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Intro to Vascular > Week 1: Intro and Basic Terminology > Flashcards

Week 1: Intro and Basic Terminology Flashcards

1
Q

_______ is an ultrasound-based diagnostic imaging technique to evaluate structural details of the carotid arteries. It is used to diagnose carotid artery stenosis and can assess atherosclerotic plaque morphology and characteristics.

A

carotid duplex exam

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2
Q

Indication for the carotid duplex exam (6)

A
  1. syncope
  2. stroke
  3. AMS (altered mental state) i.e. cognitive disorders, attention disorders, decreased level of consciousness
  4. TIA
  5. Bruit
  6. follow up for known stenosis
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3
Q

Rt CCA (right common carotid artery) further bifurcate into internal and external carotid arteries at the ________

A

carotid bulb

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4
Q

Carotid bulb supplies blood to _____ and ______

A

brain and face

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5
Q

Vertebral arteries arise from ________ traverse cephalad through the _______\_ of the cervical vertebrae: ______ and train the brain through the posterior fossa

A

subclavian artery

transverse formina

C1 - C6

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6
Q

Confluence of all these vessels joined to make the _______ (a circular and a somatic arterial network at the base of the brain) at the base of the brain

A

Circle of Willis

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7
Q

Three walls (layers) of artery/vein ?

A
  • Tunica interna
  • Tunica media
  • Tunica adventitia

*note: The middle muscular layer of the arteries are thicker than the veins

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8
Q

In which layer does the plaque build up?

A

tunica media

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9
Q

Blood flow through the common carotid artery is usually____, however, it’s not true of the ____ and in case of tortuous vessels (see below)

*type of flow

A

laminar flow

bulb

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10
Q

Carotid artery has a ________and ________ (see below)

*explain flow

A

sharp up stroke and a decent amount of diastolic flow

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11
Q

What waveform?

A

The internal carotid artery has a broad upstroke and a considerable amount of diastolic flow

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12
Q

Which waveform ?

A

The external carotid artery has a very sharp upstroke and can have little to no diastolic flow or even reversal flow (see below)

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13
Q

Spectral Doppler angle should be _______ in order to avoid overestimating the velocities

A

45-60 degrees

*angles greater than 60 degrees lead to significant erros in velocity

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14
Q

ICA/CCA ratio is important for estimating _______

A

stenosis

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15
Q

ICA/CCA ratio equation

A

ICA PSV / CCA PSV

The peak systolic velocity of the ICA and the peak systolic velocity of the CCA and divide them

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16
Q

What is normal range of ICA/CCA ratio ?

A

*ICA/CCA ratio < 2.0 wnl is considered within the normal range. It is an estimate of at least less than 50% stenosis which can be described as no hemodynamically significant stenosis.

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17
Q

Appearance of atheromatous plaques

A

homogeneous echolucent

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18
Q

Appearance of atheromatous plaques

A

homogeneous echogenic

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19
Q

Appearance of atheromatous plaques

A

heterogeneous plaque

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20
Q

Appearance of atheromatous plaques

A

cauliflower calcification

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21
Q
  • Appearance: differentiate whether the surface is smooth or irregular
  • Texture: homogenous= _______ or heterogeneous = ________
  • Keep an eye out CVC (central venous catheter) - any intra plaque hemorrhage or alteration
A

fatty plaque

contain calcium

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22
Q

The characteristics of waveform in stenotic vessel

A
  • Increased velocity
  • Waveform change - turbulence, spectral broadening, tardis parvis (in the distal site of stenosis)
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23
Q

A normal exam is considered:

velocity?

presence of plaque?

CCA ratio?

A
  • a piece of solid velocity of less than 125 cm/s
  • No plaque
  • CCA ratio less than 2.0
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24
Q

A 50-69% stenosis is considered:

velocity?

presence of plaque?

CCA ratio?

A
  • ICA peak systolic velocity of 125 to 230 cm/s
  • A plaque % estimate of 50% or more
  • CCA ratio 2-4
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25
A greater than 70% stenosis is considered: velocity? presence of plaque? CCA ratio?
* Velocity is higher than 237 cm/s * Plaque estimate greater than 50% * ICAC CCA ratio greater than 4 \*Once you start reaching levels of _near occlusion or total occlusion_, these parameters **cannot be used** to find out the degree of stenosis because there may be **no flow** or the **trigger flow** will have no Doppler spectrum
26
**Much less common pathologies:**
**carotid dissection** - a tear in the layers of the arterial wall which allows blood to pool in between them and causes a flap and increase turbulence of flow and creates blood clots which can then embolize across stroke
27
**Much less common pathologies:**
**Carotid body tumor** - tumors that form at the bifurcation of the carotid artery also called: **paragangliomas**. They represent about _65% of head and neck_ paragangliomas
28
**Much less common pathologies:**
**Fibromuscular dysplasia** - - disease process that affects the medium and large arteries of young to middle aged women and an imaging usually has the string of pearls or string of beads appearance which describes as a series of lumen stenosis and aneurysmal out pouches
29
**Much less common pathologies:**
**Takayasu’s Arteritis** - another rare vascular inflammation of the arterie, usually the large vessels from branching off of aorta
30
_medical jargon and buzzwords_ appreciate
used in medicine to mean “discern - perceive, recognize” or "distinguish" ex: in the more posterior approach, we can better appreciate the crater-like formation at the origin of the internal carotid.
31
_medical jargon and buzzwords_ proximal limit/distal limit
farthest possible point toward or away from the heart or point of origin
32
_medical jargon and buzzwords_ terms used interchangeably: plaque
\*plaque is used in sigular **atheroma**: degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue, and leading to restriction of the circulation and a risk of thrombosis **atheromata**: **areas of atheroma** **areas of calcification** **atheromatous development**
33
_medical jargon and buzzwords_ thickened walls along the artery, looking a bit like very minimal atheroma called:
intimal thickening
34
_medical jargon and buzzwords_ true lumen vs residual lumen
true lumen: the actual wall of the vessel residual lumen: the remaining (of narrowed vessel from plaque) opening through which blood continue to flow
35
_medical jargon and buzzwords_ homogeneous vs heterogeneous
all of one consistency vs having different consistencies or materials pea soup vs beef stew
36
_medical jargon and buzzwords_ The shape that is most suggestive of ulceration of plaque; scooped-out in appearance, especially if there are shelf-like projections over the arater
crater, crater-like in aeparance
37
_medical jargon and buzzwords_ caudal
toward the feet
38
_medical jargon and buzzwords_ Plaque
Atherosclerotic material that builds up on the walls of arteries
39
Embolus
Object traveling through the circulation that may lodge in a vessel and cause occlusion. - _Several types: thrombus, air, tumor cells, clumps of fat, etc._ - Arterial vs Venous
40
identify 1-4
1. ECA 2. ICA 3. bulb 4. CCA
41
What is Hemodynamics?
Study of blood flow characteristics Blood flow results due to a continual difference in pressure as blood travels through the circulatory system
42
- Blood always flows from _____ pressure to _____ pressure - Blood will always take the path of \_\_\_\_\_\_resistance
higher, lower least
43
Laminar flow
Orderly, non-turbulent flow - Smooth parallel flow in layers - Similar velocities across the vessel diameter
44
Parabolic flow
Center stream is faster, bullet shaped
45
Plug flow
All fluid traveling at a very similar speed and direction - Common in larger vessels - Creates a flattened forward patters
46
Turbulent flow
-Opposite of laminar flow -Commonly associated with diseased vessels, but there are other causes that are not disease related • Bifurcations & branching • Curved (tortuous) vessels • Changes in the natural vessel diameters
47
Doppler Effect
Shift in frequency caused by motion between the source and the observer -Occurs twice in vascular ultrasound 1. Transducer is a stationary source while the blood cells are moving receivers of the ultrasound waves 2. The ultrasound is backscattered from the blood cells, which now act as a moving source, with the transducer acting as a stationary observer
48
Flow
The volume of blood passing a point at a given time
49
Resistance
Force that opposes the flow of fluid -Factors that affect resistance: increase in viscosity, increase in tube length, decrease in radius (all increase resistance) \*\*Flow and resistance are opposites! -**High resistance = low flow**
50
Doppler Equation
f (d) = 2fv cos theta / c f: transmitted frequency v: velocity of the blood c: propagation speed
51
Spectral Doppler
52
_Multiphasic vs Monophasic_ \*normal peripheral arterial flow is multiphasic
triphasic
53
_Multiphasic vs Monophasic_
biphasic
54
_Multiphasic vs Monophasic_
monophasic
55
_Wall Filter_ * Low (slow) flow requires low wall filter * High dynamic flow requires higher wall filter
56
_Characterizing Atheromatous Lesions_ Calcific, dense appearance in echo?
-Bright echoes in the lumen
57
_Characterizing Atheromatous Lesions_ Soft, fibrous appearance in echo?
darker echoes
58
_Characterizing Atheromatous Lesions_ Intimal Thickening appearance in echo?
- Thickened walls around the artery
59
_Characterizing Venous Images_ Patent meaning ? compressible meaning ?
patent: **Open, unobstructed, affording free passage.** Characteristics of normal veins compressible: Compress with probe pressure
60
_Characterizing Venous Images_ Chronic vs. Acute thrombosis echo appearance for each?
- **Chronic:** brightly echodense, heterogeneous, striated, _collaterals present_ - **Acute:** softly echogenic, homogeneous, lightly speckled echoes, no collaterals
61
_Characterizing Venous Images_ Recanalized meaning?
Having formed a channel of flow through a thrombus -Suggestive of older/chronic clot
62
_Characterizing Venous Images_ Nonocclusive meaning?
_-Obstructed but not totally blocked_
63
patent in medical meaning
Patent (adjective): Open, unobstructed, affording free passage. Thus, for example, the bowel may be patent (as opposed to obstructed)
64
_Quiz Question_ 1. Antegrade flow is defined as which of the following? a. Flow moving in the incorrect direction b. Flow directed toward the head c. Flow moving in the correct direction d. Flow directed toward the front of the body
c. Flow moving in the correct direction
65
_Quiz Question_ 2. True or False: Hemodynamics is the study of blood flow characteristics.
T
66
_Quiz Question_ 3. Describe the difference between laminar and turbulent flow
My Ans: laminar - blood flow in parallel in a same direction. The fastest in the center and gets slower as it's closer to the wall. parabolic shape profile turbulent - blood flow in different directions with different velocities. It can be seen at the bulb, bifurcation, and stenotic vessels.
67
_Quiz Question_ 4. Which best describes the spectral waveform demonstrated below? a. Triphasic b. Monophasic c. Hyperemic d. Biphasic
a. Triphasic
68
_Quiz Question_ _\*_flag question (partial credit) 5. List 2 ways to better optimize this spectral waveform:
My Ans: increase color scale to eliminate aliasing move baseline down to show the full spectral Doppler waveform Comment: Both good suggestions, but only one is for optimizing the spectral waveform as requested by the question!
69
_Quiz Question_ 6. Describe 2 key differences between the ultrasound appearance of acute vs. chronic thrombosis.
My Ans: acute - echolucent homogeneous appearance chronic - calcific, echogenic appearance Comment: Acute is typically hypoechoic, dilated, soft, spongy, regular, may have flow around if loosely attached. Chronic is typically hyperechoic, may be atrophied, hard, irregular, likely to have flow through it.

Intro to Vascular (17 decks)

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