Vascular - Arterial

Front 1

Leriche Syndrome

Back 1

Obstruction of the terminal aorta. Usually males. Fatigue in hips, thighs or calfs with exercise, absence of pulsation in femoral arteries, impotence, & often coldness/pallor of lower limbs.

Front 2

Blue Toe Syndrome

Back 2

May be caused by ulcerated and/or atherosclerotic lesions, embolization, arteritis, and some angiographic procedures.

Front 3

Most common location for a dissection aneurysm?

Back 3

Thoracic Aorta

Front 4

Buerger's Disease

Back 4

Most common arteritis. Heavy smoking, primary in men under 40, occlusions in distal arteries, rest pain & ischemic ulcerations occurs early on, often thrombosis, superficial thrombophlebitis is a secondary result, patchy ulcerations or gangrene, often associated with collagen vascular syndromes - rheumatoid arthritis and lupus.

Front 5

Coarctation of the Aorta

Back 5

Congenital anomalies of the arterial system. Narrowing/stricture of the thoracic aorta that may affect the abdominal aorta. Clinical findings: hypertension due to decreased kidney perfusion or manifestations of lower extremity ischemia ( decreased pulses, decreased segmental Doppler pressures).

Front 6

Buerger's Disease is also known as what?

Back 6

Thromboangiitis obliterans

Front 7

Raynaud's Syndrome

Back 7

Intermittent ischemia of fingers or toes in response to cold exposure or emotional stress. May be idiopathic or result from underlying disease or anatomic abnormality. 2 kinds

Front 8

Primary Raynaud's Phenomenon

Back 8

Aka Spastic Raynaud's Syndrome. Intermittent digital ischemia caused by digital arterial spasms. Common in young women & may be hereditary. Usually bilateral & long term history of symptoms w/o progression or underlying cause. Rather benign w/ excellent prognosis.

Front 9

Secondary Raynaud's

Back 9

Aka Obstructive Raynaud's Syndrome. Normal vasoconstrictive responses of the arterioles superimposed on a fixed arterial obstruction. Ischemia is constant. May be 1st manifestation of a collagen disorder, Buerger's Disease, anatomic abnormality or other underlying causes

Front 10

Popliteal Entrapment

Back 10

Compression of the popliteal artery by the medial head of the gastrocnemius muscle or fibrous bands. Commonly found in young men. Bilateral in 2/3's of cases.

Front 11

Livedo Reticularis

Back 11

Purple patches (similar to bruising) on the skin of the dorsum of the foot. Usually result of dilated capillaries and venule filling, not arterial obstruction.

Front 12

Pulse Grading

Back 12

0-4+
0 - None
1+ Weak
2+ Good
3+ Strong
4+ Bounding

Front 13

Bruit Grading

Back 13

1+ - 3+
1+ Mild
2+ Moderate
3+ Severe

Front 14

Doppler Shift

Back 14

Doppler Effect: When a wave is reflected from a moving target, the frequency of the wave received differs from that of the transmitted wave. The difference is known as the Doppler Shift.

Front 15

Analog Analysis

Back 15

Employs a zero-crossing frequency meter to display the signals graphically on a strip-chart recorder. Counts every time the input signal crosses the zero baseline within a specific time span. Because oscillation varies, the machine estimates the frequency. Drawbacks: noise, less sensitivity, underestimate high velocities & overestimate low velocities.

Front 16

Spectral Analysis

Back 16

Advantage of showing the amplitudes at all frequencies, but free of many analog drawbacks. More sensitive.

Front 17

Pulsatility Index (PI)

Back 17

Peak-Peak Frequency
----------------------------
Mean Frequency

Ratio provides quantitative data. Applied to high-resistance beds. Index increases from central to peripheral arteries (CFA=5.5, PopA=8.0). CFA of 4.0='s proximal aortoiliac occlusive disease. If a distal occlusion, PI no longer works.

Front 18

Inverse damping factor

Back 18

Ratio of distal PI to the proximal PI of an arterial segment. Indicates the degree to which a wave is dampened as it moves through an arterial segment.

Front 19

Acceleration Time

Back 19

Helps differentiate inflow from outflow disease. Arterial obstruction proximal to the site of the doppler probe lengthens the time between the onset of systolic flow to the point of maximum peak in waveform at the probe site. Acceleration time is not prolonged when disease is distal to the probe.

Front 20

What is a Sphygmomanometer?

Back 20

Blood Pressure Cuff

Front 21

Segmental Cuff Sizes

Back 21

4 Cuff- 12x40cm
3 Cuff- 19x40cm (thigh) & 12x 40cm

Front 22

What will the toe pressure be with foot & toe ulcers that fail to heal?

Back 22

30mmHg or less

Front 23

Segmental Pressures Post-exercise results

Back 23

Normal- Elevated Pressures. Single Level- 2-6 min. Multi Level - 12 min or more

Hint 23

Segmental Pressures Post-exercise

Front 24

Segmental Pressures Post Reactive Hyperemia Results

Back 24

Normal- 17%- 34% Drop. Single Level - < 50% drop. Multi Level - > 50% drop

Front 25

What is Laser Doppler used for?

Back 25

Determining the healing potential of a wound, ulcer or amputation.

Front 26

PBI Values

Back 26

Normal: >0.75. Marginal: 0.65-0.74. Abnormal: <0.65 vasculogenic impotence

Front 27

What is a Varicocele?

Back 27

An enlargement of the veins of the spermatic cord. A condition which occurs most often in young men and adolescents. It is most common on the left side.

Front 28

What is a characteristic of a Raynaud's PPG?

Back 28

A sharp, anacrotic notch is present high on the wave.

Front 29

What does a Transcutaneous Oximetry (tcPO2) do?

Back 29

Helps determine wound and amputation healing. Reflects tissue PO2, which depends on the balence between oxygen consumption and oxygen supply.

Front 30

Other names for Volume Plethysmographic Waveforms?

Back 30

Pulse Volume Recordings (PVR)
Volume Pulse Recordings (VPR)
Pulse Contour Recordings (PCR)

Front 31

Brescia-Cimino Fistula involves which vessels?

Back 31

Radial Artery & Cephalic Vein

Front 32

When evaluating a Hemodialysis Access Graft what should you look for?

Back 32

Aneurysms, Pseudoaneurysms, Puncture Sites, Perigraft Fluid & Thrombus.

Front 33

Steal Syndrome

Back 33

Distal arterial (high pressure) blood flow is reversed into the low-resistance (low pressure) venous circulation.
Symptoms: Pain distal, pallor and coolness of the skin
Often seen with grafts.

Front 34

Brachial Artery Reactivity Testing. What is it?

Back 34

Assesses the ability of the endothelium to regulate vasodilation by measuring the degree to which the brachial artery dilates in response to reactive hyperemia.
Pt fasting & relaxed. Inflate cuff to 250mmHg for 4.5-5min.
Measure diameter of Brachial Artery: >10% Upper Arm-Normal, >6% Forearm- Normal.

Front 35

Renal-to-Aortic Ratio
RAR

Back 35

Renal Artery PSV
----------------------
Aortic PSV

Normal: <3.5
Abnormal: >3.5, 60% or greater diameter reduction

Front 36

End Diastolic Ratio EDR or
Parenchymal Resistance Ratio PRR

Back 36

End Diastolic Velocity
----------------------------
Peak Systolic Velocity

Normal: >0.2
Abnormal: <0.2 Increased resistance with in the kidney parenchyma.

Front 37

Pourcelot's Ratio/resistivity Index RI

Back 37

PSV - EDV
------------
PSV

Normal: <0.7
Abnormal: >0.7

Front 38

Acceleration Time AT

Back 38

Time interval from the onset of systole to the initial peak.
Reported in milliseconds (msec)
AT > 100 msec = Proximal >60% diameter reduction.

Front 39

Mesenteric ischemia is also know as?

Back 39

Mesenteric angina

Front 40

Postprandial high-resistance blood flow in the SMA or IMA means what?

Back 40

Distal mesenteric ischemia, distal obstruction.

Front 41

Hyperemia

Back 41

Decreased arterial resistance in SMA circulation in response to eating.

Front 42

Explain celiac compression

Back 42

Extrinsic compression of the celiac artery origin by the median arcuate ligament of the diaphragm. Fairly common among young, athletic women.

Front 43

If the celiac artery were occluded what might you see?

Back 43

Retrograde flow of the Hepatic Artery.

Front 44

B-mode signs of Kidney rejection include:

Back 44

Increased renal transplant size,
Increased cortical echogenicity,
Hypoechoic regions in the parenchyma.

Front 45

What is Watershed Area?

Back 45

Small branches of both the Deep Superior Epigastric Artery & the Deep Inferior Epigastric Artery anastomose in this region. It is located midway between the superior and inferior epigastric arteries.

Front 46

TRAM flap

Back 46

Transverse Rectus Abdominis Myocutaneous (TRAM) flap.
Used in autogenous breast reconstruction.

Front 47

What is another name for the Internal Mammary Artery and where is it located?

Back 47

Internal Thoracic Artery
Arises from the arch of the subclavian artery, descends along the posterior sides of the cartilage of the upper 6 ribs, about 1cm from the sternum.

Front 48

Why look at the Internal Mammary Artery

Back 48

Evaluate for recipient site for TRAM flap in breast reconstruction or as a graft to the left anterior descending (LAD) artery.

Front 49

Arteriovenous Fistulae AVF

Back 49

Congenital or traumatic. Abnormal connection b/t high-pressure arterial & low-pressure venous system. Close to the heart increase CHF, peripherally more ischemia. Diameter & length predict the resistance.

Front 50

Flow patterns in a AVF

Back 50

Prox Artery: Greatly increased, especially during diastole.
Flow in AVF: Elevated peak and end diastolic with spectral broadening, often bidirectional.
Distal Artery: Flows become normal, may reduce blood pressure.
Prox Venous: Elevated velocities, more pulsatile.
Distal Venous: Elevated velocities throughout. Phasicity and increased pulsatility bc mixed venous & arterial flow
Lg AVF: may have retrograde flow in the distal vein, valves become incompetent.

Front 51

Compartment Syndromes

Back 51

Caused by swelling within the osteofascial compartments of leg or arm. Intercompartmental pressure increases to the point where it exceeds capillary perfusion pressure, decreasing vascular perfusion and compromising nutritive blood flow to tissue. Nerves most susceptible to ischemia, muscle necrosis later. Most commonly occurs following revascularization to correct prolonged ischemia caused by embolic, traumatic or less common condition. Can be spontaneous or result of bleeding within a compartment.
Paresthesias, Pain, Muscle weakness, Tension of compartment.

Front 52

Treatment for Compartment Syndromes

Back 52

Fasciotomy

Front 53

Cystic Adventitial Disease

Back 53

Cystic fluid accumulates in the wall of the peripheral artery. Can cause narrowing or occlusion of vessel.
Symptoms may be claudication with bruit, may be loss of distal pulses during flexion of foot or hand.
Most common in males 40-50yrs old.
May include congenital abnormality exacerbated by repetive trauma associated with regions of joint connection or be related to development of a ganglion.

Front 54

Popliteal Artery Entrapment Syndrome

Back 54

Compression by the medial head of the gastrocnemius muscle or fibrous bands. Mostly seen in young men and bilateral in 1/3 of cases. Repeated trauma by result in aneurysm, thrombosis, atherosclerosis and emboli. Diminished flow with flexion.

Front 55

Thoracic Outlet Syndrome (TOS)
Arterial Component

Back 55

Neurovascular bundle compression by the shoulder structures (cervical rib, costoclavicular, scalene muscle).
Neurogenic compression of the brachial plexus when the arm is in certain positions. Small percent are result of venous or arterial compression.
Symptoms: Numbness, tingling and pain, 25-30% asymptomatic.

Front 56

TOS Positions

Back 56

Arm at 90 degree angle is same plane as torso
Arm at 180 degree angle in same plane as torso
Exaggerated military stance (patient sitting)
Right & Left Adson Maneuver: Exaggerated military stance (shoulders back) with head turned sharply toward the arm being tested
Causative position described by patient.

Front 57

Treatment for TOS

Back 57

Shoulder exercises
Surgical: resecting 1st rib with/without scalene muscle splitting.

Front 58

Arteriography

Back 58

2 types: Intraarterial injection & Intravenous digital technology
Puncture of an artery and insertion of a very thin catheter (Seldinger technique). Most common arteries: CFA, axillary or brachial. Liquid contrast agent injected. Image arterial lumen but not the arterial walls.
Rapid film changer used to picture as contrast moves.
Using fluoroscopy the examiner may obtain and store digital info for later manipulation and interpretation. After, patient supine and 6-8 hours with possible sandbags. Interpretation based on how much of the artery does not fill with contrast agent.

Front 59

How does atherosclerotic plaque appear on arteriography?

Back 59

Irregular or smooth negative images, where ever the plaque displaces the contrast agent.
Common locations: Origins of the great vessels at the aortic arch, bifurcations and the adductor canal.
Collaterals are seen with long-standing occlusions.

Front 60

How do aneurysms appear on arteriography?

Back 60

Dilation of the artery.
Thrombus may develop along the dilated wall, creating the appearance of a straight tube on arteriography.
Possibly lack of branches where you would expect to see them.

Front 61

How does vasospasm appear on arteriography?

Back 61

Severe narrowing of the arterial lumen, usually without occlusion.

Front 62

How does Fibromuscular Dysplasia FMD appear on arteriography?

Back 62

Multiple arterial stenosis, caused by medial hyperplasia which looks like a "string of beads". Poststenotic dilatation also may be present.

Front 63

What patients cannot undergo arteriography?

Back 63

Allergic to contrast agent (iodine).
Kidney failure.

Front 64

Endarterectomy

Back 64

Surgical removal of atherosclerotic material and usually a portion of the intimal lining from the arterial lumen.

Front 65

Common Bypass Grafts

Back 65

Aorta to both iliac arteries
Aorta to bifemoral
Femoral to popliteal
Femoral to PTA, ATA or Pero A
Axillary to femoral
Axillary to bifemoral
Femoral to femoral

Front 66

Sympathectomy

Back 66

Surgical interruption of part of the sympathetic nervous pathway to help treat severe arterial occlusive disease by producing vasodilation and thereby enhancing blood flow to an extremity. No longer commonly performed.

Front 67

Angioplasty
PTA Percutaneous Transluminal Angioplasty

Back 67

Used to dilate precisely that segment of a vessel that contains a focal atherosclerotic lesion.
Balloon-tipped catheter used under fluoroscopic guidance and small amounts of contrast agent. Once positioned within the stenotic lesion the balloon is slowly inflated, pushing the plaque against the walls, dilating the vessel and opening up flow.
Done on larger vessels: iliac, fem, popA and renals. Not usually used for smaller vessels.

Front 68

Subintimal Angioplasty

Back 68

Under ultrasound guidance a wire is passed within the wall of the blood vessel into the subintimal space rather than through the occluded true lumen from above to below the occlusion. Balloon is inflated to open a new pathway. A stent may also be used.

Front 69

3 major types of stents?

Back 69

Balloon-expandable
Self-expandable
Thermal expanding (not in wide use)

Front 70

Stent grafts
What are they used for?
What are they main types?

Back 70

Aneurysmal disease, especially in the aorta.

Tube grafts
Bifurcated grafts
Aortoiliac grafts

Front 71

Complications with stents

Back 71

Intimal hyperplasia, stent migration, twisting, dislodgment and leaks.
Endoleaks, graft stenosis or thrombosis, disection
lower extremity ischemia secondary to embolization, graft infection, delayed rupture of the aortic aneurysm, bleeding, pseudoaneurysm at the insertion site and hematoma.

Front 72

Types of Endoleaks

Back 72

Type I: Attachment @ prox/dist sites
Type II: Branch leaks
Type III: Modular connect leak
Type IV: Transgraft endoleaks
Type V: Endotension

Front 73

Thrombectomy/Embolectomy

Back 73

Procedure used to extract embolus from the affected arterial segment.
Balloon catheter is inserted past the area of thromboembolism, inflated and withdrawn with the thromboembolus.

Front 74

Atherectomy

Back 74

Cuts through or pulverizes the plaque with a rotational device at the end of the catheter.
Problems: heat generation, susceptible to puncture, & microembolization or pulverized particles.
Advantage: Reduced risk of peripheral emboli and intimal dissection.