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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
Q

A greater than 70% stenosis is considered:

velocity?

presence of plaque?

CCA ratio?

A
  • 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

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26
Q

Much less common pathologies:

A

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

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27
Q

Much less common pathologies:

A

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

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28
Q

Much less common pathologies:

A

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
Q

Much less common pathologies:

A

Takayasu’s Arteritis - another rare vascular inflammation of the arterie, usually the large vessels from branching off of aorta

30
Q

medical jargon and buzzwords

appreciate

A

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
Q

medical jargon and buzzwords

proximal limit/distal limit

A

farthest possible point toward or away from the heart or point of origin

32
Q

medical jargon and buzzwords

terms used interchangeably: plaque

A

*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
Q

medical jargon and buzzwords

thickened walls along the artery, looking a bit like very minimal atheroma called:

A

intimal thickening

34
Q

medical jargon and buzzwords

true lumen vs residual lumen

A

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
Q

medical jargon and buzzwords

homogeneous vs heterogeneous

A

all of one consistency vs having different consistencies or materials

pea soup vs beef stew

36
Q

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

A

crater, crater-like in aeparance

37
Q

medical jargon and buzzwords

caudal

A

toward the feet

38
Q

medical jargon and buzzwords

Plaque

A

Atherosclerotic material that builds up on the walls of arteries

39
Q

Embolus

A

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
Q

identify 1-4

A
  1. ECA
  2. ICA
  3. bulb
  4. CCA
41
Q

What is Hemodynamics?

A

Study of blood flow characteristics
Blood flow results due to a continual difference in pressure as blood travels through the circulatory system

42
Q
  • Blood always flows from _____ pressure to _____ pressure
  • Blood will always take the path of ______resistance
A

higher, lower

least

43
Q

Laminar flow

A

Orderly, non-turbulent flow

  • Smooth parallel flow in layers
  • Similar velocities across the vessel diameter
44
Q

Parabolic flow

A

Center stream is faster, bullet shaped

45
Q

Plug flow

A

All fluid traveling at a very similar speed and direction

  • Common in larger vessels
  • Creates a flattened forward patters
46
Q

Turbulent flow

A

-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
Q

Doppler Effect

A

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
Q

Flow

A

The volume of blood passing a point at a given time

49
Q

Resistance

A

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
Q

Doppler Equation

A

f (d) = 2fv cos theta / c

f: transmitted frequency
v: velocity of the blood
c: propagation speed

51
Q

Spectral Doppler

A
52
Q

Multiphasic vs Monophasic

*normal peripheral arterial flow is multiphasic

A

triphasic

53
Q

Multiphasic vs Monophasic

A

biphasic

54
Q

Multiphasic vs Monophasic

A

monophasic

55
Q

Wall Filter

  • Low (slow) flow requires low wall filter
  • High dynamic flow requires higher wall filter
A
56
Q

Characterizing Atheromatous Lesions

Calcific, dense appearance in echo?

A

-Bright echoes in the lumen

57
Q

Characterizing Atheromatous Lesions

Soft, fibrous appearance in echo?

A

darker echoes

58
Q

Characterizing Atheromatous Lesions

Intimal Thickening appearance in echo?

A
  • Thickened walls around the artery
59
Q

Characterizing Venous Images

Patent meaning ?

compressible meaning ?

A

patent: Open, unobstructed, affording free passage. Characteristics of normal veins
compressible: Compress with probe pressure

60
Q

Characterizing Venous Images

Chronic vs. Acute thrombosis

echo appearance for each?

A
  • Chronic: brightly echodense, heterogeneous, striated, collaterals present
  • Acute: softly echogenic, homogeneous, lightly speckled echoes, no collaterals
61
Q

Characterizing Venous Images

Recanalized meaning?

A

Having formed a channel of flow through a thrombus

-Suggestive of older/chronic clot

62
Q

Characterizing Venous Images

Nonocclusive meaning?

A

-Obstructed but not totally blocked

63
Q

patent in medical meaning

A

Patent (adjective): Open, unobstructed, affording free passage. Thus, for example, the bowel may be patent (as opposed to obstructed)

64
Q

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
A

c. Flow moving in the correct direction

65
Q

Quiz Question

  1. True or False: Hemodynamics is the study of blood flow characteristics.
A

T

66
Q

Quiz Question

  1. Describe the difference between laminar and turbulent flow
A

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
Q

Quiz Question

  1. Which best describes the spectral waveform demonstrated below?
    a. Triphasic
    b. Monophasic
    c. Hyperemic
    d. Biphasic
A

a. Triphasic

68
Q

Quiz Question

_*_flag question (partial credit)

  1. List 2 ways to better optimize this spectral waveform:
A

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
Q

Quiz Question

  1. Describe 2 key differences between the ultrasound appearance of acute vs. chronic thrombosis.
A

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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