Vascular Final Flashcards
What are the warning signs of a stroke?
Aphasia Dysphasia Dysphagia Dysarthria Tingling and numbness Vertigo Transient blindness Pg33
A difference of 20 mmHg might indicate disease in what vessel?
Subclavian Steal
What type of waveform is seen in the ECA?
High resistive
pg. 47 4th ed.
What type of waveform is seen in the ICA?
Low resistive
pg. 47 4th ed.
What are the findings we would see with an ICA occlusion?
-No Doppler flow
-ECA and CCA will have similar waveforms
pg. 60 4th ed.
Also, possible increased velocity in the ipsilateral ICA
What is a TIA?
Stroke symptoms lasting less than 24 hours
What is the criteria of an 80% diameter reduction (velocity)?
Increased velocity?
A normal vertebral artery should be?
They are often different sizes, bilaterally, and flow velocities may be asymmetrical.
One vertebral artery is often dominant in terms of flow and velocity
p91
Where should the Doppler sample volume be placed in reference to the vessel?
parallel in middle of vessel
What portion of the carotid vessel will be affected with FMD?
FMD is found in the renal arteries and in the internal carotid arteries and occurs predominantly in women.
p 63
The distal ICA should be carefully evaluated with spectral and color Doppler to detect FMD
p 64
How many strokes occur each year in USA?
795,000. (google)
The Innominate artery divides into what arteries?
RT CCA
RT Subclavian A
pg. 35 4th ed.
The Doppler sample volume should be at what?
2 mm
per Beth 10/4/16
Small
If there is an abnormal Doppler waveform in the ICA, where would that suggest disease at?
A high resistance ICA waveform may also occur with stenosis in the distal ICA. However, condition usually coexists with extensive disease in the proximal ICA. pg 65 4th ed
proximal or distal ICA occlusion/disease
Carotid Test
If there is an occlusion of the ICA, the ipsilateral ICA velocities might be what?
If one side is occluded the other side (the contralateral) the velocity will increase. pg 80 4th edt.
What portions of ICA should we Doppler?
Prox/Mid/Distal
When determining the ICA/CCA ratios, what section of the CCA is used for the ratio?
mid/dist
per Beth - 10/4/16
dist
What is characteristic of a subclavian steal?
retrograde flow in the vertebral
per Beth - 10/4/16
Is an ICA systolic velocity less than 125 cm/sec normal or abnormal?
Normal (no stenosis)
pg. 73
a stenosis less than 50% diameter reduction
carotid test
Intraoperative carotid Dopplers can identify what? What do we see in the waveforms?
What is Amaurosis Fugax?
Temporary, partial, or total blindness often resulting from transient occlusion of the retinal arteries
The carotid body assists in regulating what?
It assists in heart rate, blood pressure, and respiration
Hagen-Ansert volume 2 pg. 875
Except balance
Which branch of ECA do we see most?
Superior thyroid artery
pg. 36 4th ed.
Noise caused by tissue vibration from turbulent flow is?
Bruit
Beth - 9/27/16
While color duplex imaging there may be an area where the color doesn’t fill in the vessel, what might this be from?
boundary layer separation
per Beth 10/4/16
Blood pressure cuffs should be what percentage greater than the limb?
20%
What are the characteristics of normal Doppler signal?
A normal PVR waveform contains what?
A sharp upslope and a prominent reflected wave, also called a dicrotic notch, in late systole and early diastole
What plane should you image arteries?
Sagittal
What angle should be used for a Doppler study?
45-60 degrees
How long does it usually take to compress a pseudo aneurysm?
30-60 min
What structure may cause a palpable thrill?
turbulence
(google)
pg. 183 Palpation of Pulses section
“3+ = very strong or aneurysmal pulse (this is when you can observe your hand moving up and down with each pulsation)”
What imaging characteristics demonstrate significant narrowing
Spectral Doppler waveform
Know how to calculate ABIs (pressures will be given)
Divide the ankle pressure from the highest of the brachial pressures.
> 1.35 = probable calcified arteries
0.90 - 1.35 = normal
< 0.90 = abnormal, stress test appropriate
< 0.8 = probable claudication
< 0.5 = multi-level disease or long segment occlusion
< 0.3 = ischemic rest pain - severe disease
What do patients describe claudication as?
pain and discomfort while walking
Profunda lies where in reference to femoral artery?
Profunda is posterior and lateral to the femoral artery
What are the branches off the popliteal artery?
Anterior Tibials
Posterior Tibials
What is the anatomy of the aortic arch?
*Second main branch
First branch: the innominate/brachiocephalic artery branches off into the RT subclavian artery as well as the RT CCA.
Second branch: left common carotid artery
Third branch: LT subclavian artery
Do segmental pressures of lower extremity usually over or underestimate disease?
Underestimate disease
For what reason do PVR’s usually have greater amplitudes in the calf than the thigh?
cuff artifact
If you exercise patient and they return to baseline after 5 minutes, what kind of occlusive disease might be present?
single segment occlusive disease
Ankle systolic pressure of less than ___mmHg will not heal with ischemic skin lesions in a non-diabetic?
55 mmHg
What veins are difficult to compress in duplex scan?
Brachiocephalic
Subclavian
Prox axillary
pg. 151 4th ed.
The left renal vein is usually compressed by what structure? (hint: an artery)
left iliac ven
Possibly compressed by the Aorta when it’s in a variant position.
Normally the LT renal vein is anterior to the AO, a variant is posterior, causing compression of the LT renal vein.
left iliac vein is usually compressed by the right iliac artery
What is Virchow’s Triad?
Venous thrombosis occurs when 3 conditions existed
- Circulatory stasis
- Vein wall (intimal) injury
- Hypercoagulability state
pg. 111 4th ed.
What is the longest vein in the body?
Greater saphenous
Is the normal flow of perforating veins deep to superficial or superficial to deep?
Superficial to deep
What are normal venous Doppler signal characteristics?
–
What is the most important criteria when doing venous study?
The response of the vein when transducer pressure is applied
With an incompetent venous segment, what might you see with spectral analysis?
Reflux…? Which is defined as abnormal retrograde/reverse flow post-valsalva/augmentation
Deep veins of the Upper Extremity
Superior Vena Cava Innominate Internal jugular Subclavian Axillary Brachial Radial Ulnar Interosseous
pg. 149 4th ed.
Deep Veins of the Lower Extremity
IVC CIV IIV EIV CFV FV PROFUNDA POPLITEAL ATV PTV PERONEALS
pg. 97-98 4th ed.
Superficial veins of the upper extremity
Cephalic
Basilic
Median cubital
pg. 149 4th ed.
Superficial veins of the lower extremity
GSV
LESSER OR SMALL SAPH V
Pg. 98-99 4th ed.
When doing venous Doppler, what plane should you be looking at venous structures?
Longitudinal
pg. 116 4th ed.
What are risk factors for DVT?
Post-op Hx DVT Cancer Trauma Pregnancy High-dose estrogen Birth control Immobility "economy class syndrome" Thrombophilia Bed rest > 4 days Paralysis
pg. 111 4th ed.
Which veins have valves?
FV: 4 valves
Pop: 2 valves
CALF VEINS: each 10 valves (total: 30 valves)
pg. 136 4th ed
not in soleal sinuses-venous test
What canal does CFV lie in?
Scarpa’s canal
Quizlet/venous test
Adductor canal?
Chapter 5 in vascular book
What is the basilic vein and where is it located?
Medial portion of upper arm if palm up.
-does not have accompanying artery, nor does cephalic vein.
superficial vein of the upper extremity
Venous test
Why don’t we need an angle with venous imaging?
The flow is with respirations
pg. 131 4th ed.
flow direction is not important
Venous test
What is the perforator called that is found in distal thigh?
Dodds perforator
Quizlet/venous test
Hunterian perforator
pg. 102 4th ed.
What is the primary route for upper extremity venous drainage?
The superficial system
Adequate pressure to compress a vein should be?
Moderate probe pressure and only the vein collapses
pg. 113 4th ed.
What veins have a pulsatile venous signal?
IJV
Subclavian
Axillary
pg. 152 4th ed.
What is the criteria that indicates that we should not do compressions?
Floating thrombus
per Beth
pg. 124 4th ed
What is a lethal complication of DVT?
Pulmonary embolism
What are signs and symptoms of acute DVT?
Acute onset persistent calf pain/tenderness
Calf/leg swelling
Affects posterior/medial calf
Cyanosis limb
pg. 111 4th ed.
What is reflux?
Reflux is abnormal retrograde/reversed flow on spectral analysis for 1 second or more after having patient relax from an augmentation or valsalva.
What is the protocol for graft imaging?
Prox flow-native vessel Prox anastomosis Prox/MID/DST graft DST anastomosis DST flow-native vessel
If the greater saphenous vein is used for arterial conduit, what is that called?
In-situ graft
What is a reverse vein graft?
the GSV is removed and turned upside down without removal of valves then sewn back in.
What is it called when we follow up on a graft post surgical?
Follow up surveillance
What is a stent?
structure used to mechanically hold the artery open
What are complications of a stent?
endoleak-inadequate seal to prox or distal wall
graft infection
vessel rupture
embolization
What vessels might not have arterial disease?
Radial
Ulnar
Brachial
What is the autoimmune disorder that can affect the subclavian arteries?
Takayasu’s and giant cell arteritis. pg. 226
What is Buerger’s disease?
aka thromboangitis obliterins
Arterial disorder involving digital arteries
What is the name of the small emboli that connect through the digits?
Thrombo-emboli
What are the two types of Raynaud’s disease? Who gets it?
Vasospastic disorder brought on by cold exposure, chemicals, or vibration injury
Also called Episodiac, prolonged digital vasospasm
More common in females- 9x more than men
What is Thoracic outlet syndrome?
Intermittent pain, numbness, or weakness of arms related to arm position
Where should you put the PPG pad when doing a study?
Sensor on pad of the finger
What method of testing that should be used for Raynaud’s disease?
Cold submersion test
What is the test that is used for radial artery and hand profusion?
Allen’s test
What is a Brescia-Cimino fistula?
created in non-dominant arm
radial art to cephalic vein or brachial art to cephalic or basilic vein are the most common
Low complication rate
What veins do not have an accompanying artery?
Cephalic
Basilic
Which graft type is impenetrable by ultrasound?
Vectra
What vessels does Berger’s disease affect?
Digital Arteries
What is the standard recovery time for cold immersion test?
5 min- normal
10 min- abnormal
Hemodialysis access fistula and grafts are used to do dialysis (T/F)
True, Provides access for dialysis
What is the most common type of access graft?
Radial artery to cephalic vein
We map prior to CABBAGE (T/F)
True
What kind of waveforms do you see in the lower extremity?
triphasic
Access grafts can be between an artery and a vein (T/F)
True. The most common is the radial artery to the cephalic vein
Which portion of the ICA is evaluated during a carotid exam?
Petrous
portion of the waveform on a pulse fine recording that reflects a normal waveform, what is that component?
`
A toe pressure is normal if it is ____ mmHg
50 mmHg
T/F bypass graft evaluation begins with patient history, surgical record, and type of graft
True
T/F Aortic bifemoral graft is used to bypass the distal aorta and/or iliac arteries
True
T/F A fem to fem graft is also referred to as a jump graft
True
T/F Vein mapping prior to cardiac bypass it provides the surgeon with valid information
True
T/F An aortic bifemoral graft is also called a jump graft
False
T/F triphasic waveforms are common in the extremities
True
T/F an excess graft can be a synthetic tube placed between an artery and a vein
True
