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Terms in this set (46)
What is the first major branch arising from the abdominal aorta?
b. Celiac Artery
d. R. Renal Artery
What is the most common indication for mesenteric artery duplex evaluation?
a. Acute mesenteric ischemia
b. median arcuate ligament compression syndrome
c. chronic mesenteric ischemia
d. mesenteric artery aneurysms
How many mesenteric arteries are typically involved in atherosclerotic occlusive disease before a patient becomes symptomatic?
When does the abdominal pain many patients feel, which is associated with chronic mesenteric ischemia, typically occur?
a. after eating
b. in a fasting state
c. constantly (fasting and non fasting)
d. with aerobic exercise
Because of the abdominal pain, which of the following do patients often experience?
a. overeating and weight gain
b. fear of exercise
c. nausea and vomiting
d. fear of food and weight loss
Which of the following is a collateral system that is present in the mesenteric vascular system?
a. pancreaticoduodenal arcade
b. arc of Riolan
c. Internal iliac to inferior mesenteric artery connections
d. all of the above
From which vessel does a replaced right hepatic artery originate most often?
a. celiac artery
c. Right renal artery
With a patient in a fasting state, what should the SMA exhibit?
a. High-resistance flow pattern
b. low-resistance flow pattern
c. mixed high and low resistance flow pattern
d. respiratory phasic flow pattern
Standard criteria for determining velocity thresholds for identifying stenosis in the celiac and superior mesenteric arteries were determined with the patient in what state?
d. pre and postprandial
What should doppler waveforms obtained from the celiac, splenic, and hepatic arteries demonstrate?
a. high resistance flow
b. mixed high and low resistance flow
c. prolonged systolic upstrokes
d. low-resistance flow
During a mesenteric artery evaluation, retrograde flow is noted in the common hepatic artery. What does this finding suggest?
a. common hepatic artery stenosis
b. celiac artery occlusion
c. superior mesenteric artery stenosis
d. replaced right hepatic artery
Which technique can NOT be used to positively identify and differentiate the celiac and superior mesenteric vessels?
a. having the patient suspend breathing to reduce vessel movement
b. visualizing both the Celiac and superior mesenteric arteries in the same image
c. visualizing aliasing with color flow in the superior mesenteric artery
d. documenting characteristic low resistance flow in the celiac artery
What can turning color-flow imaging off help identify?
a. arterial dissection
b. characterization of atherosclerotic plaque
c. stent placement within the vessel
d. all of the above
During duplex evaluation of the mesenteric vessels, the SMA is noted to have velocities of 350 cm/s proximally with velocities of close to 300 cm/s in the mid-segment. No spectral broadening or turbulence is noted. With which of the following are these findings consistent?
a. compensatory flow through the SMA likely caused by occlusion of the celiac artery
b. significant stenosis of the SMA through its proximal and mid-segments
c. Occlusion of the SMA with reconstitution in the mid-segment
d. normal SMA findings with normal velocities
Which of the following describes the velocity criteria for diagnosis of >70% in the celiac and SMA?
a. >275 cm/s PSV in the celiac and >200 cm/s PSV in the SMA
b. >325 cm/s PSV in both
c. >200 cm/s PSV in the celiac and >275 cm/s in the SMA
d. >50 cm/s EDV in the celiac and >55 cm/s EDV in the SMA
Why may standard duplex ultrasound velocity criteria for mesenteric vessels NOT be accurate after treatment by stent placement?
a. velocities in treated vessels are considerably lower than standard criteria
b. velocities in treated vessels are typically higher than standard criteria
c. stented vessels are not well visualized on duplex scanning
d. Stent struts artifactually decrease reflections, making doppler signals inaccurate
What is transient compression of the celiac artery origin during exhalation, which is relieved by inhalation?
a. acute mesenteric ischemia
b. atherosclerotic disease at the celiac artery origin
c. compression of celiac artery from abdominal aortic aneurysm
d. median arcuate ligament compression syndrome
Visceral artery aneurysms are rare; however, the greatest incidence of aneurysms occurs in which of the following vessels?
a. splenic artery
b. common hepatic artery
c. celiac artery
What is the general role of the vascular lab in the diagnosis of acute mesenteric ischemia?
a. identification of the thrombus at the origin of the SMA
b. no role due to the emergent nature of the illness
c. characterization of the stenosis and degree of narrowing
d. identification of the branch vessel in which embolus is likely to have occurred.
The goal of the "kidney dialysis outcomes quality initiative" and the "fistula first breakthrough initiative" was to increase and expand the creation of which of the following?
a. prosthetic hemodialysis access grafts
b. autogenous hemodialysis access fistulae
c. lower extremity hemodialysis access
d. central venous port access
What is the most common cause of maturation failure of dialysis access fistulae?
a. small or suboptimal veins
b. venous outflow stenosis
c. arterial inflow stenosis
d. arterial steal syndrome
Which of the following should be included during the physical examination for preoperative artery mapping for dialysis fistula creation?
a. bilateral arm blood pressure measurements
b. pulse exam of brachial, radial, and ulnar arteries
c. allen test for palmar arch assessment
d. all of the above
Which of the following is NOT a finding suggestive of a central venous stenosis or occlusion?
a. arm edema
b. prominent chest wall veins
c. painful, cool, pale hand
d. presence of arm collaterals
Which of the following describes the proper patient positioning for upper extremity venous evaluation prior to fistula creation?
a. supine with arm elevated
b. supine or sitting with arm dependent
c. standing with weight held in arm to be examined
d. trendelenburg with feet elvated
With what does standard protocol for evaluation of the upper extremity arteries and veins for fistula creation begin?
a. veins of dominant arm
b. veins of non dominant arm
c. arteries of dominant arm
d. arteries of non dominant arm
What is the acceptable size for upper extremity arteries before fistula creation?
a. >2 mm
b. >2.5 mm
d. <2 mm
All doppler studies should be performed at an angle of ____ or less, even if actual velocities are not recorded to achieve adequate doppler signals
a. 75 degrees
b. 60 degrees
c. 90 degrees
d. 0 degrees
What is the acceptable minimum vein diameter for favorable fistula creation?
a. 2 mm
b. 1.5 mm
c. 2.5 mm
d. 1 mm
Which of the following should venous doppler signals from central veins NOT display?
a. respiratory phasicity
b. cardiac pulsatility
d. continuous flow
What is a type of fistula created by connecting the posterior branch of the radial artery to the cephalic vein?
a. brescia-Cimino fistula
b. transposition fistula
c. snuffbox fistula
d. Berman-Gentile fistula
The most common upper arm access is made between the cephalic vein and which artery?
a. subclavian artery
b. brachial artery
c. axillary artery
d. brachiocephalic artery
Approximately how long should it take an autogenous fistula to mature?
a. 8 to 12 weeks
b. 1 to 3 days
c. 6 to 8 months
d. 1 to 2 years
During evaluation of the upper extremity either before or after fistula creation, the examination room should be kept warm to avoid what?
c. the use of coupling gel
d. ultrasound equipment failure
Which of the following is nOT included in a physical exam of a patient with a current AV fistula?
a. assessment of thrill
b. assessment for edema or redness
c. bilateral radial blood pressures
d. visual inspection for focal dilations and collateral veins
During duplex assessment of the hemodialysis fistula, what should doppler settings be adjusted to detect?
a. low flow
b. continuous flow
c. intermittent flow
d. high flow
Which of the following describes how volumetric flow is calculated?
a. time average velocity/PSV
b. time average velocity x area x 60
c. time average velocity x vessel diameter
d. PSV - EDV / PSV
What can remaining valve leaflets that project into the lumen of a fistula become a source for?
b. pseudoaneurysm development
c. stenosis development
d. calcium deposition
A patient presents to the vascular lab for follow-up evaluation of a dialysis fistula. Velocities within the fistulae are 40 cm/s. What are those findings consistent with?
a. normal fistula function
b. fistula pseudoaneurysm
c. perigraft mass
d. inflow artery stenosis
What should be the approximate normal volume flow in a fistula?
a. 200 mL/min
b. 500 mL/min
c. 800 mL/min
d. 100 mL/min
The minimal normal hyperemic response in PSV following a test feeding is:
a. an increase of ≥20%
b. an increase in absolute velocity 75 cm/s
c. an increase of ≥10%
d. an increase in absolute velocity by 50 cm/s
What technique can be employed to help improve accuracy of the doppler angle alignment?
a. have the patient sit upright
b. have the patient take a very deep inspiration and then hold their breath
c. have a patient valsalva
d. have the patient suspend breathing for a moment
Retrograde flow in the common hepatic artery is predictive of a celiac artery occlusion or severe stenosis in what percentage of patients?
The criterion reported by the Dartmouth laboratory which has a published specificity rate of 100% for a celiac artery stenosis is:
a. EDV ≥45 cm/s
b. EDV ≥55 cm/s
c. PSV ≥200 cm/s
d. PSV ≥275 cm/s
As compared to prosthetic grafts, arteriovenous fistulae have:
a. lower secondary latency rates
b. higher maturation rates
c. higher early thrombosis rates
d. increased flow rates
A brescia-cimino fistula is created by the anastomosis of which two vessels?
a. the basilic vein and brachial artery
b. the cephalic vein and radial artery
c. the cephalic vein and brachial artery
d. the basilica vein and radial artery
A venous stenosis within an arteriovenous fistula often appears:
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