The Great Vessels Flashcards
The three layers of blood vessels
tunica intima, tunica media, tunica adventitia
What is the abnormal measurement of the AO?
Greater than 3.0cm
What does the celiac axis branch off into?
Hepatic artery, left gastric artery, and splenic artery
What are the wings of a seagull?
Hepatic artery / splenic artery
What is the nutcracker phenomenon?
Compression of the left renal vein between the superior mesenteric artery/aorta.
What is the portal triad?
Portal vein, hepatic artery, and bile duct
What is the portal confluence?
Junction of superior mesenteric vein and splenic vein to make main portal vein, posterior to pancreas
What is Arteriovenous Fistulas and what causes them?
Abnormal connection between an artery and a vein. Most commonly trauma but can be complication of AAA or RCC.
What is aortic dissesction?
Separation of the layers of the arterial wall by blood or hemorrhage.
What are the risk factors, signs and symptoms, and sonographic appearances for aortic dissection?
Risk factors: hyper tension, Marfan syndrome
S/S: intense chest pain, abdominal/back/arm/leg pain, vomiting, paralysis
SA: thin linear flap within lumen with motion during cardiac cycle, blood flow on both sides of flap
If the posterior wall and anterior wall can’t be seen on a vein but there is acoustic shadowing distal, what is likely to be missed?
Atherosclerosis; wall calcification will create shadowing
What is atherosclerosis and its SS, risk factors, SA?
Accumulation of fat and funk in the intima and media layers of the artery. Associated with aneurysms. More commonly seen at areas of bifurcation or branching.
Risk factors: hyperlipidemia, hypertension, smoking
SS: Asymptomatic until stenosis develops
SA: Luminal irregularities, wall calcifications, wall irregularities
What is a AAA? What are the 3 types?
Abnormal focal dilation (greater than 3.0cm) of blood vessel caused by a weakness in the wall.
Saccular: sac like protrusion toward one side
Fusiform: most common, gradual dilation of complete circumference of vessel
Dissecting: when a longitudinal tear in the wall allows bleeding to occur into wall
What are the risk factors of AAA?
Tobacco, hypertension, vascular disease, COPD, family history. More common in men over 65 than women. Atherosclerosis has huge correlation.
What is a pseudoaneurysm (aka a false aneurysm)?
Extravascular pulsating hematoma communicating with the intravascular space, most commonly caused by trauma
Aortic rupture most common place and S/S?
Most commonly ruptures into peritoneal space.
S/S: central back pain, hypotension
Splenic Artery Aneurysms, S/S, SA
Most common splanchnic vessel aneurysm but rare. Most commonly ruptures into peritoneal cavity. Most commonly seen in females.
Risk factor: portal hypertension, multiple pregnancies
S/S: varied, asymptomatic, LUQ pain, nausea
Hepatic Artery Aneurysm
Most common extrahepatic. Most common in males.
Comes from systemic infection, arteriosclerosis, blunt abdo trauma
S/S: asymptotic until large enough to cause symptoms
Renal Artery Aneurysm
Most commonly extrarenal. Surgery needed is bigger than 1.5cm. Comes from atherosclerosis.
S/S: Palpable mass, hypertension, flank pain, hematuria
When an AAA is diagnosed, what other arteries should be checked?
Common Iliacs
What is an aortic graft?
A structure used to repair an aortic aneurysm by preventing recurrent flow into aneurysm sac.
What is EVAR?
Endovascular repair of abdominal aortic aneurysms. A stent graft deployed into aorta.
SA: Very echogenic walls with ribbing and are straighter than native vessels
What kind of complications can an aortic graft (EVAR) create?
Pseudoaneurysms (most common complications), graft aneurysms, hematomas, abscesses, occlusion, endoleaks.
What are the four types of Endoleaks and which is most common?
I: incomplete seal
(Most Common) II: IMA or lumbar artery haven’t been exluded by device and continues to provide flow into aneurysm
III: Rare, endograft failure due to disconnection or fabric disruption
IV: rare, endograft failure due to graft porosity
