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ArterialClass > Week 11 - LE Bypass graft duplex exam > Flashcards

Week 11 - LE Bypass graft duplex exam Flashcards

1
Q

What are the indications for LE Bypass graft?

A
  • Disabling claudication
  • Rest pain
  • Ulcer
  • Gangrene
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2
Q

What are the 7 typical types of LE BPGs?

A
  1. Aorto-bi-femoral (ABF or AFB)
  2. Aorto-iliac
  3. Aorto-femoral
  4. Femoral-femoral (cross fem)
  5. Fem-pop
  6. Profunda fem-pop
  7. Fem-distal )ATA, DPA, PTA, PER)
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3
Q

What types of BPGs are indicated for an Aorto-iliac obstruction?

A

Aorto-bi-femoral
Aorto-femoral
Femoral-femoral
Axial-femoral

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4
Q

Where is the disease located if a Aorto-bifemoral bypass is used?

A

Aorta OR Both Iliacs

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5
Q

What is an Aorto-Bifemoral Bypass graft commonly called?

A

Y-Graft

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6
Q

Where is the disease located if a femoral-femoral bypass is used?

A

Blockage of One Iliac

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7
Q

What type of BPG is used for a blockage of the aorta and both iliacs with a high aorta blockage or Belly infection?

A

Ax-Fem and Fem-Fem

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8
Q

What is the most common kind of graft?

A

Fem-Pop

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9
Q

What is a Fem-Pop graft used for?

A

Bypassing the SFA

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10
Q

If the entire SFA and the popliteal is occluded, what kind of graft could you use?

A

Fem-distal

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11
Q

What type of graft is used if a vessel is completely split apart (GSW)?

A

Interpostion

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12
Q

Describe a jump graft

A

A graft that connects an existing graft to a different native artery part

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13
Q

Define Anastomosis

A

Point where the the native artery meets the graft (connection point)

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14
Q

What are the three types of Anastomoses?

A
  1. End to side
  2. End to end
  3. Side to Side
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15
Q

What type of graft uses end to end anastomoses?

A

Interposition graft

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16
Q

What is a side to side anastomoses used for?

A

Connecting an artery to a vein for a dialysis fistula

17
Q

How can you tell if an anastomosis is a proximal anastomosis or a distal anastomosis?

A

The direction the “toe’ of the anastomosis points. Proximal pointing = proximal anastomosis

18
Q

Define Conduit

A

a tube to channel fluid to another location

19
Q

What is the most common type of conduit?

A

Veins

20
Q

What veins are commonly used as conduits?

A

GSV, Arm veins, Cryopreserved veins

21
Q

Name the two man-made conduits and what they look like on duplex

A

PTFE (Gortex) - double line

Dacron - thick line, sawtooth appearance

22
Q

Study the GSV Bypass Graft slide (picture)

A

Do it.

23
Q

What are the 3 basic principles of bypass graft patency

A

Good Inflow
Good Conduit
Good Outflow

24
Q

What is the purpose of BPG scan surveillance?

A

Identify fixable problems with the graft before the graft fails

25
Q

What are some BPG problems?

A 
Intimal hyperplasia (anastomoses and graft)
Atherosclerosis (inflow and outflow)
Poor inflow or outflow
Incomplete valve lysis
Intimal flap
Twist/kink in graft
Extrinsic compression of graft
Hypercoagulable state
Infection
26
Q

What are the potential problems with PTFE grafts?

A

Atherosclerosis inflow and outflow

Occlusion without warning

27
Q

Why might you have problems viewing a new PTFE graft with duplex?

A

New grafts can have an ultrasonic shadow due to air in the walls, you would see nothing at all where graft is located

28
Q

What is important when duplexing the inflow artery of a graft?

A

Place doppler sv well above prox. anastomoses and scroll through inflow artery and p.anast. into proximal graft

29
Q

Grafts are usually the most ___________ artery seen in duplex

A

superficial

30
Q

GRAFT BODY SCAN: Velocities are normally what?

A

> 45 cm/sec but can vary

Larger grafts = lower velocities

31
Q

GRAFT BODY SCAN: Waveforms appear as what?

A

New grafts = Hyperemic waveform

Graft >2 months = triphasic wave

32
Q

Define Hyperemic

A

EDV up from the baseline

33
Q

You should expect higher velocities at the proximal end of what type of graft? Why?

A

Reversed vein graft, the smaller end is proximal

34
Q

You should expect higher velocities at the distal end of what type of graft? Why?

A

Insitu vein graft, the smaller end is distal

35
Q

How can you see where the Distal anastomosis is?

A

View in transverse to see the arteries join, should be a larger graft to small artery, Velocity usually increases at the toe of an anastomosis.

36
Q

Summarize your duplex scan in a BPG stenosis

A

Pre - few cm proximal to stenosis
At - Highest velocity in stenosis
Post - past a few cm distal to stenosis
Image - Color and B-mode, Trans and long

37
Q

What is the threshold for intervention of a graft stenosis?

A

Ratio >3.5 ratio
PSV >300 or <45
ABI ∆ > 0.15

38
Q

BPG fluid collections appear as what an US?

A

Black areas around the BPG

ArterialClass (10 decks)

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