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vas3: exam 1

Terms in this set (125)

the largest artery is the _________
aorta
the widest vein is the ________
IVC
the aorta begins after the _____(1)____ and terminates into the ___(2)___
1. descending aorta
2. RCIA and LCIA
the abdominal aorta brings blood to ________
lower extremities and abdominal organs
the abdominal aorta brings blood to the lower extremities and abdominal organs by means of what 5 main branches?
1. celiac artery
2. superior mesenteric artery
3. right renal artery
4. left renal artery
5. inferior mesenteric artery
the abdominal aorta runs on the ____(1)____ of the midline and the IVC runs on the _____(2)____ of midline
1. left
2. right
the abdominal aorta begins at the ______ thoracic vertebra
12th
the abdominal aorta high resistance normal PSV is ___-____ cm/sec
80-100
The abdominal aorta ranges from ____-____ cm in size, the average is 2.0 cm
1.1-3.0
the proximal part of the abdominal aorta is called the ____________
suprarenal
the suprarenal part of the abdominal aorta is from:
a. superior to the liver
b. SMA to the renal arteries
c. diaphragm to origin of SMA
d. renal arteries to the aortic bifurcation
diaphragm to origin of SMA
the mid part of the abdominal aorta is called the _______
juxtarenal
The juxtarenal portion of the abdominal aorta is from:
a. SMA to the renal arteries
b. diaphragm to origin of SMA
c. renal arteries to the aortic bifurcation
d. tributaries from the liver
SMA to the renal arteries
the distal portion of the abdominal aorta Is called the ____________
infrarenal
the infrarenal portion of the abdominal aorta is from:
a. SMA to the renal arteries
b. Inferior to the liver and to the level of the iliac bifurcation
c. diaphragm to origin of SMA
d. renal arteries to the aortic bifurcation
renal arteries to the aortic bifurcation
what other two names can the celiac artery called?
celiac trunk, celiac axis
what is the first major anterior branch of the aorta?
celiac artery
the celiac artery is a trifurcation, what 3 arteries does it give rise to?
1. hepatic
2. splenic
3. left gastric arteries
the celiac artery is high/low resistance?
low
the PSV of the celiac artery is _______ cm/sec
<200
What 5 organs does the Celiac artery supply?
1. liver
2. gallbladder
3. stomach
4. intestine
5. pancreas
the second anterior branch of the abdominal aorta is called _____________
superior mesenteric artery
the superior mesenteric artery supplies what part of the body?
small intestine and some of large intestine
the superior mesenteric artery can share a common trunk with the _________ artery
celiac
what are the 5 branches of the superior mesenteric artery?
1. inferior pancreatic artery
2. duodenal artery
3. colic artery
4. lleocolic artery
5. intestinal artery
what does pre prandial mean?
fasting state
what's post prandial mean?
after eating state
the superior mesenteric artery is affected both pre and post prandial, the normal PSV is ____ cm/sec
<275
the renal arteries supplies the _________ and ____________
kidney, adrenal glands
the renal arteries are high/low resistance?
low
the (left and right) renal arteries arise from the _________ branches of the aorta
lateral
The PSV for the renal arteries is ___-____ cm/sec
<180-200
What is the last or 5th anterior branch of the aorta?
inferior mesenteric branch
the inferior mesenteric branch arises ____-___ cm ABOVE the aortic bifurcation
3-4
the inferior mesenteric branch arises 3-4cm above the _______________
aortic bifurcation
The inferior mesenteric artery supplies blood to the:


(3 locations)
colon, rectum, majority of large intestines
the inferior mesenteric artery affected pre and post prandial the PSV is ______ cm/sec
<275
State the three main branches of the inferior mesenteric artery
left colic, sigmoid, superior rectal arteries
the anterolateral branches of the aorta that arise below the renal arteries are the ______ or _______ arteries
testicular or ovarian
state the artery:

arises posteriorly off the aorta, contains 4 pairs of vessels that course laterally and posteriorly along lower portion of vertebrae
lumbar arteries
state the artery:

Single artery arising off the posterior aorta, arises just above the aortic bifurcation
middle sacral artery
The external iliac vein drains the ______ and ______
inferior abdominal wall, legs
The internal iliac vein drains the _________
pelvis
Another word for internal iliac vein is ___________
hypogastric
the internal iliac vein and external iliac vein forms the __________ bilaterally
common iliac vein (CIV)
What vein is continuous with the common femoral vein?
external iliac vein
the proximal portion of the IVC is called the ___________
suprahepatic
the suprahepatiic is located where?
superior to the liver
the mid portion of the IVC is called the ___________
intrahepatic
the intrahepatic includes __________ of the liver
tributaries
The distal portion of the IVC is called _____________
infra-hepatic
the infrahepatic is located where?
inferior to the liver and level of the iliac bifurcation
Name the major tributaries of the IVC
renal veins (right and left)
hepatic veins (right, middle, and left)
lumbar veins
ovarian veins
testicular veins
how many hepatic veins are there?
3 (right, middle, left)
In _____% of individulas the middle and left hepatic veins form a common trunk before emptying into the iVC
96
The ______ and ______hepatic veins form a common trunk before emptying into the IVC in 96% of individuals
middle, left
why is the hepatic veins called the right medium liver?
drains the right middle left lobes of liver
ovarian or testicular vein usually drains into the __________
left renal vein
state the risk factors for abdominal arterial testing
age, smoking, hypertension, known atherosclerosis, male, Caucasian, immediate relative with AAA, trauma
____________ comes from vibration of tissues surrounding a high grade stenosis
abdominal bruit
with a stenosis that is < 50%, blood flow can still be ____________
normal
with a stenosis that is ________% diameter, blood flow can still be normal
<50
with a stenosis > 50% diameter, blood flow is affected and considered a ___________ stenosis
hemodynamically significant
with a stenosis ______%, blood flow is affected and considered a hemodynamically significant stenosis
>50
arterial/venous claudication comes from ischemia
arterial
arterial/venous claudication comes from reflux (too much blood in the limb)
venous
select all that are indications of an arterial testing exam:
1. known AAA, iliac aneurysm, or aneurysm in another location
2. cardiac bruit
3. abdominal bruit
4. abdominal pain
5. cardiac pain
6. non pulsatile aorta
7. pulsatile aorta
8. hypertension history
9. hypotension history
10. proximal emboli
11. distal emboli
12. cyanosis
13. pulslesnness
14. tachycardia
15. claudication of the arms and hands
16 claudication of the hips and butt
1, 3, 4, 7, 8, 11, 12, 13, 16
obesity is a contraindication for abdominal arterial testing, how can this be corrected?
increase vessel depth, decrease resolution and clarity, 2.5 MHz
abdominal gas is a contraindication for abdominal arterial testing, how can this be corrected?
apply probe pressure
list the 3 contraindications (or limitations) for abdominal arterial testing
obesity, abdominal gas, breathing difficulties
what is the patient prep for an abdominal arterial test?
fasting after midnight (6-12 hours), limit liquids, no smoking, no gum chewing
how do you know if you're scanning infrarenal?
bifurcation
identify what measurement is taken in each view: area or diameter:
____(1)_____ measurement in long view and _____(2)________ measurement in transverse
1. diameter
2. area
normal lumens should be ____________
anechoic
what is being evaluated for arterial testing?
presence of aneurysm
arterial testing; what is a good tool to asses for stenosis quickly and turbulent flow patterns?
color flow doppler
aorta is high/low resistance
high
why is the aorta considered high resistance?
supplies the legs with blood
(if supplying an organ= low resistance
if supplying an extremity= high
ex;ECA supplies the face= high resistance. ICA supplies the brain= low resistance)
what does a spectral window indicate?
normal laminar blood flow
suprarenal will have more diastolic flow than infrarenal, why?
closer to the heart
which one has more diastolic flow?
- suprarenal or infrarenal
suprarenal (closer to the heart)
For spectral doppler assessment of the abdominal aorta the angle obtained is _______degrees
60
the most common arterial disease is:
a. arteriosclerosis
b. atherosclerosis
c. thrombus
d. occlusion
atherosclerosis
State the 2 ways atherosclerosis affects blood flow
decreases blood flow, generates emboli
_________ will appear hyperechoic with acoustic shadowing
calcifications
_______ is often homogeneous with smooth borders and is found in the sac of an aneurysm.
thrombus
slow moving blood is called:
stasis or stagnant
Contents of a plaque or fragments of an organized thrombus from the heart or aneurysm loosen and flow downstream is an ____________
emboli
if an emboli becomes lodged in distant blood vessels causing _________
arterial occlusion and reduction of flow
an arterial emboli leads to _____________ while a venous emboli leads to ______________
ischemia pulmonary embolism
____________ occurs when degeneration of the elastin tissue within the media which results in dilatation, decreased wall thickness, and increased wall tension
aneurysmal disease
aneurysmal disease;
_________ breakdown plays a key role in dilatation
elastin
aneurysmal disease;
_________ breakdown leads to rupture
collagen
to be considered an aneurysmal disease diameter is ______ cm
>3
___________ is present when there are areas of dilatation less than 3cm, irregular margins or if the aorta does not taper off in diameter.
Ectasia
which part of the abdominal aorta is at higher risk for AAA
infrarenal
____________ are tiny vessels that supply blood and nutrients to the walls of the abdominal aorta
vasavasorum
Blue Toe Syndrome is caused by _________
emboli
Secondary to initial aneurysm is __________
arterial thrombosis
what are the two types of aneurysms?
fusiform and saccular
abdominal aortic aneurysms:
1. AAA in the general population________%
2. Many patients are ________
3. Predicated rate of expansion is _______cm per year
4. <4 cm patient is monitored with ultrasound every _______ months
5. AAA ______ cm needs immediate intervention
6. Rupture of AAA ____% mortality rate
1. 5-7
2. asymptomatic
3. 0.2-0.5
4. 6-12
5. >5-5.5
6. 50
select all causes of Abdominal aortic aneurysms (aaa)

1. arteriosclerosis
2. atherosclerosis
3. inflammatory process
4. hypertenison
5. hypotension
6. women
7. men
8. genetic
9. trauma
10. infection
2, 3, 4, 7, 8, 9, 10
what is the most common type of aneurysm?
fusiform
State whether it's fusiform or saccular:
asymmetric out-pouching dilatations
saccular
State whether it's fusiform or saccular:
involves the entire circumference of the affected portion
fusiform
State whether it's fusiform or saccular:
may extend to iliac arteries and higher risk of rupture
saccular
State whether it's fusiform or saccular:
gradual dilatation, where all three walls are intact but stretched
fusiform
saccular aneurysms are often caused by __________
trauma
What are the two treatment options for Abdominal aortic aneurysm (AAA) ?
surgical, endograft
what is the purpose of an endograft as an AAA treatment?
forms a new lumen for blood flow
endografting for AAA treatment; grafts are a combination of __________ and __________
intravascular stent and prosthetic graft material
Gow are grafts held in place for an endograft procedure?
by hooks and barbs
Where is the graft placed in an endograft procedure?
below the lowest renal artery (proximal) and near the iliac bifurcation (distal)
what are the 3 types of endograft stenting?
bifurcated, straight tube, uni-iliac graft
which of the three basic types of endograft stunting is the most common?
bifurcated
___________ is a surgical connection
anastomosis
identify if it is a true or false endoleaks from stent graft:

blood flow remains in the aneurysm after the graft is in place
uniform color doppler appearance that is reproducible
true endoleak
identify if it is a true or false endoleaks from stent graft:

may be seen in the early post op period. there is movement of non clotted blood within the aneurysm sac due to wall motion artifacts
false endoleak
EVAR stands for
endovascular aneurysm repair
What will symptoms will be suggestive of endoleaks? (there's 4)
increase in sac size, increase in pulsatility of sac, areas of echolucency, spongy residual sac.
identify the four main types of endoleaks:

- modular disconnection or defect in graft fabric

-retrograde flow in branch vessel (lumbar, inferior mesenteric, accessory renal, and internal iliac arteries)

-inadequate or ineffective seal at attachment site

- porous graft or microleak in graft material
3
2
1
4
identify the type of endoleaks:

porous graft or microleak in graft material
4
identify the type of endoleaks:

modular disconnection or defect in graft fabric
3
identify the type of endoleaks:

inadequate or ineffective seal at attachment site
1
identify the type of endoleaks:

retrograde flow in branch vessel (lumbar, inferior mesenteric, accessory renal, and internal iliac arteries)
2
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