Vascular Surgery Flashcards
If a patient had surgery to correct an occlusion of the right external iliac artery, what type of graft could be used
left femoral artery to the right femoral artery
You are performing an ultrasound on a fem-pop PTFE graft in a lower extremity and you suspect a stenosis at the distal anastomosis. How will you calculate the velocity ration in this patient
divide the velocity at the distal anastomosis by the velocity in the distal graft
What vascular complication is treated with a fasciotomy
anterior compartment syndrome
A patient presents for a follow up of stent placement in the SMA due to stenosis. How will you determine if the procedure was a success
peak velocities should be reduced compared to pre-procedure levels, but will still appear elevated when compared to normal velocities of non-stenotic arterial flow
What intracerebral vessel is evaluated on a TCD evaluation performed during a left carotid endarterectomy
ipsilateral MCA
What vessels are a common source for a type 2 endoleak
inferior mesenteric artery and lumbar arteries
Hemodialysis requires native vein diameter to measure _______, native artery ________ and native vein _________ for synthetic graft
> 2.5mm, >2mm, >4mm
When evaluating a patient for placement of a hemodialysis graft, what is the minimum acceptable diameter for the native artery where the graft will be connected
2mm
The type of dialysis graft where the cephalic vein is anastomosed to the radial artery is called
brescia-cimino graft
Velocities in a reversed vein graft are usually ______ at the _______ anastomosis because it is the smaller end of the vein
higher, proximal
Arterial flow proximal to an AV fistula will be
low resistance
What is a sonographic appearance of a normal renal transplant
decreased parenchymal resistance, RI <0.70
Venous flow proximal to an AV fistula becomes ______ due to the inflow of arterial flow distally
pulsatile
A fem-fem graft is used to treat
unilateral iliac stenosis
What technique is used to monitor flow during a fem-pop bypass procedure
duplex ultrasound
When evaluating a patient for placement of a AV fistula for dialysis, what is the minimum acceptable diameter for the native vein where the graft will be connected
2.5mm
When continuous TCD monitoring is used to assist with a carotid endarterectomy, when is the TCD device first activated to begin monitoring the patient
just before the surgery starts
If both common iliac arteries demonstrate significant stenosis, what type of treatment will most likely be used
kissing stents
What describes the 2D appearance of acute renal allograft rejection on ultrasound
increased echogenicity and size
Reversed vein bypass graft:
normal- PSV ______, velocity ratio ______
less than 49%- PSV _____, VR _______
50-75%- PSV _______, VR ________
>75%- PSV ________, VR ________
<125cm/s, <1.4
125-180cm/s, 1.5-2.4
180-300, 2.5-4
>300cm/s, >4
If a liver transplant patient has a piggyback anastomosis, how does this affect your evaluation
there will be a single anastomosis site in the IVC that must be evaluated
Volume flow calculations are used to assess hemodialysis graft performance. How is volume flow measured
open the sample volume from wall to wall within a normal segment of the graft and trace the waveform
A patient presents for a 3 month follow up on his aortic endograft. The aortic sac has increased in size by 0.8cm since the last ultrasound evaluation performed 2 months ago. No endoleak was detected on ultrasound or CT evaluation. What is the most likely cause for the diameter change
endotension
No leak present but there is continued expansion of the aneurysm sac greater than 5mm, sometimes referred to as type V endoleak
endotension
What will decrease with acute renal allograft rejection
diastolic flow in the segmental arteries
The most common site for hepatic artery stenosis in a transplant is
at the native hepatic artery anastomosis site located just outside the hilum of the liver
What is the most common complication of an in situ vein graft
AV fistula
A patient presents for a stat lower extremity arterial doppler evaluation following the recent placement of a fem-tib graft in the right leg. The patient complains of significant pain and weakness in the calf muscle with areas of numbness on the anterior aspect of the lower leg. What is the most likely finding on the exam
anterior compartment syndrome
What native artery is commonly used for the arterial anastomosis in a renal transplant when the external iliac artery is not available
internal iliac artery
A patient presents for a renal transplant evaluation. What native vessels will be evaluated during the exam
external iliac artery and vein
A patient presents with a radiocephalic hemodialysis fistula in the left arm. Doppler evaluation of what vessel will be used to rule out steal syndrome
distal inflow artery, within 2cm below the fistula
A patient presents for evaluation of a hemodialysis graft due to suspected stenosis. Considering the most common location of stenosis in an arterio-venous graft, where should you look first for the suspected stenosis
venous anastomosis and outflow vein
How does the imaging protocol differ when evaluating a hemodialysis graft versus a hemodialysis fistula
a graft has two anastomotic sites and the fistula only has one
Where is the most common location for the surgeon to place a renal allograft
right iliac fossa
The saphenous vein has already been harvested from both legs for CABG surgery. What other vein could be harvested for an additional bypass graft
cephalic or basilic vein
__________ is the most common endoleak and usually does not require intervention, while _______ is most dangerous and requires surgical intervention
type 2, type 1
An in situ graft exam must include the evaluation of any patent branches because
of the potential for AV fistula formation
A patient presents for pre-operative arterial mapping for the TRAM flap breast reconstruction procedure. What vessels should be evaluated
epigastric and internal mammary arteries
You are performing a vein mapping of the cephalic vein in the right arm. The patient is supine and the head of the bed is elevated. The arm is extended and relaxed. The diameter of the vein is 1.5 to 2mm in all segments from the shoulder to the wrist. What should you do next
apply a tourniquet to the upper arm and remeasure the cephalic vein segments distal to the tourniquet
When evaluating a patient with an aortic endograft, what is the minimum increase in aortic sac size that indicates a possible endoleak
0.5cm
In a graft, a volume flow rate over 1200ml/min indicates
possible CHF
