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198 Cards in this Set
- Front
- Back
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1) List some common causes of UE thrombosis?
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-IV's and central lines (#1)
-Effort thrombosis or Paget-von Shrotters syndrome -Tumors -IV drug abuse -Post op complications |
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Describe an apheresis catheter?
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-Infusion of a patient's own blood from which certain cellular or fluid elements have been removed
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Describe fibrin sheath formation
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Fibrin sheath formed around IV line within 24hrs and most central venous catheter are encased by 5-7 days.
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List some common symptoms of UE DVT?
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Swelling
-pain -inflammation at IV site -Preop -Malfunctioning central line |
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Describe a normal UE venous exam doppler
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-Spontaneous
-Pulsatile above the axilla -Phasic with pulsatility -Augmentation below the axilla -Similar side to side |
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UE venous exam what vein is often mistaken for the subclavian vein?
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-Scapular vein
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List some variation of the arm veins?
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- high radial/ulnar vein bifurcation
-High bifurcation of basilic vein -Double basilic or cephalic veins -Median nerve looks like a very small occluded brachial vein just above the artery |
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Signs of retrograde flow in the IJV or SCV are indications for what?
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Proximal BCV obstruction
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Name two major collaterals for the IJV?
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- Facial vein and superior thyroid vein
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Name two major collaterals for the innominate vein?
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Anterior jugular to the other side
-Facial veins to the other side |
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If you see partial thrombus in the vein does it affect the Doppler signal?
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No, it only affects distally with total occlusion Anterior jugular to the other side
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) What should you expect the flow to be distal to occlusion?
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Poor flow
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What upper extremity vein typically runs medially in the arm from the wrist to join the brachial vein in the mid to upper arm?
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-Ulnar vein
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When the patient takes a deep breath, what happens to the blood flow?
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Increase
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What is the most common symptom of UE DVT is?
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- Pain and swelling
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It is difficult to compress the SCV due to the presence of the clavicle. What is an alternative of achieving full compression?
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-Sniff test
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List the order of blood flow startinf from the heart
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Ventricle, aorta, arterioles, capillaries, venules, veins, superior and inferior vena cava, right atrium and ventricle, pulmonary artery, lungs and vein
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Can an embolus cause stroke?
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Yes, if there is a patent foramen ovale the embolus can travel to the brain instead of the lungs
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About what percentage of blood resides i nthe veins at any given time?
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75%, it acts a reservoir
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When does arterial flow have effect on venous flow?
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-In very severe arterial insufficiency
21) Describe three instances where you might seen pulsatility in the venous system? -CHF -Triscuspid valve insufficiency -Well hydradted individual |
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List some causes of lack of venous respiratory changes?
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Proximal thrombus (continous signal)
-Proximal extrinsic compression -Decreased respiratory effects in LE: -Shallow breathing - Chest breathers |
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Hydrostatic pressure is the primary factor in determing...
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Intravascular pressure
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About how many ml of blood pools in the LE when you stand?
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-250 ml
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Where is hydrostatic pressure the greatest when you are standing?
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- the feet
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List the normal venous intraluminal pressure
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Lying- 10mmHg
-Standing- 80 mmHg -Walking - 25mmHg |
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List the abnormal venous intraluminal pressure
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Lying- 10 mmHg
Standing >100 mmHg Walking >50 mmHg |
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List some of the effect of incompetent valves
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retrograde and antegrade venous flow
- increases HP - Increases filtration of fluids into extracellular spaces (swelling) - skin discoloration -ulceration -Venous claudication |
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What is the normal time for PPG tourniquet test?
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>20 seconds
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What is the difference b/w primary and secondary varicose veins
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- Primary- no underlying disease
-Secondary- Post-phlebetic |
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Incompeten perforating veins of what size are considered incompetence?
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>3.5 mm
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For reflux, what range is considred abnormal.
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- >.5 -1 second
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33) List some common CVI therapy
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- Compression stocking
-Elevation of LE above level of heart -Unna boots - Ligation of incompetent perforators -Superficial vein stripping -Sclerotherapy -Laser or radiofrequency ablation |
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34) For vein mapping, branches of what size can be used as additional conduit?
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>2.5mm
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For vein mapping, vein of what size is considered as optimal ?
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>3mm
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List three venous valvular dysfunction:
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- Congenital absence of competent venous valves
- Recanalization of veins with DVT - Pathologic dilatations of veins |
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) Essentially all symptoms of CVI are physiologically attributed to...
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- venous hypertension
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Which symptoms of CVI is always associated with both chronic obstruction and valvular incompetence at the same time?
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- venous claudication
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Flow reverses in early diastole due to what?
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High resistance in the distal arterioles and compliance of the artery
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Resistance in the peripheral arteries are primarily due to what ?
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-Arterioles
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List some samples where arterioles may dilate in response to needed flow
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-Exercise
-Reduced inflow -Inflammation -Infection |
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List some causes of a low resistance peripheral artery waveforms
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Inflow obstruction
-Exercise -Inflammation/infection |
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According to the resistance equation, what one factor has the most affects on resistance?
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radius
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Describe Poiseuille's law
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q= Delta P/ R
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Describe pulsitility index
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PSV(A)-EDV(b)/ mean aka Gosling equation
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Describe resistitive index
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PSV-EDV/PSV or Pourcelot equation
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Describe the flow equation
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Q= Area x mean velocity
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A low resistance wave in a vessel that is normally high R may be from what...
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- Proximal obstruction that made the arterioles dilate to increase flow
- Infection, inflammation, exercise |
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Describe bovine arch
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- Left CCA comes of the innominate
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What are the most common complications for aneurysm in the aorta and popliteal respectively.
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- Aorta- rupture
-Popliteal- Embolism |
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Describe coarctation of aorta
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-Congenital
-Causes HTN due to decreased perfusion of kidneys -Seen in young patients with HTN -Decreases perfusion of LE |
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Describe Raynaud's
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Intermittent ischemia of digits on cold or emotion, may be primary or secondary
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Describe primary and secondary Raynaud
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- Primary- Idiopathic, young women, 70-90% females, family history, bilateral, benign
-Secondary- Fixed obstruction, normal vasoconstriction with underlying cause ie scleroderma |
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An aneurysm that is enlarged by not aneurysmal <3cm is called...
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-ectatic
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What can you expect in a diffuse disease of the LE?
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-May cause change in waveforms from triphasic to biphasic with no accompanying velocity increase
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In LE arterial occlusion, what kind of waveforms should you expect distally?
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-monophasic
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List some common bypass grafts?
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Aorto bi femoral
-Aorto-femoral -Fem-Fem -Axillo-fem |
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What is the most common BPG?
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Fem-pop
-usally CFA -Prefered above knee |
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What is a jump graft?
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-An extension of a bypass graft
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Describe an interposition graft?
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Connect end to end
-Difficult to see each anastomosis |
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List some different common BPG conduits
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- GSV
-Arm veins - Cryopreserved vein |
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What is the difference b/w dacron and PTFE
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-Dacron-saw tooth on US
-PTFE- double line |
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List the three basic principles of BPG
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- Good inflow, good conduit, good out flow
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What's the main purpose of BPG scan?
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To identify potentially fixable graft-threatning problems prior to graft failure
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What is the most common BPG problem?
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-Intimal hyperplasia
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What is the most common problems with PTFE?
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- Atherosclerosis in inflow and outflow vessels or occlusion without warning
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Can you visualize an occluded graft or PTFE?
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- Vein graft- impossible to visualize
-PTFE- look for shadows |
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What's the easiest way to identify bypass graft?
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It's by itself and usually most superficial
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What type of waveform should you expect for a new graft <2 months?
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Hyperemic waveform
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If there is an AVF distally, what type of waveform pattern should you expect throughout the graft?
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Hyperemic
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What velocities are considered abnormal for BPG?
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-<45 cm/sec throughout graft, particularly distally
-Focally high velocity, with post-stenotic turbulence -Significant change in ABI |
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What type of waveform patterns should you expect in a pseudoaneurysm neck.
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Pendulum
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List some common iatrogenic false aneurysm cuases
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Puncture injury ie catheter or intravascular access
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Describe iatrogenic AVF
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flow channel has very high velocity, low pulsatility
- Visble color bruit good sign of location -Venous flow proximal to AVF very turbulent and pulsatile |
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Describe Brescia-Cimino fistula
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Radial artery to cephalic at wrist
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List the different types of dialysis access
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- Fistula
-Graft -Straight graft - Loop graft |
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What is the most common location of stenosis in AVF
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Peri-anastomotic
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Describe normal AVF flow pattern
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-Very turbulent
- Very low resistance -Higher velocities that decrease away from the AVF -Velocities change as diameters change |
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If a digital brachial ration increases from .3 to .6 on manual compression of the fistula, what does this indicate?
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Stealing
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Describe a normal mature AVF
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- >6 wks
- >500 ml/min > 4 mm diameter |
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What artery is the major contributor of blood to the thigh muscles?
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-PFA
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You are attempting to view the CFA in long view and find the vein instead. What direction should you point the transducer to find the artery
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Lateral
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The velocities measured in a reverese saphenous vein BPG are normally..
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higher proximally and lower distally
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What is the most common location for significant atherosclerosis in the LE
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SFA @ hunter's canal
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When proximal arterial occlusive disease results in distal ischemia, the arterioles...
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Dilate, decreasing distal resistance
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You are checking a patient for dialysis access steal. When you compress the fistula while taking a digital pressure, you notice that the pressure increases by 50 mmHg. This indicates what?
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the dialysis access fistula is stealing blood from the hand
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A low velocity waveform with a slow acceleration time and forward flow throughout diastole is obtained in the CFA. This is most likely due to what?
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Inflow obstruction
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Varicose veins that are present along with deep and perforating vein incompetence or post-thrombotic syndrome are categorized as
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secondary varicose veins
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A possible result of recanalization of DVT is
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Reflux from valve damage
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A patient that complains of chronic unilateal swelling and aching with a sense of heaviness in the leg. The cause of these symptoms is most likely to be
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post-thrombotic syndrome
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Chronic venous obstruction will most likely increase....
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ambulatory venous pressure
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Name of difference between venous ulcers and arterial ulcers on the LE.
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Venous ulcers @ gaiter area, arterial ulcers @ pressure points
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While a vein is being compressed by hand proximal to the transducer, what is the normal response in the venous flow?
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Flow stops
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) When using the valsava maneuver to evaluate venous valvular incompetence, at what point is reflux most likely seen if it is present?
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During the valsava
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If the anterior jugular vein is enlarged with flow moving from right neck to left, Where is the thrombosis
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The right BCV is thrombosed
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Vasodilation and increased venous flow of lower extremity veins may be caused by
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local inflammation
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Which of the following locations has a blood pressure that is closest to atmospheric pressure?
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Right atrium
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The three perforating veins located in the distal medial leg are named
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Cocketts's
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An acutely occluded UE vein is most likely to display a distal Doppler signal with which of the following characteristics?
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Continous flow
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The best place to measure the diamter of a perforating vein is
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at the fascia
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What is the average diameter of the aorta?
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2 cm
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What is the average diameter of the CIA?
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1 cm
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What is the average size of the IVC?
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less than 2.5 cm
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) What vessels run anterior and parallel to the aorta
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- SMA
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What is the normal velocities within the aorta?
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- 60-130 cm/sec
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Takayasu's disease is more commonly in men or women?
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-women under 30
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This type of aneurysm is most common in the brain
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Saccular aka berry aneurysm
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Arterial dissection requires these two things.
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Weakening of the media of the vessel
-Development of the rent or tear in the intima |
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What uncommon condition that can predispose you to arterial dissection
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Marfan's syndrome
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List some common symptoms of patients with AAA
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abdominal, back or leg pain
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What percentage of AAA patients are asymptomatic?
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30-60%
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What is the mortality rate of AA rupture
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50%
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At what size, does an aneurysm have greater risk for rupture?
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- >4.5 cm
- Surgical repair >5 cm |
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This type of aneurysms can occur in conjuction with AAA
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Iliac aneurysms
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Iliac aneurysms of what size are at greater risk of rupture?
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> 3cm
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) What is the criteria for an abnormal follow up AAA ?
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- increase in 5mm in size from exam to the next
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List some complications of AAA
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-Atherosclerotic renal and mesenteric artery obstruction
-Hydronephrosis from aneurysm compression of ureter -Rupture |
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List some common surgical treatment for AAA
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- Tube graft
-Bifurcation graft - Endovascular repair |
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List some common AAA graft complications
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Hematoma, Occlusion, true aneurysm, pseudoaneurysm, infection, stenosis
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Describe may-thurner syndrome
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Compression of CIV and CIA
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List some complications of IVC filters.
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Insertion site thrombosis
-Inadequate position of filter -IVC thrombosis -Pericaval hematoma |
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You are attempting to view the CFA in long view and find the vein instead. What direction should you point the transducer to find the artery
|
Lateral
|
|
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The velocities measured in a reverese saphenous vein BPG are normally..
|
higher proximally and lower distally
|
|
|
What is the most common location for significant atherosclerosis in the LE
|
SFA @ hunter's canal
|
|
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When proximal arterial occlusive disease results in distal ischemia, the arterioles...
|
Dilate, decreasing distal resistance
|
|
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You are checking a patient for dialysis access steal. When you compress the fistula while taking a digital pressure, you notice that the pressure increases by 50 mmHg. This indicates what?
|
the dialysis access fistula is stealing blood from the hand
|
|
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A low velocity waveform with a slow acceleration time and forward flow throughout diastole is obtained in the CFA. This is most likely due to what?
|
Inflow obstruction
|
|
|
Varicose veins that are present along with deep and perforating vein incompetence or post-thrombotic syndrome are categorized as
|
secondary varicose veins
|
|
|
A possible result of recanalization of DVT is
|
Reflux from valve damage
|
|
|
A patient that complains of chronic unilateal swelling and aching with a sense of heaviness in the leg. The cause of these symptoms is most likely to be
|
post-thrombotic syndrome
|
|
|
Chronic venous obstruction will most likely increase....
|
ambulatory venous pressure
|
|
|
Name of difference between venous ulcers and arterial ulcers on the LE.
|
Venous ulcers @ gaiter area, arterial ulcers @ pressure points
|
|
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While a vein is being compressed by hand proximal to the transducer, what is the normal response in the venous flow?
|
Flow stops
|
|
|
When using the valsava maneuver to evaluate venous valvular incompetence, at what point is reflux most likely seen if it is present?
|
During the valsava
|
|
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If the anterior jugular vein is enlarged with flow moving from right neck to left, Where is the thrombosis
|
The right BCV is thrombosed
|
|
|
Vasodilation and increased venous flow of lower extremity veins may be caused by
|
local inflammation
|
|
|
Which of the following locations has a blood pressure that is closest to atmospheric pressure?
|
Right atrium
|
|
|
The three perforating veins located in the distal medial leg are named
|
Cocketts's
|
|
|
An acutely occluded UE vein is most likely to display a distal Doppler signal with which of the following characteristics?
|
Continous flow
|
|
|
The best place to measure the diamter of a perforating vein is
|
at the fascia
|
|
|
What is the average diameter of the aorta?
|
2 cm
|
|
|
What is the average diameter of the CIA?
|
1 cm
|
|
|
What is the average size of the IVC?
|
less than 2.5 cm
|
|
|
What vessels run anterior and parallel to the aorta
|
SMA
|
|
|
What is the normal velocities within the aorta?
|
60-130 cm/sec
|
|
|
Takayasu's disease is more commonly in men or women?
|
women under 30
|
|
|
This type of aneurysm is most common in the brain
|
Saccular aka berry aneurysm
|
|
|
Arterial dissection requires these two things.
|
Weakening of the media of the vessel
-Development of the rent or tear in the intima |
|
|
What uncommon condition that can predispose you to arterial dissection
|
Marfan's syndrome
|
|
|
List some common symptoms of patients with AAA
|
abdominal, back or leg pain
|
|
|
What percentage of AAA patients are asymptomatic?
|
30-60%
|
|
|
What is the mortality rate of AA rupture
|
50%
|
|
|
what size, does an aneurysm have greater risk for rupture?
|
- >4.5 cm
- Surgical repair >5 cm |
|
|
This type of aneurysms can occur in conjuction with AAA
|
Iliac aneurysms
|
|
|
Iliac aneurysms of what size are at greater risk of rupture?
|
-> 3cm
|
|
|
What is the criteria for an abnormal follow up AAA ?
|
increase in 5mm in size from exam to the next
|
|
|
List some complications of AAA
|
Atherosclerotic renal and mesenteric artery obstruction
-Hydronephrosis from aneurysm compression of ureter -Rupture |
|
|
List some common surgical treatment for AAA
|
- Tube graft
-Bifurcation graft - Endovascular repair |
|
|
List some common AAA graft complications
|
-Hematoma, Occlusion, true aneurysm, pseudoaneurysm, infection, stenosis
|
|
|
Describe may-thurner syndrome
|
Compression of CIV and CIA
|
|
|
List some complications of IVC filters.
|
-Insertion site thrombosis
-Inadequate position of filter -IVC thrombosis -Pericaval hematoma |
|
|
Where should the IVC filter be place?
|
Distal to the renal veins
|
|
|
List some common IVC anomalies
|
Duplication of infrarenal IVC
- Left sided IVC -Congenital absence of the intrahepatic portion of the IVC |
|
|
List the three branches of the celiac axis
|
-Splenic
-Hepatic -Gastric |
|
|
The SMA supplies the blood to what organs?
|
Pancreas, duodenum, small instestine, and colon
|
|
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When mesenteric symptoms occur, what must happen for patients to show symptoms?
|
-Two of the three major splanchnic vessls are occluded or highly stenotic
|
|
|
Describe acute mesenteric ischemia
|
-Causes by embolus
-Sudden onset of abdominal symptoms and rapid progression to a life threatening condition |
|
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Describe chronic mesenteric ischemia
|
- Involves at least 2 of the 3 major vessels
- unintended weightloss -Post prandial pain (fear of food) -Treated with stents or bypass |
|
|
) If you obtain a high velocity at the celiac, what must you do?
|
Have the patient take a deep breath in and hold his breath while you take another sample to rule out median arcuate ligament compression
|
|
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What can happend to the IMA when you have celiac or SMA problem?
|
-IMA will be dilated b/c it's acting as collateral
131) List the diagnostic criteria for the SMA ->275 cm/sec and SMA/Ratio of >3.5 >70% stenosis |
|
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List the dianostic criteria for the SMA
|
->200 cm/sec and Celiac/aorta ratio o>3,5
|
|
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If there is absence of flow in the proximal arterial segment what should you expect distally?
|
Tardus parvus signal
|
|
|
What can happen to the flow of the hepatic artery if you have a celiac occulsion?
|
Reversal of flow in the hepatic
|
|
|
What is the most common correctable cause of HTN?
|
Renal artery disease
|
|
|
List some common renal arteries antomic variation
|
-Duplicate main renal arteries
-Polar acccessory renal arteries |
|
|
List some indications for renal artery duplex
|
-Uncontrolled HTN
-Abdominal bruit -HTN in young patients -Post intervention F/U -HTN patients prior to putting on ACE inhibitor -Renal insufficiency |
|
|
What''s the normal PSV ranges for renal velocities
|
74-127 cm/sec
|
|
|
List diagnostic criteria for renal arteries
|
-PSV <180 cm/sec
-<3.5 |
|
|
What's the criteria for hemodynamically insignificant stenosis of less than 60%
|
- PSV >180 cm/sec
-RAR <3.5 |
|
|
What's the criteria for renal occlusion
|
-No arterial signal in renal artery
-Kidney size <9 cm - No flow or low flow <10 cm/sec |
|
|
What's the best treatment for FMD?
|
Angioplasty
|
|
|
Patients with SAH are often placed on this type of medications to prevent vasospasm
|
Verapamil
|
|
|
) Increased bilirubin in the blood causes jaundice which is a sign of ...
|
Liver failure
|
|
|
The portal triad consists of what?
|
-Portal vein
-Common hepatic duct -Proper hepatic artery |
|
|
Describe the function of the portal vein and hepatic vein
|
-Portal vein -deliver blood to liver
-Hepatic vein- drain blood from liver |
|
|
A non-surgical way to decompress the portal venous system
|
Transjugular intrahepatic portosystemic shunt (TIPS)
|
|
|
TIPS are effective for...
|
Reducing ascites
-Preventing bleeding from gastroesophageal varices -Improving the quality of life |
|
|
The parenchyma of the kidney include what 2 components?
|
Cortex and medulla
|
|
|
Describe the glomeruli of the kidney
|
-Located in the cortex of the kidney (outer 1/3 of the kidney)
|
|
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Describe the medulla
|
Inner 2/3 of kidney consists of pyramid and renal columns.
|
|
|
Describe the renal hilum
|
- Found medially and is the point of entry for the arteries, veins, and nerves and the exit of the ureter
|
|
|
Normal kidney size is what?
|
10-12 cm
|
|
|
List some normal variants of the kidnye
|
-Dromedary hump-Most often seen in left of kidney
-Horseshoe kidney- usually connected at the poles -Hypoplastic kidney- congenitally small, usually unilateral, contralateral kidney is usally bigger to compensate for the small kidney |
|
|
Partial or complete urinary tract obstruction which leads to a collection of fluid is called.
|
Hydronephrosis
|
|
|
Describe renal calculi
|
-Loin pain, hematuria, UT obstruction
-Bright image shadowing -aka staycorn calculi |
|
|
Describe PKD
|
-Genetic disease
-predisposed to ESRD -Causes loss of cortex -Hepatic cysts are also common -can develop brain aneurysm |
|
|
Define resistive index
|
PSV-EDV/ PSV
|
|
|
What is the RI cutoff the predict the success of medical intervention in the renal artery
|
80
|
|
|
What's the different between chronic and acute renal failure
|
Acute- Normal kidney size and texture
-high resistance flow in kidney Chronic- Small kidney size -thinning of the cortex and diffuse changes in kidney texture - High resistance flow in end stanges |
