RAB: Brant Ch 54 Vascular Ultrasound

Question 1

This happens with high-velocity blood flow and improper velocity scale and baseline settings.

On spectral display, they are seen as a “wraparound” of peak velocities to the opposite end of the scale

Answer 1

Aliasing

Question 2

right CCA arises from the bifurcation of the _____ artery

Answer 2

Inominate artery
[aka brachicephalic artery or trunk]

Question 3

True of Common Carotid artery [CCA]
1. Ascend antero______ up the neck, medial to the jugular vein, and lateral to the thyroid.
2. Each CCA measures ___ mm in diameter
3. Three layers of normal vessel on UTZ:
A. ____intima
B. ____ media
C. _____adventitia
4. The distance between the two echogenic lines (intima-media thickness) is normally less than ___ mm.
5. The CCA dilates normally at the common carotid bulb and bifurcates into the ICA and ECA near the angle of the jaw

Answer 3

1. Anterolaterally
2. 6 to 8 mm in diameter
3. Echogenic, hypoechoic, echogenic
4. <1 mm

Question 4

True of ECA (external carotid A)

1. usually (70%) assumes an antero____ course off the carotid bulb.
2. It overlaps the ICA in 20% of patients and is ___ to the ICA in 10%. 3. The ECA has branch vessels that supply the head and face.
3. It measures ___ to ___ mm in diameter

Answer 4

1. Anteromedial course (70%)
2. Lateral to the ICA
3. True
4. 3 to 4 mm

Question 5

True of ICA:
1. Assumes a ___ course off the carotid bulb
2. measures ___ to ___ mm in diameter.
3. The arterial wall between the ICA and ECA at their origin is the flow divider

Answer 5

1. Posterolateral course
2. 5 to 6 mm
3. True

Question 6

True of Vertebral Artery:

The vertebral artery (VA) arises as the _____ branch of the subclavian artery, ascends in the transverse foramen of vertebrae C6 to C2, and crosses the posterior arch of C1 to enter the foramen magnum and form the ____ artery

Answer 6

First branch;
Basilar

Question 7

Carotid plaques are most comonly found within ___ cm of the carotid bifurcation.

Answer 7

Within 2 cm of the carotid bifurcation

Question 8

An index of the presence of atheroscleros and a determinant of risk for stroke.

Answer 8

Initima-media thickness
[normal thickness <1mm]

Question 9

This plaque has a lipid rich necrotic core covered by thin inflammed fibrous cap.
Plaque shows intimal neovascularity, fibrous cap fissures and high macrophage count.

Answer 9

Vulnerable plaque

Question 10

True or False
Intraplaque HEMORRHAGE does not significantly change the echolucent appearance of the vulnerable plaque.

Answer 10

True. But it increases the risk of plaque rupture and stroke.

Question 11

A severe complication of vulnerable carotid plaque.

increases the risk of thrombosis, carotid occlusion, embolism, and stroke

show an irregular plaque surface with focal depression

Answer 11

Plaque ulceration

Question 12

A well established marker of significant cardiovascular disease

Answer 12

Calcification

Question 13

Match the waveforms:
ICA, ECA, CCA, VA

A. Low resistance, high flow velocities maintained throughout diastole, provide constant BF to brain

B. HIgh resistance, sharp upstroke at onset of systole, little to no BF during diastole

C. systolic upstroke (straight arrow) is sharp, similar to the ECA. Forward flow is maintained at relatively high velocity throughout diastole (curved arrow) similar to the ICA. An early diastolic notch (arrowhead) is present similar to the ECA

D. low resistance similar to that of the ICA, with forward flow maintained throughout diastole (curved arrow

Answer 13

A - ICA
B - ECA
C - CCA
D - VA

Question 14

Results from inominate or subclavian artery occlusion or severe stenosis proximal to the origin of the VA. In this circumstance, the ipsilateral upper extremity receives blood from the ___ through the circle of Willis and down the VA, partially or completely reversing its flow

Answer 14

Subclavian steal syndrome;
- UE receives blood from CCA

Question 15

True of Abdominal Aorta
1. Enters the abdomen via ___ and descends to the left of midline anterior to spine
2. Bifurcates into B common iliac A at level of ___
3. Has ___ main branches
4. Proximal aorta measures ___ cm in men and ___ cm in women.
5. Spectral analysis: ___ waveform

Answer 15

1. Aortic hiatus
2. L4
3. 5 main branches (3 ant, 2 lat; CA, SMA, IMA & RAs)
4. 2.3 cm men, 1.9 women
5. Triphasic

Question 16

True of IVC:
1. As it reaches liver, it is cotained in deep groove on its _____ surface.
2. The hepatic veins enter the IVC from the _____ surface of liver
3. Spectral analysis of the IVC demonstrates the classic “______” pattern from cardiac and respiratory pulsations similar to the hepatic veins
4. Spectral pattern near common iliac veins is ___

Answer 16

1. Posterior
2. Posterior
3. Sawtooth pattern
4. Distally, more phasic pattern near common iliac

Question 17

The left renal vein is ____ times longer than the right

Answer 17

Left renal V is 3x longer than right.

Question 18

The renal veins are ____ to their corresponding arteries and enter the IVC at right angles.

Answer 18

Anterior

Question 19

True of AAA:
1. More than 95% involve the ____ aorta.
2. AAA tht involve the ____ arteries are more difficult to repair.
3. Most are _____ and enlarge at a rate of 2 to 4 mm per year.
4. Surgery is recommended for size ___ cm
5. AAA is defined as focal enlargemetn of aorta greater than ___ cm in AP diameter.
6. The AP dimension can be overestimated in ___ plane and ___ underestimated in ___ plane.
7. Normal aorta tapers from ____ to ___.

Answer 19

1. Infrarenal aorta
2. Renal arteries
3. Fusiform
4. > 5 cm
5. greater than 3 cm in AP diameter
6. Transverse, longitudinal
7. Tapers from proximal to distal

Question 20

In the upper extremity, the right subclavian artery arises from the ____ artery and the left subclavian artery originates directly from the ____.

The SCA lie ____ to the SCV.

Answer 20

Innominate artery
Aortic arch
SCA is superficial to SCV

Question 21

The subclavian artery continues as the axillary artery. The axillary artery becomes the ____ artery, which courses along the ______ aspect of the arm. At the elbow, the brachial artery branches into the ulnar and radial arteries, which continue into the hand forming the palmar arches

Answer 21

Brachial artery
medial;

Question 22

The common femoral artery arises at the inguinal ligament and quickly bifurcates into the profunda femoris (deep femoral artery [DFA]) and superficial femoral artery (SFA). The SFA travels along the anteromedial thigh through the ____ (_____’s) canal and becomes the popliteal artery

Answer 22

adductor’s (Hunter’s) canal

Question 23

The ____ tibial artery descends anteriorly and terminates in the dorsalis pedis artery. The peroneal artery terminates above the ankle, while the ____ tibial artery continues behind the medial malleolus to supply the plantar surface of the foot

Answer 23

Anterior tibial;
Posterior tibial

Question 24

a contained rupture of an artery wall with a persistent connection (neck) to the artery resulting in a pulsatile mass containing swirling blood flow. Most arise from the common femoral artery as a complication of arterial puncture, surgery, or trauma. The use of large-bore catheters, long indwelling catheter time, and routine postprocedure anticoagulation have increased the incidence of pseudoaneurysm from arterial puncture to as high as 6%

Answer 24

Pseudoaneurysm

Question 25

Comprise the superficial venous system

Answer 25

GSV and LSV

Question 26

Originate on the medial side of the ankle, ascends anteromedially along the thigh and empties into the CFV at the inguinal ligament

Answer 26

GSV

Question 27

It originates laterally at the ankle and ascends posteriorly along the calf. It usually empties into the popliteal vein or rarely into the profunda femoris or GSV

Answer 27

LSV

Question 28

connect the superficial to the deep system in the calf and lower thigh. Flow is directed from the superficial to deep system.

Answer 28

Small perforating veins