Ultrasound vascular 8-13 Flashcards
What are we looking for in an arterial scan?
Occlusion
What are the symptoms of PAOD?
Intermittent claudication
What is claudication?
Pain in large muscle groups caused by activity
Where does claudication occur?
distal to site of disease
What is true claudication?
when symptoms are relieved with quiet standing
what is Ischemic rest pain?
Symptoms are more serve and have diminish flow. Pain occurs when legs are at rest.
What is advanced POAD? and symptoms?
Most severe state with tissue loss causing thick toenails, scaliness, elevation pallor, gangrene, blue toes.
How should a patient be positioned?
Head raised and legs at the same level as the heart
What happens if cuff isn’t right?
narrow= false elevated pressure wide= false low pressure
What is a normal abi?
about 1 *lower=worse POAD
Explain a normal thigh pressure?
30 m mHg higher than highest brachial. *higher = prox obstruction
Contraindications for treadmill testing?
Chest pain, Arrhythmias, Post myocardial infarction, unsteady, hypertension.
What is recovery time and what does it suggest?
ABI returns to normal within 5=single >10=multi
What is Plethysmography?
cuff is used to measure volume changes in limb
With plethysmography what does a moderate to severe disease look like?
delayed peak, round peak, and diastolic phase becomes convex.
What is Photoplethysmography (PPG)?
infrared light is used to detect variations in blood flow.
What is a normal toe brachail index?
> .8
Common location for POAD in arms?
sublavian to the prox axiallry
What difference in ABI for arms indicates a disease?
> 20
How to detect Thoracic outlet syndrome?
Any postion should be held for 30 secs. to see if symptoms happen. **TOA example when raising your arm
What is Raynaud?
from cold sensitivity or emotional stimuli that can be either primary or secondary.
What id the difference between primary and secondary Reynaud?
Primary= vasopspam only (younger) secondary= fixed obstruction with associated vasospasm. (older)
What is secondary reynauds associated with?
tissue loss, trauma, and scleroderma, cancer, drug induced, autoimne.
What is the Allen test?
used to determine digital perfusion prior to certain surgical procedures
Signs and symptoms of acute arterial insufficiency?
Pallor, Pulselessness, Paralysis, Parthesia, Pain, Coolness
Risk factors for lower extr. arterial insufficiency?
Diabetes, Hypertension, Smoking, Obesity, Age, Heredity, Gender
Normal findings for spectral analysis:
PSV does not increase, High resistance=sharp upstroke, rapid deceleration, retrograde in early, Antegrade in late
What is contrast arteriography?
“GOLD STANDARD” for arterial stenosis.
What are some limitations to using a arteriography?
Delineates patent arterial lumen only. Missed thromobsis in pop. Low flow=poor. Radiation.
What causes a upper extremity arterial disease?
Mechanical obstruction. Embolism. Trauma. Raynaud. Occulsion.
Where does most atherosclerotic disease in upper ex occur?
lt prox subclavian if extensive it is in aortic arch
What is Takayasu arteritis?
it is a auto imune disorder that affects the arteris of the aortic arch and visercal abdominal aorta. Result of long occlusion or stenosis.
Who is common for takaysu?
women 20-30’s
Symptoms of takaysau?
acutley: fever, malaise, arthralgias, and myalgias
Who is common for giant cell?
white women in 40
What arteris are affected by giant cell?
opthalmic, subclavian, axillary, superfical temporal.
Who gets thromboangiitis (buerger)?
smokers under 50
What vessels get buerger?
small vessels of hands and feet
How to improve buerger?
stop smoking
Patients with dialysis grafts or fistulas may have
gangrene from end stage renal disease
Downfall to a prosthetic bypass graft
poor long termed patency rates
Why are autogenous vein grafts preffered?
better long term patancy
What is in situ bypass graft?
vein being used for bypass is left in its original anatomic position usually the great saphenous v. Lareg to small.
What is the difference in orthograde and retrograde by pass grafts both can be freed from natural postion
Orthograde=lyzing valves
retrograde= flipping vein
both= large to small
When do you have problems with bypass grafts and what are they?
technical occurs within 30 days
problems = retained valve, intimal flap, problems at suture, graft intapment, thrombosis
Between 1-24 months what can occur with a bypass graft?
myointimal hyperplasi creating stenosis or a stenosis..
After 24 months what can occur?
progression of atherosclerotic disease in inflow or outflow vessel. OR aneurysmal dialation
What images are needed for a bypass graft check up?
infow prox anastomosis mid graft sistal anasomosis outflow
How do PTFE grafts appear?
double line
What is myometrial hyperplasia?
rapid proliferation of cells into intimal layer
Normal bypass waveform?
multiphasic. high resistance. reversal may be absent in earlt period.
What an foward flow in diastol be a sign of?
indication of hyperemia or arteriovenous fistula
Stenosis categorization
Normal below 150 cm/s…… Above 180=abnormal
Treatments for PAD:
Medical treatment
surgical reconstruction/ graft
endovascular therapy
Types of endovascular treatments:
PTA,
Subintmal angio
mechanical atherectomy
stent graft angio
Nonatherosclerotic disease include
inflammatory,,, congenital abnormalities,,,, aquird,,, injuries
What is Vascular arteritis?
Inflammatory that affects vessels
W/ arteritis inflammatory process involves?
media cells infiltrated w/ white blood cells
muscular and elastic portions are eroded
fibrosis develops
weak wall and necrosis
Symptoms of arterisi
claudication
decreased asymmetrical bp
TIA/ STROKE symptoms
ANother name for giant cell arteritis
temporal arteritis
Symptoms of Giant cell arteritis
temporal headaches tenderness over superfical temp artery decreased pulse asymmetrical bps cord-like structure over temporal artery aching/stiffness in neck jaw claudication visulal disturbances
Labs for Giant cell =
elevated erythrocyes sedimentation rate and C-reactive protein
Symptoms of Takayasu arteritis
absent peripeheral pulse brachial bp difference light headednes amaurosis fugax diplopia tias hemiparesis upper extemity claudication
Does Buerger affect one side or both?
both but one is worse
Radiation Induced arteritis???
rare from radiation therapy for cancer…. results in perivascular fibrosis, inflammation, and acceleraion of atherosclerosis
What is embolic disease?
occlusion or obstruction of an artery by a transported clot of blood or mass, bacteria, or other foreign substance
Where do most arterial emboli come from?
80-90% cardic source
What causes cardiac emboli?
arterial fib********most common post myocardial infarction lt ventricle mechanical heart valves intracardiac tumors vegetation paradoxical emboli
What % of emboli arises from outside of the heart
10-20%
Other sources for emboli rather than the heart
subclavian
atherosclerotic disease in the aorta, iliac, femoral, pop
mural thrombosus from aneurysms in these vessels
Where does most pseudoanerysms, injurys occcur?
femoral artery as a result of catheter based procedur
Pseudoaneurysms symptoms
mass
ecchymosis
pain
extrinsi compressing that causes nerve irriation and venous compression swelling
AV fistula injury???
abnormal connection b/w artery and vein from trauma or catherization
signs and symptoms of av fistula injury
bruit
papable thrill
hematoma
Arterial occlusions trauma ????
occurs after various interventions or cannulations
With a arterial occlusion injury a pt may present with
partial to complete thrombosis
cold, pulseless leg
What is popliteal artery entrapment syndrome?
occurs when pop artery is compressed by medial head of gastrocnemius muscle or adjacent tendons result of congenital deformity
repeated compression of pop artery can produce?
aneurysm formation
thromboembolism
thrombosis
Symptoms of pop artery entrapment syndrome
claudication in young may occur after extensive exercise may be chronic may occur with walking not running parasthesia and numbness have been recorded
