REVIEW Flashcards
1
Q
vertebral artery originates where
A
subclavian artery
2
Q
another name for palmar arch
A
volar arch
3
Q
superficial palmar/volar arch includes what
A
branch of radial artery
distal portion of ulnar artery
4
Q
deep palmar/volar arch includes what
A
branch of ulnar artery
distal portion of radial artery
5
Q
the dorsalis pedis artery is formed from
A
the anterior tibial artery
6
Q
major branch of dorsalis pedis artery
A
deep plantar artery
7
Q
the deep plantar artery joins with what
A
lateral plantar artery (branch of posterior tibial artery)
8
Q
what vessels make up the plantar arch
A
deep plantar artery (branch of dorsalis pedis)
lateral plantar artery (branch of posterior tibial)
9
Q
the adventicial/externa layer of arteries contains what
A
vaso vasorum
10
Q
hydrostatic pressure is also referred to as
A
gravitational energy
11
Q
resistance equation
A
R = 8nL / r4pie
12
Q
resistance is directly proportional to
A
viscosity and length
13
Q
resistance is inversely proportional to
A
radius of vessel
14
Q
what has the most dramatic effect on resistance?
A
change in vessel diameter
15
Q
what type of energy loss is evident at exit of stenosis
A
inertial
16
Q
poiseuille’s equation defines relationship between
A
pressure
volume
resistance
17
Q
poiseuille’s equation
A
Q = P/R
pressure and resistance
18
Q
Poiseuille’s equation as a whole
A
Q = (p1 - P2) pie r4 / 8nl
19
Q
law of conservation of mass
A
Q = A x V
area and velocity
20
Q
bernoulli describes
A
relationship between velocity and pressure
21
Q
in a flow seperation velocity _____ and pressure _____
A
velocity decreases
pressure increases
22
Q
low resistance vessels
A
ICA celiac renal splenic hepatic vertebral
23
Q
high resistance vessels
A
eca
fasting sma
extremity arteries
24
Q
flow proximal to a significant stenosis
A
higher resistance
monophasic waveform
dampened (little or no diastole)
25
at a stenosis
elevated velocity
spectral broadening
increased doppler shift frequencies
26
post stenosis doppler
lower resistance
rounded in appearance
spectral broadening
27
flow reversal in high resistance vessels may disappear distal to a stenosis because of
decreased peripheral resistance
| due to ischemia
28
vasodilation does what
lowers distal peripheral resistance
| increases blood flow
29
exercise decreases what
resistance
30
waveform seen in an extremity after exercise
low resistance
monophasic
due to vasodilation
31
cross sectional area reduction of 75% = _____ diameter reduction
50%
32
a monophasic waveform is often obtained where
proximal to an obstruction
33
analog doppler is not capable of portraying velocities of less than
6cm/sec
34
spectral analysis
individual frequencies are displayed using fast fourier transform method FFT
35
pulsatility index
dividing peak to peak frequency difference (P1 - P2) by mean (average) frequency
36
accerelation time is measured because
if theres a proximal obstruction there is a slowing of the time between the onset of systole to the point of maximum peak
37
acceleration time that indicates proximal iliac disease
>133m/sec
38
uncompensated CHF can
dampen waveforms
| give decreased ABIs
39
width of segmental pressure cuffs should be
20% greater than diameter of limb
40
cuff should be inflated
20-30mmHG past last audible arterial signal
OR
inflated 20-30mmHg above highest brachial
41
systolic pressure is recorded as
the pressure at which the first audible arterial signal returns
42
ABI is calculated by
ankle pressure / highest brachial pressure
43
order of segmental pressures
brachial
ankle (PTA/DPA)
calf (PTA/DPA)
thigh (PTA OR POP)
44
normal extremity ABI
> 1.0
45
likely normal extremity ABI
.9-1.0
46
mild arterial disease extremity ABI
.8 - .9
47
moderate arterial disease extremity ABI
.5-.8
| CLAUDICATION
48
Severe arterial disease extremity ABI
49
ABI is unreliable / incompressible vessel
>1.3-1.5
50
segmental pressure drop between levels indicates a significant obstruction
30 mmHG
51
a horizontal difference in pressures indicates a significant obstruction
20-30mmHg
| suggest disease at or above extremity with lower pressure
52
four cuff technique thigh high pressure should be
around 30mmHg more than highest brachial pressure
53
four cuff technique at knee and below pressure should be
around the same as highest brachial pressure
54
three cuff technique high thigh pressure should be
around the same as highest brachial pressure
55
toe pressures for ulcers that fail to heal
<30mmHg
56
post exercise dopplers should be obtained
effected side first
both ankles
highest brachial
57
normal post exercise ABI does what
increases
58
abnormal post exercise ABI does what
decreases
59
ABI post exercise single level disease recovery
takes 2-6 minutes for ABIs to increase back to resting levels after exercise
60
multilevel disease recovery
takes 6-12 minutes for ABIs to increase back to resting levels after exercise
61
reactive hyperemia techinque
19x40cm thigh cuffs inflated bilaterally 20-30mmHG above highest brachial for 3-5 minutes
62
normal limb ABI after reactive hyperemia
decrease of 17-34%
63
single level disease ABI after reactive hyperemia
< or = decrease of 50% in ankle pressure
64
multiple level disease ABI after reactive hyperemia
>50% ankle pressure drop
65
cuff sizes for upper extremity seg pressures
12 x 40cm upper arms
| 10 x 40 cm forearms
66
50% stenosis of subclavian artery OR vessel under cuff of UE segmental pressures is indicated by a pressure drop of what
15-20mmHg from one brachial to another
67
what information do you need to get for penile imaging
doppler CFA, PTA, DPA,
obtain ABIs
penile pressure with doppler or PPG
68
penile imaging cuff size
2.5 x 12cm
69
normal penile brachial index
> or = .75
70
marginal penile brachial index
.65-.74
71
abnormal penile brachial index
72
penile doppler normal results
cavernous arteries size increase post injection
PSV increases 30cm/sec higher
dorsal vein should not increase
73
dorsal vein doppler
< 3 cm/sec normal
| >20cm/sec abnormal
74
plethysmography is used to
determine true claudication vs nonvascular sources
| localize area of obstruction
75
PPG is mainly used for
digits and penile exams
76
volume air plethsmography cuffs are inflated to
10-65mmHg
77
how does volume air plethsmography work
pressure xducer converts pressure changes into analog waveforms and displays them on strip chart recorder
78
PPG detects
cutaneous blood flow
79
cuteaneous blood flow in PPG determines
the amount of reflection
80
increased blood flow in PPG results in
increased attenuation
decreased reflection
positive upstroke
81
volume air plethysmography start at
upper extremity and move distally
82
PPG results: normal
rapid upstroke
sharp systolic peak
reflective wave
83
PPG results: minimally abnormal
rapid upstroke
sharp peak
no reflective wave
downslope bowed away from baseline
84
PPG results moderately abnormal
slow up stroke and down stroke
flattened systolic peak
no reflective wave
85
PPG results severely abnormal
low amplitude or absent
86
reduced amplitude with normal wave reflects
insignificant disease unless its unilateral
87
good waveform with abnormal segmental pressures reflects
collaterals
88
displacement plethysmography: displacement is measured by
amount of displacement of water in chimney
89
displacement plethysmography: volume change is measured by
spirometer
90
with volume air plethysmography if cuff is too tight
can obliterate or diminish wave forms
91
toe plethysmography exam cuff size
1.2 times size of toe
| about 2.5-3cm cuff applied to base of great toe
92
PPG toes method
cuff at base of great toe
photocell attached to plantar side of toe
paper speed slowed to 5mm/sec
cuff inflated to 20-30mmHg past highest brachial pressure
no pulsations are seen
cuff slowly deflated until first pulse returns
93
PPG fingers without cold stress
```
UE arterial study
Pressures
doppler palmar arch to verify patency
apply finger cuffs (2-2.5cm)
same method as toes
```
94
PPG fingers with cold stress
after resting study hands go into cold water for 3 minutes
| then waveform and pressures obtained immediately and then after 5 minutes
95
normal PPG digital waveform qualities
sharp upstroke
downstroke with reflected wave/notch halfway down
finger amplitude greater than toes
96
abnormal obstructive PPG digital waveform
slow upslope
rounded peak
downslope bows away from baseline
97
digital abnormal peaked waveform
slow upslope
sharp anacrotic notch
reflected wave high on downslope
98
Raynauds disease waveform
peaked pulse
99
digital PPG completely abnormal if
waveforms fail to return after 5 minutes
100
UE digits Finger/brachial index
.8-.9
101
LE digits toe/brachial index
60-80% of brachial pressure
102
Transcutaenous Oximetry is used to determine
if ulcers will heal
| amputation level
103
TCP02 technique
clean skin with alcohol pad
ring fixed on skin
electrolyte solution put inside ring
electrode attached to ring
104
TcP02
```
heats skin to 45 celcius
blood flow increases, lipid layer melts
02 escapes through skin
measured by sensor in electrode
electrode converts chemical reaction to reading of 02 converted into mmHg
```
105
TcP02 calibration
manual
106
healing likely to occur
70-80mmHg
107
borderline healing
30-40mmHg
108
non healing
10-15mmHg
109
sample size for acquiring pulsed doppler information
1-1.5mm
110
most common sites of stenosis of hemodialysis graft site is
venous anast and outflow
111
steal syndrome of hemodialysis graft site is caused by
distal arterial flow reversed into venous circulation
112
assess for steal of graft site
ppg on atleast two fingers
manual compression of graft
if flow to digits improves ---> steal
if flow does not improve --> no steal
113
if the patient has steal syndrome what are the symtoms
pale hand
coolness of skin dst to shunt
pain in fingers and hand
114
doppler equation
df = 2FoVCos0 /C
```
df = doppler shift
FO = transducer frequency
V= velocity of moving reflectors
c= speed of sound
```
115
speed of sound through soft tissue
1540 m/sec
116
calculating velocity equation
V = c DF/ 2FO cos 0
117
Reversed Saph Vein Graft RSVG
small end prox
large end distal
vein valves stay open due to arterial flow pressure
branches are ligated
118
in situ vein graft
stays in place
valves broken up prior to surgery
branches ligated
119
synthetic bypass graft
gortex
120
bypass graft imaging
```
ABIs
inflow art
prx art anast
body
dst art anast
outflow art
vein graft check for branches may lead to av fistula
```
121
stenotic PSV to pre stenotic PSV 2:1 ratio
50% diamater reduction
122
stenotic PSV to pre stenotic PSV 4:1 ratio
75% diameter reduction
123
PSV >400cm/sec
75% diameter reduction
124
normal bypass graft doppler
lower resistance
| retrograde flow seen in native artery at distal anastomosis of RSVG
125
abnormal bypass graft doppler
decrease of 30 cm/sec
change in waveforms
decrease of ABI >.15
126
RAR equation
highest renal artery PSV / aorta PSV
127
normal RAR
<3.5
128
you cannot use RAR if
AAA
| Ao PSV >90cm/sec or less than 40cm/sec
129
abnormal RAR
>3.5 suggest 60% diameter reduction
130
End diastolic ratio (EDR) or PR
EDV / PSV
131
normal EDR or PR
>.2
132
abnormal EDR or PR
133
Resitive index (RI) equation
PSV - EDV / PSV
134
normal RI for kidneys
135
Acceleration time of what is considered to be abnormal for kidneys
>100cm/sec
136
fasting SMA
high PSV
low EDV
flow reversal
137
non fasting SMA
PSV and EDV increased
| loss of flow reversal
138
normal SMA PSV
110-177cm/sec
139
stenosis of SMA
>275cm/sec
| 70% diameter reduction
140
celiac artery fasting
high PSV and EDV
| no flow reversal
141
celiac artery non fasting
no change
142
celiac artery normal velocity
50-160 cm/sec
143
stenosis of celiac artery
>200cm/sec
| 70% diameter reduction
144
celiac band syndrome
compression of celiac artery by median arcuate ligament of diaphgram
145
what do you see with celiac band syndrome
stenosis on expiration
| improved with deep inspiration
146
waveform seen proximal to an AV fistula
increased diastolic flow because fistula reduces resistance
147
flow throughout fistula
high velocity
| low resistance
148
epigastric artery
branch of internal mammary artery
149
what supplies rectus abdominus
epigastric artery and perforators
150
internal mammary artery is also known as
internal thoracic artery
151
internal mammary/internal thoracic artery arises off of
subclavian artery
152
vein dimension for vein mapping
at least 2-3mm
| outter to outter
153
most common compression of thoracic outlet syndrome is
brachial plexus (97%)
154
ICA branches
opthalmic artery
| posterior communicating artery
155
ICA terminates in the
middle cerebral artery
| anterior cerebral artery
156
first branch off of ECA
superior thryoid artery
157
basiliar artery divides into
posterior cerebral artery
158
circle of willis includes
```
dst ica
ant cerebral artery
ant communicating artery
post cerebral art
post communicating art
```
159
supraorbital artery is a brach off the
ophthalmic artery
160
supraorbital artery joins with
ECA via superficial temporal artery
161
frontal artery
arises from ophthalmic art
supplies mid forehead
joins eca
162
ECA ICA anastomosis
via orbital and ophthalmic artery
163
occipital branch of ECA anasts with
atlantic branch of vertebral art
164
poiseuill's law and resistance equation
```
Q = (P) pie r4 /8nL
p= pressure
r= radius of vessel
n = viscosity
l= length
```
165
atheromatous plaque is formed
within or beneath intima
166
fatty streak
thin layer or lipid material on intimal layer
167
fibrous plaque
lipids
collagen
elastic fibers
homogenous
168
complicated plaque
```
fibrous plaque that includes
collagen
calcium
cellular debris
echogenic and heterogenous
```
169
ulcerative lesion plaque
smooth surface of fibrous cap deteriorates
| can result in distal embolism
170
intra-plaque hemorrage
evident as sonolucent area within plaque
171
fibromuscular dysplasia is
dyplasia of media and overgrowth of collagen in mid/dst ica
172
FMD is common in
young women
173
neointimal hyperplasia
intimal thickening from rapid production of smooth muscle cells
common post endarterectomy
174
lt cva results in
problems on right side of body
175
eye symptoms suggest disease of
ICA on the same side
176
ICA disease symptoms
```
unilateral paresis (weakness)
unilat paresthesia (pins and needles)
aphasia (difficulty speaking)
amaurosis fugax (blindness of one eye)
```
177
MCA disease symptoms
aphasia, dysphasia
facial and arm paralysis
behavorial changes
178
ACA disease symptoms
severe hemiparesis or plegia
incontinence
loss of coordination
179
vertebrobasilar disease symptoms
```
vertigo
diplopia
ataxia (loss of coordination)
drop attack
bilat parethesia
```
180
PCA disease symptoms
dyslexia
| coma
181
carotid doppler uses
spectral analysis
continuous wave doppler
pulse doppler
182
continuous wave
2 crystals one constantly sending one receiving
no range resolution
fixed sample size
183
pulsed wave doppler
crystals send then receive
high range resolution
variable sample size
184
high resistance patterns of ICA consider disease
carotid siphon
185
normal PSV of carotids
<125 cm/sec
186
carotid PSV with less than 50% stenosis
PSV <125cm/sec
187
carotid PSV/EDV with 50-75% stenosis
PSV >125cm/sec
| EDV <140 cm/sec
188
carotid PSV/EDV with 80-99% stenosis
PSV >125cm/sec
| EDV >140cm/sec
189
NASCET criteria for carotids > than 70% stenosis
ICA/CCA ratio >4.0
190
occlusion signals of carotids
CCA may have low or absent diastole
| pre occlusive thump
191
maximum frequency is
1/2PRF
192
nyquist limit
flow greater than 1/2 PRF
193
to increase PRF or nyquist limit
```
change scale
change transducer frequency
bring down baseline
change wall filter
use CW doppler
change depth
change angle of insonation
```
194
mirror image/cross talk
doppler shifts above and below baseline
| artifact from strong reflectors or too much gain
195
transtemporal approach for
MCA
ACA
PCA
dst ICA
196
transorbital approach for
ophthalmic and carotid siphon
197
transforaminal/suboccipital approach
vert and basilar art
198
MCA
30-60mm
antegrade
55 +/- 12cm/sec
angle: ant/sup
199
ICA
55-65mm
bidirectional
55 +/-12 cm/sec
ant/sup
200
ACA
60-80mm
retrograde
50 +/-11cm/sec
ant/sup
201
PCA
60-70mm
antegrade
39 +/- 10cm/sec
posterior
202
Opthalmic artery
40-60mm
antegrade
21 +/1 5
medial
203
ICA carotid siphon
```
60-80mm
supraclinioid : retrograde
genu: bidirectional
parasellar: antegrade
47 +/-14 cm/sec
```
204
Vertbral artery
60-90mm
retrograde
58 +/- 10cm/sec
right/lt of midline
205
basilar artery
80-120mm
retrograde
41 +/- 10 cmsec
midline
206
cross over of ACA
antegrade flow in ACA due to cross over collateralization
207
external to internal collateralization
retrograde flow in ophthalmic artery
208
posterior to anterior collateral pathway
increase flow in PCA
| reversed flow in pcom artery
209
occlusion is most accurately identified in
ICA or MCA
210
vasospasm most accurately identified in
MCA
211
vasospasm
>120cm/sec
212
severe vasospasm
>200cm/sec
213
AV malformation causes
increased systolic and diastolic flow
low PI
reduced flow in adjacent arteries
214
subclavian steel results in
retrograde flow in ipsilateral vertebral artery
215
calculate diameter reduction
1 - d/D x 100
216
may thurners syndrome
lt common iliac vein travels under rt common iliac artery and may be compressed leading to DVT in left lower extremity
217
intracranial venous sinus
space between dura matter and periosteum that drains blood into jug vein
218
veins without valves
```
IVC
SVC
innominate
iliac
soleal sinuses
```
219
GSV # of valves
12 mostly below knee
220
small saph v # of valves
6-12
221
perforators # of valves
each contain a valve
222
infra pop veins # of valves
7-12
223
pop and fem vein # of valves
1-3 each
224
common fem v # of valves
1
225
IJV # of valves
1
226
shape of veins is determined by
transmural pressure
| pressure within vein vs pressure outside of vien
227
low transmural pressure
low blood volume
hour glass shaped vein
(offers more resistance)
228
high transmural pressure
high blood volume
| circular shaped
229
hydrostatic pressure equation
```
HP = PGH
P= specific gravity of blood
G= acceleration due to gravity
H= distance from the heart
```
230
what helps propel blood towards the heart
muscle contraction
231
ineffective calf pump muscle results in
reflux
venous volume and pressure increases
venous pooling
ambulatory venous hypertension
232
inspiration
decrease in intrathoracic pressure
increase intra abdominal pressure
decrease venous return from legs
increase venous return from arms
233
expiration
increase intra thoracic pressure
decrease intra abdominal pressure
increase venous return from legs
decrease venous return from arms
234
valsalva
increases intra thoracic and intra abdominal pressure
all venous flow should halt
same as prx compression during lower extrem exam
235
phlegmasia alba dolens
arterial spasm due to iliofemoral thrombosis
| causes pallor
236
phlegmasia cerulea dolens
severely reduced venous outflow from iliofemoral thrombosis
| causes cyanosis
237
pitting edema causes
fluid retention
CHF
elevated venous pressure
238
virchows triad
venous stasis
hypercoagulability
trauma to vessel
239
picc line will most likely develop thrombosis
proximal picc
240
paget schroetter syndrome
stress induced dvt of axillary or subclavian vein
common in young men
venous form of TOS
241
superior vena cava syndrome
obstruction by neoplasm
| pt may have cough/sob
242
with SVC syndrome what happens to flow
flow in UE remains the same during inspiration
243
primary varicose veins
dilated superficial veins due to incompetence of superficial system
deep system intact
244
secondary varicose veins
dilated superficial veins due to incompetence of superficial system that is caused by DVT
deep system not intact
245
klippel-trenaunay
multiple varicosities of superficial system
| hypoplastic or absent deep veins
246
chronic venous insufficiency
stretching of walls results in damage to valves
| increase venous pressure causes flow changes
247
post phlebitic syndrome
chronic flow changes result in persistent edema, stasis, pain
may lead to ulceration
248
PPG venous normal venous refill time VRT
> or = 20 seconds
249
PPG venous superficial system incompetence VRT
<20 sec without tourniquet
| then normalizes to >20 seconds with tourniquet
250
PPG venous deep system incompetence VRT
< 20 seconds with and without tourniquet
251
PPG of venous system is used to detect
venous insufficiency
| venous reflux
252
venous APG cuff inflates to
6mmHg
253
venous filling index shows what
rate of venous refilling
254
VFI is calculated using
```
Venous Volume (VV)
Venous filling time (VFT)
```
255
normal VFI should be
low number
256
what measures the calf muscle pump function
Ejection Fraction EF
257
EF is calculated how
```
Ejection volume (EJ)
Venous Volume (VV)
```
258
normal EF is
high percentage
259
the calf expels how much of venous blood volume with one toe pump
60%
260
Residual volume fraction RVF is equivalent to
ambulatory venous pressure in mmHg
261
Residual volume fraction is calculated how
percentage of VV remaining after 10 toe tips
262
RVF should be
low %
263
limitations of APG
will not diagnose incompetent perforators or isolated incompetent distal veins
264
APG systems are
manually calibrated
265
VV is calculated
EV and VRT
266
sources of false positives for CW venous doppler
extrinsic compression
peripheral arterial disease PAD
COPD
267
PAD can cause
decreased venous filling
268
COPD can cause
elevated central venous pressure
269
trendelenburg position for venous doppler
head 30 degrees lower than heart
270
venous flow patterns
spontaneous
phasic
augment with dst compression
aug with prx release
271
to improve venous doppler imaging
adjust scale
change wall filters
increase gains
272
with chronic venous insufficiency what do you normally see with valsalva
flow reversal which indicates reflux
273
venous insufficiency testing with doppler cuffs sizes
19x40 thigh
12 x 40 calf
12x40 ankle
274
rapid cuff inflator for venous insufficiency inflates
80 mmHg thigh
100 mmHg calf
120 mmHg foot
275
spectral analysis with chronic venous insufficiency
reversed flow lasting more than 30 seconds to 1 minute
276
color flow with chronic venous insufficiency
color change noted during prx compression or cuff deflation
277
if flow is not spontaneous at CFV FV and POP veins
obstruction distal to or at that site
278
if flow is continuous and not phasic
prx obstruction
279
no augment is dst compression is seen
obstruction between where you are compressing and where you are listening
280
if flow increases during prx compression
venous reflux
281
rouleau formation
slow swirling flow seen within vein
| could suggest prx obstruction
282
doppler seen with chronic venous thrombosis
venous reflux lasting 30 sec or longer
| continous or decreases phasicity
