Vascular 25 & 32 Flashcards by Hope Spriggs

What percent of patients of HYPERtension have underlying renal disease

6%, test will say hypo and that is wrong

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Renal artery stenosis should be suspected with (4)

sudden onset or worsening chronic HYPERtension, azotemia, unexplained renal insufficiency/pulmonary edema, hypertensive children

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What is azotemia

high nitrogen compounds in the blood

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What is the average kidney length

8-13cm (BE ABLE TO IDENTIFY A # WITHIN THIS RANGE)

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Renal arteries are _____ to the _____ renal vein

inferior, left (KNOW THAT IT IS INFERIOR TO THE LEFT RENAL VEIN)

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Renal arteries have ______ segmental branches ____ to the hilum

2-5, proximal

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Duplicate renal arteries often arise from

aortic wall below main renal artery

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Duplicate renal arteries usually occur on the

left side

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Medial FMD and non-atherosclerotic disease affects

mid-to -distal segment of artery (MAY SAY SOMETHING ELSE ON TEST, KNOW THIS SEGMENT)

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What produces “string of beads” appearance on ultrasound or angiogram

medial FMD (FMD ALWAYS MEANS STRING OF BEADS)

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What is the sonographic appearance of FMD

string of beads, MULTIPLE segmental concentric narrowing and dilations

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Renal arteries lie

INFERIOR TO LEFT RENAL VEIN

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Normal renal length

9-13cm

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Renal length >cm compared to contralateral kidney indeicates

compromised flow in smaller kidney

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PSV of normal renal artery

90-120 cm/s

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In normal renal artery, normal range for distal renal artery is

70-90cm/s

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Flow0Reducing Renal Artery stensosis, PSV increases significantly above

180 cm/s (MORE THAN 180, VELOCITY INCREASES)

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Characteristics of flow reducing renal artery stenosis are (3):

elevated velocity, post stenotic turbulence, dampened distal waveforms

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Dampening parvus tardus signal distally showing greater than

60% renal artery stenosis

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In renal artery occlusion, low velocity doppler signals are usually noted in the

renal medullary signals (ABSENCE OF FLOW)

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PSV ______ and length _____ consistent with CHRONIC renal artery occlusion

<10cm/s, <9cm

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Normal renal parenchymal signals demonstrate

continuous high diastolic flow

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Normal renal parenchymal is ______ of systolic velocity

40-50%

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Elevated renovascular resistance is

not a consideration (WITH 40-50% HIGH DIASTOLIC FLOW)

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Parenchymal disease results in impedance to arterial inflow, diastolic-to-systolic velocity ration ____ or resistive index ______ indicates increased ____

<0.3, >0.8, renovascular resistance/medical renal disease

Acceleration index (AI) of ____ indicates proximal flow limiting lesion

<3.78

Acceleration time (AT) of ____ indicates proximal renal artery disease

>100ms (ACCEL TIME IS WHEN FLOW STARTS TO WHEN FLOW PEAKS--HOW LONG)

Renal-Aortic ration (RAR) of ____ is consistent with ____

>3,5, >60% stenosis

In renal vein thrombosis, what is the "nutcracker syndrome"

left renal vein compressed by mesentary or SMA (COMPRESSION OF LEFT RENAL VEIN)

With renal stents, slight velocity increase is expected due to

reduction in ARTERIAL COMPLIANCE

What resistive index is predictive of unsuccessful renal revascularization

0.9

What is an RI of 0.9 predictive of? Is it useful?

unsuccessful renal revascularization, no

What should you do first to saline for it to be used

agitate

Microbubbles are (3)

nonuniform in size, relatively small, unstable (HOW WOULD YOU DESCRIBE MICROBUBBLES CAUSED BY AGITATION)

What is a patent foramen ovale (PFO) also called

intracardiac shunt (RULLIGN OUT CARDIAC SHUNT)

What size should the microbubbles be

less than 8 microns

What are microbubble shells made of

human serum albumin, lipid, phosolipid

Why is IV infusion also used

prolongedenhancement times

What is a method that can prolong enhancement times

IV infusion

To be clinically effective, tissue-specific agents must

affinity for target tissues, ability to alter tissue appearance

What changes the signal impedance of normal or abnormal tissues

tissue specific agents

Thrombus-specific agents (2):

attach to fibrin, enhance thrombus detection

What type of agent helps with thrombus detection

tissue specific

Ability to enhance the lysis of thrombus using targeting ultrasound contrast agents and ultrasound energy

sonothrombolysis (KNOW THIS DEFINITION)

Harmonic imaging is ____ and also called ____

twice the transmit frequency (second harmonic)

Harmonics is sending out ___ and receiving ____

1,2

Harmonic imaging have a ____ signal-to-noise ration

higher

What will improve with harmonics

better signal/resolution

What is a contrast-specific equipment modification

low mechanical index (MI)

What minimizes destruction of microbubbles

low MI

Top two uses for contrast are

echocardiography, liver evaluation

Contrast agents can be used to differentiate ____ from _____

stenosis, occlusion

Contrast agents increase visualization of

iliac arteries with bowel gas

How does contrast aid in peripheral arteries

poor visualization of deeply located or small vessels, low veloctiy flow, low volume blood flow

Contrast agents can be used to increase the diagnostic accuracy in identifying thrombus at what percent

26%

Evaluation of carotid artery vasa vasorum and plaque neovascularity may prove to be useful to identify _____ and determine _____

vulnerable plaques, risk of cardiovascular events

Hepatic applications can be used to

enhance detection and characterization of hepatic masses, assess flow through transjugular intrahepatic portosystemic shunt (TIPS)

Hepatic applications improve detection of ____ both in ____ and those with ____

intra and extrahepatic blood flow, normal subjects, portal hypertension

In renal artery stenosis, evaluation of main renal and intrarenal vesses limited by what anatomical variants

duplicate or accessory renal arteries

Contrast agents are useful in exams and have

reduced exam times

For organ transplants, contrast agents improve assessment of blood flow leading to the transplant as well as within

the parenchyma of the transplanted organ

Contrast agents improves ability to detect what in native and transplant organs

ischemic regions

Contrast has the ability to _____ in real time using CES improves _____ and ______

assess blood flow, detection, characteristics of endoleaks

Contrast has the ability to _____ in real time using CES improves _____ and ______

assess blood flow, detection, characteristics of endoleaks

Peripheral arterial applications (3):

differentiate stenosis from occlusion, increase visualization of iliac arteries with bowel gas, degree of arterial collateralization