Venous (Quiz ) Flashcards
What are the three different things you can measure with any vessel?
LD: lumen diameter (intimal to intimal layer)
IAD: interadventitial diameter (adventitia to adventitia)
IMT: intimal-medial thickness (outermost intima to outermost media)
What is the standard measurement of vessel diameter?
IAD - interadventitial diameter
What is a spectral doppler tracing?
graphs of velocity over time
What is the most basic information to obtain from a spectral waveform?
PSV and resistivity
When does PSV occur?
at ventricular systole
What does resistivity do?
compares EDV with PSV
Where does the aorta originate?
at left ventricle and terminates at level of umbilicus
List the aortic segments.
aortic root, ascending aorta, aortic arch, descending aorta, abdominal aorta
What is a normal aortic diameter?
normal is less than 2.5cm
ectatic (aka dilation): 2.5-3cm (irregular margins and non-tapering profile)
aneurysmal: >3cm (or focal diameter increase by more than 50% of normal segment
What is the normal PSV of the aorta?
40-100 cm/s
Is the aorta low or high resistive?
typically high
List the major branches of the aorta.
celiac axis (left gastric, common heptic, and splenic), SMA, right and left renal artery, IMA, right and left CIAs
List the minor branches of the aorta.
right and left inferior phrenic arteries, right and left suprarenal arteries, right and left gonadal arteries
Which aortic branches are examined with sonography?
major branches
minor branches are not examined with US
What does the CA supply?
liver, duodenum, stomach, esophagus, spleen, pancreas, omentum
What is the normal PSV of the CA?
<200 cm/s
What is the resistivity of the CA?
low resistivity
What are the main branches of the SMA?
inferior pancreatic, duodenal, colic, ileocolic, intestinal
What does the SMA supply?
pancreasm duodenum, ileum, jejunum, cecum, appendix, ascending and transverse colon
What is the normal PSV of the SMA?
<275 cm/s
What is the resistivity of the SMA?
high resistive in fasting patient
low resistive in non-fasting patient
Where do the renal arteries originate on the aorta?
a few centimeters below the SMA
What is the normal PSV of the renal arteries?
<180 cm/s
What is the resistivity of the renal arteries?
low resistive
Where does the IMA originate on the aorta?
anterior-lateral
in trv, at 2oclock position of Ao
What are the branches of the IMA?
left colic, sigmoid, superior rectal
What does the IMA supply?
descending colon, sigmoid colon, and rectum
What is the normal PSV of the IMA?
<200 cm/s
What is the resistivity of the IMA?
varies between low and high resistive
What are the branches of the CIAs?
internal and external iliac arteries
What do the CIAs supply?
muscles and nerves of the back, reproductive organs, bladder, rectum, iliac crest and pelvic bone, lower extremity
What is the normal PSV of the iliac arteries?
determined by lack of increase of less than 2x velocity of previous segment
What is the resistivity of the CIAs?
high resistive
Which part of the aorta has more diastolic flow?
proximal due to more visceral branches
What is the most common pathology of the abdominal aorta?
aneurysm
List risk factors for AAA.
advancing age, male gender, hypertension, history of smoking, history of heart disease, history of COPD, hx of peripheral vascular disease, family hx of aneurysm
What is the number one cause of AAA?
atherosclerosis
What are causes of AAA?
atherosclerosis, trauma, congenital defects mycosis, cystic medical necrosis, increased pressure, abnormal blood volume
List symptoms of AAA.
palpable mass, back pain, drop in hematocrit, often asymptomatic
Describe the two types of AAA.
Fusiform: involves entire circumference of aorta
saccular: asymmetric outpouching dilations - often caused by trauma or penetrating aortic ulcers
What is the most common type of aneurysm?
fusiform
Where do most AAA appear?
infrarenal
What is the treatment for <4cm AAA?
followed every six months with intervention if pt becomes symptomatic
What is the treatment for 4-5cm AAA?
surgery if pt in good health
What is the treatment for >5-6cm AAA?
may bennefit from surgical repair if other risk factors for rupture
What is the treatment for >6-7cm AAA?
highest risk; risk increases with age and and other medical problems
What is the mortality rate for AAA?
50%
Aneurysms ___cm have a ___% cumulative incidence of rupture over __ years.
> 5cm
25%
8 years
Symptoms of aortic rupture include:
excrusiating abdominal pain, shock, expanding abdominal mass
What is the sonographic appearance of AAA rupture?
retroperitoneal hematoma, free fluid (ranging from anechoic to complex), possible displacement of kidneys
What is considered an iliac aneurysm?
diameter increases by 50% when compared to normal segment or when diameter is >1.5cm
What type of aneurysm is often bilateral?
iliac aneurysm
What are the treatment options for aortic iliac aneurysm?
open and endovascular aortic repair
Which treatment option (open or endovascular repair) is preferred?
endovascular
What is an aortic endograft?
a fabric covered metallic stent, peripherally inserted into the aorta at the level of the aneurysm
Describe the three basic types of EVAR devices?
bifurcated: most common
straight tube
uni-iliac grafts: straight tube that splits into one leg
Additional optional components for EVAR include:
side-branch occluding devices, coil embolization of branches, and femoro-femoral crossover grafting
What are EVAR complications?
iatrogenic injury at catheter insertion site and/or technical complications
What are iatrogenic EVAR complications?
AV fistula, pseudoaneurysm, hematomas, arterial thrombosis, arterial embolization, dissection
What are technical EVAR complications?
graft fracture, graft migration, endoleak
Describe the types of endoleak.
I: Flow into the aneurysmal sac at the proximal or distal end of the graft.
II: Backflow of an Aortic branch vessel into the aneurysmal sac. (vacuum affect)
III: Flow between two separate components of an endograft into the aneurysmal sac.
IV: Flow into the aneurysmal sac secondary to graft porosity.
V: Flow into the aneurysmal sac from an unknown source
What is a normal EVAR?
residual sac size should decrease over time, spectral doppler flow should be high resistive and multiphasic, color doppler flow should fill entire graft and absent in residual sac
What does an abnormal EVAR look like?
any increase in size, pulsitility of sac, or areas of echolucency in sac
residual sac that appears spongey (heterogeneous with hypoechoic areas) with increased sac size
What is endotension?
when the aneurysm continues to expand due to persistent or recurrent pressurization in the absence of an endoleak
What are benefits of aortic duplex?
low cost and low risk alternative to CT, in some studies are as effective as CT, can accuarately monitor residual aneurysm sac size, demonstrate graft and limb patency, identify endoleaks and leak source, detect graft limb dysfunction and kin, detect migration of stent graft device, and shows hemodynamic information
When scanning and EVAR, how many passes should be made?
three- the first looking in trv at the graft only
the second in long
the third with endoleak only
What are the pitfalls of imaging an EVAR?
mistaking intraluminal clot for EVAR, measuring endograft instead of AAA (the graft remains the same size, measure the aneurysm!), color doppler box too small, PRF too high
How many times should you look at the EVAR with color Doppler?
twice
the first to look at the graft and the second for the endoleak
because the flow velocities are so different
How long should the patient fast before their exam of the mesenteric vessels?
at least 6 hours
including smoking and chewing gum
What position should the patient be in for mesenteric scan?
supine
reverse trendelenburg or head elevation helpful
What doppler waveforms are obtained with a mesenteric scan?
adjacent Ao, celiac axis origin, splenic and hepatic arteries when appropriate, sma origin, prox sma, ima
What is the resistivity of the splenic artery?
low resistive
What is the resistivity of the common hepatic artery?
low resistive
What is the resistivity of the celiac axis?
low resistive
What is the resistivity of the IMA?
high resistive
What does a color bruit indicate?
significant stenosis
What should be changed with different flow velocities?
PRF
What direction of flow is in the common hepatic artery?
retrograde
What conditions should not be imaged with color doppler?
intimal flap dissections, stents, and atherosclerotic plaque
What is a common treatment for messenteric ischemia?
bypass grafting
What can be used to find more information about the patient graft?
operative report
True stenosis demonstrates…
increased flow and poststenotic turbulence/spectral broadening
Collateral flow demonstrates…
little spectral broadening and no stenotic profile
Name the pitfalls to mesenteric US.
poor visualitzation due to bowel gas, midline scarring from abdominal surgery
What is the most common application for mesenteric duplex exam?
mesenteric ischemia
What is the incidence of mesenteric ischemia?
more common in women between 40 and 70
What are the risk factors for mesenteric ischemia?
coronary artery disease, peripheral vascular disease, history of smoking, hypertension, and diabetes
What are causes of mesenteric ischemia?
fibromuscular dysplasia, dissection, thrombosis, atherosclerosis, extrinsic compression
Which type of mesenteric ischemia is life threatening?
acute
Acute mesenteric ischemia can result from:
embolis to mesenteric arteries (usually occurs in distal SMA) or thrombosis of an artery with existing chronic disease
What are the symptoms of acute mesenteric ischemia?
severe abdominal pain, abdominal tenderness, lack of bowel sounds, bruit, pt afraid to eat (because it hurts)
What are the symptoms of chronic mesenteric ischemia?
abdominal pain and cramping after eating (periumbilical pain 30 minutes after eating and lasts 1-2 hours), abdominal bruit, weight loss, sitophobia, diarrhea
What is the sonographic appearance of mesenteric insufficiency?
celiac axis with absent flow, SMA with low resistive or absent state, IMA with absent flow
What is the diagnostic criteria of 70% stenosis with mesenteric insufficiency?
CA: >200 cm/s
SMA: >275 cm/s
IMA: >200 cm/s
What is median arcuate ligament compression syndrome?
transient compression of the celiac artery origin byt the median arcuate ligament of the diaphragm
When does compression occur with median arcuate ligament compression syndrome?
with exhalation (increased CA PSV) compression is relieved by inhalation
If a visceral aneurysm is identified, on which artery is it normally in?
splenic artery
What is the insidence of SAA?
more common in women than men
What are causes of SAA?
medial degenreation due to arterial fibrodysplasia, portal hypertension, and repeated pregnancies
What are other visceral artery aneurysms?
hepatic artery (more men than women), SMA, CA
Treatment options for visceral artery aneurysms include:
open surgery or endovascular repair
Causes of mesenteric dissection include:
athersclerosis, fibromuscular dysplasia, mycotic infection, trauma, connective tissue disorders, vasculitis, iatrogenic induced, unknown etiology
What is the most common visceral artery to have a dissection?
sma
What is the sonographic appearance of visceral dissection?
color shows seperation with antegrade flow along one wall with retrograde flow along the other wall; two flow channels noted with spectral doppler as well
Treatment of visceral dissection is:
may be conservative management with anticoagulation or stent or surgical procedures
