1
Q
What are the capabilities of Duplex upper extremity?
A
Localize stenosis, occlusion, aneurysm & hemodialysis access graft surveillance.
2
Q
What is a hemodialysis access graft?
A
Surgically placed arterial veins fistula.
3
Q
What does a Hemodialysis Access Graft connect to?
A
Artery & vein
4
Q
What does a Hemodialysis access graft do?
A
Allow for greater volume flow as needed
5
Q
What are the 2 types of hemodialysis grafts?
A
Autologous & synthetic
6
Q
Autologous AKA
A
Brescia-Cimino
7
Q
Autologous usually connects what vessels?
A
Radial artery to cephalic vein
8
Q
Synthetic hemodialysis is what shape?
A
Straight or looped.
9
Q
What ultrasound probe is used for a Hemodialysis fistula graft?
A
7-9 MHz Linear array transducer
10
Q
How is a Hemodialysis fistula graft scanned?
A
Pledge position
11
Q
What is the pledge position?
A
The arm extended laterally & 45 degrees to the body.
12
Q
What is evaluated for a hemodialysis fistula graft?
A
Thrill
13
Q
What is a thrill?
A
Vibration felt under skin due to high velocity turbulent flow
14
Q
What vessels are evaluated in a hemodialysis fistula?
A
Inflow artery, artery anastomosis, graft body, venous anastomosis & outflow vein
15
Q
Prox artery aka
A
inflow artery
16
Q
Normal Native arteries sonographic appearance how?
A
High resistance triphasic or biphasic
17
Q
Abnormal sonographic appearance in an upper extremity duplex?
A
Focal elevated velocity & post-stenotic turbulence
18
Q
inflow artery Normal waveform?
A
Low resistance & increase EDV
19
Q
Distal artery normal waveform?
A
high resistance triphasic
20
Q
Normal Fistula Waveform?
A
Turbulent flow High velocity, Low Resistance hi psv & hi edv
21
Q
Prox vein aka
A
Outflow Vein
22
Q
Normal outflow vein waveform is what?
A
Pulsatile
23
Q
What is the normal flow in a graft?
A
High velocity & turbulent
24
Q
What is Graft occlusion sonographic appearance?
A
Thumping high resistance in prox artery or graft
25
What is prox inflow problem sonographic appearance?
Low resistance tardus parvus ( dampened continuous)
26
What is graft stenosis sonographic appearance?
Focal elevated velocity
27
Most common location for graft stenosis is what?
Outflow vein ( venous anastomosis stenosis)
28
What are the sonographic signs of graft infection?
Perigraft fluid
29
What is steal syndrome?
Reversal of flow in distal artery
30
Steal syndrome symptoms?
Pain on exertion, pallor & cool to touch.
31
DRAW GRAFT & NORMAL FLOW WAVEFORM
32
What are the capabilities of Duplex of lower extremity?
evaluates the location & severity of stenosis vs occlusion, % diameter reduction, aneurysm, bypass graft & stent surveillance
33
Bypass graft does what?
Connect artery to dst artery to reroute blood flow in presence of arterial obstruction.
34
What vessels should be evaluated in Lower extremity stent or graft?
Inflow artery
proximal anastomosis
graft body
distal anastomosis
outflow artery
35
A successful bypass must start where?
Above disease
36
With a synthetic graft made of PTFE what must be evaluated?
Anastomosis sites for possible leaks
37
What are the 2 types of Autologous grafts?
In situ saphenous vein graft & reversed saphenous vein graft
38
What is an in situ saphenous vein graft?
Vein kept in place removed from venous & connected to artery. Branches must be ligated & valves removed.
39
What is evaluated with an in situ saphenous vein graft?
The graft body for AVF from branches or stenosis from residual valves
40
What is reversed saphenous vein graft?
Vein is removed & flipped upside down, branches ligated & valves kept in place.
41
What is evaluated with a reversed saphenous vein graft?
Prox anastomosis due to small size
42
What is the stenosis velocity criteria for extremity duplex imaging?
Prestenotic to stenotic ratio ( Prox normalPSV compared to highest stenotic PSV)
43
2:1 ratio mean in a lower extremity duplex?
Greater than or equal to 50% diameter reduction (PSV doubles at stenosis)
44
4:1 ratio mean in a lower extremity duplex?
Greater than or equal to 75% diameter reduction (PSV quadruples at stenosis)
45
Any velocity >400cm/s means what in a lower extremity duplex?
Greater than or equal to 75% diameter reduction
46
What is the surveillance criteria for a bypass with a prior study?
Decrease of 30cm/s in the same graft segment from one study to next.
Change in waveform
& decrease ABI >0.15
47
Retrograded flow in native arteries at distal anastomosis is what?
Normal
48
What is a peripheral aneurysm?
Any increase in diameter >50%
49
Where is a peripheral aneurysm most likely seen in the Lower extremity?
Popliteal artery
50
Aneurysm should be measured how?
Outer to outer
51
Intraoperative lower extremity dopplers evaluate for?
Patency of anastomosis, intimal flap & platelet aggregation
52
For a synthetic bypass graft what should be evaluated intraoperative?
Anatomosis site for leakage
53
For a Reversed saphenous vein graft what should be evaluated intraoperative?
Prox anastomosis due to small size
54
For an in situ saphenous vein graft what should be evaluated intraoperative?
Residual valves & branches that can form into fistulas
55
What transducer is used for an abdominal duplex?
3-5mHz curvilinear
56
For a large body habitus patient what frequency should be used?
Lower frequency deeper penetration
57
For a thinner patient what frequency should be used?
Higher frequency superficial penetration
58
What is the patient prep for an abdominal duplex?
Fasting
59
What measurement is taken in the Sagittal plane of the Aorta?
Max AP
60
What measuremsnt is taken in the transverse plane of the Aorta
AP/width
61
How are calipers placed when measuring aorta?
Outer to outer perpendicular to the walls of the aorta
62
If bowel gas obstructs view in a supine patient what scanning plane can be used?
Coronal
63
An abdominal aortic aneurysm measures what?
> 3cm
64
What’s the sonographic finding of a dissecting aneurysm?
Visualization of an intima flap
65
What’s the sonographic finding of a stenosis in the abdominal aorta
2:1 ratio greater than or equal to 50% diameter reduction
4:1 ratio greater than or equal to 75% diameter reduction
66
What is the clinical finding in a patient with renal artery stenosis?
Hypertension
67
What vessels are imaged during a renal artery Doppler?
Renal artery Origin Prox, mid & distal. Segmental arteries & aorta
68
Segmental arteries are found where?
Renal sinus
69
Interlobar arteries are found where?
In between the renal pyramids
70
Arcuate arteries are found where?
Renal cortex
71
DRAW THE KIDNEY VESSELS
72
What’s an abnormal Renal Aorta Ratio?
Greater than or equal to 3.5
73
A RAR of 3.5 mean what?
Greater than or equal to 60% diameter reduction
74
Tardus parvus distally in the segmental artery indicates what?
Possible stenosis
75
Cannot use RAR is Aorta measures what?
<40cm/s or >90cm/s or aneurysm
76
If the aorta cannot be used what should be evaluated?
Focal renal artery velocities & stenosis changes( spectral broadening, post-stenotic turbulence & dst tardus parvus waveform)
77
What is the purpose of a Renal perfusion exam?
R/o Nephrosclerosis (renal disease)
78
What vessels are imaged during a Renal perfusion exam?
Segmental, Interlobar & arcuate arteries.
79
what is the normal sonographic appearance of any renal vessel?
Low resistance
80
What is the normal end diastolic ratio?
> 0.2
81
What is the normal Poucelot’s resistive index?
<0.7
82
The end diastolic ratio is related how to the diastole?
Directly Related
83
The restive index is related to how to resistance?
Directly related
84
If the EDR( end diastolic resistance) is decreased what happens to diastole, resistance & resistive index?
Decrease EDR
decrease diastole
increase resistance
increase RI
( finding of nephroclerosis)
85
What are the clinical findings of mesenteric ischemia?
Abdominal pain & cramping 15-30mins after eating. Patients are malnutrition or underweight.
86
What vessels are imaged during a mesenteric Doppler?
Celiac SMA IMA
87
what are the Splanchnic vessels?
Celiac SMA & IMA
88
What transducer is used for a mesenteric Doppler?
5-6Mhz curvilinear (high frequency)
89
what is the patient prep for a mesenteric Doppler?
Fasting & post prandial
90
What is the normal fasting SMA waveform?
High resistance, Low EDV
91
what is the normal post parandial SMA waveform?
low resistance High EDV
92
What is the abnormal PSV in fasting SMA?
greater than or equal to 275cm/s = greater than or equal to 70% diameter reduction
93
The celiac artery will always appear how?
Low resistance high EDV
94
What is the abnormal PSV in the celiac artery?
Greater than or equal to 200cm/s = greater than or equal to 70% diameter reduction
95
IMA is usually seen when?
Used as a collateral with high velocity ABNORMAL FINDING
96
The IMA normally appears how?
Not seen
97
What does it mean if 2 out of 3 vessels appear abnormal in a mesenteric Doppler?
Chronic mesenteric ischemia
98
What is celiac band syndrome?
Compression of the celiac artery by median arcuate ligament of the diaphragm
99
What is the celiac band patient profile?
Young athletic women
100
What are the findings of celiac band syndrome?
Compressed during expiration normalizes with inspiration
101
Organ transplants AKA
allografts
102
What vessels are doppler during a Liver Transplant?
Hepatic artery portal veins & hepatic viens
103
what vessels are doppler during a Renal Transplant?
Renal artery & vein EIA & EIV
104
Renal transplant is usually placed where?
Right lower quadrant
105
Normal transplant should have what kind of blood low?
Normal organ flow LOW RESISTANCE
106
The liver portal vein flow appears how?
Hepatopedal
107
In the presence of transplant rejection the artery supplying the blood appears how?
High resistance
108
Other signs of transplant rejection?
Increased organ size
altered echogenicity
fluid
possible thrombosis of veins
109
What does hepatopedal flow mean?
Blood flows towards the liver
110
What does hepatofugal flow mean?
Blood flows away from the liver
111
Abnormal renal transplant findings are what?
High RI renal artery
thrombosis renal vein
112
Abnormal Liver transplant findings are what?
Hi RI hepatic artery
PV thrombosis or hepatofugal flow
Vascular
flashcards
Decks in class (21)
# Cards
-
Arterial Anatomy83
-
Arterial Hemodynamics109
-
Arterial Disease75
-
Arterial Non-imaging Testing144
-
Arterial Duplex112
-
Arterial Miscellaneous testing78
-
Cerebrovascular Anatomy29
-
Cerebrovascular Hemodynamics11
-
Cerebrovascular Disease & Clinical History100
-
carotid duplex64
-
Transcranial Doppler62
-
Cerebrovascular Alternative Testing & Treatment23
-
vascular anatomy88
-
Venous Hemodynamics51
-
Venous Disease & Clinical History65
-
venous non-imaging testing63
-
Venous Duplex50
-
Venous Alternative Testing & Treatment51
-
Physics Quality Assurance22
-
Physics Principles review101
-
missed questions41
