CVS 202T Vascular Exam 1 2025

Abdominal aorta characteristics - -largest artery begins after DA passes through diaphragm bifurcates into RCIA & LCIA (terminates) brings blood to LE & abdom organs runs on left of midline characteristics: pulsatile non-collapsible "most of the time" red higher pressure/resistance oxygenated more defined circular shape (trans) consistent diam in long: straight appearance more echogenic walls IVC characteristics - -widest vein in body runs on right of midline receives blood from LE & abdom organs confluence of RCIV & LCIV form IVC terminates at RA characteristics: collapsible non-pulsatile "tear drop" shape in trans deoxygenated non consistent in diameter; "hammock" shape in long low pressure/ resistance varies in size w/ inspiration & expiration what are the 5 main branches of the abdominal aorta? - -1st Celiac Artery 2nd Superior Mesenteric Artery 3rd & 4th R & L Renal Arteries 5th Inferior Mesenteric Artery renal views on ultrasound exam - -suprarenal (prox) (supra=above renal arteries) diaphragm to origin of SMA juxtarenal (mid) (supra= above renal arteries) SMA to renal arteries infrarenal (distal) renal arteries to aortic bifurcation CVS202 CVS202 Is the AA low or high resistance and what is the PSV? - -high resistance PSV= 80-100cm/sec What is the avg diameter of the AA and what is the range? - -avg diameter= 2.0cm range= 1.1-3.0cm, smaller as you go down What is the celiac artery also known as? - -celiac axis, celiac trunk Where does the celiac artery arise from and what does it supply? - -arises from the anterior wall of the suprarenal aorta, it supplies the liver, gallbladder, stomach, intestines & pancreas Is the celiac artery high or low resistance? and what is the PSV - -low resistance, PSV= 200cm/sec What are the 3 branches of the celiac artery? - -left gastric-stomach, splenic-spleen, common hepatic-liver Where does the superior mesenteric artery SMA originate and what wall? - -originates 1-2cm inferior to Celiac A on anterior wall of suprarenal A Is the SMA high or low resistance? - -both, it is high resistance when fasting and low resistance post prandial What is the SMA's PSV - -275cm/sec What does the SMA supply blood to? - -small intestines, pancreas, & sections of colon What are the 5 branches of the SMA & how many branches can they each have? - -1. inferior pancreatic A 2. duodenal A 3. colic A 4. ileocolic A 5. intestinal A they can each have 10-16 branches What do the renal arteries supply blood to? - -the kidneys and adrenal glands Are the renal arteries high or low resistance and what is the PSV? - -low resistance & PSV is 180-200cm/sec What does the IMA supply? - -colon, rectum, & majority of large intestine Is the IMA high or low resistance and what is the PSV? - -both, high resistance pre prandial & low resistance post prandial. the PSV is 275cm/sec CVS202 CVS202 Where does the IMA originate from? - -anterolateral wall of aorta above iliac bifurcation 3-5cm What are the 3 main branches of the IMA - -1. left colic 2. sigmoid 3. superior rectal arteries What does the external iliac vein drain? - -inferior abdominal wall & legs/ LE What does the internal iliac vein drain? - -pelvis What is the IVC's approximate diameter? - -17.2mm; largest vein in the body Where does the IVC terminate? - -right atrium What are the portions of the IVC on an ultrasound exam? - -supra hepatic- superior to liver intrahepatic- includes tributaries from liver Infrahepatic- inferior to liver & to level of iliac bifurcation Abdominal arterial testing risk factors? - -age, smoking, HTN, known atherosclerosis, male in gender(female for venous), caucasian, relative w history of AAA, trauma Indications for abdominal arterial exam? - -known AAA/iliac aneurysm (5cm or more), abdominal bruit, abdominal pain, pulsatile aorta/ mass on physical exam, relative w history of AAA, aneurysm in another location (always more than 1), distal emboli (none in fem or pop LE vessels), cyanosis, pulselessness, claudication of hips/buttocks What is an abdominal bruit? - -auscultation, tissue vibration from high grade stenosis high velocity flow What can a distal emboli lead to? - -causes ischemia, blue toe syndrome What is blue toe syndrome? - -AAA leads to clot thrombus stuck in digit, thrombus breaks off leads to emboli overweight/diabetic - calcified walls harden leading to Dr thinking its from LE What are the contraindications/limitations of an ultrasound eval? - -obesity- affects vessel depth & clarity abdominal gas- probe pressure & pt breathing helps pt breathing difficulties What is the pt prep for an ultrasound eval? - -fasting after midnight, limit liquids, no smoking, no gum chewing CVS202 CVS202 What is the ultrasound equipment for ultrasound eval? - -3.5MHz for curved linear array, and 2.5 MHz for phased array transducer (travel further into body for obese pt's) What is the ideal pt position for ultrasound eval? - -supine with knees bent to relax stomach midline, or right lateral decubitus What is the 2D assessment for ultrasound eval? what do you look for/do - -eval for echogenic material in lumen, presence of aneurysm, measure diameter in long and area in transverse What do you use color flow doppler for? - -assess stenosis & look for turbulent flow patterns Facts about spectral doppler abdominal ultrasound - -aorta is high resistant suprarenal has more diastolic flow than infrarenal obtain 60 degree angle PSV measurements 180-200cm/sec What is the most common arterial disease? - -atherosclerosis What is atherosclerosis & what does it do? - -forms on intima lining blocks flow/ occlude/ narrow lumen/stenosis What happens when atherosclerosis narrows a vessel greater than 50%? - -changes pressure & flow distally, considered a hemodynamically significant stenosis What is an emboli? - -plaque/ piece of thrombus that breaks off from heart/aneurysm flowing down stream, can lodge In distal BV What happens if an emboli gets lodged distally in BV - -causes an arterial occlusion, reduced flow & always leads to ischemia What is extrinsic compression - -compression of vein/artery from an outside source - indicated on ultra by continuous venous flow on waveform What things result in stenosis/occlusion? 3 things - -tumors, musculoskeletal configuration, hematoma What is the most common cause of aneurysmal disease - -atherosclerosis/ inflammation Why do aneurysm's occur? - -degeneration of elastic tissue in media resulting in dilation, decreased wall thickness & increased wall tension What happens with elastin breakdown? collagen breakdown? - -dilation, rupture infrarenal abdominal aorta is at a ___ risk for aneurysms - -higher CVS202 CVS202 What do vaso vasorum do? - -bring oxygen & nutrients to arterial walls, bifurcations have less VV What comes secondary to the initial aneurysm? - -arterial thrombosis What happens to BF velocity in dilated segment of aneurysm - -slows down & prevents coagulation which can cause an emboli What are the etiologies/ causes of AAA's? - -atherosclerosis, high BP, genetic, infection, trauma, male gender What are the two types of aneurysms? - -fusiform & saccular Which type of aneurysm is the most common? - -fusiform Describe a fusiform aneurysm. - -gradual dilation occurs in the walls of the vessel, all 3 walls intact but are stretched Describe a saccular aneurysm - -spherical & larger diameter 5-10cm, part/completely filled w thrombus, may extend to iliac arteries (higher risk of rupture) Dilation occurs on one side of the vessel What is the percentage range of AAA in the general population? - -5-7% What is the predicted rate of expansion of AAA per year? - -0.2-0.5cm per year What is the mortality rate of AAA rupture? - -50% True or false: many patients are asymptomatic when they have AAA's - -true An AAA with a diameter of more than 5-5.5cm re