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ABD 313 > Vascular Diseases > Flashcards

Vascular Diseases Flashcards

1
Q

What is Morbidity Rate?

A

The frequency with which a disease appears in a population.

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2
Q

What is Mortality Rate?

A

Death rate to a specific cause.

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3
Q

What is Mural?

A

Relates to the wall of any cavity.

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4
Q

What are emboli/embolus?

A

A blockage causing material that moves within a vessel (can be clot/fat/air).

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5
Q

What are thrombi/thrombus?

A

A blood clot inside a vessel.

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6
Q

What is a true aneurysm?

A

A true aneurysm is a bulging in a vessel that involves all three layers of the vessel being weakened and dilated.

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7
Q

What is a false aneurysm?

A

A pseudoaneurysm is when a tear in the vessel wall allows blood to pool between the layers.

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8
Q

What is a stenosis?

A

The abnormal narrowing of a blood vessel.

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9
Q

How does the flow pattern of the aorta change?

A

Proximal (above renals) = Moderate/Low waveform

Distal (below renals) = High resistance waveform

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10
Q

What is the flow pattern of the renal arteries?

A

Low resistance

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11
Q

How does the flow pattern of the SMA change?

A

Pre-pandial = high res

Post-prandial = low res

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12
Q

What does hepatofugal mean?

A

Away from the liver

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13
Q

What does hepatopedal mean?

A

Towards the liver

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14
Q

What is normal portal venous flow?

A
  • Hepatopedal

- Monophasic with slight undulations

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15
Q

What is the normal flow of the hepatic veins and IVC?

A
  • Phasic

- “sawtooth”

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16
Q

What is the normal measurement of the Aorta?

A

2-2.5 cm

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17
Q

What is the normal measurement of the distal aorta?

A

1.5 cm

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18
Q

When is an aorta considered aneurysmal?

A

AP of 3cm or greater

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19
Q

What is the usual size of the IVC?

A

Less than 25 mm

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20
Q

When is the IVC considered dilated?

A

3.7cm

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21
Q

How does respiration affect the size of the IVC?

A

Initial inspiration = decreases

Suspended respiration = IVC increases

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22
Q

What are the indications for an arterial assessment?

A
  1. Pulsatile abdominal mass
  2. Abdominal pain
  3. Abdominal bruit
  4. Hemodynamic compromise of the lower limbs
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23
Q

What is a bruit?

A

The abnormal sound generated by turbulent flow of blood in an artery.

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24
Q

What is Arteriosclerosis?

A

Hardening of the arteries

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25
Q

What is Atheroma?

A

Lipid deposit in the arterial intima

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26
Q

What is Atherosclerosis?

A

A form of Arteriosclerosis effecting large and medium arteries where the artery is narrowed due to plaque build up.

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27
Q

What is plaque?

A

Platelets forming a cap over a fat deposit

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28
Q

What is another name for Atherosclerosis?

A

Atheromatous Disease

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29
Q

What is atheromatous disease?

A

Lipid deposits on the intimal lining of any artery alter the lining and provoke fibrosis and calcification.

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30
Q

What is atheromatous disease associated with?

A

Hypertension, smoking and diabetes.

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31
Q

What increases the incidence of atheromatous disease?

A

Age

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32
Q

Who does atheromatous disease more commonly effect?

A

Males

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33
Q

How does atheromatous disease appear on US? (4)

A
  • Irregular walls
  • Tortuous vessel
  • Calcifications
  • Narrowed lumen
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34
Q

What arteries can aneurysms affect?

A

Any artery

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35
Q

What is AAA?

A

Abdominal Aortic Aneurysm

A weakening of the aortic wall that leads to focal dilation.

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36
Q

What is ectasia?

A

A slight widening of the aorta up to 3 cm.

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37
Q

Where do AAA most commonly occur?

A

Below the level of the renals

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38
Q

When is an AAA more difficult to treat?

A

When is occurs above the renal vessels

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39
Q

What is the main cause of AAA?

A

Atherosclerosis

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40
Q

What are some other causes of AAA?

A
  • Syphilis
  • Systemic infections
  • Cystic medial necrosis
  • Other diseases (Marfan’s)
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41
Q

What is marfan’s disease?

A

Genetic disorder of connective tissue

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42
Q

What are the risk factors of AAA? (5)

A
  • Men over 60
  • Hypertension
  • 1st degree family history
  • Hypercholesterolemia
  • Smoking
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43
Q

What is Hypercholesterolemia?

A

High cholesterol

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44
Q

What are the signs/symptoms of AAA? (5)

A

Generally asymptomatic but:

  • Palpable mass
  • Low back pain
  • Abd pain
  • Leg pain
  • Incidental find on x-ray
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45
Q

What are the types of AAA?

A
  1. Fusiform - uniform dilation

2. Saccular - Protrusion on one side

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46
Q

What is saccular AAA usually due to?

A

Trauma or infection

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47
Q

What is the most common type of AAA?

A

Fusiform

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48
Q

What is the typical location of thrombus in AAA?

A

Anterior and left

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49
Q

What are the US features of AAA?

A
  1. 3 cm or greater
  2. Wall irregularities
  3. Thrombus
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50
Q

What is thrombus?

A

Clot attached to the vessel wall seen on US as medium to low level echoes.

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51
Q

What is thrombus caused by?

A

Slowing of the blood stream, injury to the vessel and alterations to the blood constituents.

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52
Q

How do platelets affect clotting?

A

More platelets = more clotting

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53
Q

Why is thrombus concerning?

A

Poorly attached thrombus can result in the release of emboli.

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54
Q

What are common associated findings of AAA?

A
  1. Bilateral iliac artery aneurysms of 2 cm or greater

2. Popliteal aneurysms greater than 1 cm

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55
Q

How often are popliteal aneurysms seen in conjunction with AAA?

A

25% of cases

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56
Q

What is the average rate of growth for AAA?

A

2-5 mm per year

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57
Q

What is important to do when imaging AAA? (7)

A
  1. Outer to outer wall meas
  2. Meas perpendicular to vessel
  3. 3 planes
  4. Note shape (sac vs fus)
  5. Image renals and iliacs
  6. Describe wall thickening/thrombus
  7. Document flow pattern
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58
Q

What is the follow-up/treatment on a 3-5cm aneurysm?

A

If it is increasing 2-5mm/year then serial US exams

If it is increasing 10 mm/year then surgery aortic graft

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59
Q

What is the follow-up/treatment on a 5-6 cm aneurysm?

A

Surgery with good prognosis

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60
Q

When is surgery considered imperative on a AAA?

A

6cm

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61
Q

What is the follow-up/treatment on a AAA greater than 7cm in size?

A

Surgery-aortic graft asap

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62
Q

What is the prognosis of a AAA greater than 7 cm with no surgery?

A

75% fatal rupture

25% will survive one year

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63
Q

What are the complications of AAA? (4)

A
  • Stenosis/occlusion (distal)
  • Rupture
  • Dissection
  • Thrombosis (distal)
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64
Q

What is aortic dissection?

A

When the aortic intima (and sometimes media) tears allowing blood to surge through the layers creating a false lumen.

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65
Q

What is the mortality rate of an AAA rupture?

A

Greater than 50 % (will die)

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66
Q

What is the operative mortality rate of a AAA rupture?

A

Greater than 40-60% (will die)

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67
Q

What are the signs/symptoms of a AAA rupture? (3)

A
  1. Pain
  2. Shock
  3. Expanding abdominal mass
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68
Q

What is the sonographic appearance of AAA?

A
  • Free fluid in abdomen
  • Complex fluid
  • Compression/displacement of surrounding structures
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69
Q

What are the options of AAA repair?

A
  1. Traditional graft

2. Endovascular aortic stent

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70
Q

What is a traditional graft?

A

A way to repair the aorta by using a surgical bypass graft using a flexible synthetic material.

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71
Q

What materials are bypass grafts made out of?

A

Teflon or Dacron

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72
Q

What is an endovascular stent?

A

A less invasive way to repair a AAA by inserting a stent and ballooning it out.

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73
Q

How will a repaired AAA appear on US? (5)

A
  1. Ribbed appearance
  2. Straight distinct borders
  3. Increased echoes
  4. Difficult to visualize after 8 years
  5. Small layer of fluid post-op (normal)
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74
Q

What are common complications of AAA repair? (5)

A
  1. Fluid collections
  2. Hematomas, seromas
  3. Abscesses
  4. Pseudoaneurysms
  5. Stenosis
75
Q

What complication of AAA repair occurs with endovascular repairs only?

A

Endo-leaks

76
Q

What arteries do splanchnic artery aneurysms affect?

A

Celiac(splenic, hepatic, gastric), SMA, IMA

77
Q

What is another name for splachnic artery aneurysms?

A

Mesenteric aneurysms

78
Q

What is the most common artery effected by splanchnic artery aneurysms?

A

Splenic artery

79
Q

What artery is second most commonly effected by splanchnic artery aneurysms?

A

Hepatic

80
Q

What artery is least commonly effected by splanchnic artery aneurysms?

A

SMA

81
Q

What are the underlying causes of splanchnic artery aneurysms? (4)

A
  • Congenital
  • Atherosclerosis
  • Mycotic
  • Inflammatory
82
Q

What is mycotic?

A

An bacterial infection of the arterial wall.

83
Q

How common is splanchnic artery aneurysms?

A

Rare but life threatening

84
Q

What is the US appearance of splanchnic artery aneurysms?

A

Anechoic or complex area continuous with the vessel that has a doppler signal

85
Q

Where are renal artery aneurysms located?

A

Extra-renal

86
Q

What are common underlying causes of renal artery aneurysms?

A

Atherosclerosis and polyarteritis

87
Q

What are the signs/symptoms of renal artery aneurysms? (3)

A
  • Palpable mass
  • Hypertension
  • Hematuria
88
Q

What is the US appearance of a renal artery aneurysm?

A

An anechoic mass connected to artery with a doppler signal

89
Q

How do iliac artery aneurysms typically present?

A
  • Asymptomatic
  • Bilateral
  • In older men
90
Q

What are iliac artery aneurysms assoicated with?

A

AAA and popliteal artery aneurysms

91
Q

Why are iliac artery aneurysms concerning?

A

They can rupture

92
Q

What can iliac aneurysms cause?

A

Hydronephrosis due to the compression of ureters

93
Q

What are mycotic aneurysms?

A

Rare aneurysms that are due to bacterial or fungal infections.

94
Q

How do most mycotic aneurysms appear?

A

Saccular with asymmetric wall thickening

95
Q

What are inflammatory aneurysms?

A

Uncommon aneurysms involving the retroperitoneum that have a dense fibrotic reaction around the aneurysm.

96
Q

What is retroperitoneal fibrosis?

A

A fibrotic reaction in the peritoneum but does NOT relate to an aneurysm.

97
Q

What are inflammatory aneurysms adherent to?

A

Bowel, ureter, iliac veins and IVC.

98
Q

What is the US appearance of inflammatory aneurysms?

A
  • Dilated aorta
  • Thick wall
  • Hypoechoic mantle around aorta
99
Q

What is aortic dissection frequently related to?

A

Hypertension

100
Q

Where does aortic dissection begin?

A

Thorax

101
Q

What is the symptom of aortic dissection?

A

Chest pain

102
Q

What are the 3 types of aortic dissection?

A
  1. Involving the arch and moving down the aorta
  2. Marfan’s - involving ascending aorta only
  3. Involving the descending aorta after the subclavian
103
Q

What is the most common aortic dissection?

A

Involving the descending aorta after the subclavian.

104
Q

What is the US appearance of aortic dissection?

A

Thin, linear echogenicity within the arterial lumen that has a flap that moves with the cardiac cycle.

105
Q

How can you determine aortic dissection with doppler?

A

Demonstrate blood flow on both sides of flap.

106
Q

What are the causes of a pseudoaneurysm?

A
  1. Failed graft, post angiogram

2. Trauma

107
Q

What is the appearance of a pseudoaneurysm on US? (4)

A
  • Round/oval protuberance
  • Blood circulates through in systole
  • Pulsatile entry jet
  • Variable waveform
108
Q

What is important to identify on a pseudoaneurysm?

A

The neck of the mass

109
Q

What is the treatment of a pseudoaneurysm?

A
  1. US guided compression

2. US guided thrombin injection

110
Q

What is an AV fistula?

A

An arteriovenous fistula is an abnormal communication between an artery and a vein where the blood moves from high to low pressure.

111
Q

What are the causes of AV fistulas?

A
  1. Trauma

2. Complication of AAA

112
Q

What is the clinical presentation of AV fistulas? (5)

A
  1. Low back pain
  2. Abd pain
  3. Hemodynamics altered
  4. Swelling of lower trunk and extremities
  5. Dilated veins
113
Q

What is the US appearance of AV fistulas? (4)

A
  1. Markedly dilated IVC
  2. Pulsatile IVC
  3. Irregular waveform
  4. Reduced distal arterial flow
114
Q

What is vascular atherosclerosis caused by?

A

Atherosclerotic plaque

115
Q

What is the US appearance of vascular stenosis? (4)

A
  • Narrowed lumen
  • Post-stenotic dilation
  • Increased velocities at stenosis
  • Downstream changes
116
Q

What is renal artery stenosis associated with?

A

Uncontrollable hypertension

117
Q

What does renal artery stenosis cause?

A
  • Decreased glomerular filtration rate

- Ischemic renal damage

118
Q

Where are renal artery stenosis’s commonly found?

A

Origin from the aorta or within the first 2 cm

119
Q

When assessing the IVC what 4 things do we look for?

A
  1. Patency
  2. Compressibility
  3. Echo-free lumen
  4. Changes with respiration
120
Q

What is IVC dilation associated with?

A

Right ventricle failure

121
Q

What are the signs/symptoms of IVC dilation?

A
  1. Abd pain
  2. Ascites
  3. Hepatomegaly
  4. Lower extremity edema
122
Q

What are the types of IVC tumours?

A

They can be primary, metastatic or extensions.

123
Q

What conditions indicate an IVC tumour?

A

Leg edema, ascites, abd pain

124
Q

What are primary IVC tumors?

A

Uncommon tumors, leiomyoma or leiomyosarcoma

125
Q

What does leio mean?

A

“Smooth” (muscle)

126
Q

Where do IVC tumors most commonly metastasize from?

A

RCC

127
Q

What is the sonographic appearance of IVC tumours? (4)

A
  1. Intraluminal echogenic foci
  2. Isoechoic or heterogenous
  3. IVC dilated
  4. Loss of respiratory changes
128
Q

What is the most common abnormality of the IVC?

A

IVC thrombosis

129
Q

How does IVC thrombosis occur?

A

Spreads from another vein

130
Q

Why is IVC thrombosis concerning?

A

It’s life threatening

131
Q

What are the signs/symptoms of IVC thrombosis?

A

Same as IVC dilation but also GI complaints

132
Q

What is the treatment of IVC thrombosis?

A

IVC filter

133
Q

What is renal vein thrombosis a serious complication of?

A

Dehydrated or septic infant

134
Q

What does renal vein thrombosis occur as a result of in adults? (4)

A
  • Shock
  • Renal tumour
  • Renal transplants
  • Trauma
135
Q

What is renal vein thrombosis associated with?

A

Diabetes and high blood pressure

136
Q

What are the signs of renal vein thrombosis?

A
  • Flank pain/mass
  • Hematuria
  • Proteinuria
137
Q

What is the sonographic appearance of renal vein thrombosis? (4)

A
  • Enlarged kidney, hypoechoic
  • Dilated renal vein
  • Filling defects of variable echogenicity
  • Decreased or absent venous signal
138
Q

Where do the congenital abnormalities of the IVC occur?

A

At or below the renals

139
Q

What are the most frequent congenital abnormalities of the IVC?

A

Duplication and transposition

140
Q

What are the 3 congenital abnormalities of the IVC?

A
  1. Transposition
  2. Duplication
  3. Azygous Continuation
141
Q

When does azygous continuous occur?

A

When the hepatic segment if the IVC fails to develop

142
Q

What is transposition of the IVC?

A

The IVC is located on the left side until the level of left renal vein where it crosses anteriorly to join with a normal pre-hepatic IVC.

143
Q

What is duplication of the IVC?

A

IVC is normal on the right side but is also duplicated on the left side below the left renal vein.

144
Q

What is azygous continuation of the IVC?

A

The absence of the hepatic IVC causing the hepatic veins to join and empty into the right atrium directly.

145
Q

What is hepatic congestion?

A

Passive edema of the liver secondary to vascular congestion.

146
Q

What is hepatic congestion related to?

A

Impairing blood flow to the right heart causing heart failure.

147
Q

What is the US appearance of acute hepatic congestion? (4)

A
  • Enlarged liver
  • IVC dilated/no respiratory changes
  • Hepatic veins highly pulsatile with flow reversal
  • Portal vein flow is pulsatile
148
Q

What is the US appearance of chronic hepatic congestion? (3)

A
  • Shrunken liver
  • Ditented hepatic veins
  • LFT’s altered
149
Q

What is portal hypertension due to?

A

Increased portal venous pressures

150
Q

What are the two types of portal hypertension and what are they based on?

A
  1. Presinusoidal
  2. Intrahepatic

Based on whether hepatic vein pressure is normal or elevated

151
Q

What are the two types of pre-sinusoidal portal hypertension?

A
  1. Extrahepatic

2. Intrahepatic

152
Q

What is extra-hepatic presinusoidal portal hypertension marked by?

A

Portal vein and splenic vein thrombosis

153
Q

What is extra-hepatic presinusoidal portal hypertension caused by? (5)

A
  • Malignancy
  • Infection/inflammation
  • Trauma
  • Splenectomy
  • Hypercoagulable states
154
Q

What does extra-hepatic presinusoidal portal hypertension result in? (3)

A
  • ascites
  • splenomegaly
  • varices
155
Q

What is intra-hepatic presinusoidal portal hypertension caused by?

A

Diseased affecting the portal zones:

  1. Schistosomiasis
  2. Primary biliary cirrhosis
156
Q

What is the most common cause of intrahepatic portal hypertension in the western world?

A

Cirrhosis

157
Q

What is cirrhosis?

A

When normal liver parenchyma is replaced which leads to increased resistance to PV flow and obstruction of HV outflow.

158
Q

What does intrahepatic portal hypertension lead to?

A
  • Ascites
  • Splenomegaly
  • Collaterals
159
Q

What is the US appearance of portal hyper tension? (6)

A
  • Dilated portal veins
  • Collateral flow
  • Patent umbilical/coronary vein
  • Ascites
  • Splenomegaly
  • Changes in portal flow from monophasic to biphasic to hepatofugal
160
Q

What is the upper limit of normal for the main portal vein diameter?

A

13 mm

161
Q

What are the 5 most common collateral routes?

A
  1. Gastroesophageal (fatal hemorrhage)
  2. Paraumbilical
  3. Splenorenal/gastrorenal
  4. Intestinal
  5. Hemorrhoidal
162
Q

What is a portal vein thrombosis?

A

Clot in the portal venous system

163
Q

What are the causes of portal vein thrombosis? (4)

A
  • Malignancy
  • Infection/inflammation
  • Trauma
  • Splenectomy
164
Q

Why is colour doppler important in imaging portal vein thrombosis?

A
  1. Can tell between benign and malignant thrombi (malignant will have flow)
  2. Acute thrombus may be anechoic and get overlooked
165
Q

What can portal vein thrombosis result in?

A

Cavernous transformation

166
Q

What is cavernous transformation?

A

The formation of venous channels around a thrombosed portal vein

167
Q

What is Budd-Chiari Syndrome?

A

A rare syndrome where the hepatic veins are obstructed with possible IVC occlusion

168
Q

What are the causes of Budd-Chiari syndrome?

A
  • Coagulation/congenital abnormalities
  • Trauma
  • Oral contraceptives
  • Tumor invasion
169
Q

What type of tumour invasion may cause Budd-Chiari Syndrome?

A

Hepatocellular carcinoma

170
Q

What is the sonographic appearance of Budd-Chiari? (5)

A

Depends on stage

  • Enlarged liver (acute)
  • Poor visualization of the hepatic veins
  • Possible thrombus in the IVC
  • Caudate lobe enlarged/hypoechoic
  • Hepatic vein flow absent or reversed
171
Q

What are the signs/symptoms of Budd Chiari? (3)

A
  • RUQ pain
  • Hepatomegaly
  • Occasionally splenomegaly
172
Q

What is the treatment of portal hypertension?

A

Portosystemic shunts

173
Q

What are portosystemic shunts?

A

Shunts used to shunt blood from congested venous system to a sytemic vein in order to decompress the PV system

174
Q

How can portosystemic shunts be placed?

A

Surgically or percutaneously (through skin).

175
Q

What is TIPS?

A

Transjugular Intrahepatic Portosystemic Shunt = shunt inserted percutaneously via jugular vein to hepatic vein to portal vein

176
Q

What is an infarction?

A

Sudden interruption of blood supply that may lead to necrosis

177
Q

What is a splenic infarct?

A

Loss of flow to spleen due to occluision of the splenic artery

178
Q

What does splenic infarct cause?

A

Focal splenic lesion

179
Q

What is the underlying cause of the occlusion that causes splenic infarct?

A

Variety

One may be sickle cell anemia

180
Q

What is a sign of splenic infarct?

A

Sudden onset of LUQ pain

181
Q

What is sickle cell anemia?

A

Red blood cells have abnormal sickle shape that cause them to break down easy and do not allow them to carry proper amount of O2 (causing clots).

182
Q

What is the sonographic appearance of splenic infarct?

A

Hypoechoic wedge shaped/round area that becomes more hyperechoic over time

183
Q

How can renal infarct vary?

A
  • It can be segmental or diffuse

- Appearance depends on time: Early = hypo, resolving = echogenic

184
Q

How does renal infarct affect renal function?

A

Often remains normal

ABD 313 (11 decks)

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