ARDMS (RVT) Ultrasound Vascular Registry Review Questions with 100% Correct answers

ARDMS (RVT) Ultrasound Vascular Registry Review Questions with 100% Correct answers Ultrasound Vascular Registry Review Questions with 100% Correct answers What is the first branch of the aortic arch? Innominate artery/ Brachiocephalic Name the three branches of the aortic arch? a. Innominate artery/ Brachiocephalic b. Lt CCA c. Lt Subclavian artery The radial artery runs on what side of the forearm? Lateral side The radial artery branches to form what part of the palmar arch? Superficial palmar arch Where does the radial artery terminate? (Just remember that the ulnar branch and termination is opposite of the radial artery) Terminates in the deep palmar arch What vessel is the predominate source of blood flow to the hand come from? Ulnar artery The Deep Palmar arch is a branch of the? Ulnar artery What are the three branches of the celiac trunk? a. Left Gastric artery b. Splenic artery c. Common Hepatic artery What organs does the celiac trunk supply? Stomach, Liver, Pancreas, Spleen, & Duodenum The SMA is located 1cm below the celiac trunk and supplies what? Small Intestines, cecum, and parts of colon,Is it an uncommon finding to see multiple renal arteries bilaterally? No it is not uncommon at all. What vessel runs anterior to the aorta? Left Renal vein What arises from the abdominal aorta about 3-4 cm above the bifurcation, that can act as a collateral connection? IMA (Inferior Mesenteric Artery) What are the most distal branches of the aorta that supply blood to the pelvis, abdominal wall, and lower limbs? Common Iliac Arteries (CIA) What vessel is also referred to as the Hypogastric artery? Internal Iliac Artery What vessel runs along the medial side of the psoas mucsle and underneath the inguinal ligament? External Iliac artery What vessel becomes the CFA in the groin region? External Iliac Artery The SFA passes through an opening in what tendon to enter the popliteal fossa? Adductor Hiatus (Adductor Canal or Hunter's Canal) What is another name for the deep femoral artery? Profunda Femoris What is the region called where the SFA terminates and the popliteal artery begins? Adductor Hiatus What 3 branches is sometimes known as the trifurcation? APA, PTA, Peroneal Artery Whats the first branch off distal popliteal artery? ATA - Anterior Tibia Artery What vessel does the ATA become once it crosses the dorsum of the foot?DPA - Dorsalis Pedis Artery What is a major branch of the DPA (dorsalis pedis artery)? Deep Plantar Artery- penetrates the sole of foot, it unites with lateral plantar artery to complete plantar arc. How does the PTA run down the leg? Posterior and Medial side of leg What is the Tibioperoneal Trunk? Short segment between ATA branch and branches of PTA and peroneal arteries. The plantar arch in foot consists of what branch from DPA? Deep plantar artery The plantar arch in foot consists of what branch from the PTA? Lateral plantar artery, which unites with the deep plantar artery Arteries progressively decrease in size from the largest being __ and the smallest being ___? A. Largest = Aorta B. Smallest = Arterioles Arterioles are considered what type of vessels and assist in regulating what? a. Arterioles are considered resistance vessels b. They assist in regulating blood flow through contraction and relaxation. Where does the exchange of nutrients and waste products between blood and tissue take place? Capillaries What is the inner thin layer of the arterial wall called? Tunica intima, which consists of smooth endothelium and connective tissue What layer of the arterial wall is thickest and made up largely of elastic type of smooth mucsle and connective tissue? Tunica media / intermediate layer Which layer of the arterial wall is made up of fibrous connective tissue? Tunica externa / outer layer (adventitia) What layer of the arterial wall contains the vasa vasorum? What is the vasa vasorum?The vasa vasorum tiny vessels found in the adventitial layer of the arterial wall, that carry blood to the walls of the largest arteries. Proximal to aortic arch, what are the first branches of the ascending aorta? Coronary Arteries What events lead up to the beginning of cardiac contractions? 1. Pressure in left ventricle begins to rise 2. Left ventricle pressure exceeds that in the aorta 3. Aortic valve opens; blood is ejected, blood pressure rises What generates the pressure wave to move the blood? Pumping Heart What governs the amount of blood that enters the arterial system? Cardiac output What determines the amount of blood that leaves the arterial system? Arterial pressure and total peripheral resistance Where is pressure greatest in the arterial system? Pressure is greatest at the heart, gradually decreasing as blood moves further away. What 2 things is required for movement of any fluid medium between 2 points? 1. Pathway for fluid to flow 2. Pressure difference / Energy gradient Low resistance yields what type of flow rate? High flow rate The total energy contained in moving fluid is the sum of what 3 energies? 1. Potential (Pressure) 2. Kinetic 3. Gravitational What type of energy is stored energy and is the major form of energy for circulation of blood? Pressure (Potential) Energy, measured in mmHg. What form of energy id equivlent to the weight of the column of blood extending from the heart to the level where pressure is measured?Gravitational energy or Hydrostatic Pressure (HP) What is the tendency of a fluid to resist changes in its velocity? Inertia What 2 things affect the movement of fluid? 1. Physcial properties of the fluid 2. What the fluid is moving through Internal friction within a fluid is measured how? It's measured by its Viscosity What is an example of something that would increase blood viscosity? Decrease blood viscosity? 1. Elevated hematocrit increases viscosity 2. Severe anemia would decrease viscosity Viscosity measures what of a fluid? Viscosity measures the thickness of a fluid. What type of energy loss is due to increased friction between molecules and layers? Viscous energy loss What type of energy loss occurs with deviation from laminar flow, due to changes in direction and / or velocity? Inertial energy loss Whose equation define the relationship between: pressure, resistance, and volume flow? Poiseulle's Equation: Q = P/R ; it helps answer the question of how much fluid moves through a vessel What can occur due to geometry change with or without intra-luminal disease and becuase of curves in vessels? Pressure gradients (Flow separation), they occur in areas with stagnant or little movement. What predicts when fluid becomes unstable? Reynolds Number (Re)- >2000 is the point when laminar (stable) flow turns into turbulent (disturbed) flow In a rigid tube, energy losses are mainly viscous; this can be described by whose principles? Poiseuille's equationWhat kind of flow feeds dilated vascular beds like: ICA, vertebral, renal, celiac, splenic, hepatic? Low resistance flow, which is continous (steady) flow What is one visible sign that you can differentiate a low resistant waveform from a high resistant waveform? The reversal of flow seen in high resistant waveforms. As the inflow pressure falls as a result of stenosis, what is the natural response of the periphery vessels? Vasodilate or vasoconstrict? Vasodilate Exercise should induce peripheral vasodilation, which does what to the distal peripheral resistance? Raise or Lowers? Lowers the peripheral resistance, increasing blood flow. What is the single best vasodilator of resistance vessels within skeletal muscle? Excercise What is the ability of most vascular beds to maintain constant level of blood flow over a wide range of perfusion pressures called? Autoregulation If your blood pressure rises, how will your resistance vessels responed? Resistance vessels will constriction Will your vessels be constricted or dilated if you scan a cool vs a warm extremitiy? A. Warm- Dilated B. Cool- Constricted Laminar Flow is the even distribution of frequencies at systole: where are lower frequencies found in laminar flow? where is the fastest moving flow? Slow flow is near vessel walls, with the fastest flow in the centerstream What 2 things are reduced in a significant stenosis? Volume flow and Pressure are both significantly reducted At what point in a stenosis is the flow frequencies dampened, with or without disturbance? Proximal to a stenosis At what point in a stenosis is spectral broadening and elevated velocities seen?Entering the stenosis, with the high velocity at the narrowest part of the stenosis. At what point in a stenosis is flow reversals, flow separation, and vortices / eddy currents seen? Exiting the stenosis, post-stenotic turbulence. What is pain in muscles usually occurin during exercise; subsides with rest? Claudication What arterial condition has symptoms of the 6 P's: pain, pallor (white), pulselessness, paresthesia, paralysis, and polar; it may result from thrombus, embolism, or trauma? Acute Arterial Occlusion What coniditon exists when symptoms of intermittent digital ischemia occur in response to cold exposure or emotional stress? Raynaud's phenomenon What form of Raynaud's is seen as ischemia due to digital arterial spasm and is commonly seen in young women? Primary Raynaud's What form of Raynaud's is also known as obstructive Raynaud's syndrome and may be the first manifestation of Buerger's disease? Secondary Raynaud's What word (color) results from deficient blood supply; skin pale? Pallor What word (color) suggests dilated vessels secondary to reactive hyperemia; skin is reddened? Rubor What word (color) results from a concentration of deoxygenated hemoglobin, causing bluish discoloration? Cyanosis Name a few areas where palpable pulses can be felt. Aorta, femoral, popliteal, DPA, PTA What is most common arterial pathology? Thickening, hardening, loss of elasticity of the artery wallWhat syndrome occurs in males and is caused by obstruction of the aorta, resulting in fatigue in the hips, thighs, and calves during exercise, absense of femoral pulse, and impotence? Leriche Syndrome What are 2 examples of types of true aneurysms? 1. Fusiform 2. Saccular What is a common location for a dissecting aneurysm to occur? Thoracic Aorta What is most common location for a true aneurysm? Infrarenal What are the 2 most frequent complications of Aneursyms? 1. Rupture of the aortic aneursym 2. Embolization of the peripheral aneurysms What is a non-atherosclerotic lesion, with Buerger's disease (thromboangitis obliterans) as a form of the condition, which is when LE arterial vessels become inflammed and lead to thrombosis of the vessels Arteritis What is a congential anomalie of the arterial system that is seen as congential narrowing or stricture of thoracic aorta called? Coarctation of the aorta What layer of the aortic wall develops a tear, which allows for blood to leak through and form a false lumen? Intimal layer tears and allows blood to leak into the media layer which weakens the media layers. What occurs when the frequency of the wave received is different from the transmitted wave, which is relative motion between the source (blood) and the receiver of sound (transducer)? Doppler shift What Doppler method uses individual frequencies displayed by FFT (Fast Fourier Transform) method? Spectral analysis What 5 arterial vessels in upper extremities are evaluated in arterial study? Subclavian, axillary, brachial, radial, and ulnar.Analog Doppler are not capable of portraying velocities less than what cm/sec? No velocities < 6cm/sec What are somethings you can do to reduce noise on a spectral trace? 1. Decrease gain 2. Increase wall filter 3. Turn machine on/off 4. Try another wall plug What is the difference between the 4 cuff method vs the 3 cuff method? 3 cuff method only has one cuff on thigh while the 4 cuff method has 2, high thigh and above knee (low thigh). The 3 cuff method provides more accurate pressure readings. What frequency probe and what Doppler angle should you have for arterial studies? 8-10 MHz probe with a Doppler angle 45-60 degrees to the skin. What percentage should the width of cuff used in arterial segmentals be greater than the limb? >20% What order is segmental pressures taken? a. Brachial (upper arm) b. Ankle (use PTA or DPA; peroneal A. only if necessary) c. Calf (BK) (Use PTA or DPA-that had highest pressure) d. Above knee (AK) (Same as above-may need to use pop) e. High Thigh (HT) How is the ankle/brachial index (ABI) or (Ankle/arm pressure API) calculated? ABI's are calculated by dividing the ankel pressure by the higher of the 2 brachial pressures. What value is considered normal for an ABI? >1.0 What ABI value is seen in patients with claudication? 0.5 - 0.9 What ABI value is seen in patients with severe arterial disease that have rest pain? < 0.5 What type of error will you get if a patient has a incompressible arterial vessel, when doing an ABI?An artery with an ABI >1.3-1.5 is considered incompressible and will give a falsely elevated and inaccurate pressures. Segmental pressure drop of what between 2 consecutive levels or horizontal difference, would suggests significant obstruction? > 30mmHg between 2 consecutive levels and >20-30mmHg of horizontal difference, to suggest significant obstruction A horizontal difference of > or = to 20-30mmHg suggests obstructive disease at or above the level of which leg? At or above the level in the leg with lower pressure. What segmental pressure is more reliable to use than the ankle pressure in diabtetic patients? Toe pressure At what toe pressure is it evident that a foot or toe ulcer has failed to heal? < or = 30mmHg What are some MAJOR risks factors for atherosclerosis? Smoking, Family history, and hyperlipidemia. (Less impt factors: HTN, diabetes, sedentary (lazy/unhealthy) lifestyle, and arterial wall shear/stress. In the normal patient, will the ABI increase or decrease post-exercise? In a normal patient the ABI's should increase, while in an abnormal patient ABI's will decrease. How many minutes does it take the ABI's to increase back to resting levels in a patient with single level disease? Takes 2-6 minutes How many minutes does it take the ABI's to increase back to resting levels in a patient with Multi-level disease? Takes 6-12 minutes What's an alternative method for stressing the peripheral circulation, for patients with PVOD, ones that use a cane or walker, have pulmonary problems, or bad heart? An how does it work? Reactive Hyperemia, which is done by inflating bilateral thigh cuffs to suprasystolic pressure levels and maintianing the pressure for 3-5 minutes. This produces ischemia and vasodilation distal to the occluding cuffs. How is single vs multi-level disease determined with the use of reactive hyperemia?a.Single level has < or =50% drop in ankle pressure b.Multi-level has >50% drop in ankle pressure. c. Normal limbs may show a transient drop of 17-34% What test is used to evaluate the patency of the palmar arch? Allen test How is the Allen test performed? Tech compresses patients radial artery while the patient clenches fist for at least a minute or until pallor. Then the patient relaxes hand while the tech continues to compress radial artery. A normal finding would be to see color return; an abnormal finding would be for the color not to return which would either mean an ulnar artey occlusion or palmar arch obstruction. What pressure difference from one brachial to the other suggests >50% stenosis of subclavain artery? 15-20mmHg difference What penile arteries and veins are measured during the imaging technique to determine whether impotence is related to peripheral vascular insufficiency? Cavernous arteries and Dorsal veins. What is the normal response of the cavernous arteries post-injection? Increase or decrease? They normally should increase in size. What is a normal PSV range for the cavernous arteries of the penis? Normal PSV range is approx 30 cm/sec or higher, anything less is often considered abnormal. What is plethysmography used to help determine? It helps to differentiate true claudication from non-vascular sources. What is PPG used to evaluate mainly? Digits and Penile vessels What instrument is used for measuring changes in volume within an organ or whole body (usually resulting from fluctuations in the amount of blood or air it contains)? Plethysmography What is pledge position, in reference to upper extremity exams? Arm is at 45 degree angle from body, & externally rotated. Brescia-Cimino fistula, straight, & looped synthetic graft are all types of what?Dialysis access examples Which end of a hemodialysis access graft is stenosis more commonly seen? At venous anastomosis and outflow vein What is a "steal syndrome" in reference to hemodialysis It's when the distal arterial blood flow is reversed into the lower resistant venous circulation and can cause pain in hand/fingers on exertion, pallor and coolness of the skin distal to the shunt. What is the ideal Angle for Vasucalar studies? 60 degrees, obtained centerstream, parallel to vessel walls In reference to stenotic vessels, where is the highest PSV seen? Where is turbulence usually seen? a. Narrowest part within stenosis will have highest PSV b. Post stenosis will usually have turbulenct waveform What is the mechanism for hypertension? Renal ischemia triggers the release of renin and a secondary increase in BP. Renin converts angiotensin I into angiotensin II, which causes severe vasoconstriction. Give examples of low resistive abdominal vessels? Renal, celiac, hepatic, and splenic arteries. Give examples of high resistive abdominal vessels? Aorta, as are a fasting SMA and IMA How do you calculate the renal to aorta ratio (RAR)? Divide the highest renal artery PSV by the aorta PSV. Whats considered a normal renal to aorta ratio?Abnormal? a.Normal = < 3.5. b.Abnormal = > or equal to 3.5 What are 2 situations that you cannot use the (RAR) renal to aorta ratio? a. If AAA is present b. If aortic PSV >90cm/s or <40cm/s Whats the normal length of the kidneys? 10-12cm depending on patients body habitus. `How do you calculate resistive index for kidneys? Whats considered normal vs abnormal? a. PSV minus EDV divided by PSV b. Normal = <0.8 and Abnormal = > or = to 0.8 What does an abnormal RI or RAR indicate? It indicates an increase in distal resistance. What is the dampened, weak signaled waveform called, that results from renal artery stenosis/occlusion? Tardus-parvus A patient presents w/ a history of aching and cramping abdominal pain 15-30 minutes after meals. What would you suspect to be the problem? Mesenteric ischemia or mesenteric angina; which may be due to stenosis or occlusion of the SMA, celiac, or IMA. Whats the normal velocity of the SMA? Abnormal? a.Normal = 110-177 cm/sec b. Abnormal = >or equal 275 cm/sec (> or = 70% diameter reduction) Extrinsic compression of celiac artery origin by what ligament can cause reversible celiac artery stenosis during expiration? Median arcuate ligament of the diaphragm What vessels should be evaluated pre and post operative liver transplants? Evaluate for patency of: portal vn, hepatic veins, IVC and hepatic artery. What is the transplanted renal artery, in a renal transplant, anastomosed to? Transplanted renal vein? a. Tx Renal artery is anastomosed to either EIA or IIA. b. Tx Renal vein is anastomosed to EIV. What are signs of rejection of a renal transplant? a. Increased renal transplant size b. Increased cortical echogenicity c. Increased renal arterial resistance What is an abnormal connection between a high-pressure arterial system and a low-pressure venous system called? Arteriovenous Fistulae (AVF) If a fistula is found close to the heart, what issue is the patient at an increased risk for?Cardiac failure What 2 things predict the resistance an AVF will offer? Diameter and length of the AVF predict the resistance it offers. Describe the arterial flow seen proximal to an AVF. Proximal arterial flow has increased diastolic flow because the fistula reduces resistance. What is Compartment Syndrome Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow. How is anterior compartment syndrome treated? Fasciotomy, which is a procedure where the fascia is cut to relieve tension or pressure. What is the key to success when it comes to compression of pseudoaneurysms? The key to success is whether aneurysm "neck" between native artery and pseudoaneurysm can be Uniformly and Completely compressed. What is popliteal artery entrapment syndrome? Its when the popliteal artery can be compressed by medial head of gastronemius muscles, or fibrous bands, which results into claudication or chronic leg ischemia. What is referred to as the TRAM flap and what is it used for by surgeons? TRAM- Transverse Rectus Abdominis Myocutaneous Flap, which consist of the rectus abdominis muscle, sub-q fat, arteries, perforators, and overlying skin. Surgeon's use the TRAM flap for autogenous breast reconstruction. What are the reasons for mapping the internal mammary artery (internal thoraic artery)? a. Utilized as a recipient site for free flaps in breast reconstruction. b. Second important use for this artery is as graft to the left anterior descending (LAD) coronary artery. What is Radial artery mapping used for? To determine suitability for use as graft for coronary artery bypass. What are some indications for preoperative vein mapping? a. Extremity or coronary artery bypass b. Use in dialysis access/graft What veins do you map for LE and UE?a. LE- GSV b. UE- Basilic and Cephalic veins What is thoracic outlet syndrome (arterial component)? Occurs with neurovascular bundle compression by shoulder structures (cervical rib, clavicle, scalene muscle); occurs in certain arm positions. Most symptoms are due to neurogenic compression of brachial plexus; which cause numbness/tingling of arm or pain/aching of shoulder/forearm. What is described as multiple arterial stenoses caused by medial hyperplasia, appearing as "string of beads"? Fibromuscular Dysplasia What are the most common arteries used for an Angio exam? CFA (safest approach), Axillary, or Brachial arteries What are some complications that can follow an angio exam? Puncture site hematoma, pseudoaneurysm, local arterial occlusion, or possible neurologic complications What type of arterial study uses radio fequency energy and a strong magnetic field to produce images in multiple planes that quantitate blood flow and distinguish it from soft tissue without using contrast agents? MR Angiography (MRA) What is one benefit of performing and MRA study instead of and angiogram? MRA's dont require contrast agents so patients with renal failure or patients that are allergic to the contrast agents are able to have exam. What type of pharmacologic agents can be used to help treat arterial vessel issues? a.Any medication that helps decrease blood viscosity, like aspirin, which is an antiplatelet drug that decreases platelet aggregation, resulting in decreased thrombotic activitiy. b. Antihypertensive drugs may serve to decrease shearing forces against vessel walls. What is the surgical removal of atherosclerotic material, usually includes portion of intimal lining? Endarterectomy What are the 3 components that are needed to acheive a successful bypass graft? a. Good Inflow b. Conduit c. Outflow What is a PTLA (Percutaneous Transluminal Angioplasty used for and how is it done?a.Angioplasty is used to dilate focal plaque formation in a vessel. b.Same technque used as arteriography, except a balloon tipped catheter is used under fluoroscopy to region of stenosis, where the balloon is slowly inflated, pushing plaque against walls of vessl, dilating artery lumen. What is an endoleak when referring to graft complications? Endoleak is defined as a persistent blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or adjacent vascular segment being treated by the device. Endoleaks are due to incomplete sealing, or exclusion of the aneurysm sac, and thus cause reflux of blood flow into the sac. The Right CCA is a branch of the? Right Innominate The Left CCA is a branch off the? Aortic Arch The majority of the CCA's blood, flows into what vessel? Internal Carotid Artery (ICA) What is the carotid siphon and what artery originates near it? Carotid siphon is a significant curve of the ICA where the Ophthalmic artery originates What are the 2 branches of the ICA? What type of vascular beds does the ICA feed? a.Ophthalmic artery and posterior communicating artery b. Low Resistant vascular beds How many major branches does the ECA have and what is usually its first branch? a. 8 Major branches b. Superior Thyroid artery is usually 1st branch What is firts branch of the subclavian artery? Vertebral artery The vertebral arteries unite in skull to form what vessel? Basilar artery Basilar artery is formed by the confluence of what arteries? Vertebral arteries The basilar artery divides into what?Posterior cerebral arteries What is the largest intra-arterial connection (collaterl pathway) in the human body? Circle of Willis Whose principle stated that total fluid energy along a streamline of fluid flow is constant? Bernoulli's Principle What causes fleeting neurologic dysfunction, with symptoms that last less than 24 hrs and are usually caused by embolic from heart or carotid artery? What about if symptoms last more than 24hrs and complete recovery doesnt occur? a. TIA (Transient Ischemic Attack) b. CVA (Cerebrovascular Accident) How do you differentiate thrombus from embolisms? Embolism is a piece of thombus that breaks loose and travels distally until it lodges in a small vessle. What is intimal thickening from rapid production of smooth muscle cells in response to vascular injury/reconstruction, such as post carotid endarterectomy? Neointimal Hyperplasia What is Auscultation? Listening through a stethoscope What does paresthesia mean? Prickling and tingling of the skin What does Aphasia mean? Inability to speak What does Amaurosis fugax mean? Temporary, partial or total blindness, usually in one eye. What does paresis mean? weakness or slight paralysis on one side of body What does myopia mean? Nearsightedness What does Homonymous hemianopia mean?Defective vision or blindness in the right or left halves of the visual field. What does Vertigo mean? Difficulty in maintaining equilibrium What does Ataxia mean? Muscular uncoordination; inability to control gait What does Diplopia mean? Double vision or bilateral visual blurring What are some things that can cause falsely elevated velocities during a carotid exam? Tortuous vessels, cardiac output, compensatory flow, an inappropriate Doppler angle. What type of technique uses FFT (Fast Fourier Transform) method to analysis signals and displays the results as freqency shifts; x-axis representing time and the y-axis = velocities? (Spectral analysis, CW Doppler, Pulsed Doppler, or Color Doppler)? Spectral analysis What type of technique uses 2 PZT crystals, one for sending signals and the other for recieving signals, it has no range resolution, and only has 1 fixed sample size? (Spectral analysis, CW Doppler, Pulsed Doppler, or Color Doppler) CW Doppler What type of technique uses multiple crystals to send out then recieve reflections, has range resolution, and variable sample size? (Spectral analysis, CW Doppler, Pulsed Doppler, or Color Doppler) Pulsed Doppler What type of technique uses assigned colors to diaplay velocities and direction of moving blood? (Spectral analysis, CW Doppler, Pulsed Doppler, or Color Doppler) Color Doppler Information greater than 1/2 PRF that cannot be displayed is called? Nyquist Limit What are some things you can do to increase your PRF/Nyquist limit? a. Decrease baseline b. Increase Doppler scale c. Change transducer to Lower frequencyd. Decrease Depth e. Alter angle of insonation or use CW Doppler What artifact can be produced from strong reflectors or by having too much gain that results in a Doppler shift above and below the baseline? Mirror Image Artifact What type of flow occurs when flow moves into a wider portion of the vessel (ex: Carotid Bulb), and the Doppler shift is seen above and below baseline differently? Helical flow What are the three acoustic windows used with transcranial Doppler? Transtemporal, Transorbital, and Transforaminal (suboccipital) What type of velocity is measure with Transcranial Doppler? Peak velocity or Time average maximum velocity (TAMV) or Mean velocity? TAMV or Mean velocity What vessels are accessed with a unilateral transtemporal approach? MCA, ACA, PCA, and terminal ICA What vessels are accessed with isilateral transorbital approach? Ophthalmic artery and Carotid siphon What vessels are accessed with transforaminal/subocciptal approach? Vertebral and Basilar arteries What is the TMVA and the mean velocity for the MCA? TMVA = 55 +/- with the mean velocity = 12cm/s What is a small terminal artery with muscular walls, that continues into the capillary network called? Arteriole What is a small blood vessel with only an endothelium membrane where the exchange of nutrients and waste occcurs called? Capillary What is a small vein that is continuous with a capillary bed called? VenuleWhat 2 vessels supply blood to the brain? ICA and Vertebral arteries What cranial caviity does the vertebral artery enter through? Foramen magnum What 3 main veins drain the head and neck? IJV, EJV and vertebral veins What two veins unite to form the Innominate/brachiocephalic vein? IJV and Subclavian vein The vertebral and internal mammary arteries are branch of what? Subclavian artery What artery divides into the radial and ulnar arteries? Brachial artery The ulnar artery travels distally in forearm to wrist where is becomes what? Superficial palmar arch The radial artery travels lateral & distally in forearm to wrist where is becomes what? Deep palmar arch What are the three major branches of the abdominal aorta? Celiac axis/trunk (Hepatic, splenic, and Lt gastric) SMA, and IMA What vessel courses posterior to the IVC in abdomen? Right renal artery, which is usually longer and slightly higher than left renal artery. Both renal arteries are found anteriorly or posteriorly to the renal veins? Posteriorly What 2 arteries branch anterior-lateral off aorta just below level of renal arteries? Hint: This vessel is different in each gender. Female its the ovarian arteries and in males its the testicular arteries. What does the internal iliac arteries supple? External Iliacs?A. Internal iliacs= pelvic organs B. External iliacs= BLE At the inguinal ligament, what does the external iliacs turn into? Common femoral arteries Whose law describe the steady laminar flow of Newtonian fluids or the pressure/flow relationship? Poiseuille What type of energy is represented by the velocity of moving blood? Potential or kinetic Kinetic energy What type of energy is represented by the intravascular pressure, which is supplied by contractions of the heart and is used to distend the vessels? Potential or Kinetic Potential energy Where is the lowest and highest pressure in the vascular system found? A. Highest-Left Ventricle @ 120mm/Hg B. Lowest-Right Ventricle @ 2-6mm/Hg Whose principle states that when a fluid flows without a change in velocity from on point to another, the total energy content remains constant? Bernoulli's Principle Vessels involved in regulating blood flow are called the what vessels, also known as arterioles? Resistance vessels When nerve fibers release norepinephrine what happens to arterioles? They vasoconstrict which causes contractile tone of arteriole vessels. What is the pressure within the vascular system due to the weight of a column of blood? Hydrostatic pressure What event results in retrograde flow in ipsilateral vertebral artery? Subclavian steal/occlusion How do you calculate % stenosis a vessel? Diameter reduction = [1-(d/D)] x 100; where d = narrowest part of stenosis & D = diameter of normal vessel wallExample of an antiplatelet drug that decreases platelet aggregation resulting in decreased thrombotic activity. Aspirin If you see slow upstroke and no diastolic flow in CCA, where would you think the disease is located? Proximal or distal to CCA? Proximal disease What if you see fast upstroke and no diastolic flow in CCA, where would you think the disease is located? Proximal or distal to CCA? Distal disease What is May-Thurner Syndrome? Left sided DVT due to the left common iliac vein passing under the right common iliac artery, which can cause extrinsic pressure. What vessel passes through the interosseous membrane, traveling distally between the tibia and fibula to joint the Dorsalis pedis at the ankle? Anterior Tibial vessels What is the longest vein in the human body? GSV (greater saphenous vein) Carrying blood from superficial veins into deep veins is acomplished by what veins? Perforators What perforators play a major role in development of venous stasis ulcers? Posterior arch vein, which has 3 perforators What is the intracranial space between the dura mater and periosteum that drains blood into the IJV called? Intracranial Venous sinuses In between what 2 muscles are the lower extremity Venous sinuses located? Soleal and gastrocnemius muscles What is formed by the confluence of axillary and cephalic veins? Subclavian vein What is formed by the confluence of brachial and basilic(superficial) veins?Axillary vein What is formed by the confluence of subclavian and IJV? Innominate vein What is formed by the confluence of rigth and left innominate veins? SVC (Superior Vena Cava), which carries blood to the right atrium List the deep veins of the upper extremity. Radial, Ulnar, Brachial, Axillary, Subclavian, Innominate, and SVC List the superficial veins of the upper extremity. Basilic and Cephalic veins List the deep veins of the lower extremity. Paired PerV & PTV, ATV, PopV, SFV, CFV, EIV, CIV, IVC List the superficial veins of the upper extremity. SSV and GSV What terminates in the right atrium and drains the head and BUE? SVC What terminates in the right atrium and drains lower half of body? IVC The confluence of what 2 veins forms the Portal vein? SMV and Splenic vein What percentage of blood flow is supplied to the liver by the portal vein? 80% Portal vein carries blood INTO (hepatopetal flow) what exact part of the liver? Sinusoids What vein carries blood FROM the liver to the IVC? Hepatic vein What veins in the body dont have valves?Soleal sinuses, IVC, SVC, Innominate, Common Iliac, Internal iliac, and the External iliac has valves 25% of the time The pressure within the vein versus pressure outside the vein is called what type of pressure? Transmural or Distention pressure What type of pressure is equivalent to the weight of a column of blood pressing against the vessels of the body? Hydrostatic pressure A dumbbell shaped vein has what type of transmural pressure? low or high? Low transmural pressure, while a circular shap vein has high transmural pressure. What you exhale where is the pressure increased and where is it decreased? Exhale forces diaphragm up = increased thoraic pressure and decreased abdominal pressure. When the valsalva maneuver is perform, what happens to the pressure within the thoracic and abdominal cavity? Pressure in both cavities is increased causing total hault of venous return. What does erythema mean? Redness seen with an inflammatory process What is induration of tissue? Edema, or fluid accumulation A lower extremity has a brownish discoloration, what can that represent? Venous statis ususally in lower leg-to-ankle area (gaiter zone) If a patient comes in for a venous study an there lower extremity has a pallor/whiteness appearance, what could be going on? What if the extremity was bluish/cyanosis color? A. Pallor color = arterial spasms secondary to extensive, acute iliofemoral thrombosis, also called phlegmasia alba dolens B. Bluish/cyanosis = severly reduced venous outflow from iliofemoral thrombosis markedly reduces arterial inflow as welll; also called phlegmasia cerulea dolens Where are venous ulcerations usually seen and how do they look? Venous ulcerations are often near the medial malleolus and are shallow, irregular shaped. The skin of these patients: inflammed, infected, and may have presence of variocosities. Where are arterial ulcerations usually seen and how do they look?Arterial ulcerations are very painful and are often seen in the tibial area, toes, or bony prominences. They are usually seen as deep, regular shaped ("punched out" appearance). The skin of patients with arterial ulcers is dry, scaly, and/or shiny, with loss of hair and toenail thickening. What are the three components to Virchow's Triad? 1. Trauma to vessel 2. Venous stasis 3. Hypercoagulability What are Avalvular veins? Valveless veins What is Klippel-Trenaunay syndrome? Its a congenital venous disease characterized by multiple varicosities of the superficial system and hypoplastic or absent deep veins. What does plethysmography measure? Volume changes Whats the difference between DC and AC coupling? What type of studies is each used for? A. DC- Direct current w/ electric voltage being + or -, it only flows in 1 direction, and it detects slow changes in blood content. Its used for venous studies. B. AC- Alternating current that uses reverse polarity (+/-) 60/sec, it flows in both directions and detects fast changes in blood content. Its used for arterial studies. Explain difference between ascending and descending venography. A. Ascending venography the contrast is injected into a vein in dorsum of foot w/ a series of x-rays taken. Its used to detect acute and chronic DVT. B. Descending venography the contrast is injected into the CFV w/ a series of x-rays taken. Its used to detect reverse flow from incompetent venous valves. What is Virchow's Triad? 1. Venous stasis 2. Hypercoagulability 3. Trauma to a vessel What is the triangular region located anterior to an below th elbow? Antecubital fossa A connection created surgically to connect 2 vessels that were not formerly connected? AnastomosisA connect between an artery and vein that was created as a result of surgery? AV Fistula A channel that diverts blood flow form 1 artery to another; usually done to shunt flowaround an occluded portion of a vessel? Bypass A conduit that can be prosthetic material or autogenous vein used to divert blood flow from one artery to another? Graft An increase in blood flow; this can occur following exercise; it can also occur following restoration of blood flow following periods of ischemia. Hyperemia The GSV is left in its normal anatomical position and used to create a diversionary channel for blood flow around an occluded artery. In situ bypass Rapid proliferation of cells into the intimal layer of the cell wall that can lead to stenosis of a bypass graft? Myointimal Hyperplasia What appear as small confined projections into the vessel lumen made up of a segment of the vessel wall that has separated from the remainder of the wall in a abnormal bypass graft? Initmal flap The most common site for bypass graft pseudoaneurysms to occur? Would be the CFA in the groin at the outflow of a prosthetic aortofemoral or femoro-femoral crossover graft What is the longest vein in the body? Greater Saphaneous What two vessels does the popliteal vein recieve? 1. Lesser Saphaneous 2. Gastrocnemius What does dyspnea mean? Shortness of breathWhat does hemoptysis mean? Coughing up blood. What is the inflammation of the superficial veins, often seen with thrombus called? Superficial phlebitis. What can venous hypertension cause? Venous hypertension can cause excessive fluid to leak out of capillaries and into interstial spaces, causing edema and swelling.