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radiology > vascular > Flashcards

vascular Flashcards

1
Q

lateral and medial margins axillary v

A
  • lateral=teres major

- medial-bx SCV at 1st rib lateral margin

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2
Q

where does cephalic v drain?

A

into SCV

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3
Q

how is pelvic venography obtained?

A
  • prone from popliteal access

- check IVC rel to spine

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4
Q

which renal v is higher

A

left

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5
Q

breakdown of ascending aorta

A
  • aortic valve annulus
  • aortic root (from AV to sinotubular junction)
  • sinus of valsalva
  • sinotubular junction
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6
Q

isthmus

A

segment of aorta btw org L SCA and lig arteriosum

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7
Q

ductus bump

A

just distal to isthmus; contour along lesser curvature.

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8
Q

aortic variant percentage bd

A

normal 75%
bovine 15%
sep org left vert 5%

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9
Q

branches of SMA

A
  • inferior pancreaticoduo
  • ileocolic
  • middle colic
  • right colic
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10
Q

arc of riolan (meandering mesenteric a)

A

anastomoses btw middle colic and left colic

*not always present

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11
Q

how often is traditional celiac anatomy seen? BD of variants

A

60%

  • replaced RHA-10%
  • accessory LHA 10%
  • replaced LHA 7%
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12
Q

why care about variant celiac anatomy

A
  • partial hepatectomy
  • course through Calot’s triangle + short cystic a (lap cholecystectomy)
  • pancreatic surgery (replaced RHA)
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13
Q

“vessel through straight” sign

A

vess through lig venous

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14
Q

Posterior division internal iliac artery

A

I Love Sex
Iliolumbar
Superior gluteal
lateral sacral

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15
Q

Ant division int iliac a

A
  • umbilical
  • sup vesicular
  • inferior vesicular
  • uterine
  • middle rectal
  • int pudendal
  • inf gluteal
  • obturator

I Love Going
Places In My Very Own Underwear!

  • Pudendal
  • Inf gluteal
  • middle rectal
  • inf Vescicular
  • Obturator
  • Uterine/umbilical
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16
Q

persistent sciatic a

A

continuation of internal iliac passing pst to femur and anastomose with distal vasculature

  • aneurysm, early athero
  • “ext iliac occluded but strong pulse in foot”

Internal iliac artery continues as sciatic artery and then as popliteal artery
Hypoplastic external iliac, common femoral, and superficial femoral arteries (SFA)
2 types based on degree of SFA hypoplasia
Aneurysms in 25%, typically under gluteus maximus due to compression of artery by greater trochanter

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17
Q

arc of buhler

A

-4% variant collateral pw Celiac – SMA

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18
Q

anastomoses SMA-IMA

A
  • chr mesenteric isch, treating type 2 endoleak
  • arc of riolan-not always present
  • marginal of Drummond-always present
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19
Q

mc loc penetrating ulcer

A

desc thoracic aorta

-high flow at aortic root prevents formation of athero

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20
Q

anastamoses btw IMA and int iliacs

A
  • sup rectal (From IMA)

- inf rectal (From int pudendal)

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21
Q

Winslow pathway

A
  • sup epigastric (from internal thoracic)

- inf epigastric (From EIA)

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22
Q

corona mortis/crown of death

A
  • variant anastomosis btw obturator and EIA coursing over sup pubic bone–> sev bleed in trauma (6-8% deaths?)
  • theoretical cause of type 2 endoleak
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23
Q

orientation SCA and SCV

A
  • SVA pst to SVC.

- SVA in scalene triangle (w/ brachial plexus), SVC ant to triangle

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24
Q

branches of subclavian

A
  • vertebral
  • internal thoracic
  • thyrocervical
  • costocervical
  • dorsal scapular
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25
Q

subclavian –> brachial

A
  • ax at 1st rib
  • brachial at lower border tires MAJOR
  • radial at radial head
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26
Q

ulnar vs radial a on angiogram/cta

A
  • ulnar bigger, gives off common interosseous
  • ulnar supplies superficial palmar arch
  • radial appear at radial head. supplies deep arch
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27
Q

“high org radial a”

A

from ax or high brachial a

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28
Q

anterior interosseous branch (median artery)

A

upper extremity variant
-persistence of branch supplying deep palmar arch

The anterior interosseous artery is one of the two branches of the short common interosseous artery (from the ulnar artery). The artery courses deep in the anterior compartment of the forearm on the anterior surface of the interosseous membrane along with the anterior interosseous nerve (from the median nerve). It runs between flexor digitorum profundus (medially) and flexor pollicis longus (laterally) muscles supplying both. It gives off several small branches that pierce the interosseous membrane, supplying the deep extensor muscles within the posterior compartment of the forearm. Small nutrient vessels also supply the radius and ulna. At the upper border of pronator quadratus, the artery:

gives off a small branch to anastomose with the palmar carpal arch and,
pierces the interosseous membrane to enter the posterior compartment of the forearm and anastomoses with the posterior interosseous artery which continues distally to join the dorsal carpal arch.

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29
Q

when does EIA bc CFA?

A

-once it gives off inf epigastric at ing ligament

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30
Q

course of deep femoral artery

A

lateral, pst.

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31
Q

course SFA

A

anterior, medial into flexor m compartment (adductor/hunter’s canal)
-popliteal once emerge from canal

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32
Q

popliteal branches

A
  • ant tib (1st branch)
  • tibioperoneal trunk
  • at level of distal popliteus m
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33
Q

adductor/hunters canal

A

The adductor canal extends from the apex of the femoral triangle to the adductor hiatus. It is an intermuscular cleft situated on the medial aspect of the middle third of the anterior compartment of the thigh, and has the following boundaries:

Anteromedial wall - sartorius.
Posterior wall - adductor longus and adductor magnus.
Laterally - vastus medialis.

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34
Q

course of ant tibialis

A

anterolat through interosseous membrane

-dorsalis pedis at angkle

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35
Q

most medial a in leg?

A

-pst tibial (felt at medial malleolus)

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36
Q

isolated gastric varies-cause and drainage

A
  • splenic v thrombus

- –> inf phrenic v –> renal v –> gastrorenal shunt

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37
Q

splenorenal shunt

A
  • collateral btw splenic and renal v
  • not ass w/ GI bleed!!!
  • but is ass w/ hepatic encephalopathy
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38
Q

left SVC ass

A
  • ASD (mc)

- unroofed coronary sinus

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39
Q

duplicated IVC ass

A
  • renal stuff
  • horseshoe
  • cross fused ectopic kidneys
  • circumaortic renal collars
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40
Q

circumaortic venous collar/renal vein-when it matters and loc of limbs

A
  • renal tx, ivc filter

- ant=sup, pst=inf

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41
Q

azygos continuation of ivc ass

A
  • duplicated IVC
  • polysplenia
  • dilated azygos in chest
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42
Q

MC cong venous anomaly in chest

A

left SVC

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43
Q

sac like aneurysm above vs below diaph

A
  • above=penetrating ulcer

- below=mycotic aneurysm

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44
Q

path of penetrating ulcer

A

atherosclerotic –> erosion of intimal –> hematoma in media –> pseudoaneursym, rupture

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45
Q

mcc acute aortic syndrome

A

dissection 70%

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46
Q

who’s at risk of dissection

A
  • htn #1
  • CT do
  • preg
  • cocaine
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47
Q

ascending aorta Ca

A

takayasu
syphilis
*matters during clamping for CABG

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48
Q

acute dissection by week

A

<2wks

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49
Q

contents of true vs false lumens

A

true: celiac trunk, SMA, right renal

false= left renal

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50
Q

aneurysm with mural thrombus vs thromboses dissection

A

diss should spiral and displace intimal calcs

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51
Q

predictors of shitty outcome in intramural hematoma

A
  • > 2 cm thickness
  • 5cm+ aneurysm
  • +diss/penetrating ulcer (PU worse than diss)
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52
Q

true vs false aneurysms shape

A
  • true=fusiform

- false=saccular

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53
Q

causes of aortic pseudoaneurysm

A 
trauma 
iatrogneic
inf
pancreatitis
vasculitides
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54
Q

sinus of valsalva aneurysm-who, which sinus, causes, ass, compl, mx

A
  • asian men
  • R sinus
  • cong or acquired (inf)
  • VSD
  • cardiac tamp
  • bentall procedure
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55
Q

MCC ascending aortic aneurysm

A

medial degeneration

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56
Q

sgx’s of impending aortic aneurysm rupture

A
  • draped aorta
  • growth 10mm+/yr
  • focal discon’t in circumferential wall calcs
  • hyperdense crescent sax-hemorrhage. One of most spec manifestations of impending rupture
  • periarotic stranding
  • pain
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57
Q

MC img finding of aortic rupture

A

RP hematoma

58
Q

embolic vs thrombotic colitis/enteritis

A
  • embolic=branch points

- thromboic=otsteium

59
Q

what protects against aneurysm rupture?

A

circumferential mural thrombus

60
Q

mycotic aneurysm-how, app, where, mx

A
  • seeding from endocarditis
  • SACCULAR, PA, inflamm, gas. Expand faster than athero
  • thoracic or suprarenal abd
  • small, asyx and enruptured.
61
Q

where are most atherosclerotic AAA

A

infrarenal

62
Q

joeys Dietz syndrome-triad

A

hypertelorism
bifid uvula or cleft palate
-aortic aneurysm with tortuosity
*shitty version of marfans

63
Q

pathophy marfans vs ehlers danlos

A
  • marfans=fibrillin gene.

- ehlers-danlos-collagen

64
Q

marfans systemic findings

A
  • ectopic lens
  • tall
  • pectus deformity
  • scoliosis
  • long fingers
  • vascular-aneurysm, diss, pulm a dilation
65
Q

Ehlers danlos systemic findings

A
  • many subtypes
  • stretchy skin, hypermobile joints, bv fragility w/ bleeding diatheses
  • vascular issues-aortic root, abd visceral a’s
66
Q

who should you avoid precut on?

A

Ehlers danlos-excessive risk arterial dissection

67
Q

syphilitic leutic aneruysm

A

untreated tertiary syph

  • saccular, asc aorta and arch + root branches
  • heavily “tree bark” intimal ca
  • 30% CA ostium narrowing
  • AV insufficiency
68
Q

aortoenteric fistula-types, where

A
  • 1˚ and 2˚ (mc)

- 3rd, 4th pts duo

69
Q

inflammatory aneurysms

A
  • young men
  • often syx. rupture risk ind of size
  • RF= smoking-smoking cessation; periarotic RP fibrosis, AI (SLE, GC, RA)
  • 1/3 hydro/renal fx
  • ESR+
  • sparing pst wall (diff from vasculitis)
70
Q

how to differentiate inflamm aneurysm from vasculitis

A

-sparing pst wall

71
Q

leriche syndrome

A

-compl occlusion aorta distal to renal a’s (MC at aortic bifurcation.) 2/2 athero
+ collateral
-triad: impotence, claudication, ø femoral pulse

72
Q

mid aortic syndrome (CoA of abd aorta)-how, triad

A
  • absolute zebra off children/young adults 2/2 intrauterine insult w/ fragmentation of elastic media
  • narrowed long segm aorta w/o arteritis or atherosclerosis

Triad:

  • htn-mc presenting sx and cause of death
  • weak/ø fem pulse
  • claudation
  • renal fx
73
Q

CoA vs pseudocoA

A

-pseudo=no P gradient, collateral formation, rib notching

74
Q

what a supplies 1st and 2nd rib

A

costocervical trunk

75
Q

thoracic outlet syndrome-how, order of spectrum, causes, mx, img

A
  • cong or acquired compression SC vess and brachial plexus passing through inlet
  • spectrum (N 95%&raquo_space;»»» SCV > SVA)

causes:

  • compression by ant scalene (MC)
  • cervical rib
  • muscular HTr
  • firous bands
  • pagets
  • tumors, etc

mx:
sx removal rib/m

img:
occlusion w/ arms up on angiogram

76
Q

paget schroetter

A
  • TOS + venous thrombus in SCV
  • athletes
  • mx: lysis + sx removal offending agent
77
Q

pulm a aneurysm

A
  • swan ganz
  • behcets
  • chronic PE
  • rasmussen
  • TOF repair gone wrong
  • Hughes-stovin syndrome
78
Q

splenic artery aneurysm-high risk rupture

A
  • liver tx
  • portal htn
  • pregnancy
  • ct do
  • alpha 1 antitrypsin def
79
Q

spelnic a aneurysm-rx

A

->2cm
pseduoanerusym
woman planning to get pregnant

80
Q

splenic a aneurysm mimic

A

-islet cell pancreatic tumor-ie: don’t bx an aneurysm

81
Q

causes splenic a aneurysm

A
  • portal htn
  • mult pregn
  • pancreatitis (false aneurysms)
82
Q

MC loc splenic a aneurysm

A

distal

83
Q

SMA aneurysm-mx, ass

A 
treat all (high rate of rupture)
-ass w/ mes ischemia
84
Q

hepatic a aneurysm-mx

A
  • syx or >2cm

- FMD, PAN-treat regardless of size.

85
Q

median arcuate lig syndrome (dunbar syndrome)

A
  • compression celiac a by medical arcuate lig
  • worse on expiration
  • 20-40 yo
  • “hooked appearance”
  • –> pancreaticoduonenal collaterals and aneurysm
  • sx
86
Q

griffith’s point

A

SMA-IMA watershed.

MC loc for ischemia

87
Q

Sudeck’s point

A

IMA-iliac watershet

-highly susceptible to ischemia

88
Q

mcc death HHT

A

-stroke, brain abscess

89
Q

problem with HHT in liver

A

-shunting –> biliary necrosis –> bile leak

90
Q

uterine avm vs RPOC

A

myometrial

91
Q

renal artery stenosis causes

A
  • athero 75%
  • FMD- 2nd MCC
  • PAN, takayasu, NF1, radiation
92
Q

next step: CTA+ or high susp FMD

A

1) angio w/ P measurements
AND
2) CTA head to toe (look for occult aneurysms)

93
Q

FMD locs

A

renal-mc

  • carotid 2nd mc
  • vertebral 3md
  • lower extrem=EIA (BL and MF)
94
Q

FMD types and classification

A
  • 3 histo types (medial mc (95%))

- classification=angiographic (focal vs MF)

95
Q

Segmental arterial mediolysis

A

abN medial layer –> aneurysms (mult, saccular, diss, occlusion). Spon’t intraabdominal hemorrhage.

  • splanchnic in elderly
  • coronaries in young
96
Q

FMD ass

A
  • spon’t dissection

- spon’t coronary artery dissection (SCAD)

97
Q

FMD mx

A

-mx but if pressure gradient: angio (no stent)

98
Q

nutcracker syndrome vs SMA syndrome

A
  • nutcracker=renal v compressed by sma

- SMA syndrome= duo compressed by SMA

99
Q

nutcracker syndrome-who, syx

A
  • health female 30s-40s

- left flank pain, hematuria, llc pain/testicular pain if gonad v involved

100
Q

splanchnic a’s

A

Celiac, SMA, IMA

101
Q

pelvic congestion syndrome

A

chronic pelvis pain via venous obstruction at left renal v (nutcracker) or income ovarian vein

  • mul dilateer parauterine v’s
  • mx: ovarian v embo
102
Q

branches of IMA

A

Left colic
Sigmoid
Superior rectal arteries

103
Q

testicular varicocele-which are bad

A
  • non decompressible

- right sided

104
Q

uterine AVM causes

A
  • cong

- acquired (D&C, abortion, mult pregs

105
Q

mx uterine AVM

A

-embo

106
Q

May Thurner

A

compression left common iliac v by right common iliac a

107
Q

popliteal aneurysm ass, main concern, bilaterality

A
  • mc peripheral arterial aneurysm (2nd to aorta)
  • BL 50-70%

ass:

  • AAA (30-50%)
  • 10% AAA have popliteal aneurysm

concern: acute limb from thromb/distal embo

108
Q

popliteal entrapment

A

symptomatic compression/occlusion popliteal a via medial head gastrocnemius (less commonly popliteus)

  • men <30 yo
  • normal pulse that decrease w/ doors/plantar flexion of foot
  • dx: medial deviation of pop a
109
Q

cystic adventitial dx

A
  • multiple mucoid-filled cysts in outer media and adventitia of popliteal a –> compr popliteal arter
  • uncommon disorder
  • young men
110
Q

who’s more likely to dev VTE: paraplegic or tetraplegic?

A

para (doesn’t make sense)

111
Q

Klippel Trenaunay Syndrome (KTS)-what, ass, dx

A

low flow (venous) AV malformations

  • port wine nevi
  • bony/soft tissue HTr (gigantism)
  • venous malform
  • ass: -peristent sciatic v
  • gi involvement/bleed 20%
  • margincal v of servelle=pathognomonic. superficial v in lateral calf and thigh. ie: great saphenous on wrong side

think of this when you see MRA/MRV of leg w/ bunch of superficial vessels (and no deep drainage)

*often linked with Parkes-weber (high flow arterial AVM)

112
Q

ABI for claudication?

A
  • 0.75-0.9=mild
    0. 5-0.75-claudication
    0. 3-0.5=severe
113
Q

ABI for rest pain?

A

<0.3

114
Q

intimal HP

A
  • recurr stenosis after revascularization

- can grow through stent (if fenestrated) or at tips (if covered)

115
Q

hypothenar hammer

A

blunt trauma to ulnar a and superficial palmar arch

  • aneurysm +/- thrombosis
  • corkscrew or pseudoaneurysm app
116
Q

takayasu types

A

-5 total, #3 MC (involving aortic arch and abd aorta

117
Q

takayasu vessel involvement

A

-aorta and branches, pulm a’s (“pruning”)

118
Q

MC primary system vasculitis?

A

Giant cell

119
Q

GCA ass

A

polymyalgia rheumatica (morning stillness in shoulders/arms)

120
Q

location strategy: central chest, mid clay, armpit

A

central=takayasu
-mid clavicle=thoracic syndrome
=armpit=gca

121
Q

cogan syndrom

A

-kid with eye and ear syx’s + aortitis

122
Q

vasculitides based on vessel size

A
  • large-takayasu, GCA, Cogan
  • medium-PAN, Kawasaki
  • small, ANCA+: granulomatosis w/ polyangiitis, churg-strauss, microscopic polyangiitis
  • small ANCA-: HSP, Behcets, Beurgers
123
Q

PAN- involved organs, app, ass

A
  • renal (90%), cardiac (70%), GI (50-70%)
  • microaneurysm (typically at branch points) –> infarction (wedge shaped)
  • hep B
124
Q

which vasculitides are MC in men?

A
  • PAN (MAN)

- beurgers

125
Q

when is a CA aneurysm ass with Kawasaki not good?

A

> 8mm (risk MI) (smaller may regress)

126
Q

clinical sequelae of kawasaki

A
  • 5 day fever
  • strawberry tongue
  • neck LAD
  • sore throat/diarrhea
  • palm/sole feet
127
Q

ways of showing henoch schonlein purpura

A

intuss

massive scrotal edema

128
Q

behcets

A

mouth/genical ulcers

aortic thickening, pulm artery aneurysm

129
Q

beugers

A

smokers

  • legs> hand, more than one limb
  • BW: “auto amputation”
130
Q

mc vasculitis in children

A

-henoch schonlein purpura

131
Q

corkscrew angiogram of hand

A

ulnar=hhs

finger=buergers

132
Q

what’s considered narrow neck in pseudo aneurysm?

A

-neck:PA <1/2

133
Q

where do superior & inferior epigastric anastomose?

A

umbilicus

134
Q

how common is the 3 vessel L aortic arch?

A

-70-80%

135
Q

most common arch variation and how common?

A

common trunk of brachiocephalic and L common carotid (21-27%)

136
Q

congenital vascular anomolies ass w/ aberrant right subclavian?

A

PDA
ACoA
VSD
carotid/vertebral anomolies

137
Q

Complications of a kommerell diverticulum?

A

dissection, rupture

138
Q

“significant carotid stenosis”

A

PSV > 230 cm/s in ICA
OR
ICA/CCA ratio > 4
*suggest 70% stenosis –> intervention required

139
Q

Aortic arch types

A

1-3 based on degree of elongation (origin brachiocephalic to cephalic portion of arch)

140
Q

HU normal bf

A

40-50

141
Q

Monckenberg calcification-what, vs atheromatous Ca

A
  • calcification within media of vessels
  • diabetes, elderly
  • no luminal narrowing
  • vs: atheromatous plaque: intermittent, nonuniform calcification of atheromatous plaques, which is associated with luminal narrowing, ischemic symptoms, and aneurysmal development.

radiology (31 decks)

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