
87
Q

what affects the risk of rupture?

A

the condition and size

88
Q

when an cerebral aneurysm bursts and bleeds into the brain, what complications can this cause?

A
  • hemorrhagic stroke
  • permanent nerve damage
  • death
  • more commonly: subarachnoid hemorrhage
89
Q

what is a subarachnoid hemorrhage?

A

bleeding into space between skill bone and brain

90
Q

what is a second importnt cause of cerebral embolism?

A

irregular heartbeat known as “atrial fibrillation”

91
Q

what does atrial fibrillation cause?

A

creates conditions where clots can form in the heart and dislodge and travel to the brain

92
Q

_____of patients with cerebrovascular events will have a cardiac thrombus as the source of emboli

A

26%

93
Q

what is the most common type of arrhythmia?

A

atrial fibrillation

94
Q

what is atrial fibrillation?

A

The heart can beat too fast,too slow or irregularly-disorganized electrical signals are the cause
-Fibrillate means to contract very fast and irregularly

95
Q

what happens in the heart with atrial fibrillation?

A

blood ppools in the atria and is not completely pumped into ventricles

96
Q

what does stasis cause?

A

clotting
thrombus forms
and embolism ensues

97
Q

what is chronic heart failure?

A

inability of the heart to supply sufficient blood flow to meet metabolic needs of the body

98
Q

what is CHF associated with?

A

with increased risk of thrombus formation and risk of stroke due to a hypercoagulable state-leading to embolism

99
Q

how is CHF treated?

A

anticoagulation therapy

100
Q

what doubels the mortality up to 29% in cardiac thrombus?

A

The finding of a right heart thrombus in the setting of PE and RV strain

101
Q

what require a more aggresive treatment with cardiac thrombus and what is the treatment?

A

A right heart thrombus usually requires more aggressive treatment such as embollectomy or lytic therapy compared to heparin alone

102
Q

cardiac thrombi may be seen following what?

A
  • ventricular dysfunction
  • cardiomyopathy
  • myocardial infarction
  • ventricular aneurysm
103
Q

what are some non atherosclerotic vascular diseases?

A 
Dissection
Pseudoaneurysm
Arteriovenous fistula(AVF)
Carotid body tumor
Fibromuscular disease(FMD)
Buerger’s disease
Takayasu’s arteritis
Giant cell arteritis
104
Q

what is the most common cause of stroke in YOUNG ADULTS?

A

carotid artery dissection

105
Q

what are carotid artery dissection ischemic signs and symtoms?

A

transient vision loss and ischemic stroke

106
Q

what are the 2 classes of causes of CA dissection?

A

Spontaneous or traumatic

107
Q

where does carotid artery dissection originate and extend?

A

Usually originates at the aortic arch and extends to the bifurcation and may extend into ICA

108
Q

who does spontaneous dissection usually effect?

A

70% of patients are between ages 35 and 50

109
Q

what are the risk factors for spontaneous dissection?

A
  • Family history of stroke

- Hereditary connective tissue disorder

110
Q

what are dissection-connective tissue disorders?

A 
Marfan syndrome
Ehlers-Danlos syndrome
ADPKD
Fibromuscular dysplasia
Osteogenesis imperfecta
111
Q

how is dissection more comonly caused?

A

severe trauma to the head or neck

112
Q

what are other causes to traumatic dissection?

A

include pseudoaneurysm,thrombosis or fistula

113
Q

what is the mechanism of injury for traumatic dissection?

A
  • rapid deceleration with resultant hyperextension and rotation of the neck
  • This stretches the ICA over the upper cervical vertebrae producing a tunica intimal tear
114
Q

what are the symptoms of traumatic dissecton?

A

may remain asymptomatic, have a TIA or suffer a stroke

115
Q

what does an intimal tear allow for?

A

blood to enter the space between the layers of the vessel which creates a false lumen

116
Q

what can a false lumen cause?

A

stenosis or occlusion

117
Q

what may complete occlusions lead to?

A

ischemia

118
Q

what is the pathophysiology of dissection?

A

blood clots form and break away from site of tear and form emboli that travel to the brain causing a stroke (cerebral infarction)

119
Q

what does dissecton cause to the brain?

A

irreversible damage to the brain

120
Q

what is the treatment of dissection?

A

prevent the development of continuation of neurological deficits

  • observation
  • anticoagulation
  • stent implantation
  • carotid artery ligation
121
Q

what is a sonographers role in dissection?

A
  • Doppler spectrum of the common carotid artery
  • different flow velocities within true and false lumens
  • We must R/O occlusion or high grade stenosis
122
Q

what is the sonographic appearance of dissection?

A
  • Intima may flutter in the flow stream with each cardiac cycle
  • Severe flow disturbances are caused by flapping intima
  • Classic presentation of ICA dissection is a smooth tapering stenosis usually seen in younger individuals without atherosclerosis
  • Regardless of age,consider dissection in a patient with a smooth tapering ICA without visible plaque
123
Q

what is the most specific sonographic finding of arterial dissection?

A

double lumen sign

124
Q

what does an intramural hematoma look like?

A

be demonstrated as an eccentric echogenicity that surrounds a relatively narrowed arterial lumen

125
Q

in vertebral arterial dissection what is the flow?

A

the absence of arterial flow or low blood velocities in the dissected artery, often with a compensatory increased blood flow in the contralateral vertebral artery

126
Q

what is a true aneurysm?

A

true aneurysm occurs when the artery wall layers are intact but stretched

127
Q

Pseudoaneurysm

A

false aneurysm -is a vascular mass that results from a hole in the arterial wall with circulating blood flow that is confined by soft tissue and hematoma

128
Q

what do patients present with for a pseudoaeurysm?

A

palpable pulsatile mass

129
Q

what must a pseudoaneurysm have to be considered a pseudoaneurysm?

A

communicate with the artery

130
Q

pseudoaneurysms are rare and _________

A

lethal

131
Q

what are the causes of CCA pseudoaneurysms?

A
  • Blunt or penetrating trauma
  • Infection and vasculitis
  • Iatrogenic and unknown causes
132
Q

what are causes of ICA pseudoaneurysms?

A
  • Penetrating trauma
  • Post head and neck surgeries
  • Carotid endarterectomies
  • Infiltrating metastatic lymph nodes and neoplasms
133
Q

what is the managment for ICA pseudoaneurysms?

A
  • Ultrasound guided compression
  • percutaneous thrombin injection
  • coil embolization
  • endovascular stent graft insertion
  • and surgery
134
Q

pseudoaneurysm on doppler?

A

Bidirectional turbulent flow within the neck connecting the vessel
to the pseudoaneurysm

135
Q

what is a fistula?

A

opening that connects two epithelialized structures

136
Q

what does an AVF alomost always result from?

A

traume-either violentor iatrogenic

137
Q

what can inadvertent arterial injury result in?

A

development of

  • hematoma
  • pseudoaneurysm
  • AVF
138
Q

how does Arteriovenous fistula occur?

A

Complication of Internal Jugular Vein Catheterization

139
Q

how is Arteriovenous fistula seen on doppler?

A
  • aliasing
  • arterial and venous flow simultaneously
  • communication between SCA and IJV
  • bruit or thirlll
140
Q

what will the flow proximal to a fistula be?

A

monophasic

141
Q

what will flow within the fistula vein be?

A

“arterialized” flow signal with lack of respiratory phasicity

142
Q

I ended at slide 40, check if thats when we end

A

finnish if have to

Vascular Term 3 (8 decks)

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