Terms in this set (45)
What is the tunica intima?
Inner layer endothelial cells, basement membrane is the inner most layer of intimal cells.
What is the tunica media?
Middle layer, muscle, thicker and more organized layer in arteries than veins.
What is the tunica adventitia/externa?
Outer layer, epithelial cells.
Why do veins have a thinner media layer than arteries?
To allow flexibility of lumen size with varied flow volume.
How does the aorta course through the chest and how does it enter the abdomen?
Inferior through the chest, and it enters the abdomen through the diaphragm.
Where is the aorta located?
Anterior and to the left of the spine and to the left of the IVC.
What are the paired arteries of the aorta and what do they supply?
Suprarenal arteries - supply adrenal glands
Renal arteries - supply kidneys
Gonadal arteries - supply ovaries/testicles
Common iliac arteries
What are the unpaired branches of the aorta?
Celiac axis - 1st abdominal branch of the aorta, supplies blood to the common hepatic artery, splenic artery, and left gastric artery.
Median sacral artery
What are the anterior branches of the aorta from superior to inferior?
Median sacral artery
What are the lateral branches of the aorta from superior to inferior?
Common iliac arteries
The common iliac arteries bifurcate where?
What does the common iliac arteries supply?
The legs and pelvis
What kind of flow does the common iliac arteries have?
High resistance flow
Above the umbilicus abdominal arteries are posterior or anterior to veins?
Below the umbilicus abdominal arteries are posterior or anterior to veins?
What are the indications to scan the aorta?
Aneurysm seen on x-ray
What is the lab test associated with the aorta and what can decreased levels indicate?
Hematocrit - decreased levels can indicate an active bleed in the body that could be an aneurysm that is leaking into the abdomen.
What kind of probe is used for adults to scan the aorta?
2.5 - 6.5 MHz
What kind of probe is used for pediatrics to scan the aorta?
4 - 8 MHz
Multiple patient positions can help view the aorta behind gas containing bowel loops. What patient positions can be used?
How would you obtain the aorta and the IVC in the same image? Explain the approaches.
Position the patient in a decubitus position.
Use a coronal approach to angle through the abdomen to visualize the aorta and IVC simultaneously.
A right coronal approach will demonstrate the aorta as the posterior vessel on the image.
A left coronal approach will demonstrate the IVC as the posterior vessel on the image.
What position can be especially helpful for evaluating the distal aorta bifurcation into the common iliac arteries?
Right posterior oblique
Identifying the celiac axis guarantees what?
A complete evaluation of the proximal segment
Identifying the aortic bifurcation guarantees what?
A complete evaluation of the infrarenal segment
What is the sonopgraphic appearance of the abdominal aorta?
Best anatomic landmark in the abdomen.
Longitudinal hollow tube anterior to the spine.
Transverse-circular structure to the left of the comma shaped IVC.
Gradual tapering as it courses distally.
Becomes more anterior in the abdomen as it courses distally.
What are the normal measurements of the aorta?
Prox 2.0 - 2.6 cm
Mid 1.6 - 2.4 cm
Dist 1.1 - 2.0 cm
Iliacs 0.6 - 1.4 cm
What kind of resistance and spectral window does the Doppler of the abdominal aorta have?
High resistance flow, clean spectral window
What kind of flow is visualized above the renal arteries in the aorta and why?
Biphasic due to low resistance branches to organs. Increased diastolic flow in diastole due to branches supplying organs proximally.
What kind of flow is visualized below the renal arteries in the aorta and why?
Triphasic because it supplies the lower extremities which causes an increased resistance. Slightly increased velocity.
What disease may change resistance and phasicity of the waveform?
What disease may show increased turbulence, especially with color Doppler?
What is aortic ectasia?
Lack of tapering of the aorta as it travels distally, size remains constant from proximal to distal portions. Can be a precursor to aneurysm formation.
What is an abdominal aortic aneurysm?
Focal dilation of the aorta >3cm or increase in diameter >50% between two adjacent segments. All three walls of the abdominal wall are stretched.
What is the most common cause of a AAA?
What are the risk factors of a AAA?
What can be indicators for a slow bleed from a AAA?
Anemia and low hematocrit
What is a saccular AAA?
Localized round out pouching, may have small stalk.
What is a fusiform AAA? What is the most common location for them?
Vessel wall stretches in a circumferential manner; most common type.
Below the renal arteries.
What is a berry AAA?
Tiny out pouching, usually found in the cerebrum and splanchnic arteries
What is a mycotic AAA?
Infected aneurysm seen with syphilis
If there is a AAA above the renal arteries what needs to be done?
Immediate surgical intervention
If there is a AAA below the renal arteries what needs to be done?
Surgical intervention >5.5 cm
What arteries can have associated aneurysm formation?
Iliac and popliteal
AAA requires follow up exams when?
After the AAA is first identified.
The annual follow up is on a AAA 4 - 4.4cm diameter
The Semiannual follow up is on a AAA <4.5 cm
What are the complications of a AAA?
Rupture - blood collects in the perirenal space first
Decreased flow to lower extremities
Blue Toe Syndrome with thrombus accumulation and embolization.
Affects renal circulation and systemic blood pressure, if suprarenal or junxtarenal location.
Large AAA can compress IVC causing decreased flow toward the heart and pedal edema.
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