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115 Cards in this Set
- Front
- Back
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What veins connect to form the SVC? |
The two nominate veins. There is only one right denominate artery |
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Venae comitantes |
A pair of veins accompanying an artery |
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Venus valves are an extension of? |
Turnica Intima |
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What is the most tortuous vessels in the body? *** |
The splenic Vein, having a Reynolds number of greater than >2000 |
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Which gonadal vein empties into the IVC? |
The rt gonadal vein, the lt gonadal v empties into the lt renal vein |
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Measurement for portal vein |
Inner to inner, should not exceed 13mm, supine with quiet respiration |
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Most common congenital anomaly of the circle of willis?** |
the absence of one or more communication arteries |
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What's an artery supplying the penis$$$ |
The prudental art supplied by the internal iliac |
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How many valves do perforators have? ** |
Just one |
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Gastrocnemius veins are also called the *** |
Sural veins |
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Flow direction pulmonary veins vs arteries ** |
Pulmonary veins go towards the heart and away from the lungs, pulmonary art away from and towards the lungs |
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First branch of the ECA** |
Superior thyroidal artery |
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What veins typically do not demonstrate spontaneous flow without augmentation?@@ |
Deep calf veins and superficial veins |
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About how many perforators are in each leg? ** |
About 100 |
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What is associated with non-pitting edema?** |
Lymphedema usually does not leave marks when pressed, |
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What kind of swelling is usually not associated with foot swelling?** |
Venous disease is usually not associated with foot swelling, ankle and calf is more common |
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Where are adventitial cyst most common? |
In popliteal artery |
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What is d dimmer most useful for? |
D dimer levels amongst accurate for predicting the absence of DVT. D diameter may be increased to various reasons, including DVT, if absent it is very unlikely that there is a DVT |
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What is an abnormal ABI exam from one exam to another @@ |
when values drop more than 0.15 from one exam to another |
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Origin of small saphenous vein? $$ |
Originates posterior to the lateral malleolus and ascend along the midline aspect of the posterior calf |
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Poiseuille's Law states that. . .$$ |
the vessel radius has the most significant effect on the blood flow in a vessel |
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Normal intracranial waveform** |
Low resistance with spectral broadening SB due to the small size of the vessels |
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How long is exercise perform when performing exercise testing? |
About 5 minutes |
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With post-reactive hyperemia how long are cuffs inflated for? |
For about 5 minutes |
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Snuff box fistula? ** |
Located in the wrist connecting the radial artery with the cephalic vein |
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What is considered normal after a liver transplant? $$ |
Increased resistance in the hepatic artery |
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Kissing stents |
Stents that are placed at the origin of the common iliac arteries touching at the aortic bifurcation |
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Common complication for reverse vein graft? *** |
Stenosis at proximal anastomosis |
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Reperfusion of the leg via bypass graft may lead to @@ |
Anterior compartment syndrome |
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Liver piggyback anastomosis @@ |
Single liver anastomosis where hepatic confluence is connected directly to IVC |
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What's common within the first two months of graft placement? @@@ |
Monophasic waveforms for the first two months as body adjust to graft. Due to reactive hyperemia |
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What increase in aortic sac diameter indicates possible endoleak after AAA repair @@ |
An increase of 0.5cm or greater |
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Hemodialysis requirements@@@ Art/venous size |
Native vein >2.5mm Native artery >2mm Native vein for synthetic graft >4mm |
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Abn reflux in superficial system? And deep?@@ |
>0.5 sec >1.0 sec |
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Peak systolic velocity for renal artery duplex@@@ |
Normal PSV <180 cm/s 60% or greater stenosis > 180-200 cm/s |
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Normal renal aortic ratio @@@ |
Normal <3.5Abnormal _> 3.5 consistent with a 60% or greater diameter reduction |
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When should you not use the renal aortic ratio? $$$ |
If there is AAA present or if the aortic PSV is <40 or >90 cm/s |
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What is an Endo leak in aneurysm repair? @@@ |
Flow within the aneurysm sac outside of the graft walls |
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Normal dorsal vein flow post injection? $$$@@@ |
The dorsal vein velocity should not increase post injection. An increase is suggestive of venous leak.Normal <3cm/secAbnormal >20cm/sec |
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What is evaluated during arterial artery mapping? *** |
This is the determine the suitability of the of the vessel to be used as a graft for the coronary artery bypass. Disease and patency is assessed.Allen test is used to evaluate patency of vessels. The artery should not be used if the hand is dependent on it. The brachial, radial, and ulnar arteriesare assessed.The diameter of the radial artery is assessed for abnormalities proximal, mid, and distal. It should be greater than 2 mm |
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What do we look for in veins for eval of graft use? *** |
Measurements of each vessel is taken proximate and distal. Their patency is evaluated. The diameter should be at least >2 or 3mm. One should comment on any anatomic anomalies which are common in the venous system. For example accessory veins, a typical anatomic course, high brachial artery bifurcation.. |
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Cavernosal artery post injection $$$@@@ |
Pre and post injection waveforms are compared. Cavernosal artery diameter should increase post injection Flow resistance should decrease postinjection, suggesting a higher metabolicdemandPSV should increase >30 cm/second |
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Cuff size for digital pressures |
20% rule. 20% greater than diameter of the toe or finger |
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Normal finger brachial index *** |
0.8-0.9Lower is abnormal and higher is useless |
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Normal ABI? |
1-1.3. lower abn. Higher useless. |
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Normal toe brachial index? *** |
0.66 - 0.75 |
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Normal penis brachial index? $$$ |
Abnormal <0.66 Normal _>0.75 |
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What blood pressure measurement has poor healing potential in the toes? * |
<30mm/Hg |
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What does a positive cold stress study look like?** |
The waveforms will not return to normal within 5 minutes |
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What is the rule of thumb for PVR?$$ |
Air volume should be kept within +/ 10% for each cuff Otherwise dramatically different volumes yield differently appearing wave forms |
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With pvr, a severity of disease often underestimated or overestimated?*** |
Underestimated |
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What rule of thumb does the 4 cuff method violate? *@@ |
20% rule and will result in artifactually elevated thigh pressuresWill be approx 30 mm/Hg higher |
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How much do you inflate the cuff above the last audible Doppler signal? ***$$ |
20-30mm/HgIf repeating wait a minute before trying again.Record signal when first audible signal returns |
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What pressure gradient is significant in the presence of an abnormal abi?$$ |
20-30mmHg side to side or from one level to the next |
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What about upper extremity?**$$ |
15-20mmHg |
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What difference in pressure between radial and ulnar suggest obstruction of the vessel with the lower pressure** |
>20mmHg |
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What is obtained after exercising? |
Ankle pressures should be taken again. They should be the same or higher. If the ankle pressure decreases you may monitor it every two minutes until the pre-existing pressure is attained. |
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What drop in ankle pressure post exercise confirms vascular etiology for claudication?***$$ |
A drop in pressure more than 20 mm/Hg |
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What length of time to recover is consistent with single level disease? And mult level disease? ** |
2-6mins 6-12mins |
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Post-occlusive reactive hyperemia interpretation** |
<50% drop in pressure is consistent with single level >50% drop in pressure is consistent with multi-level disease |
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What is the normal drop in pressure with post occlusive reactive hyperemia $$ |
17 to 34% |
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Delayed systolic acceleration time** |
Think proximal to a stenosis |
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Increased diastolic flow suggest? ** |
Decreased distal peripheral resistance |
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2:1 ratio increase equals*" |
_> 50% diameter reduction |
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CW number of crystals and function |
1 continuously transmitting and 1 continuously receiving |
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At what pressure does blood leave the heart? |
85-95mmHg this is a mean average |
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Where does pressure begin to fall after leaving the heart? |
Pressure falls very little though distributing arteries, Falls greatly at small arteries and arterioles, which are resistance vessels, falls to 25-30mmHg |
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Parabolic flow |
Flow faster in the middle |
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Reynolds number*** |
A unitless number Predicts when stable fluid will become disturbed/turbulent flow Laminar flow <1500 Disturbed flow >2000 |
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Define hemodynamically significant stenosis...$$$ |
A stenosis that causes a notable reduction in flow(Q) and pressure (P) Around 50% diameter reduction |
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50% diameter reduction = _____ area reduction |
75% |
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What does the flow typically look like in a bypass graft? ***@@ |
Low flow velocity <45cm/sec |
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Flow velocity throughout a stent? **@@ |
Uniformly higher throughout |
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CW Doppler Mhz?**@@@ |
7-10Mhz |
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Micro emboli TCD&& |
<300micro secs |
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What does streptokinase do? |
It lyses acute art/venous clots. |
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Recanalization |
Reestablishment of blood flow into a previously occluded region |
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Simethicone is used for @@@ |
Reduce bowel gas. |
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How long after injury does neointimal hyperplasia occur?@@@ |
6-24 months |
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In a dissection, the false lumen usually has what type of flow? |
High resistance flow |
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What happens when a lesion embolizes to the ACA or MCA?@@ |
ACA - More likely to affect the leg than the arm MCA - More likely to affect the arm than the leg, also seen in dysphasia |
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Vertebrobasilar symptoms |
Lesions affecting the posterior circulation, vertebral, basilar, post communicating and post cerebral art.Non-lateralizing symptoms 5 Ds include Dizziness, dyssynergia, diplopia, drop attack, dyslexiaSyncope and vertigo |
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Mesenteric Doppler velocity interpretation@@@ |
70% stenosis or greater Celiac >200 Sma >275 |
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Arcuate ligament compression syndrome, What does inspiration expiration do? |
With inspiration, the diaphragm is brought down in the compression is relieved. With expiration, the diaphragm is brought up in the compression by the ligament is increased |
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Renal Aortic Ratio |
Normal <3.5Abnormal _> 3.5 consistent with a 60% or greater diameter reduction |
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When should you not use the renal aortic ratio? |
If there is AAA present or if the aortic PSV is <40 or >90 cm/s |
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Peak systolic velocity for renal artery duplex@@ |
Normal PSV <180 cm/s60% or greater stenosis > 180-200 cm/s |
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Abnormal renal resistive index@@@ |
>0.8 |
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Abnormal renal acceleration time |
>100 milliseconds |
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Poor healing potential. Unlikely to heal for transcutaneous oximetry? @@ |
< 30 mmHg Same as laser Doppler |
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Review Endo leak types |
Pls |
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How much should cavernosal artery velocity increase after injection? |
It should become less resistant with an increase of at >30cm/s |
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Dorsal vein post injection |
The dorsal vein velocity should not increase post injection. An increase is suggestive of venous leak.Normal <3cm/secAbnormal >20cm/sec |
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What drop in ankle pressure post exercise confirms vascular etiology for claudication? |
An drop in pressure more than 20 mm/Hg |
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What length of time to recover is consistent with single level disease?***$$@ |
2-6 minutes |
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What length of time to recover is consistent with multi-level disease?***$$$@ |
6-12 minutes |
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Post-occlusive reactive hyperemia interpretation |
<50% drop in pressure is consistent with single level>50% drop in pressure is consistent with multi-level disease |
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What is the normal drop in pressure with post occlusive reactive hyperemia |
17 to 34% |
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What pressure gradient is significant in the presence of an abnormal abi |
20-30mmHg side to side or from one level to the next |
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Pulsatility Index |
Peak to peak velocity difference (P1-P2) (peak systolic - diastolic) divided by the mean (average) frequency>4 Normal<4 Abnormal - consistent with a >60% stenosis proximal to the sample |
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(Systolic) Acceleration Time (AT) |
Proximal obstruction results in a delayed time interval between onset of systole and peak velocity Normal AT <133 millisecondsAbnormal AT >133 milliseconds = proximal obstruction |
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Outflow versus inflow |
Outflow is infra inguinal, inflow is Supra inguinal |
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Pain occurs distal to disease, how does pain occur in Leriche Syndrome? |
Aortoiliac obstruction, absent femoral pulses.Symptoms appear in hips, thighs, and lower |
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Normal capillary refill time in toes |
<3 seconds |
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Turbulent vs disturbed flow. Which is associated with disease? |
Turbulent flow |
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Gastrocnemius veins are also called the |
Sural veins |
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Alternative window for visualizing the distal ICA |
The submandibular approach |
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Which forearm are green supplies the majority of blood to the hand? |
The ulnar artery |
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The great saphenous vein is attached to what aspect of the common femoral vein |
The medial side |
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Atherectomy vs endarterectomy |
Endarterectomy - surgical incision is made on the neck Artherectomy - done through a catheter, rotor rooter |
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Gonadal artery and veins origin |
Both arteries originate from the aorta, one being originates from the IVC and the other from the left renal vein |
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Through the trans temporal view the MCA will display flow towards or away from the probe |
Towards |
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The deep femoral artery course compared to the superficial femoral artery |
The DFA travels posterior and lateral to the SFA |
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What will flow look like in the CCA within ICA occlusion? |
It will become higher resistant |
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When is a renal artery stenosis considered significant? |
60% or greater |
