Vascular Registry CCI Review| 63 pages| 633 questions| with
complete solutions
Abdominal Aorta waveform(s) Correct Answer: Low resistance proximal, Higher resistance
beyond renals
Celiac Artery supplies Correct Answer: Liver, spleen, stomach, & proximal small bowel
Branches of the Abdominal AO Correct Answer: 1st major-Celiac artery (trunk/axis)
2nd major-SMA
Renals
3rd major-IMA (after renals)
Celiac Axis Correct Answer: Branches into Common Hepatic (to right), Splenic, & Left Gastric
(off left)
Common Hepatic Arteries Correct Answer: Gives rise to the Gastroduodenal artery in PANC
head & divides into Rt & Lt Hepatics
Splenic Artery Correct Answer: Branches left and posteriosuperior to PANC body/tail
SMA/IMA waveforms Correct Answer: High resistance preprandial/Low resistance postprandial
SMA supplies Correct Answer: Bowel from duodenum to prox small bowel
IMA supplies Correct Answer: Bowel descending & rectosigmoid colon
Right Renal Artery Correct Answer: Branches anterolateral, posterior to IVC
Left Renal Artery Correct Answer: Branches posterolateral
Renal Artery waveform Correct Answer: Low resistance
Portal vein is usually formed by the confluence of Correct Answer: SMV & Splenic veins
*It also receives blood from the inferior mesenteric, gastric, and cystic veins
Portals walls/waveforma Correct Answer: echogenic walls & phasic waveforms
Renal veins are formed by Correct Answer: renal tributaries
Left Renal Vein Correct Answer: Longer than Rt.; Receives suprarenal/Gonadal vein
Left Renal pathway Correct Answer: Anterior to AO; Posterior to SMA
Right Renal Vein Correct Answer: No tributaries; shorter
,Hepatic Veins Correct Answer: Hepatofugal flow; from liver to IVC
Patient status for Abdominal Vascular Imaging Correct Answer: NPO 8-12 hours
Ectasia Correct Answer: Local diameter increase with small bulge
(20% increase for Ao <3cm)
AAA growth rate Correct Answer: 1-2mm/year until 3-4cm; 5 mm/yr >4cm
Aneurysm classification Correct Answer: 2-3cm; 3-4cm for AAA
AAA Intervention Correct Answer: 5.5cm (high risk for rupture-catastrophic)
Fusiform Correct Answer: Concentric enlargement; All 3 layers intact
Saccular Correct Answer: Eccentric enlargement; All 3 layers compromised; Less common
(<1%); Usually in Thoracic Ao
Types of Saccular AAA Correct Answer: 1-Cannula Placement
2-Mycotic aneurysm (bacterial infection Ao wall)
3-Vasculitis (Inflammatory process)
4-Penetrating ulcer rupture into media
Vasculitis/Aortitis Correct Answer: Inflammatory process in wall of Ao beginning with outer
(adventitia) layer and moving inward; ie: Takayasu's
Dissection Correct Answer: Intimal wall compromised resulting in 2 lumens
false>true; flow reversal
Type 1 (a/b) endoleak Correct Answer: Leak in anastamosis of graft at (a) prox or (b) distal end
Type 2 endoleak Correct Answer: Aorta branch vessel; exhibits retrograde flow; more
dangerous b/c internally bleeding
Type 3/4 endoleak Correct Answer: (3) Junction of modular components; (4) Trans graft flow-
graft defect
Chronic Mesenteric Ischemia Correct Answer: "Fear of Food" 95% of Bowel Ischemia cases
Atherosclerotic stenosis/occlusion in main mesenteric arteries: >70% stenosis in 2/3 of principle
mesenteric arteries
Ischemia diagnosis criteria via Moneta Correct Answer: Celiac >200cm/s
SMA >275cm/s
Median Arcuate Ligament Syndrome (MALS) Correct Answer: Arch impedes on Celiac during
EXPIRATION (non-compressed during inhalation)
,Measurement(s) of Splenic Vein Correct Answer: 7-17 cm long; 5-10mm diameter
Portal vein diameter Correct Answer: <13mm
Blood supply to liver Correct Answer: 75% from Portal VEIN; 25% from Hepatic ARTERY
Portal vein carries ____________ to the liver Correct Answer: Nutrients
Hepatic artery carries ______________ to the liver Correct Answer: Oxygen
Portal Hypertension Correct Answer: Extrahepatic, Hyperdynamic, Intrahepatic (more common)
Extrahepatic Portal HTN Correct Answer: Prehepatic (Portal/splenic vein thrombus, Extrinsic
compression of Potral vein)
Posthepatic (IVC/Hepatic vein obstruction)
Hyperdynamic Portal HTN Correct Answer: AV malformation causing arterial portal fistulas
Intrahepatic (within liver) Correct Answer: Presinusodial (less common)
Postsinusoidial (more common)
Cirrhosis/Venoclusive disease
Small liver, large spleen, ascites
LaPlace's law Correct Answer: Larger vessel radius, larger wall tension to compensate for extra
pressure
Hydrostatic pressure Correct Answer: Gravitational
Large vessels serve as Correct Answer: Pressure reservoirs
Vasodilation Correct Answer: Stretch to absorb
Vasoconstriction Correct Answer: shrink/squeeze
Energy and stenosis Correct Answer: Prox- PE↑, KE↓(highest total energy)
Within-PE↓, KE↑ (lower TE, Bernouille's)
Distal-PE↑, KE↓ (lowest total energy)
A-Early Systole (Forward flow to periphery)
B-Peak Systole (Store PE)
C-Late Systole (Temporary reversal-Peripheral resistance)
D-Early Diastole (Forward-reduced resistance)
E-Late Diastole (Vessel Recoil/Vasoconstrict/PE turns KE) Correct Answer:
Brain Correct Answer: Supplied by ICA & Vertebrals
, 2% of Body's weight
15% CO
20% Total blood supply
3-8 minutes of oxygen deprivation results in Correct Answer: cellular death
Bovine Arch Correct Answer: Common origin of Lt. CCA and Innominate
ICA Correct Answer: Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose-
70-80% from CCA
ECA Correct Answer: Does not feed brain unless needed as collateral circulation
ECA supplies Correct Answer: Neck, face, scalp
ECA Branches Correct Answer: Superior Thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Maxillary
Superficial Thyroid
Vertebral supply Correct Answer: Medulla/Inferior cerebellum
Basilar supply Correct Answer: Pons/superior anterior cerebellum
Circle of Willis has atleast ____ variations with the most common being ___________________
Correct Answer: 9; the absence of one or both communicating arteries
What portion of the population has an incomplete CofW? Correct Answer: 50%
What portion of the population has a complete Cof W? Correct Answer: 20-25%
Anatomic interrogation Correct Answer: B-mode/2D best
Physiologic/hemodynamic interrogation Correct Answer: Spectral/Doppler best
Hemorrhagic Stroke Correct Answer: Bleed; HTN
Ischemic Stroke Correct Answer: Oxygen interruption; Blood clot/emboli from Atherosclerosis
Which stroke is known to be the 3rd leading cause of death? Correct Answer: Ischemic Stroke
Small perforating artery obstruction Correct Answer: Occurs in elderly/diabetics
complete solutions
Abdominal Aorta waveform(s) Correct Answer: Low resistance proximal, Higher resistance
beyond renals
Celiac Artery supplies Correct Answer: Liver, spleen, stomach, & proximal small bowel
Branches of the Abdominal AO Correct Answer: 1st major-Celiac artery (trunk/axis)
2nd major-SMA
Renals
3rd major-IMA (after renals)
Celiac Axis Correct Answer: Branches into Common Hepatic (to right), Splenic, & Left Gastric
(off left)
Common Hepatic Arteries Correct Answer: Gives rise to the Gastroduodenal artery in PANC
head & divides into Rt & Lt Hepatics
Splenic Artery Correct Answer: Branches left and posteriosuperior to PANC body/tail
SMA/IMA waveforms Correct Answer: High resistance preprandial/Low resistance postprandial
SMA supplies Correct Answer: Bowel from duodenum to prox small bowel
IMA supplies Correct Answer: Bowel descending & rectosigmoid colon
Right Renal Artery Correct Answer: Branches anterolateral, posterior to IVC
Left Renal Artery Correct Answer: Branches posterolateral
Renal Artery waveform Correct Answer: Low resistance
Portal vein is usually formed by the confluence of Correct Answer: SMV & Splenic veins
*It also receives blood from the inferior mesenteric, gastric, and cystic veins
Portals walls/waveforma Correct Answer: echogenic walls & phasic waveforms
Renal veins are formed by Correct Answer: renal tributaries
Left Renal Vein Correct Answer: Longer than Rt.; Receives suprarenal/Gonadal vein
Left Renal pathway Correct Answer: Anterior to AO; Posterior to SMA
Right Renal Vein Correct Answer: No tributaries; shorter
,Hepatic Veins Correct Answer: Hepatofugal flow; from liver to IVC
Patient status for Abdominal Vascular Imaging Correct Answer: NPO 8-12 hours
Ectasia Correct Answer: Local diameter increase with small bulge
(20% increase for Ao <3cm)
AAA growth rate Correct Answer: 1-2mm/year until 3-4cm; 5 mm/yr >4cm
Aneurysm classification Correct Answer: 2-3cm; 3-4cm for AAA
AAA Intervention Correct Answer: 5.5cm (high risk for rupture-catastrophic)
Fusiform Correct Answer: Concentric enlargement; All 3 layers intact
Saccular Correct Answer: Eccentric enlargement; All 3 layers compromised; Less common
(<1%); Usually in Thoracic Ao
Types of Saccular AAA Correct Answer: 1-Cannula Placement
2-Mycotic aneurysm (bacterial infection Ao wall)
3-Vasculitis (Inflammatory process)
4-Penetrating ulcer rupture into media
Vasculitis/Aortitis Correct Answer: Inflammatory process in wall of Ao beginning with outer
(adventitia) layer and moving inward; ie: Takayasu's
Dissection Correct Answer: Intimal wall compromised resulting in 2 lumens
false>true; flow reversal
Type 1 (a/b) endoleak Correct Answer: Leak in anastamosis of graft at (a) prox or (b) distal end
Type 2 endoleak Correct Answer: Aorta branch vessel; exhibits retrograde flow; more
dangerous b/c internally bleeding
Type 3/4 endoleak Correct Answer: (3) Junction of modular components; (4) Trans graft flow-
graft defect
Chronic Mesenteric Ischemia Correct Answer: "Fear of Food" 95% of Bowel Ischemia cases
Atherosclerotic stenosis/occlusion in main mesenteric arteries: >70% stenosis in 2/3 of principle
mesenteric arteries
Ischemia diagnosis criteria via Moneta Correct Answer: Celiac >200cm/s
SMA >275cm/s
Median Arcuate Ligament Syndrome (MALS) Correct Answer: Arch impedes on Celiac during
EXPIRATION (non-compressed during inhalation)
,Measurement(s) of Splenic Vein Correct Answer: 7-17 cm long; 5-10mm diameter
Portal vein diameter Correct Answer: <13mm
Blood supply to liver Correct Answer: 75% from Portal VEIN; 25% from Hepatic ARTERY
Portal vein carries ____________ to the liver Correct Answer: Nutrients
Hepatic artery carries ______________ to the liver Correct Answer: Oxygen
Portal Hypertension Correct Answer: Extrahepatic, Hyperdynamic, Intrahepatic (more common)
Extrahepatic Portal HTN Correct Answer: Prehepatic (Portal/splenic vein thrombus, Extrinsic
compression of Potral vein)
Posthepatic (IVC/Hepatic vein obstruction)
Hyperdynamic Portal HTN Correct Answer: AV malformation causing arterial portal fistulas
Intrahepatic (within liver) Correct Answer: Presinusodial (less common)
Postsinusoidial (more common)
Cirrhosis/Venoclusive disease
Small liver, large spleen, ascites
LaPlace's law Correct Answer: Larger vessel radius, larger wall tension to compensate for extra
pressure
Hydrostatic pressure Correct Answer: Gravitational
Large vessels serve as Correct Answer: Pressure reservoirs
Vasodilation Correct Answer: Stretch to absorb
Vasoconstriction Correct Answer: shrink/squeeze
Energy and stenosis Correct Answer: Prox- PE↑, KE↓(highest total energy)
Within-PE↓, KE↑ (lower TE, Bernouille's)
Distal-PE↑, KE↓ (lowest total energy)
A-Early Systole (Forward flow to periphery)
B-Peak Systole (Store PE)
C-Late Systole (Temporary reversal-Peripheral resistance)
D-Early Diastole (Forward-reduced resistance)
E-Late Diastole (Vessel Recoil/Vasoconstrict/PE turns KE) Correct Answer:
Brain Correct Answer: Supplied by ICA & Vertebrals
, 2% of Body's weight
15% CO
20% Total blood supply
3-8 minutes of oxygen deprivation results in Correct Answer: cellular death
Bovine Arch Correct Answer: Common origin of Lt. CCA and Innominate
ICA Correct Answer: Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose-
70-80% from CCA
ECA Correct Answer: Does not feed brain unless needed as collateral circulation
ECA supplies Correct Answer: Neck, face, scalp
ECA Branches Correct Answer: Superior Thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Maxillary
Superficial Thyroid
Vertebral supply Correct Answer: Medulla/Inferior cerebellum
Basilar supply Correct Answer: Pons/superior anterior cerebellum
Circle of Willis has atleast ____ variations with the most common being ___________________
Correct Answer: 9; the absence of one or both communicating arteries
What portion of the population has an incomplete CofW? Correct Answer: 50%
What portion of the population has a complete Cof W? Correct Answer: 20-25%
Anatomic interrogation Correct Answer: B-mode/2D best
Physiologic/hemodynamic interrogation Correct Answer: Spectral/Doppler best
Hemorrhagic Stroke Correct Answer: Bleed; HTN
Ischemic Stroke Correct Answer: Oxygen interruption; Blood clot/emboli from Atherosclerosis
Which stroke is known to be the 3rd leading cause of death? Correct Answer: Ischemic Stroke
Small perforating artery obstruction Correct Answer: Occurs in elderly/diabetics
