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157 Cards in this Set

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Activated Clotting Time (ACT)

Blood test measuring the clotting ability of the blood


- determines if patient has adequate dose of heparin (or other anticoagulant) to prevent clotting of interventional equipment


- ACT test is used in cath lab during interventional procedures and is especially critical when using a stent


- ACT level is kept at greater 250 seconds

Acute

Having a sudden onset, sharp rise, and short course (pain, symptoms, etc)



Acute Gain

The difference in lumen diameter measured before and immediately after an intervention. Acute gain is due to plaque removal and/or arterial expansion

Adjunctive

A treatment that is used in addition to another treatment

Adventitia

Outermost layer of arteries, aterioles, veins, and venules

Amputation

The removal of a body extremity by surgery. This may also occur from a traumatic injury. In peripheral trials a major amputation is typically at or above the ankle

Anastomosis

Surgical joining of vessels, such as arteries, that allow blood to flow directly from one vessel to another; provide alternative pathways or blood flow in case of vessel blockage

Aneurysm

Thinning of the wall or lining that causes an abnormal blood filled dilation (often bulges or sacs) of a blood vessel, especially an artery, resulting from disease or injury to the vessel wall.

Anastomotic Stricture

A narrowing, usually by scarring or inflammation of a suture line following a surgical procedure (anastomosis) the suture was placed to connect the end of o one vessel to the end of another vessel

Angiography

Procedure in which radiopaque dye is injected into the circulatory system in order to visualize the coronary and peripheral arteries

Angioplasty

Non surgical repair or recanalization of a blood vessel; dilation of an obstructed atherosclerotic artery by the passage of a balloon catheter through the vessel to the area of disease where inflation of the balloon at the distal end of the catheter compresses the plaque against the vessel wall.

Ankle Brachial Index (ABI)

A measure of the fall in blood pressure in the arteries supplying the legs and is used to detect evidence of blockages in the peripheral vessels. It is calculated by dividing the higher systolic blood pressure in the ankle (dorsalis pedis or posterior tibial) of the one leg by the higher of the two systolic blood pressures in the arms.

Antegrade

Occurring in the normal direction or path of blood circulation

Anterior

Relational term meaning "in front of" a reference point.


- Ex: anterior side of the body is the abdomen



Anticoagulant

A drug which delays blood clotting

Anterolateral

Relational term meaning in front and to the side from the middle line.


- Ex: The ears are anterolateral from the base of the skull

Aorta

Major artery in the body that transports blood from the left ventricle of the heart to the branch arteries which supply the body; the main trunk of the systemic circulatory system

Aortagram

Visualization of the aorta using x rays during and following the injection of a radiopaque substance (contrast material)

Arteries

Muscular and elastic walled vessels which carry oxygenated blood from the heard throughout the body

Arterioles

Arteries branch into smaller vessels called arterioles that conduct blood to the capillary bed

Arteriovenous Fistula (AV Fistula)

An abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm.


- An AV fistula can also occur at the access site for percutaneous procedures when both the artery and vein are accessed

Atherectomy

Removal of plaque material from a vessel's wall by using a catheter usually fitted with a cutting blade or grinding burr

Atherosclerosis

Highly prevalent disease characterized by gradual accumulation of fibrous and fatty plaque on the walls of arteries, leading to progressive narrowing of the arterial lumen.

Balloon Pressure

Pressure generated by the fluid within the angioplasty balloon.


- measured in atmospheres (ATM) or pressure

Bifurcation

Location where a blood vessel branches

Bolus

A large volume of fluid (saline) or drug given intravenously and rapidly for immediate response.

Brachial Artery

Main artery of the upper arm that is a direct continuation of the axillary artery. This artery divides into the radial and ulnar arteries just below the elbow. This artery can be used to gain percutaneous access as an alternative to the femoral artery.

Bruit

Abnormal sounds (swishing) heard on auscultation (listening with a device - stethoscope); an audible "bruit" produced by an artery reflects turbulence of flow.

BTK

Below The Knee

Calcification

Abnormal deposits of the mineral calcium in vessels and other structures; can form over long periods of time

Cannulate

To insert a tube, such as a catheter into an artery

Capillaries

Smallest, thin walled, blood vessel; site for exchange of nutrients and metabolic end products (oxygen, CO2) between the blood and cells of body tissues

Cardiac Arrest

Cessation of ventricular activity; lack of heartbeat of peripheral pulse

CAS

Carotid Artery Stenting

Catheter

Tubular structure intended for insertion into a blood vessel, duct, or passage for diagnostic or therapeutic purposes

Catheterization

Examination of the heart or peripheral vessels by means of a thin catheter inserted into a vein or artery

Caudal

A projection angle of fluoroscopy when the view is tipped towards the patient's feet



Chronic

Marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness; suffering from a disease or ailment of long duration

CLI

Critical Limb Ischemia (chronic)

Clot

Fibrous network produced as the end product of blood coagulation; consists primarily of fibrin, an insoluble protein

Coagulation

Process whereby blood thickens to a viscous, jellylike or solid state, as in formation of a clot

Collateral Circulation

Small blood vessels which enlarge or develop when blood flow in arteries is reduced or stopped by stenoses or occlusions, and can no longer supply blood to tissue.


- they provide blood supply to the artery distal to the stenosis or occlusion

Concentric

Blockage that is equal in all directions from the center of the vessel lumen

Congenital

Indicates any disease or abnormality present at birth

Cranial

A projection angle of fluoroscopy when the view is tipped towards the patient's head

Circulatory System

The closed system of arteries, capillaries and veins that carry blood oxygenated by the lungs from the heart to all the cells of the body as well as through the filtering systems of the liver and kidneys.


- main components of cardiovascular system are the heart, veins, and arteries.


- includes the pulmonary circulation, a "loop" through the lungs where blood is oxygenated; and the systemic circulation, a "loop" through the rest of the body to provide oxygenated blood

Contralateral

On the opposite side of the body.


- Ex: right kidney is contralateral to the left kidney


- Ex: contralateral approach would be accessing the right groin to work on the vessels in the left leg

Contrast Induced Nephropathy (CIN)

Contrast induced nephropathy is the worsening of renal function, typically when serum creatinine increases >25% above baseline within 24-48 hours following contrast administration.


- CIN is the 3rd leading cause of hospital acquired renal failure


- Strategies to decrease risk of CIN is use of low-osmolar or isoosmolar contrast media, minimizing contrast volume, and intravenous hydration

Contrast Media

AKA: Dye


A substance (iodine or barium sulfate) comparatively opaque to X rays that is introduced into the body (by injection/swallowing) to contrast an internal organ (blood vessels, gastrointestinal tract, kidneys) with its surrounding tissue in radiographic visualization

Computerized Tomography Scan (CT Scan)

3D images of structures within the body created by a computer that takes the data from multiple X ray images

Computerized Tomography Angiography (CTA)

CT scan utilizing contrast media

Diabetes

A metabolic disease in which the body loses its ability to regulate blood sugar, leading to high blood sugar (hyperglycemia) and many complications, including vascular and kidney damage.


- Hypertension is twice as common in people with diabetes as in those without the disease, and blood pressure is harder to control in diabetics

Diagnostic Catheter

Hollow tubes that are inserted into the patient's arterial system either from the femoral, radial or brachial arteries and advanced to other arteries using fluoroscopy to monitor progress.


- Radiopaque dye is injected into the arteries to diagnose blockages

Dissection

Splitting of the arterial wall between layers;


- angioplasty causes "controlled" dissection which optimally leads to appropriate healing response and maintained lumen;


- "uncontrolled" dissection can lead to a false lumen, flaps, and/or total occlusion

Distal

Farthest away from the sight of origin.


- Ex: the foot is distal to the knee

Distensibility

The ability of a blood vessel to stretch

Dye

AKA Contrast Media:


Fluid that can be injected into patient's arteries that is radiopaque (does not allow X rays to penetrate) and therefore creates a shadow of the internal lumen of the artery

Duplex Ultrasound

Formation of 2D image used to examine internal body structures. It can display in both spectral and color flow images are seen simultaneously. This facilitates assessment of blood flow through an artery or vein under investigation

Eccentric

Blockage that is not equal in all directions from the center of the vessel lumen



Embolus

Abnormal particle (clot, air bubble, etc) that can dissipate or be carried by the blood to smaller vessels

Endarterectomy

Surgical removal of the inner layer of an artery.


- Surgery is performed when plaque reduced blood flow or blocks an artery and reduces or obstructs the flow of blood and oxygen delivery to other parts of the body

Endothelization

Proliferation (growth) of the endothelium (cells that line the blood vessels) Endothelium may be damaged during a percutaneous procedure

- New endothelium cells will grow to repair the vessel lining and cover stent struts if applicable.



Fibrin

Insoluble fibrous protein that forms the backbone of a clot; produced by the final series of reaction of the coagulation cascade

Fluoroscope

X ray equipment used in catheterization labs to visualize body parts that are either radiopaque intrinsically (bones) or can accommodate contrast media that is radiopaque (arteries)

Fractional Flow Reserve (FFR)




- see also Gradient and Pressure Wire

FFR is a guide wire based procedure that can measure blood pressure and flow through a specific part of an artery


- FFR is the fraction of normal maximal flow that remains despite the presence of a lesion.


- FFR is done with a standard diagnostic catheter at the time of the angiogram (its useful to show whether or not to perform angioplasty or stenting on "intermediate" blockages


- Pressure wires used for measuring FFR are similar to conventional guide wires with the exception of micro sensors at the distal end (pressure wire manufacturers include St Jude/Radi and Volcano Corp)




FFR - maximal blood flow in the presence of a stenosis divided by the normal blood flow




FFR = Pd (mean distal pressure) / Pa(mean aortic pressure)




typically the operator will advance the pressure wire distal to the renal stenosis to assess the mean distal renal pressure (Pd) and measure the mean aortic pressure (Pa) through a guiding catheter



Gradient




- see also FFR Pressure Gradient, Pressure Wire

The difference in blood pressure across the lesion

Guide Wire

Wire with a flexible, curved tip that can be threaded through a catheter and steered into position through a lesion. Balloon catheters or other devices are then threaded over the guide wire.

Guiding Catheters

Large lumen tubular devices that are used to engage the artery from a hole in the patient's femoral artery; the interventional catheter (balloon, stent, laser, etc) are then passed through this catheter

Hemodynamics

The study of the movement of the blood and the forces concerned therein. The physics of fluid flow within the circulatory system and each heart or vascular compartment. IT is a subset of more general fluid dynamics, which studies the pressure and flow characteristics of liquids, especially when confined within tubes (as blood is within arteries and veins)

Hemodynamic Instability

A state requiring pharmacologic or mechanical support to maintain a normal blood pressure or adequate cardiac output.

Hemorrhage

Bleeding

Hyper

A prefix signifying above, beyond or excessive


- Ex: Hyperglycemia is high blood sugar

Hyperlipidemia

Elevated concentrations of any or all of the lipids in the plasma

Hypertension

High blood pressure, generally defined as BP readings over 140/90 mmHg

Hypo

A prefix signifying below or insufficient.


- Ex: Hypoglycemia is low blood sugar

Hypotension

Abnormally low pressure (<90/60 mmHg) which can be associated with inappropriate organ perfusion and symptoms such as fainting if insufficient blood flow is reaching the brain

Hypovolemia

Decreased blood volume below normal

Hypoxia

Insufficient oxygen reaching the tissues of the body. Anoxia is hypoxia of such severity as to result in permanent damage

Inferior

Relational term meaning below a reference point


- Ex: The ankle is inferior to the knee

Intermittent Claudication

Cramping pain and weakness in the legs and especially the calves on walking that disappears after rest and is usually associated with inadequate blood supply to the muscles



Intima

Inner layer of a blood vessel wall

Ischemia

A reduction in blood supply causing the supply of nutrients or oxygen to fall below the requirements for cells to survive. Ischemia can lead to cellular necrosis and death.


- the heart, kidneys and brain are particularly sensitive to ischemia



IVUS (Intra Vascular Ultra Sound)

use of catheters with an array of transmitters and sensors around their distal tip, facing toward the vessel walls. Sound waves are bounced off the vessel walls and their echo provides detailed images of the composition of lesions, and the vessels themselves.


- with IVUS it is possible to distinguish different plaque morphologies that may not be appreciated with angiography alone.


- used also to confirm stent placement (especially ostial lesions) and complete wall apposition of the stent

Laser

Device that concentrates high energies into a narrow beam of coherent monochromatic light; can be used to destroy tissue so quickly that surrounding tissue is not heated or damaged


- Laser (Light Amplification by Stimulated Emission of Radiation)

Late Loss

The difference in lumen diameter after intervention and at future angiographic follow up, reflects the net effects of intimal hyperplasia, elastic recoil and vascular remodeling.

Lateral

Relational term meaning to the side (either right or left) of a reference point


- Ex: ribs are lateral to the spine

Lesion

A blockage in an artery (lesion = occlusion = blockage = stenosis = narrowing = plaque)

Lesion Morphology

Characteristics that classify the lesion/blockage as to size, length, severity, location, etc

Less Invasive Procedure

Treatment of disease that requires a needle puncture or small hole in the patient's skin to access an artery ( or other organ) but no open surgery;


- for vessels any treatment where guiding catheters are used

Lumen

The inside of a blood vessel

Manifold

Series of stopcocks that allow the medical staff to monitor blood pressure, inject contrast, inject heparinized saline and pull blood samples form one port on a catheter

Media

Middle layer of a blood vessel

Medical Therapy

The treatment of a disease with the use of medications/pharmaceuticals.


- Many times this is the first line of defense in early stages of PVD and CAD


- when medical treatment fails or does not provide adequate relief more invasive therapy may be an option

Millimeters of Mercury (mmHg)

A unit of pressure equal to the pressure exerted by a column of mercury


- A unite of pressure equal to 0.001316 atmosphere

Morbidity

A diseased state or symptom or pertaining to the incidence and/or rate of disease or sickness

Mortality

Pertaining to death; death rate

Magnetic Resonance Angiogram (MRA)

MRA is a noninvasive test that has demonstrated usefulness in defining the anatomy of blood vessels of certain size


- Test doesn't require radiation of nephrotoxins (contrast)

Necrosis

Cell or tissue death; can be caused by the impaired or disrupted supply of blood which leads to the lack of nutrients reaching the cells

Neointimal Hyperplasia

The thickening of the intima of a blood vessel as a result of an interventional procedure or endarterectomy


- Intimal hyperplasia is the universal response of a vessel to injury and is one reason stents become stenosed or bypass grafts my fail

Nitroglycerin

Often referred to as "Nitro"; medication that dilates arteries and therefore increases blood flow

Non-Invasive Procedure

Procedure that requires no opening of the body


- Ex: X ray, CT scan, MRI, etc

Occlusion

A blockage or obstruction of an artery

Oculo-Stenotic Reflex

When a physician sees a blockage in a blood vessel that may not be tightly stenosed and wants to treat it


- this is a reaction ( you see a stenosis, so you open it up and stent it)

Ostial

Referring to the origin (beginning/opening) of an artery

Overlapping Vessels

On Fluoroscopy, vessels filled with radiopaque fluid may appear to overlap (cross over) in a two dimensional picture, such as an angiogram: where in reality, they may not overlap.


- To diagnose a blockage or determine if a vessel closure device can be used, multiple angiograms at different angles may be needed

Parenchymal Tissue

Tissue that constitutes the essential part of an organ as contrasted with e.g. connective tissue and blood vessels

Peak Systolic Velocity (PSV)

Measured from Doppler waveform at the lesion site and at a normal appearing segment proximal to the lesion

Peak Velocity Ratio (PVR)

The ratio of the maximum PSV at the lesion site to the maximum PSV proximal to the lesion

Perfusion

Continual and constant circulation of blood through tissues

Plain Old Balloon Angioplasty (POBA)

Where the stenosis of an artery has been treated by balloon dilatation only, without inserting a stent

Post Luminal Diameter

Cross section measurement of artery inner lumen after a procedure has been done to open a blockage

Posterior

Relational term meaning behind a reference point


- As it relates to the body posterior would be considered the back of a structure or organ

Posterolateral

Situated on the side toward the posterior aspect


- Ex: the kidneys are posterolateral to the top of your abdomen

Pressure Gradient




- see also FFR, Gradient, and Pressure Wire

AKA Gradient:


The Gradient is the difference in blood pressure across the lesion


- Pressure is measured on the distal side of the lesion and compared to the pressure measured on the proximal side of the lesion

Pressure Wire




- see also FFR, Gradient, and Pressure Gradient

Pressure wires are used for measuring the pressure distal and proximal to a lesion


- Pressure wires are similar to conventional guide wires with the exception of micro sensors at the distal end


- Pressure wires manufacturers include St Jude/Radi and Volcano Corporation

Prolapse

The falling down or slipping of a body part or device from its usual position


- When discussing interventional devices, this is when the wire or catheter bends at the tip when it meets resistance and forms a "J" shape instead of traveling down the vessel with a straight tip



Prothrombin

A clotting factor; when converted to its active form, thrombin, triggers the conversion of fibrinogen to fibrin (the backbone of a clot)

Proximal, Mid, Distal

Terms relating to the body or a device...


Proximal: closer to the point of origin


Distal: further away from the point of origin


Mid: reference point somewhere in between


- Ex: mouth could be point of origin, throat is proximal to esophagus and the esophagus is distal to the mouth and the throat

PTA (Percutaneous Transluminal Angioplasty)

Using a balloon catheter to apply pressure to a stenosis or occlusion to attain a larger lumen and better blood flow


Percutaneous: performed through a skin puncture/catheter as opposed to surgery


Transluminal: applying the treatment from within the lumen of the artery


Angioplasty: remodeling the artery lumen, frequently with a balloon

PTCA (Percutaneous Transluminal Coronary Angioplasty)

*** Specific to coronary vessels


Using a balloon catheter to apply pressure to a stenosis or occlusion to attain a larger lumen and better blood flow

Psuedoaneurysm

A dilation of an artery with actual disruption of one or more layers of its walls, rather than with expansion of all wall layers

Pulsatile Flow

Movement of fluid through a tube (vessel) that occurs in spurts as it is pumped from the heart


- pressure varies between maximum contraction (systolic) and baseline (diastolic)

Radiopaque

X rays cannot penetrate a radiopaque material (bones, contrast media, metals) therefore it is visible under x ray, fluoroscopy, MRA, CTA, etc

Recoil (%)

Used in reference to elastic recoil of a vessel


- the amount of spring back a vessel or stent experiences after it has been expanded

Reference Vessel Diameter (RVD)

The diameter of the vessel. The RVD is typically measured in the non-stenosed portion of the vessel that is close to the lesion


- the reference diameter measurement may be proximal, distal, or on both sides of the lesion

Re-Occlusion

The reoccurrence of occlusion in an artery after it has been treated (as by balloon angioplasty) with apparent success

Reperfusion

Restoration of blood flow to ischemic tissue

Residual Stenosis

Blockage that remains in the artery immediately after the interventional procedure is performed

Restenosis

A condition in which the blockage returns to a vessel segment that has been previously treated by percutaneous intervention

Revascularization

Opening of a narrowed or blocked artery

Rutherford Becker Clinical Categories

A system for categorization of chronic lower limb ischemia


- Grades: 0-III


- Categories: 0-6


- Clinical Descriptions: Asymptomatic, Mild Claudication, Moderate Claudication, Severe Claudication, Ischemic Rest Pain, Minor Tissue Loss, Major Tissue Loss

Shortening

Stent shortening that occurs when the stent is expanded

Shunt

To bypass or create a passage between two channels, especially between blood vessels; to divert blood from one part to another by a surgical shunt

Stenosis

A narrowing in an artery (lesion = stenosis = narrowing = plaque)

Stent

A framework that is permanently implanted to provide internal support to artery lumen

Sub-Acute

Between acute and chronic, but with some acute features.


- after the patient is discharged from the cath lab but within the first 24 hours (typically used in reference to stent thrombosis)

Sub-Intimal

Beneath the intima

Superior

Relational term meaning above a reference point


- Ex: the knee is superior to the ankle

Take Off

When an artery branches, the ostium (origin) of the arterial branch is called the take off

Tandem Lesions

Two blockages in the same artery where the segment in between is not diseased

Target Lesion Revascularization (TLR)

Revascularization (repeat procedure) of a lesion that was previously repaired




*Note: term is typically used for clinical trials

TASC

TransAtlantic Inter-Society Consensus on the management of PAD created to address the lack of uniformity in atherosclerotic disease management among countries as well as hospitals

Thromboembolism

Blood clot which forms in one site then detaches and lodges in another part of the body

Thrombolysis

Action of lysing or breaking up a blood clot (thrombo = clot, lyse = dissolve)

Thrombolyctic

Descriptive of a medication that can dissolve a blood clot


(thrombo = clot, lyse = dissolve)

Thrombosis

Formation of a blood clot

Thrombus

Aggregation of plasma components (platelets and fibrin) that occludes a vessel at the site of its formation

Titrate

Incremental increase or decrease in drug dosage to a level that provides the optimal therapeutic effect

Tortuosity

Full of twists and turns; may be a characteristic of arteries in some patients

Total Occlusions

Blockages in arteries that will allow no blood flow to pass

TVR

Target Vessel Revascularization

Vascular

Relating to the blood vessels

Vascular Remodeling

Vessel shrinkage or expansion post stent procedure.


- usually it is a shrinkage of the vessel which also contributes to restenosis

Vasoconstriction

Narrowing of the blood vessels caused by contraction of the muscles of their walls

Vaso-Vagal Reaction

The response of the blood vessels (vaso) to the stimulus from the vagus nerve; causes dilation of blood vessels

Vein

Vessels which return deoxygenated blood to the heart

Walking Impairment Questionnaire (WIA)

A disease-specific instrument utilized to characterize walking ability through a questionnaire as an alternative to treadmill testing.


- measure of subject perceived walking performance for subjects with PAD and/or intermittent claudication.


- includes questions about degree of pain, aching, or cramping, the reason for difficulty in walking, walking distance, speed and stair climbing