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Arterial Procedures > UE Arterial Duplex > Flashcards

UE Arterial Duplex Flashcards

1
Q

Are UE arterial diseases common?

A

No, they are rare compared to LEA obstructions.

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2
Q

What is the most common UE diseases?

A

SCA atherosclerosis.

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3
Q

What is arteritis?

A

Inflammation of artery.

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4
Q

Where is the brachicephalic located?

A

on the right side, and ends at the carotid/subclavian bifurcation.

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5
Q

To evaulate axillary artery, should the patient be postioned?

A
  • Arm should be externally rotated and postioned away from the body to find the distal end. (“pledge position”)
  • Head may need to be rotated depending on area to be examined.
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6
Q

While scanning the axillary, what should you do with the patient?

A

Place a towel over chest and under arm.

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7
Q

For good ergonomics, how should you scan a patients right side?

A

From the patient’s right side is okay.

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8
Q

For good ergonomics, how should you scan a patients left side?

A

Patients head should be on the foot of the bed.

  • Scan backwards or shit at the head and scan outward.
  • DO NOT use the patient as an armrest.
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9
Q

How does the BCA look on an ultrasound screen?

A

It is usually more vertical on the screen.

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10
Q

What vessels are peak systolic velocities recorded in?

A

For each vessel you are scanning.

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11
Q

When scanning, what is the optimal angle used in the longitudinal plane?

A

<60°

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12
Q

What should you look out when you are scanning in regards to PSV?

A

Watch for changes in psv (doubling) with post stenotic tubulence.

(note psv pre-stenosis, in stenosis, and post-stenosis when present)

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13
Q

What should you document when scanning an aneurysm?

A

document diameter (AP and lateral).

(measure perpendicular to flow)

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14
Q

What is the normal critera for a normal UE waveform?

A
  • Triphasic
  • Sharp systolic peak
  • Brief period of diastolic reversal flow.
  • minimal continued forward flow in diastole.
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15
Q

What is the normal PSV in the subclavian?

A

varies from 80-120 cm/s

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16
Q

What is the normal PSV in the brachial, radial, and ulnar arteries?

A

Varies between 40-60 cm/s

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17
Q

What is considered an abnormal finding in a UE waveform?

A
  • Elevated PSV
    • Velocity ratio ≥2 is consistent with >50% stenosis.
    • post-stenotic turbulence
    • Dampened distal waveforms with loss of end-systolic flow reveral
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18
Q

Waveform changes and brachial blood pressures can help determine what?

A

The significance of a stenosis.

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19
Q

How is an occlusion documented?

A
  • Absence of flow within lumen by color and spectral doppler.
  • Power doppler may also be used for confirmation.
  • Adjust equipment settings to increase sensitivity to slow flow states
    • increase gain
    • decrease gain
  • Use companion veins to help determine proper location of artery.
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20
Q

What do you see in this picture:

A
  • Scale is low and gain is high.
  • overgain (cross-talk artifact) speckles but no flow.
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21
Q

What is an aneurysm?

A

Permanent localized dialation resulting in 1.5X increase in diameter of an artery compared to adjacent normal artery.

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22
Q

Where do aneurysms oftenly occur?

A

SUbclavian artery in association with TOC

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23
Q

What is important to document about an aneurysm?

A

Diameter measurements and mural thrombus.

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24
Q

What is TOC?

A

Thoracic Outlet Compression.

It is the impigement of the neurovascular bundle at the thoracic outlet.

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25
Q

What causes the compressions in TOC?

A
  • cervical ribs
  • abnormal fibrous bands
  • hypertrophy of the scalene muscle.
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26
Q

Can duplex ultrasound be used to confirm neurogenuc TOC/TOS?

A

Yes. However, evidence is not supportive of this conclusion.

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27
Q

Who is affected by TOC/TOS?

A

It occurs primarily in younger patients.

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28
Q

What can repeat trauma to the brachial plexus from TOS cause?

A

It cancause an aneurysm, stenosis, ulceration, or occlusion of subclavian artery.

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29
Q

What kind of skill level does TOC duplex require?

A

Advanced skill level.

30
Q

During a TOC duplex exam, how should the patient be positioned?

A

Sitting.

31
Q

Where should you get the axillary duplex?

A

DIstal (inferior to) the clavical so you are scanning distal to the thoracic outlet.

32
Q

Why is it important to scan in LIVE B-MODE when doing a TOC duplex exam?

A

To be sure you’re still on the artery.

33
Q

While preforming the TOC duplex, what should you have the patient do?

A

Have the patient move SLOWLY into various positions, but primarily arm straight up.

34
Q

What are you looking out for when you have the patient move into various positions while preforming a TOC Duplex?

A

See if the velocity increases, then STOPS.

35
Q

What is sometimes used as a conduit in a coronary artery bypass graft?

A

Radial artery.

36
Q

In order to use the radial artery in a coronay bypass, what test must be done?

A
  1. Duplex scan of the entire radial artery looking for an obstruction.
  2. Allen’s test to see if the hand will perfuse if the radial artery is removed.
  3. Measure the diameter of radial artery→ prox, mid, distal. (want it to be at least 2 mm in diameter) and check for aneurysmal and ectatic, or thickening sections.
37
Q

Where is the most common location to enter a catheter for imaging?

A

CFA

38
Q

What happens to the artery when the catheter is removed?

A

It creates a hole in the artery.

39
Q

What is usually done when a catheter is removed?

A

Pressure is applied to the artery to stop bleeding outside the artery.

40
Q

What are pseudoaneurysm?

A

Vascular injury causinf pulsatile flow out of the artery into a contained area in the surrounding tissue.

41
Q

What are the characteristics of a pseudoaneurysm?

A
  1. Pulsatile mass
  2. Visible “neck” or tract
  3. To and from flow patterns in neck.
  4. Red/blue color in mass
  5. Radial pulsations.
42
Q

What does iatrogenic mean?

A

It is illness caused by medical examination or treatment.

43
Q

What are some IATROGENIC false aneurysm caused by?

A
  • Angio catheter
  • Cardiac catheter
  • Intravascular catheter
44
Q

Where are IATROGENIC false aneurysm usually in?

A

They are usually in the femoral artery; in the SFA/PFA bifurcation or PFA branch.

45
Q

What documentation should you obtain while imaging a pseudoaneurysm?

A
  1. Size in transverse and long.
  2. Amount of thrombus that may be forming.
  3. Try to identify the artery with the hole.
  4. Image the neck with doppler showing to and fro flow.
46
Q

What does to and fro flow look like?

A

THIS IS A VITAL WAVEFORM TO DOCUMENT TO PROVE A PA.

47
Q

What can happen to iatrogenic PA’s?

A

They may spontaneously thrombose, so waiting and retesting is an option.

48
Q

What are some treatments for a PA?

A
  1. ultrasound compression therapy.
  2. Ultrasound guided thrombin injection
  3. Surgery
49
Q

What is the ultrasound compression technqiue procedure?

A
  1. compress PA with ultrasound probe for 10 min. intervals until thrombosed.
  2. Chec for flow in PA
  3. Check for flow in artery and vein.
50
Q

What are the negatives for the ultrasound compression technique?

A
  1. It is slow, painful for patient and techs.
  2. Requires medication for patients.
51
Q

What are the contraindications for the ultrasound compression technique?

A
  1. Anti-coagulation
  2. Skin necrosis
  3. Local infection
52
Q

What does the ultrasound guided thrombin injection do?

A

Causes a rapid thrombosis of a PA.

53
Q

What is the thrombin medication used?

A

Bovine thrombin

54
Q

What are the contraindications of an US guided thrombin injection?

A
  1. Anti-coagulation
  2. Skin necrosis
  3. Local infection
55
Q

What is very important to do following a thrombin injection?

A

Check flow in artery after procedure.

56
Q

Where shouldn’t you use a thrombin injection?

A

On grafts.

57
Q

What is a PA commonly confused with?

A

A lymph node, or vascularized mass.

58
Q

What makes a lymph node and a vascularized mass different from a PA?

A

A lymph node and mass have arteries and adjacent veins with normal flow patterns, so no equal time to and fro.

59
Q

What is a PA typically caused by?

A

It is caused by a puncture of the artery.

SO…NO PUNCTURE, NO PA.

60
Q

What is an iatrogenic AVF? (ARTERIOVENOUS FISTULA)

A

It is a hole in BOTH the artery and adjacent vein which allows flow to move directly from artery into vein.

61
Q

What is the characteristics of the flow channel within the AVF?

A

Very high velocity, low pulsatility.

62
Q

What is a good indicator of a AVF location?

A

Visible color bruit.

63
Q

How is the venous flow proximal to the AVF?

A

Very turbulent and pulsatile, a good sign of location.

64
Q

What the VITAL images you must take for an AVF protocol?

A
  1. Find point of fistula by looking for color bruit at point of injury.
  2. Confirm fistula at hole with doppler PSV.
  3. Take arterial doppler proximal to AVF
  4. Take arterial doppler distal to AVF
  5. Take venous doppler proximal to AVF
  6. Take venous doppler distal to AVF
65
Q

To find an iatrogenic PA, where should you look?

A

Look for the wound and search proximal to it.

66
Q

To find an iatrogenic AVF, where should you look?

A

Look for the wound and search for THE AREA.

67
Q

What is popliteal entrapment?

A

The popliteal artery compressed by the medial head of the gastrocnemius muscle or fibrous bands.

68
Q

When might a patient experience pain with popliteal entrapment?

A
  • Leg extrension.
  • Plantar flexion, or dorsiflexion.
69
Q

What complications arise from popliteal entrapment?

A
  1. aneurysm
  2. atherosclerosis
  3. thrombosis
  4. emboli
70
Q

How is popliteal entrapment commonly diagnosed?

A

PPG. look for flattening or worsening of waveform during dorsiflexion and plantarflexion.

Arterial Procedures (13 decks)

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