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Intro to Vascular > Week 9: Lower Extremity Arterial Scanning > Flashcards

Week 9: Lower Extremity Arterial Scanning Flashcards

1
Q

CHRONIC ATHEROSCLEROTIC OBSTRUCTIVE DISEASE

  1. Individuals usually suffer from ____
  2. Pain is most located in the ____
  3. Arterial obstruction will be ____ to the site of claudication symptoms
A
  1. claudication
  2. calf
  3. proximal
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2
Q

FLOW CHARACTERISTICS: STENOSIS

  1. Pre stenotic: flow velocity is _____
  2. At the site of stenosis, flow _____ within the stenosis and becomes turbulent distally
  3. Arterial stenosis eliminates the ____ phase
  4. Flow distal to the stenosis or post stenotic can be characterized as _____
A
  1. decreased
  2. accelerates
  3. diastolic
  4. biphasic or monophasic
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3
Q

FLOW CHARACTERISTICS: STENOSIS

  1. Proximal pulsatility changes, flow velocity ____
  2. ____ velocity in the stenotic zone
    3.____ flow in the post stenotic zone
    4.Distal pulsatility changes, flow velocity decreased, ____ waveform noted
A
  1. decreased
  2. Increased
  3. Disturbed (turbulent)
  4. tardus-parvus
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4
Q

FLOW CHARACTERISTICS: STENOSIS

Always take a PW sample prestenosis, at the area of stenosis, and post stenosis

A
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5
Q

ARTERIAL STENOSIS GRADING

  1. ____ - Divide the maximum PSV recoded across the stenosis by the PSV recoded in a normal area of the artery just proximal to the stenosis

2.____: focal doubling of the velocity suggests a > 50% arterial stenosis (If the maximal stenotic PSV doubles the pre stenotic PSV)

A
  1. Peak systolic velocity ratio
  2. Rule of thumb
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6
Q

ARTERIAL STENOSIS GRADING
Jean Ellison at Cedars-Sinai Medical Center in LA:

> 2:1 ratio for ____ stenosis

A

> 50%

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7
Q

ARTERIAL STENOSIS GRADING
Jean Ellison at Cedars-Sinai Medical Center in LA:

> 4:1 ratio for ____ stenosis

A

> 75%

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8
Q

ACUTE ARTERIAL OCCLUSION

  1. Symptoms are ____, severely ____, and _____
  2. _____ have not had time to develop
A
  1. immediate, painful, cyanotic
  2. Collaterals

*note: no color/PW Doppler flow or collaterals formes yet

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9
Q

What are the causes of acute arterial occlusion? (2)

A
  1. Thrombotic: from thrombus formation at an aneurysm or pseudoaneurysm
  2. Embolic: from thrombus or other material traveling from a proximal level to plug a stenotic segment of the artery
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10
Q

HEMATOMA VS PSEUDOANEURYSM

What are they caused by?

A

Both can occur after a patient undergoes a cardiac catheterization procedure

Both are caused from the artery not closing well after accessing the femoral artery resulting in
blood escaping into the surrounding tissues

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11
Q

What are the difference between hematoma and pseudoaneurysm?

A

Hematoma
- blood escaped the artery then clots and forms a mass
- homogenous and grainiy appearance sonographycally
- DO NOT have blood flow within

Pseudoaneyrysm
- blood continues to flow into and out of a discrete area in the tissue through the interrupted arterial wall (fails to seal)
- Sonographically the color flow pattern will look like a “yin-yang symbol”
- Treated by ultrasound guided thrombin injection

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12
Q

What is this?

A

hematoma

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13
Q

What is this?

A

pseudoaneurysm

*key is to find the neck. notice that there’s severe aliasing, it won’t close its own unless applying the pressure or use thrombin to clot the blood

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14
Q
  1. PW Doppler waveform within the pseudoaneurysm will demonstrate a____ pattern
  2. Systole- ____ flow through the neck/tract into the pseudoaneurysm
  3. Diastole- ____ flow out of the pseudoaneurysm due to the pressure being higher in the pseudoaneurysm than in the arterial lumen
A
  1. “to-fro” flow *note: “to-fro” or “to and fro” - constant movement backward and forward.
  2. antegrade
  3. retrograde
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15
Q

What are the 2 common treatment for pseudoaneyrysm?

A
  1. Thrombin injection-most common
  2. Hold transducer pressure over the area
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16
Q

What is this?

A

arteriovenous (AV) Fistula

17
Q

What is AV fistula?

A

An abnormal communication between an artery and a vein

*appears arterial flow/pulsatation in veins = a sign of AV fistula

18
Q

AV Fistula:
1. can be ____ or ____
2. Caused when the ____ and ____ are punctured simultaneously
3. It can steal flow from distal circulation, causing ____
4. In severe an AV fistula it can reduce distal resistance so significantly it can cause some degree of ____
5. Most close on their own, do not need surgical intervention

A
  1. congenital or acquired (from a femoral stick at cardiac cath)
  2. artery, vein
  3. ischemic symptoms
  4. heart failure
19
Q

ARTERIOVENOUS (AV) FISTULA

1.Blood typically shunts from the ____ into the ____ at the site of the fistula
2.Loss of the triphasic waveform within the artery ____ to the fistula
3.Decreased blood flow within the artery ____ to the fistula
4.Increased pulsatile blood flow within the vein ____ to the fistula

A
  1. artery, vein
  2. proximal
  3. distal
  4. proximal
20
Q

BYPASS GRAFT SURVEILLANCE

  1. Checks for graft ____ and to try to spot impending graft failure
  2. Easily ____ and ____
  3. Better to repair a narrowed graft than to start all over with a new one
  4. Most lower extremity grafts are made using the patient’s ____*Better patency rate than synthetic material
A
  1. patency
  2. repeatable, harmless
  3. greater saphenous vein (GSV)
21
Q

When a vein graft is not possible surgeons use a synthetic material

  1. ____: sonographically has *a double-wall appearance
  2. ____: sonographically has a fuzzier, wavy/woven appearance
A
  1. Gore-Tex
  2. Dacron
22
Q

What is this?

A

Gore-tex
*double walls

23
Q

What is this?

A

Dacron

24
Q

BYPASS GRAFTS

Grafts using the patient’s own GSV have 2 configurations (2 ways to get around the problem if valves allowing flow to only go cephalad)

What are 2 configuration?

A
  1. in situ
  2. reversed
25
Q

LOWER EXTREMITY BYPASS GRAFTS: TYPES (5)

A
  1. Aortoiliac and aortofemoral
    -Provide flow around inflow obstructions
    -Frequently bilateral
  2. Femrofemoral
    -Used when the iliac artery on one side is severely obstructed
  3. Axillofemoral
    -Run from the axilla artery down to the common femoral artery
    -Commonly used in combination with femrofemoral grafts
  4. Femropopliteal
    -Run from the common femoral artery down to the popliteal artery
    -Usually used to bypass obstructions in the superficial femoral artery

5.** Femrotibial and popliteal-tibial**
-Can be used to try to perfuse a foot that is threatened by ischemia

26
Q

BYPASS GRAFT SURVEILLANCE

  1. ____ : the attachment or connection of one vessel to another
  2. Most common type of anastomosis in the lower extremities is the ____ (The end of the graft is joined to the side of the native artery).
  3. Obstruction often develops at the ____ and ____ anastomoses due to the altered hemodynamics in these areas
  4. ____ more commonly due to the** lower velocities** there
  5. ____ sites also promote obstructive disease
     Spectral velocities can be high within a graft shortly after it is installed, and lower over time
A
  1. Anastomosis
  2. end-to-side
  3. proximal, distal
  4. Distal
  5. Valve
27
Q

What type of graft is this?

A

end-to-side

28
Q

most common type of graft

A

femropopliteal

29
Q

What type of graft is used to bypass obstruction in the superficial femoral artery?

A

femropopliteal

30
Q

What type of graft is used to perfuse a foot that is threatened by ischemia?

A

femrotibial or popliteal-tibial

31
Q

What type of graft commonly used with femrofemoral grafts?

A

axillofemoral

32
Q

What type of graft is used when the iliac artery on one side is severely obstructed?

A

femrofemoral

33
Q

What type of graft is used to provide flow around inflow obstruction and frequently bilatreral?

A

aortoiliac or aortofemoral

Intro to Vascular (17 decks)

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