ARDMS VASCULAR EXAM SCRIPT
✔✔what occurs in the portal system in a patient with CHF - ✔✔the main portal vein may
demonstrate a doppler waveform that is bidirectional with pulsatile flow
✔✔what is the origin of the portal vein - ✔✔begins at junction of splenic and SMV
immediately posterior to pancreas neck and courses superior to the right and passes
posterior to the first portion of the duodenum and terminates at the porta hepatis
✔✔what joins to form the MPV - ✔✔the SMV runs superior from the intestines to join
the SV and form the MPV
✔✔what is the largest tributary to the IVC - ✔✔the hepatic veins
✔✔what is the normal flow of the hepatic veins - ✔✔hepatofugal flow that is chaotic
pulsatile flow pattern from transmission of RA pulsatations
✔✔what effect does CHF have on the hepatic veins - ✔✔they become enlarged
✔✔Which lobe do the hepatic veins not drain - ✔✔the caudate lobe
✔✔where does the right hepatic vein run - ✔✔coronal betwen the anterior and posterior
segments of the right lobe
✔✔where does the middle hep v run - ✔✔between the right and left lobes
✔✔where does the left hep v run - ✔✔between the medial and lateral segments of the
left lobe
✔✔where is the IVC located - ✔✔anterior to the spine and to the right of the aorta
✔✔what is the normal size for the IVC - ✔✔seldom exceeds 2.5 cm but varies with
respiration and cardiac cycle (inspirations limit venous return and enlarge IVC)
✔✔what is the normal waveform for the IVC - ✔✔somewhat pulsatile due to the close
proximity to the RA
✔✔where do most IVC anomalies occur - ✔✔below the renal veins (duplication,
transposition)
✔✔what happens if the IVC is interrupted - ✔✔flow enters the heart through the azygos
and hemiazygos veins and the hepatics drain directly into the right atrium
, ✔✔what occurs with dupication and transposition - ✔✔the left sided IVC joins left renal
vein and crosses over to join normal right sided IVC
✔✔what occurs with azygos and hemiazygos IVC - ✔✔results from failure of
intrahepatic segment of IVC to form, flow is diverted to heart vi the azygos and
hemiazygos veins and hep veins drain directly into the rt atrium
✔✔where is the origin of the renal arteries - ✔✔arise laterally from the aorta below SMA
origin
✔✔which renal artery branches off the aorta first - ✔✔right; it also passes posterior to
the IVC
✔✔what is the normal waveform for the renal artery - ✔✔low resistance flow pattern
with a rapid systolic upstroke and continuous forward diastolic flow
✔✔where does the left renal vein run - ✔✔passes anterior to the arta and posterior to
sma and enters the left side of the IVC
✔✔what are two other possible paths the left renal vein can follow - ✔✔(1.) circumaortic
with separate veins passing anterior and posterior to the aorta (2.)retroaortic passing
posterior to the aorta
✔✔what other vessels does the left renal vein receive blood from - ✔✔the left
suprarenal (adrenal) vein and the left gonadal vein
✔✔what is different about the anatomy of the right renal vein - ✔✔it follows a much
shorter course to the IVC with no tributaries
✔✔what is the normal waveform for the renal veins - ✔✔phasic flow patern (like IVC) -
cardiac pulsatations close to the IVC
✔✔what is the best window to evluate the hepatic veins - ✔✔sub-xiphoid window
✔✔what effect does inspiration have on normal hepatic vein flow - ✔✔it causes a
blunted appearance
✔✔what occurs during right atrium diastole in the hepatic veins - ✔✔slow forward flow
from veins to IVC and eventually flow reversal
✔✔what occurs during right atrial diastole in the hepatic veins - ✔✔acceleration n
forward flow from hepatic vein to IVC and slows down as RA begins to fill
✔✔what occurs in the portal system in a patient with CHF - ✔✔the main portal vein may
demonstrate a doppler waveform that is bidirectional with pulsatile flow
✔✔what is the origin of the portal vein - ✔✔begins at junction of splenic and SMV
immediately posterior to pancreas neck and courses superior to the right and passes
posterior to the first portion of the duodenum and terminates at the porta hepatis
✔✔what joins to form the MPV - ✔✔the SMV runs superior from the intestines to join
the SV and form the MPV
✔✔what is the largest tributary to the IVC - ✔✔the hepatic veins
✔✔what is the normal flow of the hepatic veins - ✔✔hepatofugal flow that is chaotic
pulsatile flow pattern from transmission of RA pulsatations
✔✔what effect does CHF have on the hepatic veins - ✔✔they become enlarged
✔✔Which lobe do the hepatic veins not drain - ✔✔the caudate lobe
✔✔where does the right hepatic vein run - ✔✔coronal betwen the anterior and posterior
segments of the right lobe
✔✔where does the middle hep v run - ✔✔between the right and left lobes
✔✔where does the left hep v run - ✔✔between the medial and lateral segments of the
left lobe
✔✔where is the IVC located - ✔✔anterior to the spine and to the right of the aorta
✔✔what is the normal size for the IVC - ✔✔seldom exceeds 2.5 cm but varies with
respiration and cardiac cycle (inspirations limit venous return and enlarge IVC)
✔✔what is the normal waveform for the IVC - ✔✔somewhat pulsatile due to the close
proximity to the RA
✔✔where do most IVC anomalies occur - ✔✔below the renal veins (duplication,
transposition)
✔✔what happens if the IVC is interrupted - ✔✔flow enters the heart through the azygos
and hemiazygos veins and the hepatics drain directly into the right atrium
, ✔✔what occurs with dupication and transposition - ✔✔the left sided IVC joins left renal
vein and crosses over to join normal right sided IVC
✔✔what occurs with azygos and hemiazygos IVC - ✔✔results from failure of
intrahepatic segment of IVC to form, flow is diverted to heart vi the azygos and
hemiazygos veins and hep veins drain directly into the rt atrium
✔✔where is the origin of the renal arteries - ✔✔arise laterally from the aorta below SMA
origin
✔✔which renal artery branches off the aorta first - ✔✔right; it also passes posterior to
the IVC
✔✔what is the normal waveform for the renal artery - ✔✔low resistance flow pattern
with a rapid systolic upstroke and continuous forward diastolic flow
✔✔where does the left renal vein run - ✔✔passes anterior to the arta and posterior to
sma and enters the left side of the IVC
✔✔what are two other possible paths the left renal vein can follow - ✔✔(1.) circumaortic
with separate veins passing anterior and posterior to the aorta (2.)retroaortic passing
posterior to the aorta
✔✔what other vessels does the left renal vein receive blood from - ✔✔the left
suprarenal (adrenal) vein and the left gonadal vein
✔✔what is different about the anatomy of the right renal vein - ✔✔it follows a much
shorter course to the IVC with no tributaries
✔✔what is the normal waveform for the renal veins - ✔✔phasic flow patern (like IVC) -
cardiac pulsatations close to the IVC
✔✔what is the best window to evluate the hepatic veins - ✔✔sub-xiphoid window
✔✔what effect does inspiration have on normal hepatic vein flow - ✔✔it causes a
blunted appearance
✔✔what occurs during right atrium diastole in the hepatic veins - ✔✔slow forward flow
from veins to IVC and eventually flow reversal
✔✔what occurs during right atrial diastole in the hepatic veins - ✔✔acceleration n
forward flow from hepatic vein to IVC and slows down as RA begins to fill
