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Vascular final

Terms in this set (55)

1. matching
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2. Female patient with a none healing ulcer in the medial axis of the left malleolus, in addition it has brown discoloration, skin change, the lesion most likely relates to?
Venous Reflux
3. review cerebral vascular and cerebral hemodynamics
Which percentage out of this order represent hemodynamics critical stenosis
:(
4. patient is having RT upper extremity swollen , pt will be getting Duplex ultrasound to rule out Thrombosis.
What is the difference between the Doppler venous signal from upper arm vs lower extremities
The subclavian veins normally maybe non-compressible

the arm has increased flow during inspiration, while flow from the leg decreases with inspiration

Normally the subclavian veins may be pulsatile

All of the Above
5. after 15-20 mins of eating patient is having major abdominal pain and cramping. Which vessel will you scan to find where the trouble is ?
a. the splenic artery
b. the superior mesenteric artery
c. the renal artery
d. the aorta

b. The superior mesenteric artery
6. Patient is having pulsate cold lower extremity, complains of sudden onset of leg pain and numbness what clinical condition might you suspect ? read POAD in acute and chronic
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7.Review reactive hyperemia and its mechanisms what causes it? how it does it work ?
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8. if I'm having 50 % diameter reduction of the vessel, how many times will the resistance to the flow be increase ?
16 times the resistance will be increase
9. pt venous duplex revels non pulsatile and non phasic flow through the IVC what's wrong ?
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10. Review the anatomy of the lower extremities, starting from femoral artery all the way to the calf.
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11. Review anatomy of Portal Vein ,branches , and echogenicity of Portal Vein (all are true except ?)
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12. Review anatomy of the upper venous extremities and distinguish which vein is superficial and which one is deep?
Basilic and cephalic are superficial

radial, ulnar, brachial are deep veins
13. All of the following mechanisms assist in the return of venous flow form the lower extremities to the heart EXCEPT for
A. Inspiration
B.Expiration
C. Calf muscle contraction
D. Venous Valves

A. Inspiration
14. T or F Patient is having blue toe syndrome, question also mentions abdominal aortic aneurysm
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15. Review hepatofugal and hepatopetal flow direction. What type of flow do you see within Portal Vein , Hepatic Artery and Hepatic vein
Hepatopetal = flow direction into the liver
portal vein and hepatic artery are hepatopetal

Hepatofugal = away from the liver
hepatic vein are in hepatofugal
16. Given original lumen diameter (x cm) & residual lumen (y cm). Calculate percentage of diameter reduction.
% of diameter reduction= (1-residual diameter/orignal diameter)x 100
17. How do you know if a valve is incompetent? Review Valsalva maneuver
sensation of flow proximal, compression maneuver all of the above
18. Which vessels shows high and low resistance in CCA ICA & ECA.
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19. Review splenic venous diameter & portal venous diameter. Normal and Abnormal values. inspiration, expiration
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20. Patient is complaining of pain on both legs and can not tolerate any compression on calf veins. Veins above knee are coaptable. All of the following can be on sonographers report except?
We are not allowed to diagnose what patient has, only describe what we see.
22. T/F: Patients right brachial pressure is 140/80 mmHg, left brachial pressure is 120/80 mmHg and ankle pressure is 110/70. Calculate ABI.
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23. What do you define iliac artery aneurysm? how much?
1.5?
24. Scanning arteries of legs(lower extremities), using transverse or longitudinal approach, which approach is best to calculate velocity for lower extremities? Sagittal, Longitudinal or Transverse?
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25. When performing transcranial doppler study (TCD), which can be best visualize w/ submandibular aproach?VEN
A. Submandibular Approach
B. Occipital
C. Transtemporal approach w/ 3 windows
D. Transorbital Approach
26. Venous duplex study, patient has acute DVT. exhibits all if the following except
signs & symptoms
sparky texture
dilated vessels
echo texture dark
chronic bright 53.12
27. Venous duplex scan for lower extremity DVT. All are diagnostic values for DVT except?
compressability
echogenecity will be dark
28. Define May Thurner Syndrome.
explains highest incidence of left sited of DVT
29. what is the proper direction of the hypotopetal vein? normal blood flow direction
Colaterals normal flow
high resistance.
change of velocities
injection of
all of the above 55.43
30. What is the normal flow characteristic through renal arteries? is it monophonic or trifasicpulsatile?
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21. T/F: Review pathology related to Hypercoagulability state of blood. What diseases it?
cancer causes Hypercoagulability
63. Cerebral vascular Anatomy & origins of vertebral arteries.
The arteries in the cerebral area consists of anterior and posterior circulation where The vertebral arteries originate from the subclavian arteries and rises in to C6 to the transverse foramen where right and left vertebral join to make the Basilar artery. It also includes the circle of willis which is formed by Internal carotid artery (left and right)
Anterior cerebral artery (left and right)
Anterior communicating artery
Posterior cerebral artery (left and right)
Posterior communicating artery (left and right). low in resistance, 4 main common approaches used for scanning.
64. Review Fibromuscular dysplasia
An abnormal growth of the lining of the arteries, resulting in narrowing causing slight aneurysm and shaping into a string of beads structure. Seen mostly in Caucasian woman ages 25-50. Most common location is the Renal arteries and secondly in the ICA. Often with no symptoms, but could cause TIAs. During Doppler waveform, turbulence is shown.
65. Review the lower extremities venous system
Consists of deep (higher risk of embolism and life threatening Pulmonary embolism) and superficial veins (plays a big role in regulating body temperature) contains one way valves to keep blood moving from superficial to deep (class 13.) Common Veins scanned CFV, GSV, FV ,Popliteal, anterior tibial vein, posterior tibial, peroneal veins. Healthy veins should have the ability to be compressed and augment.
66. Review carotid, internal carotid & branches
The carotids extend from the aorta, on the right side there is the brachiocephalic which bifurcates on to the right subclavian and right common carotid artery, the common carotid which bifurcates in to external carotid artery and the internal carotid artery that has three Branches: Ophthalmic Artery, Posterior Communicating Artery, and Anterior Choroidal Artery. On the left side the left common artery arises from the aorta which also bifurcates in to the left eca and ica, last branch is the left subclavian
67. Which ulcer is more painful an Arterial or venous ulcer, which bleed, or are irregular?
Arterial ulcers develop around the ankles, feet, or toes caused by lack of blood to the tissue. They are deep wounds, and cold to the touch, no bleeding, and painful. Venous ulcers develop from damage to the veins by insufficient blood back to the heart, they are inflamed, flaky skin, and discharge.
68. Which structural layer of the arterial wall is affected by atherosclerosis?
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69. What is involved/ associated with AAA?
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70. Review bakri syndrome.
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71. Review arterial and venous ulcers.
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72. Review virchows triad stagnation (True or False)?
Factors that contribute to thrombosis. vessel injury being the most common. Venous stasis: condition of slow flow. Example: bed rest, Immobility, congestive heart failure, chronic obstructive pulmonary disease,pregnancy,estrogen intake. / Vessel wall injury. example:trauma, surgery, Iatrogenic injury/ Hypercoaguability: a tendency of blood to clot, Example: Pregnancy, cancer, estrogen intake(class 13)
73. What will Temporal Tapping cause to ECA and spectra?
74. What is the normal diameter for hemodialysis Vein?
2.5
75. Patient is having portal hypertension, what is the most collateralization in portal hypertension?
There is an increase in blood pressure in the portal venous system,
76. primary cause of extra cranial cerebral disease.
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77. When scanning large arteries, should the sample volume be small or big and where should volumes be takes from?
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78. Where do you place calipers during an abdominal aneurysm scan?
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33. Review ABI Values, at what value does Rest Pain occur?
Pain in foot while patient is lying down.
Represents increasing severity of disease

If the ABI ratio is less than 0.5, this indicates severe ischemic symptoms, including rest pain.

>1.30 Calcified
0.9-1.3 Normal
0.75-0.89 Mild
0.5-0.74 Moderate

<0.5 Severe
<0.35 Tissue Threatening
34. What happens to the velocity at a stenotic lesion of 50% diameter reduction in the aorta?
Greater than >50% stenosis is consistent with
Increase in velocity of 100% (doubling)
Post stenotic turbulence
Distal waveform changes (dampened systolic component and loss of reversal component)
35. What are the symptoms and Location of Phlegmasia alba dolens?
Extensive iliofemoral DVT that causes marked swelling of lower extremity with pain, pitting edema, and blanching.
Also called milk leg or white leg
LEG SWELLING IS SEVERE (SIZE OF THE LIMB MAY DOUBLE IN 24 HOURS). NO REDNESS OR CYANOSIS IS IN EVIDENCE
36. Review Renal Transplantation, where is it anastomosed?
Most transplants are placed extra peritoneally in the right iliac fossa
Donor main renal artery (with patch of aortic wall in a DD) is anastomosed to the recipient's external iliac artery.
Use of patch reduces renal artery stenosis.

Donor renal vein is anastomosed to the recipient's external iliac vein.

An ureteroneocystostomy is performed to connect the ureter to the bladder.
Implantation of the donor ureter into the dome of the bladder above the native ureteral orifice (UJV).
37. Define Critical Stenosis in the Renal Artery, 60% Reduction and greater.
CRITERIA FOR > 60% STENOSIS
• Peak systolic velocities exceed 180 cm/sec
• Renal Aortic Ratio (RAR) > 3.5
• Exhibits stenotic profile
• Spectral broadening
• Post stenotic turbulence
• Increased resistance to flow
• RAR IS CALCULATED BY DIVIDING THE RENAL ARTERY PSV BY THE AORTA PSV.
• RAR = Renal Artery psv / Aorta Artery psv

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Normal Spectral Doppler demonstrates:
Rapid systolic upstroke
Slightly blunted peak
Forward diastolic flow
Low Resistance
Early systolic peak or compliance peak often seen on upstroke to systole

PSV = 90-120 cm/s; EDV exceeds one-third of PSV value
PSV and EDV decrease throughout length of artery and into parenchyma
38. Review Abdominal Aortic Aneurysm (AAA). When is it suitable for Surgery?
AAAs occur more frequently in older men, mostly located inferior to renal arteries

AAAs are commonly associated with iliac, femoral, and popliteal aneurysms

Ectasia
Aortic diameter >2 cm but <3 cm
OR, irregular margins and non-tapering profile

Diameter >3 cm consistent with aneurysm; or focal diameter increase by more than 50% of normal segment

True aneurysms involve all three layers of vessel wall

Most commonly involve distal aorta (infrarenal)

Surgery is needed when aneurysms reach 5cm or > *

Fusiform
Bulging which involves entire circumference of aorta
Most common type of aneurysm

Saccular
Asymmetric outpouching dilations
Often caused by trauma or penetrating aortic ulcers

"Iliac artery aneurysm"
- Diameter increases by 50% when compared to normal segment
- Iliac considered aneurysm with diameter >1.5 cm
- Usually associated with atherosclerotic disease
- Often bilateral
39. Advantages of 4 Cuff Segmental Limb Systolic Pressure.
Four-cuff Method

Two smaller cuffs on thigh (high thigh and above knee), one at calf, and one at ankle

Allows ability to further define level of disease by separating iliofemoral disease from superficial femoral artery disease

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Notes:
Pressure drop > 20-30 mm Hg indicates presence of proximal obstruction

Width of thigh cuff changes interpretation
Single large thigh cuff results in a thigh pressure equal to the brachial pressure

Use of narrower high thigh cuff results in artificial higher thigh pressure (about 30 mm Hg above brachial pressure)unless patient has small thigh

LEVEL OF PRESSURE DROP DISEASE LEVEL
1. HIGH THIGH Aortoiliac

2. LOW THIGH Iliofemoral

3. HIGH CALF Femoropopliteal

4. LOW CALF Tibioperoneal

WHEN A PRESSURE DROP OF 20-30 MM/HG OR MORE IS SEEN BETWEEN THE LEVELS ON THE LEFT, THE DISEASE LEVEL IS SUSPECTED TO BE AT THE LEVEL ON THE RIGHT. +

A PRESSURE DROP BETWEEN THE BRACHIAL PRESSURE LEVEL AND THE HIGH THIGH LEVEL SUGGESTS AORTO-ILIAC DISEASE.

A PRESSURE DROP BETWEEN THE HIGH THIGH AND LOW THIGH SUGGESTS ILIO-FEMORAL DISEASE.

A PRESSURE DROP BETWEEN THE LOW THIGH AND THE HIGH CALF SUGGESTS FEMORO-POPLITEAL DISEASE.

A PRESSURE DROP BETWEEN THE HIGH CALF AND THE LOW CALF SUGGESTS TIBIO-PERONEAL DISEASE.
40. Region of the body called "peripheral heart?"
Calf Muscle Pump, Called the "little heart" or "venous heart"
Contraction of soleal and gastrocnemius muscles

Contraction
Pressure from muscles squeezes blood forward

Relaxation
Potential space, blood pools, low or absent pressure
41. The *portal vein* is usually formed by the confluence of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, left and right gastric veins, and cystic veins.
Portal Vein
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