Vascular Flashcards
Where does the abdominal aorta begin?
The diaphragm
What are the vessel layers?
Tunica Intima, tunica media, tunica adventitia
What are the branches of the Celiac axis?
Which is not seen in ultrasound?
Hepatic artery, left gastric artery, splenic artery.
Left gastric is not seen on ultrasound.
Banana peel sign refers to…
Renal arteries.
What are the branches of the abdominal aorta?
Celiac axis, SMA, rt & lt renal arteries, IMA, bifurcation rt & lt common iliac arteries.
Right renal artery courses
Posterior to IVC
What is atherosclerosis?
What are risk factors?
What could it cause?
How does it appear on ultrasound?
Alteration of vessel wall due to lipid deposits.
Smoking, HTN, diabetes, hyperlipidemia
May cause aneurysm
Vessel looks tortuous and may have Ca+
What is ectasia?
Vessel dilation (aorta >3cm)
What is an aneurysm?
What are clinical findings of an aneurysm?
What are the types of aneurysms?
Which type is the most common?
What is the most common location?
What is the most common cause of aneurysm?
What are the risk factors?
When are elective repairs performed?
Focal vessel enlargement,
pulsatile abdominal mass, may have bruit
Dumbell, bulbous, saccular, fusiform
Fusiform (has uniform dilation)
Inferior to the renal arteries
Atherosclerosis
Tobacco use, HTN, vasc disease, COPD, male, > 60 yrs, family hx
Aneurysms > 5.5cm
A true aneurysm involves all 3 layers of aorta.
A false aneurysm is a pseudoaneurysm, mc in groin from catheters inserted through common femoral artery during arteriographic procedures.
What are AAA rupture symptoms/findings?
What is the mortality rate with surgery on a ruptured aneurysm?
What happens if the AAA is 6-7cm?
US findings
Back pain, hypotension, falling hematocrit.
50%.
Rupture rate dramatically increases.
Aneurysm w. free fluid
What is dissection?
Tear in the intimal lining of the arterial wall.
What is the Standard and DeBakey classifications of dissection?
In what part of the aorta increases mortality rate with dissection?
Causes
Symptoms
US findings
Standard:
A-ascending aorta
B-not asc aorta
DeBakey:
I-entire aorta
II-asc aorta
III-desc aorta
Asc aorta inc mortality rate
Male, 40-60 yrs, HTN, pregnancy, aortic valve disease, CHD, Cushing’s syndrome, trauma, Marfan syndrome
Pain, n/v, paralysis, blind, coma, confusion, absent extremity pulse
Linear flap with motion. Acute or chronic (has clot in false lumen)
What is an aortic graft?
Used to repair an aneurysm. A guided wire inserted through femoral artery up to aorta.
IVC
Expands with inspiration. < 2 cm, terminates at rt atrium
Left renal vein courses
Anterior to aorta and posterior to SMA
Portal splenic confluence contains
Splenic vein, SMV, main portal vein
Mickey Mouse sign / Portal Triad
CBD (rt ear), MPV (face), HA (lt ear)
What is Budd Chiari syndrome?
Thrombosis of hepatic veins or IVC
What is portal vein HTN?
What are causes?
Signs/symptoms
US findings
Increase in portal venous pressure
Cirrhosis, hepatitis, ETOH abuse, PV thrombus, Budd Chiari, schistosomiasis
Ascites, gi bleed, dec renal function, dec coagulation
Portal vein diam >13mm, hepatofugal flow, patent umbilical vein, collaterals, ascites, splenomegaly, sm nodular liver
Portal vein thrombosis
Clot in PV, dec blood flow, low level echoes in PV
Echogenic material within lumen, inc PV diam, portosystemic collateral circulation, cavernous transformation
Filter placed in IVC to catch thrombosis before reaching the heart
Hepatic veins
Right, middle, left
Pulsatile
Arteries vs Veins
Arteries carry blood away from the heart. Arteries are pulsatile.
Veins carry blood to the heart. Veins expand with inspiration. Veins have a larger diameter. Veins have valves.
What is vasa vasorum
Tiny arteries & veins that supply vessel wall
Sections of Aorta
Root (3 cusp prevents back flow to heart), asc aorta, aortic arch (brachiocephalic, lt common carotid, lt subclavian), desc aorta, abdominal aorta (celiac trunk, SMA, renals, IMA)
Size of aorta, level of iliac bif, iliac size.
Men 23 mm, women 19 mm
Bifurcates L4. Iliac diam < 1.2 cm
What is mesenteric insufficiency?
Risk
Symptoms
US findings
Lack of blood flow to GI tract. Must ID 2 stenosis in either celiac, SMA, IMA, hep art.
Smoking, HTN, coronary artery disease, renal insufficiency, diabetes
Post prandial pain. Wt loss, epigastric bruit, n/v/d
High resistant blood flow after eating. Stenosis in 2 vessels.
What is a major branch of the common hepatic artery?
Gastroduodenal artery
What vessel passed anterior to the uncinate process of the pancreas?
SMV
What artery changes from high to low resistant when a patient eats?
SMA
IVC and hepatic vein enlargement wth a normal liver is due to
Right sides heart failure
Name causes of prehepatic, intrahepatic, and posthepatic portal HTN
Pre: PV thrombus
Intra: cirrhosis, schistosomiasis
Post: Budd Chiari syndrome
Renal vein thrombus
Renal Tumors, renal allografts, trauma, nephrotic syndrome, ivc or renal vein extrinsic compression
Dilated thrombosed renal vein, absent venous flow in kidney, enlg hypo kidney, high resistant renal artery
RI =
(S-D) / S
Arteriovenous fistula
Abnormal connection between artery and vein.
Artery will show low resistance and inc diastoli
Vein shows inc velocity, pulsatility, spectral broadening due to turbulence
Placed in IVC to prevent thrombus from lower extremities from entering lungs.
IVC filter
US can look at filter location, detect thrombus in filter, IVC perforation with a concurrent hematoma
Diaphragm crus is ___ to the aorta
Anterior
Diaphragm crus is ____ to the celiac axis
Superior
Diaphragm crus is ___ to the IVC
Posterior
Diaphragm crus is ___ to the adrenal glands
Medial and posterior
Left gonadal vein drains gonads into
Left renal vein then IVC
Rt gonadal vein drains into
IVC
What is the nutcracker syndrome
Obstruction of the left renal vein between the SMA and the aorta.
Dilated parenchymal side of lt renal vein when compared to the caval side. This documents extrinsic compression of left renal vein.
Describe main lobar fissure
Imaginary line between gb fossa and IVC. Separates rt and lt lobe. Middle hepatic vein is a landmark.
Pseudoaneurysm / false aneurysm
Trauma, walled off blood, MC in groin, from catheters
Renal artery stenosis
Kidney < 9cm
Peak velocity > 100 cm/sec
Renal artery to aorta ratio > 3.5
Tardus Parvus wave of segmental renal artery
IVC
Rt & Lt suprarenal Rt & Lt renal Rt & Lt gonadal Inferior phrenic Hepatic veins Common iliac veins
Aorta
Celiac axis Superior mesenteric artery Inferior mesenteric artery Inferior phrenic artery Suprarenal branch of inferior phrenic artery Suprarenal branch of aorta Suprarenal branch of renal artery Left renal artery Gonadal artery Common iliac artery
Portal venous gas indicates
Bowel infarct in ulcerative colitis or necrotizing enterocolitis
Portal venous gas is seen within liver. Biliary gas is closer to the hilum.
Lymphadenopathy “Mantel Sign”
Layered appearance over & around abd vessels
