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Vascular > Week 9 Alternative Diagnostic Test and Therapeutic Interventions > Flashcards

Week 9 Alternative Diagnostic Test and Therapeutic Interventions Flashcards

1
Q

What is an arteriography?

A

the radiographic visualization of an artery after injection of a radiopaque substance.
Uses a catheter. Contrast fills the arteries on an x-ray.

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2
Q

What are some limitations of an arteriography?

A
  1. Patients may be allergic to iodine.
  2. No hemodynamic information
  3. Can’t provide multiple images in multiple planes in real time.
  4. Not good for vessel walls
  5. Poor kidney
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3
Q

What are some advantages of using a catheter?

A
  1. Minimally Invasive
  2. Reduced recovery time
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4
Q

Intra-arterial Injection Technique

A

Seldinger technique

  1. Percutaneous puncture of a superficial artery.
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5
Q

What is a DSA? ( Digital Subtraction Angiography)?

A
  1. Contrast and radiation used
  2. Will subtract everything except blood vessel
  3. Image is only focused on the vessel
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6
Q

Hemodynamically significant stenosis on an Arteriography.

A

Diameter reduction of 50% = 75% area reduction.

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7
Q

Normal interpretation of an arteriography.

A

Contrast medium completely fills the vessel.

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8
Q

Aneurysm on an Arteriography.

A
  1. Has the appearance of a straight tube.
  2. Thrombus may develop along the dilated wall.
  3. LACK of arterial branches where you would expect them.
  4. Elongation and tortuosity of the vessel.
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9
Q

Vasospasm on Arteriography.

A
  1. Severe narrowing of the arterial lumen.
  2. Usually in smaller arteries.
  3. Vessel appearance is very smooth.
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10
Q

Fibromuscular Dysplasia.

A

“string of Pearls”
Multiple area stenosis

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11
Q

What causes Fibromuscular Dysplasia?

A

Medial Hyperplasia

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12
Q

Where does Fibromuscular Dysplasia often occur?

A
  1. Distal ICA
  2. Distal Renal artery
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13
Q

endovascular therapy provides flow around an occlusion and creates an intentional dissection.

A

subintimal angioplasty

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14
Q

Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA).

A

Uses radiofrequency energy and a strong magnetic field to produce multiplanar images.

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15
Q

MRA is used for what?

A

imaging blood vessels
1. Used for evaluating abdominal aortic aneurysm (AAA)
2. Used to evaluate peripheral arterial disease.

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16
Q

MRA can…..

A
  1. Quantify blood flow
  2. Can distinguish blood flow from soft tissue.
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17
Q

MRA Limitations

A
  1. Pacemakers
  2. Degree of stenois is difficult to asses accurately
  3. Nonlaminar or slow-flow (stenosis may be overestimated
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18
Q

MRA Interpretations.

A

Similar to that of Arteriograms.

Lack of filling =pathology
Diameter reductions measured.

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19
Q

What is Computed Tomography (CT) ?

A
  1. Uses ionizing radiation
  2. Obtains cross-sectional images of anatomic structures.
  3. Can be performed with or without contrast.
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20
Q

Computed Tomography Angiography (CTA).

A
  1. Better visualization of vasculature than CT.
  2. Performed with contrast agents.
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21
Q

CTA purpose.

A
  1. Helps define the relationship of the aorta to renal artery origins.
  2. Determines whether an aortic aneurysm is present.
  3. Asses for presence/location of dissection.
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22
Q

CTA Limitations

A
  1. Images are degraded by patient motion and surgical clips
  2. Limited application in peripheral arterial disease due to small size of the vessels.
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23
Q

CTA Interpretations.

A

similar to arteriograms

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24
Q

Different types of surgical therapy.

A
  1. Bypass grafts
  2. Endarectomy
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25
Q

What is an Endarectomy?

A

Surgical removal of Atherosclerotic material.

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26
Q

What is the purpose of a Bypass graft?

A

to form an alternate pathway for distal blood flow.

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27
Q

A Bypass graft requires what?

A
  1. good arterial inflow
  2. Patent conduit
  3. Patent distal runoff.
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28
Q

What are the 3 type of bypass graft materials used?

A
  1. Synthetic (PTFE)
  2. Reversed Vein ( great saphenous)
  3. In situ vein ( great saphenous vein)
29
Q

Types of vein harvesting methods

A

1.Open Saphenous vein harvest (OVH) Long incision, wound complication, nerve pain, prolonged recovery.
2. Endoscopic Vein Harvesting (EVH). Less invasive

30
Q

Endovascular Therapy

A

Therapeutic procedures by insertion of a catheter into the vessel
2. Serious complications occur in less than 5% of cases.

31
Q

When using a saphenous vein as a bypass graft, which type has eliminates the need for valve removal?

A

Reversed

32
Q

A surgeon has just treated an occluded vessel by performing a successful lower extremity bypass graft. We scan the vessel intraoperatively (immediately after placement). What type of waveform do we expect to see, and why?

A

Low resistant, because distal capillary beds have been dilated

33
Q

An aneurysm is defined as a segment….

A

An aneurysm is defined as a segment….

34
Q

Why would a subclavian artery aneurysm put us at risk for distal occlusions?

A

Because stagnant blood becomes coagulated along the walls of the aneurysm; then break loose and travel distally

35
Q

Which has a lower risk of atherosclerotic disease?

A

upper extremity

36
Q

Where do we encounter atherosclerosis the most in the lower extremity?

A

in the distal thigh (hunter’s canal) area

37
Q

What is an angioplasty?

A

Mechanical widening of narrowed or obstructed arteries by balloon catheter.

38
Q

Angioplasty technique

A

Used under fluoroscopic guidance ( continuous x-ray beam)

39
Q

Why would an ultrasound be used with an Angioplasty?

A

For patients who are not able to use contrast.

40
Q

What is a Subintimal Angioplasty?

A

Minimally invasive way to provide blood flow around a totally occluded artery.

Creates a channel between the intima and media.

41
Q

What is an Intravascular Ultrasound (IVUS)?

A

Utilizes ultrasound to see inside the blood vessel.
More detailed visualization of the intima and plaque.

42
Q

What is an atherectomy?

A

An endovascular therapy uses a cutting device located on the end of catheter to remove plaque from large vessels.

43
Q

What is a thrombectomy?

A

An endovascular therapy refers to the surgical removal of a blood clot.

44
Q

What is stenting?

A

An endovascular therapy maintains an open lumen using a wire mesh tube.

45
Q

What is an embolectomy?

A

An endovascular therapy refers to the surgical removal of an embolus.

46
Q

What types of stents are prone to twisting?

A

stent grafts

47
Q

What types of stents are prone to migrating?

A

mesh wire stents and stent grafts.

48
Q

What types of stents are limited by leaks?

A

Stent grafts

49
Q

What types of stents are prone to being dislodged?

A

Both mesh wire and stent grafts

50
Q

This method uses ionizing radiation to obtain cross-sectional images of anatomic structures and can be performed with or without contrast.

A

CT

51
Q

Where should thrombin be injected for treatment of pseudoaneurysm?

A

into the pulsatile mass

52
Q

What is the ultimate goal of manual transducer compression of a pseudoaneurysm?

A

To compress the neck

53
Q

This is defined as behavior modification and drug therapy

A

medical therapy

54
Q

This method optimizes tissue transfer procedures in plastic surgery

A

angiosome concept

55
Q

The control of risk factors is considered….

A

Medical Therapy

56
Q

This may change the geometry of the vessel.

A

Endarectomy

57
Q

This bypass graft harvesting method involves an camera to view internal parts and one inch incisions.

A

Endoscopic vein harvesting (EVH)

58
Q

To detect an endoleak using ultrasound, you should..

A

Use a low PRF

59
Q

Which artery could be used for catheter insertion?

A

Axillary

60
Q

This endovascular therapy refers to the surgical removal of a blood clot.

A

Thrombectomy

61
Q

This endovascular therapy uses a cutting device located on the end of catheter to remove plaque from large vessels.

A

atherectomy

62
Q

With this endovascular therapy, there is widening of obstructed arteries by a balloon catheter…

A

angioplasty

63
Q

Endoleak Type I

A

Attachment site leak

One of the most dangerous and should be repaired.

64
Q

Endoleak Type II

A

Main type of endoleak

Branch leaks, originates from native vessel branching off the aorta

65
Q

Endoleak Type III

A

Leaks from the connections of modular components
Leaks from multiple graft connections
One of the most dangerous and should be repaired.

66
Q

Endoleak Type IV

A

Minute tears in the fabric or changes in porosity
Not seen anymore

67
Q

Endoleak Type V

A

Early manufacturing defect.
Continued growth without endoleak
Pressure of pulsating graft

68
Q
A

Vascular (3 decks)

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