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Arterial Procedures > Week 11: LE arterial angioplasty & stent assessment & duplex > Flashcards

Week 11: LE arterial angioplasty & stent assessment & duplex Flashcards

1
Q

What are the 4 treatment options for PAD?

A
  1. Medical treatment
  2. Excersise therapy
  3. Endovascular therapy
  4. Surgical reconstruction/bypass graft.
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2
Q

What do the type of interventions depend on?

A

Depends on the severity of symptoms, disease location and extent.

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3
Q

Stents are being used________in LE.

A

More frequently.

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4
Q

What is the duplex protocol for LE stents?

A

It is the same for LE native artery duplex but ass images/velocities:

  • Pre-stent
  • Prox. stent
  • Mid. Stent
  • Distal Stent
  • Post-stent.
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5
Q

What are the 2 types of endovascular treatment types?

A
  1. Percutaneous transluminal angioplasty
  2. Endovascular Intervention.
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6
Q

Which endovascular treatment is preferred for focal, <5 cm in length regions of stenosis?

A

Endovascular intervention.

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7
Q

What are some percutaneous transluminal angiplastly treatment?

A
  1. Subintimal ballon angioplasty
  2. Stent-graft angiplasty
  3. Mechanical atherectomy.
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8
Q

What are some endovascular interventions?

A
  1. Iliac angiplasty: has a higher patency rate than femoral-pop.
  2. more severe disease has lower stenosis-free patency rate.
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9
Q

What is the main mechanism for a balloon angioplasty?

A

Lumen dilation.

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10
Q

What is the lesion anatomy for a balloon angioplasty?

A

Focal, <5 cm stenosis or occlusion.

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11
Q

What is the “stenosis-free” patency at 1 year for a balloon angioplasty?

A

40-50%

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12
Q

What is the “failure mode” for a balloon angiplasty?

A
  1. Plaque dissection.
  2. Myointimal hyperplasia.
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13
Q

What is the mechanism for a stent angioplasty?

A

Lumen dilation.

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14
Q

What is the lesion anatomy for a stent angioplasty?

A

Focal & longer (>10 cm) stenosis or occlusion.

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15
Q

What us the “stenosis-free” patency at 1 year for a stent angioplasty?

A

50-60%

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16
Q

What us the “failure mode” for a stent angioplasty?

A
  1. Myointimal hyperplasia.
  2. Stent fracture.
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17
Q

What is the mechanism for atherectomy?

A

Plaque excision.

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18
Q

What is the lesion anatomy for atherectomy?

A

Focal & longer (>10 cm) stenosis.

19
Q

What is the “failure-mode” for atherectomy?

A
  1. Myointimal hyperplasia
  2. Atherectomy site thrombosis.
20
Q

What is the mechanism of subintimal angioplasty?

A

Lumen dilation.

21
Q

What is the lesion anatomy for subintiml angioplasty?

A

>10 cm stenosis or occlusion.

22
Q

What is the “stenosis-free” patency at 1 year for subintimal angioplasty?

23
Q

What is the “failure-mode” for subintimal angioplasty?

A
  1. Myointimal Hyperplasia
  2. Angioplasty site thrombosis
24
Q

What is the mechanism for stent-graft angioplasty?

A

Lumen dilation.

25
Q

What is the lesion anatomy for a stent-graft angioplasty?

A

Long, >15 cm stenosis or occlusion.

26
Q

What is the “stenosis-free” patency at 1 year for a stent-graft angioplasty?

27
Q

What is myointimal hyperplasia?

A

Abnormal proliferation of smooth muscle cells.

28
Q

What should you look for when scanning a stent?

A

Look for bright lines/circumferential dots in trans.

29
Q

Areas of distrubanes or stenosis should be carefully evaluated with a spectral doppler by doing what?

A
  • Sample volume should be “walked” through area using a 60 degree angle.
  • PSV should be measured.
30
Q

Velocity ration_______ indicates 50% stenosis.

31
Q

What can also be used to classify stenosis?

A

End diastolic volume.

32
Q

How will a waveform look if:

<50% DR

<180 PSV

<2 Vr

33
Q

How will a waveform look if:

>50% DR

180-300 PSV

2-3.5 Vr

>0 EDV

A

Monophasic

34
Q

How will a waveform look if:

>77% DR

>3.5 Vr

>300 PSV

>45 EDV

A

Damped, monophasic, low velocity.

35
Q

Why might Psv be higher in area with angioplasty and stenting?

A

Doesnt remove plaque which causes:

  • plaque dissection
  • stent geometry
  • myointimal hyperplasia
  • decreased arterial wall compliance
36
Q

What is angioplasty failure defined as?

A

occlusion.

>70% stenosis

37
Q

What are 4 dupex findings on in-stent-stenosis?

A
  1. Lumen reduction
  2. Elevated PSV values (200-300)
  3. Reduction in ABI’s
  4. Damped, low velocity spectral waveform distally.
38
Q

What is the LE stent critera?

A
  1. >50%
  2. PSV >180 cm/s in fem-pop stent that has a ratio of >2.5
  3. >75-80%
  4. PSV >275-300 cm/s and ratio >3.5
  5. no color, no doppler= occluded.
39
Q

How should you report an image with disease?

A

Either inside stent or outside stent.

40
Q

What 3 criteria is considered as a post-intervention success?

A
  1. Increase in ABI’s >.15
  2. Resolution of limb ischemia sign and symptoms.
  3. <50 DR stenosis by duplex or angioplasty
41
Q

What is considered a post-intervention failure?

A

>70% DR stenosis or occlusion.

Requires further intervention.

42
Q

The rationale for surveillance testing is to?

A

Identify PTA site abnormalities before failure occurs.

43
Q

What are 4 post-intervential abnormalities?

A
  1. In-site stenosis
  2. Stent deformation/kinking.
  3. Myointimal hyperplasia.
  4. Thrombosis/embolism.

Arterial Procedures (13 decks)

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