Vascular Final

1. A route (artery) along which the fluid can flow
2. A difference in energy (pressure gradient) levels between the two points
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FusiformWhat is the most common type of aneurysm?< 3.5What is the normal RAR for kidneys?Superior thyroid arteryWhat is the first branch of the ECA?Ophthalmic arteryWhat is the first branch of the ICA?- Major curve right before the ophthalmic artery take off - Located at distal ICAWhat is the carotid siphon and where is it located?- Arterial waveform is high resistance - BP drops slightly or severelyWhat are the abnormal post-exercise findings for lower extremities?Slow upstroke with more rounded peak slow down stroke no reverse componentWhat is the abnormal doppler waveform analysis of post-exercise findings for lower extremities?- Arterial waveform is monophasic - BP increases slightlyWhat are the normal post exercise findings for lower extremities?Dividing the ankle pressure by the highest brachialHow do you calculate ABI?Question calcified arteriesABI findings: greater than 1.3 = what?NormalABI findings: 1.0-1.3 = what?Asymptomatic disease (minimal arterial disease)ABI findings: .9-1.0 = what?ClaudicationABI findings: .5-.9 = what?Rest pain (severe arterial disease)ABI findings: less than .5 = what?Anterior Tibial Artery (ATA)What is the first branch of the distal popliteal artery?Multiple renal arteriesWhat is the most common anatomic variant of the renal arteries?Intraabdominal pressure increases and intrathoracic pressure decreases, halting blood flow in the legs and increasing venous return to the heart from the armsHow does breathing in affect blood flow from legs and arms?Intrathoracic pressure increases and intraabdominal pressure decreases, increasing venous flow in the legs and halting blood flow of the armsHow does breathing out affect blood flow from legs and arms?Left renal veinWhere does the left testicular vein drain into?Calf muscleWhere are soleal sinus veins located?Allow venous blood to accumulate and then drain into the posterior tibial and perineal veins - Act as major part of the calf-muscle pumpWhat do the soleal sinus veins do?Transmural pressure - difference between pressure within (intraluminal) and outside (interstitial) of the veinWhat determines the shape of a vein?Doppler waveforms would show increase in diastolic flow in the femoral artery after exercise can remain the same (or monophasic with vigorous exercise)What would happen to the waveform in the femoral artery after exercise?Length and diameter of vesselsWhat controls peripheral resistance?- Ulcerated and/or atherosclerotic lesions - Embolization - Inflammatory process of arteritis - Some angiographic proceduresWhat causes blue toe syndrome?- Numbness or tingling of the arm - Pain or aching of the shoulder and forearmWhat are the symptoms of thoracic outlet syndrome?- Compare both brachials to see if they are identical to evaluate subclavian steal - To make sure they are equalWhy would you take bilateral brachial pressures for a carotid scan?V: shallow, uneven or irregular shape, brawny discoloration A: deep, well-definedWhat is the difference between arterial and venous ulcers? (appearance)V: near medial malleolus where incompetent perforators are located A: on/near toes, above lateral malleolus, or on the headWhat is the difference between arterial and venous ulcers? (location)V: mild pain, venous ooze A: severe pain, little bleedingWhat is the difference between arterial and venous ulcers? (symptoms)- Irregular borders - Brawny discoloration - Located near medial malleolusWhat are the characteristics of a venous ulcer?- Near lateral malleolus - Well defined margins - Deep - Severe painWhat are the characteristics of an arterial ulcer?Left hemisphereWhat hemisphere controls the right side of the body?Right hemisphereWhat hemisphere controls the left side of the body?Right hemisphereBlood flow from the right ICA goes to what hemisphere of the brain?Left hemisphereBlood flow from the left ICA goes to what hemisphere of the brain?Right ICAWhat vessel could cause left sided paresis?Left ICAWhat vessel could cause right sided paresis?Right ICAWhat vessel could cause left arm numbness and right transient vision loss?- Unilateral paresis - Unilateral paresthesia or anesthesia - Dysplasia or aspasia - Amaurosis fugax - Behavior changes (decreased level of consciousness)What are the anterior circulation symptoms?- Vertigo - Ataxia - Bilateral visual blurring - Diplopia - Bilateral paresthesia - Drop attacks - Nonlocalizing symptomsWhat are the posterior symptoms?DiabetesWhat disease causes calcification to arteries in younger people?Peak to peak frequency / mean frequencyHow do you calculate the pulsatile index?Acceleration timeWhat measurement helps in differentiation of inflow vs. outflow disease by measuring the time between the onset of systole to the maximum systolic peak?Posterior tibial arteryWhat artery runs behind the medial malleolus?Axillary arteryThe subclavian artery turns into what artery?cephalic veinthe subclavian vein gives a branch off what to become the axillary vein75%A stenosis usually becomes a HDSL when the cross-sectional area of the arterial lumen is reduced to ______.- Warmth - Exercise - Relax - StenosisWhat are the causes of vasodilation?- Cold - Nervous - SmokingWhat are the causes of vasoconstriction?Bilateral leg swellingIVC thrombosis would most likely cause what?- Patient body habitus can limit access to renal arteries - Stenosis in accessory renal arteries may not be detected - Doppler angle less than 60 may be difficult to obtain at the renal artery originWhat are the limitations to direct Doppler interrogation of the renal artery origins?Mildly abnormal obstruction/claudicationA volume plethysmography waveform with normal amplitude, rounded peak, and absent dicrotic wave is most likely indicative of what?- Postprandial (post eating) - Stenosis - Replaced hepatic arteryIncreased diastolic flow is seen in the SMA with what? (3)- Celiac axis/trunk - SMA - Renal arteries - IMA - Bifurcation (common iliac arteries)What is the order of the abdominal aorta branches? (5)2 MHzWhat frequency is used for transcranial Doppler studies?Nyquisit limit- 1/2 PRF - The point which aliasing occurs - Highest Doppler frequency or velocity that can be measured without appearance of aliasing- Eye surgery within last 6 months - Retinal detachment - Acute unstable glaucoma - Allergies to local anestheticsWhat are the contraindications to OPG? (4)Proximal to stenosisFlow velocities are usually dampened (decreased) with or without disturbance (turbulence)Flow entry/passing/exit through stenosisIncreased velocities stenotic jet and spectral broadening (turbulence flow)Poststenotic- Turbulence at the exit of the stenosis - Flow reversal, flow separation, vortices and eddy currents can occur near the edge of the flow pattern - Spectral broadening- Innominate/ brachiocephalic artery - Left Common Carotid artery - Left Subclavian arteryWhat are the branches of the aortic arch?Pressure gradientWhat is known as a difference in energy (pressure) levels between two points?Right atriumWhere does the IVC end?CapillariesWhat constitutes the most vital part of the circulatory system? Nutrients and waste products are exchanged between tissue and blood to maintain the constancy of the internal environment Vessels of microcirculation/ size of RBCsAct as a reservoir for blood until calf contracts and propels blood towards the heart (cephalad)What is the function of the venous valves?EmbolizationWhat is the most serious risk from a peripheral aneurysm?Amaurosis fugaxWhat is temporary partial or total blindness (usually of only one eye)?AspirinWhat can reduce the chance of thrombosis?Intravenous Catheter (IV)What is a major cause of upper extremity DVT?- Cusps of venous valves - Soleol sinuses because of stagnationIn the lower extremity, what is the most common place for thrombus to begin? (2)Basilar arteryWhat do the vertebral arteries turn into?- Anterior brain - Eyes - Forehead - NoseWhat does the ICA feed? (4) (wtf i didnt HL this one)- Ulcerated plaque - Mural thrombus within aneurysm - Cardiac dysrhythmiasWhat can be a source of an emboli? (3)Popliteal entrapment syndromeWhat is thought to be caused by compression of the popliteal artery by the medial head of the gastrocnemius muscle?10-12How many valves does the greater saphenous vein contain?1-3How many valves do the popliteal vein contain?1How many valves does the common femoral vein contain?1-3How many valves does the femoral vein contain?To provide nourishment to the tunica adventitiaWhat is the major function of the vasa vasorum?VolumeOPG is a noninvasive technique that records changes in what?High resistantMesenteric arteries studies: In a fasting state, the waveform is ____________ with a reverse component.LowerMesenteric arteries studies: normal post eating the waveform changes to one of _______ resistance.IncreaseMesenteric arteries studies: the end diastolic velocity will ______ from what it was preprandial (pre eating).HighMesenteric arteries studies: abnormally, the postprandial waveform in the SMA or IMA remains ______ resistant.Mesenteric ischemiaMesenteric arteries studies: the presence of a low resistant wave form in the SMA or IMA in a fasting state indicates what?End to side of the external iliac veinHow are transplant kidney veins tied to the patient?Patency of: - Portal veins - Hepatic veins - Splenic vein - SMV - IVC - Hepatic artery RI (resistive index)What do you look at pre and post liver transplant?8-10 MHzWhat is the frequency used for periorbital Doppler study?Subclavian stealWhat would cause a decreased radial pulse?Bernoulli's PrincipleShows that velocity and pressure are inversely relatedPoiseuille's Law- Defines the relationship between pressure, volume flow, and resistance - The radius of a vessel is directly proportional to the volume flow - Q =P/RDiastolic flow reversalWhat is the hallmark sign of high resistance?Radial and ulnar arteriesWhat does the brachial artery split into?ClaudicationWhat is pain in muscles that occurs during exercise but subsides with rest?Not audible; cannot be heardIn segmental arterial studies, the cuff at each site is inflated until the systolic pressure sound of Doppler waveform is _________.- Increased pressure in the veins and increased pooling - Decreased venous return to the heart - Decreased cardiac outputWhat 3 things can happen with valvular incompetence?DissectingWhich type of aneurysm is a small tear of the inner wall allows blood to form a cavity between two wall layers?- ICA - Anterior cerebral - Middle cerebral - Anterior communicating arteriesWhat makes up the anterior circulation?May cause an increase in RIsWhat will acute rejection of the liver transplant do to the resistive index?A prominent pulsatile neck massWhat can excessive CCA tortuosity cause?- Trauma to the vessel - Venous stasis - HypercoagulabilityWhat are the 3 factors of Virchow's triad?Buerger's disease- Associated with heavy cigarette smoking - Occurs primarily in men younger than 40 - Patients present with occlusions of the distal arteries - Rest pain and ischemic ulceration occur early in the course of the diseaseIVCWhat do the hepatic veins drain into?Anterior tibial arteryThe dorsalis pedis is a continuation of which artery?ProximalModerate or severe abnormal volume plethysmography waveforms always reflect hemodynamically significant disease ________ to the level of tracing.History of dull, achy or crampy abdominal pain 15-30 minutes after mealsWhat are the symptoms for an SMA study?Internal iliac arteryThe hypogastric artery is another name for?Arteriovenous fistulaeWhat is an abnormal connection between the high pressure arterial system and low pressure venous system? *can be congenital or traumatic* - close to heart= cardiac failure - peripherally= ischemiaSharp systolic peak with prominent dicrotic waveWhat do normal plethysmography waveforms look like?Left renal veinWhat vein normally courses between the superior mesenteric artery and the abdominal aorta?Form communication between the superficial and deep system (normally goes from superficial to deep)What do perforators do?More severe symptom of diminished blood flow to the most distal portion of the extremity - pain at rest (sleeping) occurs in forefoot, heel, toes (NOT calf)What is rest pain?Raynaud's phenomenonWhat is a condition that exists when symptoms of intermittent ischemia of the fingers and toes occur in response to cold exposure as well as emotional stress?Primary Raynaud's- Intermittent digital ischemia caused by digital (distal) arterial spasm - Common in young women and may be hereditary - Usually bilateral - Benign condition with an excellent prognosisSecondary Raynaud's (AKA Obstructive Raynaud's Syndrome)- Normal obstructive vasoconstrictive response of the arterioles superimposed on a fixed arterial obstruction - Ischemia is constantly present - May be the first manifestation of a collagen disorder or Buerger's diseasePulmonary embolismWhat is the greatest danger from a DVT?ECAWhat artery feeds a carotid body tumor?Lead to hemosiderin depositsWhat happens if perforating veins are incompetent?StrokeBlockage that causes no blood flow to the brain; permanent neurological deficitGreater saphenous veinWhat is the longest vein in the body?- Cannot be specific to a single vessel because it measures volume change in a large segment of a limb - Cannot discriminate between major arteries and collateral branches - Difficult to perform on obese patientsWhat are the limitations to volume Plethysmography?- In combo with doppler segmental pressures, helps differentiate arterial claudication from nonvascular source - Helps locate level of obstruction - PPG and strain gauge plethysmography most often used to evaluate the digitsWhat are the capabilities of Plethysmography?CFAWhat does the external iliac turn into?- Splenic artery - Hepatic artery - Left gastric arteryWhat are the 3 branches of the celiac axis/trunk?Absence or hypoplasia of one or both of the communicating arteriesWhat is the most common anomaly of the Circle of Willis?- Valvular incompetence - Absent valvesPrimary varicose veins form as a result of what?Reactive hyperemia- An alternative method for stressing the peripheral circulation - Can be used if patient can not walk on a treadmillECAManual tapping on the superficial temporal artery will result in the most prominent oscillations on the spectral display of what?Towards the transducerIn transcranial Doppler, with the probe placed over the right temporal bone, flow in the right middle cerebral artery will be what?- Basilar artery - Intracranial vertebralWhat vessels can be evaluated from the transforamenal (foramen magnum) window?Phlegmasia alba dolensWhat are arterial spasms that occur secondary to acute iliofemoral vein thrombosis? (what is swelling of the leg without redness or cyanosis secondary to acute iliofemoral vein thrombosis?)StandingWhat is the best patient position best to visualize varicose veins?May be caused by extrinsic compression due to: - Improper patient position - Pain/anxiety may cause muscle contraction and venous compression - Pregnancy (chronic venous occlusion. that's a false negative)What are the false positive results with impedence plethysmography? (a false positive result with impedance plethysmography is all of the following except what?)Increased end diastolic flowWhat does a low resistant waveform look like?Acute iliofemoral vein thrombosisWhat is Phlegmasia cerulea dolens associated with?reduction in arterial inflowPhlegmasia cerulea dolen: severely reduced venous outflow causes a marked _____ in ______ ______Phlegmasia cerulea dolensBluish discoloration may be seen in ______________Phlegmasia alba dolensWhiteness/pallor may be seen in ______________.- Acceleration flow is mistakenly attributed to a stenosis - collateralizing for ipsilateral or contralateral disease - Inappropriate Doppler angle - Artifact is mistaken for plaqueOverestimation of the degree of stenosis in the ICA may be due to what?- Increase PRF (increases Nyquist limit) - Change to lower frequency transducer - Decrease depth of the vessel - Increase Doppler angle - Use a continuous waveHow do you prevent aliasing?- 2 crystals - No focus - Picks up flow within line of Doppler (range ambiguity), no aliasingProperties of a continuous wave (3)- 1 crystal - Intermittently transmit and receives - Sample gate provides range resolution, sample from exact location, aliasing dependent upon Nyquist limitProperties of a pulsed wave (3)VasodilationWhat can make you lose a triphasic waveform?- Appropriate sample volume size and depth - Knowledge of the direction and velocity of blood flow - Relationship of the various flow patterns to one anotherWhat is the criteria used to correctly identify vessels during a transcranial Doppler exam? (3)Venous Doppler signal should halt or decrease when compressedWhat are the normal findings of proximal augmentation?Venous doppler signal will augment when compressed showing valvular incompetenceWhat are the abnormal findings of proximal augmentation?Doppler signal should increase when you squeeze (should not be an abrupt signal)What are the normal findings of distal augmentation?When you release your squeeze, blood will flow the opposite direction indicating valvular incompetenceWhat are the abnormal findings of distal augmentation?Velocity goes down (decreases) the two are inversely related!What happens to velocity when viscosity goes up (increases)?Ulnar artery- Travels down the medial side of the forearm into the hand - Gives off a deep palmar branch - Terminates in the superficial palmar archChange in vessel diameterWhat has the most dramatic effect on resistance?Hypertension with renal vascular hypertensionWhat are the symptoms of renal artery stenosis?- Cirrhosis - Small liver - Enlarged spleen (splenomegaly) - Dilated portal vein - Blood flow in portal vein in the wrong directionWhat are the characteristics of portal hypertension?Portal hypertensionWhat is the elevation of blood pressure within the portal venous system?Valve leaflets do not close properly and maintain unidirectional flow in the veins, letting blood leak backward across the valve (regurgitation)What is a valvular incompetence?IncreasesVelocity ______ when radius gets smaller.Onset of systole to peak systoleHow do you measure acceleration time?Cannot see areas of high velocity or directionWhat is a limitation to power Doppler?Changes with respirationWhat does phasic flow mean?No shift (zero)What is the doppler shift at normal incidence? (90 degrees/perpendicular)infrarenal aortaWhere do most aneurysms occur?IncreasesWhat happens to RI with renal artery stenosis?RuptureWhat is the biggest risk for an abdominal aneurysm?2:1 = 50% stenosis 4:1 = 75% stenosis 2X faster= 50% blocked 4X faster= 75% blockedPre stenosis to stenosis ratio?Anatomical (not functional)Arteriography is primarily an ____________ study.Multiple images in multiple planesWhat can arteriography not provide in real time?Communication channel or neckWhat is the most important parameter for a pseudoaneurysm?As a severe narrowing of the arterial lumen usually without occlusionHow does a vasospasm appear with arteriography?a single large vein located near the brachial vein (Ascends medially up the arm, becoming the axillary vein where it joins the brachial vein)Where is the basilic vein located?- The vessel is dilated - Poorly attached (can easily break off) - Hypoechoic with smooth borders (- Color flow will show no filling or partial filling)What are the characteristics of acute thrombosis? (4)ECA: usually medial, high resistant waveform (low end diastolic flow), can see take offs, usually smaller, temporal tap ICA: Usually lateral, low resistant waveform (high end diastolic flow), cannot see take offs, usually largerWhat are the ways to tell the ECA from the ICA?- Severe stenosis - Occlusion of the distal subclavianWhat can a subclavian steal not be caused by? (2)Before vertebralThe blockage of a subclavian steal has to be _____ the ______ comes off to cause a negative vertebral artery.Subclavian stealBlood flows retrograde (down the neck away from the brain) down the vertebral artery; blood is stolen from your brain to feed your arm- Brachial blood pressure difference of 15-20 mmHg or greater from one side to another - Decreased pulses in affected arm2 clinical findings that can help diagnose a subclavian steal- Venous anastomosis - Outflow veinsWhat is the most common site for stenosis or occlusion of the hemodialysis access graft? (2) (this wasn't even HL!)IncreasesWhat is the normal response for ankle pressures in comparison with resting value following exercise?75% area reductionA 50% diameter reduction is equal to what?increaseduring the Valsalva maneuver, what happens to pressure in the abdomen and thorax3 cuff techniqueWhich technique uses one large cuff placed as high as possible on the thigh?It gives a more accurate thigh pressureWhat is the advantage of the one thigh cuff in the 3 cuff technique?Only one cuff will fit on the upper thighWhat is the disadvantage of the one thigh cuff in the 3 cuff technique?It provides proximal and distal thigh pressureWhat is an advantage of the 4 cuff method vs. 3 cuff method for segmental pressures?It gives artificially elevated pressureWhat is a disadvantage of the 4 cuff method vs. 3 cuff method for segmental pressures?- One cuff (19x40cm) satisfies the recommended width-girth relationship - Gives more accurate thigh pressureWhat is an advantage of the 3 cuff method vs. 4 cuff method?- One cuff will not fit on the upper thigh - Cannot get prox and distal thigh pressures - Thigh pressure almost same as brachial pressureWhat is a disadvantage of the 3 cuff method vs. 4 cuff method?- 15-20mmHg from brachial to brachial - 15-20mmHg from upper arm to forearm - 2-10mmHg from radial to ulnarHow much blood pressure can be off and still be considered normal in the upper extremities?- Side to side: 20mmHg - Top to Bottom: 30mmHg - Toes: <30mmHg evident in unhealing foot/toe ulcersHow much blood pressure can be off and still be considered normal in the lower extremities?Inflow disease from outflow disease Inflow: Aorta-iliac stenosis/obstruction with thigh/buttock pain (groin) Outflow: superficial femoral stenosis/obstruction (thigh)What does acceleration time help differentiate?