Vessels Flashcards
Ao enters the abdominal cavity in a ____ location and progressively becomes more ______ as it travels caudally.
posterior
anterior
The IVC mainatins a ______ course throughout the retroperitoneum.
horizontal
First major branch of Ao
celiac axis
The celiac axis is __-___cm long, located superior to the ____ and branches into what 3 arteris?
2-3cm sup to panc CHA (common hepatic artery) LT gastric artery Splenic Artery
Describe the termintaion of the celiac axis
terminates with the bifurcation of the CHA and SA, which is seen as the “seagull” or “dove sign”
What is the largest branch of the celiac axis?
SA
The left gastric artery is usually not visible but can be seen extending ____ from the celiac axis.
cranially
As the CHA course towards the _____ it dives into what two arteries?
LIV
bifurcates into the PHA (proper hepatic artery) and the GDA (gastroduodenal artery)
The SMA branches off the Ao ____cm inferior to the ____ ____. It ______ the Ao and is seen ____/_____ to the body of the pancreas.
1cm
celiac axis
parallels
post/inf to body of panc
SMA Doppler waveform in a fasting state?
high resistance, low diastolic
SMA Doppler waveform in a postprandial state?
low resistance, increased velocity
Renal arteriesarise from where?
from the lateral walls of Ao, just below the origin of teh SMA
Which renal artery is longer?
right
left is shorter as the Ao lies to the left of ML
Course of the right renal artery?
passes posterior to the IVC
The right and left gonadal arteries arise ____from the ___ Ao and are rarely imaged.
directly
distal Ao - LT is slightly superior
The inferior mesenteric artery arises from the ___ aspect of the ____ Ao. It is typically small although easy to image
anterior
distal
In the presence of SMA and CA stenosis/occlusion, what will happen to the IMA?
becomes enlarged
IVC lies to the _____ of the Ao and posterior to the _____ and _____ _____.
right
liver and panc head
Why might the IVC dilate?
cardiac failure
fluid overload
Most common tumor to involve the IVC?
RCC
Reasons for IVC displacement (6)
liver mass RT renal artery aneurysm lymphadenopathy tortuous Ao Right renal mass Right adrenal mass
Retrocaval lymphadenopathy will displace the IVC _____ in a ______ formation.
anteriorly
arcing
Purpose of the Greenfield filter
to prevent the ascent of lower extremity vein thrombosis
What is the proper location for an IVC filter?
inferior to the renal veins
Hepatics veins
RT, middle, left
-drain into the iVC
What is shorter, the left renal vein or right renal vein?
- right RV, drains directly into the iVC
- left RV is longer, passes b/w SMA and Ao as it travels from LT Kid to the iVC
Nutcracker syndrome
engoregment of the left RV due to its compression by the SMA and Ao
retroaortic left renal vein
anatominal variant, left RV located between the Ao and the vertebra, drains into the IVC
What does the right gonadal vein drain into?
IVC
What does the left gonadal vein drain into?
left renal vein
A right liver mass will displace the IVC ________
posteriorly
A right renal artery aneurysm will displace the IVC ______
anteriorly
A tortuous Ao will displace the IVC _______
right
A right adrenal mass will displace the IVC _____/_______
medial/anterior
A right renal mass will displace the IVC ______/______.
medial/left
Although lyphandenopathy typically surrounds longitudinal vessels in the abdomen, it commonly displaces the IVC and SMA _______
anteriorly
A left adrenal mass will displace the splenic vein _______
anterior
A hematoma in the pouch of Douglass will displace the bladder _______
anterior
With a gastric outlet obstruction and dilatation of the stomach, the pancreatic tail will be displaced ________
posteriorly
A mass in the uncinate process will displace the SMV _________
anteriorly
A neuroblastoma will displace the ipsilateral kidney ______
inferiorly
A mass in the left lobe of the liver will displace the GE junction __________
posteriorly
Three general types of aneurysms
true
false/pseudo
dissecting
Specific types of aneurysms (5)
berry mycotic athersclerotic fusiform saccular
Berry A
small saccular A
commonly located in the cerebrum
Mycotic A
infected aneurysm
Athersclerotic A
results from weakening of the media in severe althersclerosis
Fusiform A
spindle-shaped dilatation, the stretching process affects the entire circumference of the artery
Saccular A
localized spherical outpouching of the vessel wall
Arterial layers
adeventita
media
intima
Which layers of the artery are involved in a true aneurysm?
all three
MC cause of AAA (true A)?
arteriosclerotic disease
AAA are typically what kind of A?
fusiform, rarely saccular
How are A measured?
A/P and TRV from outer wall to outer wall
Aortic A have a ______ association.
genetic
Where are most Aortic A?
distal Ao (infrarenal) -prox Ao is infrequently involved
Aneurysms by definition are a _____ dilatation with at least ____% increase over normal aortic diameter
focal
50%
What other aneurysms are associated with aortic A?
iliac and popliteal artery aneurysms
What do false/pseudo A reults from?
injury to the vessel wall and then extravasated blood is walled off by the surrouding tissues
Can false/pseudo A mimic true aortic A?
Yes
It is important to deterime the true aortic wall
The term “pseudoaneurysm” is typically used when dealing with ________ arteries. They are commonly associated with _______ _______ or ______ ______.
peripheral arteries
angiographic punctures
surgical anastomoses
Correction of a pseudoaneurysm may be accomplsihed by
surgical repair
compression repair
thrombin injection
Sonographically, psedo A are seen as a vascular compartment connected to the native artery. What kind of waveform is see and where should you place your caliper?
caliper should be placed at the stalk
biphasic/bidirectional
Where do dissecting A usally originate?
at the aortic arch in the thorax
What is a dissection?
separation of the intima from the media of the Aortic wall, floating intima
Where can an Ao dissection extend into?
carotid arteries or down to the femoral arteries
Etiologies of dissecting aneurysms (8)
Marfan syndrome chornic HTN Ao aneurysms Ao athersclerosis (cystic medial necrosis) Iatrogenic cardiac intervention Congenital Ao valve anomalies Coarctation of the Ao Chest trauma
Most frequent cause of premature death?
dissecting aneurysms
For patients with an AAA, what alternative treatment exists for repair?
Endovascular stent graft inserted into the groin and deplored within the Ao
Who qualifies for an endovascular stent graft?
Patient with AAA that os infrarenal
Post graft placement eval includes
monitoring for leaks
the A should be measured and compared to the pre graft size
-over time the A should contract down around the grafting material
What is MAy-Thurner Syndrome?
chronic left common Iliac vein compression against the lumbar vertebrae by overlapping right right common iliiac artery
What are patients with May-Thurner’s syndrome at risk for?
developing DVTs in the LLE
Mesenteric (intestional) Ischemia
rare chronic intestional ischemia that presents as recurring postprandial ABD pain and weight loss
What else has symptoms similar to chronic mesenteric ischemia?
abdominal malignancy
ulcerative disease
cholelithiasis
What vessels should be evaluated is chornic mesenteris ischemia is suspected?
CA
SMA
IMA
When do symptoms of chronic mesenteris ischemia usually present pathologically?
Not until at least 2 of the major mesenteric arteries are occluded or highly stenosed…. this typically results in silatation of the IMA
Can symptoms result from a single mesenteric vessel occlusion?
Yes
typically the SMA is occluded
can occur in patient who have had previous abdomina surgery that interrupted important mesenteric collaterals
Criteria for mesenteric artery stenosis (mesenteric ischemia)?
SMA velocity >275cm/sec
CA velocity >200cm/sec
*suggests a 70% stenosis
MALS (median arcuate ligament compression syndrome) or celiac axis compression syndrome
compression of the proximal celiac axis by the median arcuate ligament of the diaphragm
What should a sonorgapher do if they discover an elevated celiac axis velocity
compare insp/exp velocities
MALS may present with an abdominal _____ with expiration and disappears with ispiration.
bruit
If a case of MALS, what happens with expiration?
the median arcuate ligament compressions the ventral aspect of the celiac axis
-makes a “S” shaped axis in TRV and produces a significant stenosis
If a case of MALS, what happens with inspiration?
the celiac axis should straighten out and any stenosis should disappear
-elevated velocities decrease to normal <200cm/sec
Anterior/Posterior Nutcracker Syndrome
when the left renal vein is compressed between the SMA and Ao if anterior or between the Ao and vertebra if LRV is retroaortic
What can Nutcracker syndrome cause?
venous HTN that results in venous collateralsand retrograde flow in the adrenal and gonadal veins….. this can then cause pelvic congestion syndrome in females and varicoceles in males
What is a common symptom in patients with Nutcracker syndrome?
heamturia and left flank pain
What is an arteriovensou shunt or fistual?
connection between an atery and vein
ex: cca and jug
AV shunts are commonly associated with angiographic punctures/biopsies of the _____ ______ artery just inferior to the _____.
common femoral
groin
What are AV shunts assoc with (6)
trauma surgery biopsy inflammation neoplasm congenital formation
How might an AV shunt present in patient?
bruit or thrill depending on lcoation
HTN
cardiomegaly
heart failure
Sonorgaphic characteristic of an AV shunt?
color flow bruit tissue vibration….. bc it’s a jet
pulsatile venous flow…..doesn’t have to go through cap bed
low resistive arterial flow
intrarenal AV shunts result from what
renal biopsy
percutaneous renal biopsy is the most common known acquired renal AV fistual
-est 15 to 50% of biopsies result in some degree of fistual formation
intrarenal shunts will produce what kind of waveform?
high velocity, low resistance
