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Vascular sonography
Test 4 Abdominal Doppler- Aorta &Mesenteric vessels part 2
| Question | Answer |
|---|---|
| What are the risk factors for developing an Abdominal Aortic Aneurysm (AAA)? | Smoking, Genetic factors, Increasing age, Male gender, High cholesterol, and Obesity. Also may occur with atherosclerotic disease |
| Color Duplex Ultrasonography (CDU) is an important modality for evaluating the ___? | The AORTA |
| What is CDU used for? | Used extensively for detection of AAA. |
| CDU has excellent correlation with arteriography in the detection of ____? | Aorto-iliac atherosclerotic disease |
| CDU provides anatomic and physiologic info as well as? | It is noninvasive, nontoxic, and well tolerated by PT's |
| What is the incidence of AAA? | 60 per 1,000 |
| What is the 12th leading cause of death; approx 15,000 deaths annually from rupture? | AAA |
| Who do AAAs occur more frequently in? | Older men |
| Where are AAAs mostly located? | Inferior to the renal arteries (~90%) |
| What are AAAs commonly associated with? | Iliac, femoral and popliteal aneurysms |
| What are some indication for aorto-iliac exams? | Pulsatile abdominal mass, suspected or known iliac or aortic aneurysm, claudication (hip or butt) or ischemic rest pain, ↓ femoral pules or abdominal bruit, emboli in ischemic digits(blue toe), suspected inflow disease, follow-up after intervention |
| How long should PT's fast before getting an abdominal scan? | Overnight (8-12 hours) |
| What is discouraged before getting scanned? | Chewing gum or smoking because ait goes in the body |
| What is the best TD for this scan? | 2-5 MHz curved linear most commonly used, 2-4MHz sector phased array could also be helpful |
| Where does the exam begin for AAA protocol? | At the level of the celiac axis and extends through bifurcation |
| What are the characteristics of a normal aorta? | Lies adjacent to the spine, has smooth margins, no focal dilatation, and tapers distally |
| What is important to note with an aneurysm? | Length, proximity to renal arteries, presence and extent of intraluminal thrombus, residual lumen |
| What else is important to document with AAA protocol? | Dissection, intimal flap, or other wall defect, Pseudoaneurysms, Stenosis &/or occlusion w/ characterization of any plaque visualized |
| When doing AAA protocol what should be performed? | Spectral Dopper, use 60 degrees or less |
| Where should Peak systolic volume (PSV) be recorded from in AAA protocol? | Prox, mid, and distal aorta |
| What are normal findings when scanning the aorta? | Aortic diameter <2 cm, Aorta tapers as it courses distally, smooth walls with well defined margins |
| Proximal aorta typically has more what? | Diastolic than distal due to visceral organ branches |
| Proximal aorta has slightly lower resistance than what? | Distal aorta (below the renals) |
| Iliacs are what? | High resistance, triphasic |
| What is seen with AAA? | Ectasia (dilation), Aortic diameter >2 cm, but < 3cm, OR irregular margins and non-tapering profile |
| A diameter of ____ or ______ is consistent with an aneurysm? | Diameter >3 cm or focal diameter ↑ by more than 50% or normal segment |
| True aneurysms involve what? | All three layers of vessel wall |
| What is most commonly involved with AAA? | Distal Aorta (infrarenal) |
| What is a Fusiform AAA? | Bulging which involves entire circumference of aorta, MOST COMMON type of Aneurysm |
| What a saccular AAA? | Aysmmertic outpouching dilation, Often caused by trauma or penetrating aortic ulcers |
| What are Aneurysm complications? | Rupture, the larger the aneurysm the greater the risk of rupture (especially over 5cm), High mortality rate w/ aortic rupture |
| What is another complication with an AAA? | Hydronephrosis(swelling of kidney) due to the compression of the ureter, Bladder compression |
| What wall defects are seen with AAA? | Intimal tears-can protrude into vessels lumen and cause stenosis or occlusion. Dissection- w/ or w/out aneurysm, Tear between layers of vessel wall, associated w/ 2 flow channels |
| What is seen with stenosis or occlusion? | Thrombus, plaque, &/or calcification may be present, Plaque may appear hetero or homo, w/smooth or irregular borders, calcification will appear as hyperecohic area w/ shadowing, Thrombus is often homo w/smooth borders (often w/in aneurysm) |
| Where should you asses stenosis? What should you document? | Prox, in sten, and distal to, Document poststenotic turbulence and distal waveform changes |
| >50% stenosis is consistent with? | ↑ in Vel of 100% (doubling) & assess presence of poststenotic turbulence, Distal waveform changes (dampened systolic component & loss of reversal component) |
| What does ICAVL stand for? | Intersocietal Commission for the Accreditation of Vascular Laboratories |
| What is the most common application of mesenteric duplex exam? | Chronic Mesenteric ischemia |
| What is chronic mesenteric ischemia? | Rare disorder w/nonspecific symptoms, Mesenteric vessels have extrensic collateral network, Typically 2 of 3 mesentericvessels (celiac, superior mesenteris, & inferior mesenteris arteries) must be diseased before symptoms appear |
| Who does Chronic Mesenteric Ischemia occur most commonly in? | Women between the ages of 40-70 |
| What is the Celiac artery? | First branch of abdominal aorta, ~2-4 cm long, |
| Where does the Celiac artery arise from? | Arises on the anterior aspect, 1-2cm long |
| What does the Celiac artery branch into? | Common hepatic, splenic, and left gastric arteries (left gastric typically not visualized by ultrasound) |
| What is the SMA? | Also arises from the anterior surface of aorta, Arises ~ 1-2 cm below celiac artery, Parallels aorta through abdomen |
| What is the IMA? | Arise from the anterior aspect of distal aorta, just above aortic bifurcation |
| What are the signs and symptoms of Chronic Mesentaric ischemia? | Abdominal pain & cramping after eating (periumbilical pain starts ~ 30 mins after eating and lasts for 1-2 hrs), Presence of abdominal bruit, Weight loss (due to food avoidance rather than malnutrition), Diarrhea |
| It is V important for PT's to do what before getting scanned? | FAST fot at least 6 hrs, Diagnostic criteria is established for fating vessels |
| What artery changed drastically after eating? | SMA, changes from high res to low res |
| What is required documentation for this mesentaric scanning? | Adjacent Aorta, Celiac artery origin, Splenic & hepatic arteries when appropriate, SMA origin & Prox SMA, & IMA |
| What kind of TDs are used for mesenteric scanning? | Lower freq TD 2-5 MHz, probe pressure is used to move overlying bowel |
| In the presence of stenosis what turbulence should be recorded? | Post-stenotic turbulence && PSV and EDV |
| What plane is Celiac best viewed in? | Transverse plane |
| The Celiac bifurcation often has the what sign? | Seagull sign (wings are the hepatic and splenic arteries) |
| What resistance flow pattern does Celiac, common hepatic and splenic arteries demonstrate? | Low res |
| The SMA is best visualized in what plane? | Sag |
| A fasting SMA demonstrates what kind of resistance flow pattern? | High res, Triphasic |
| What does postprandial mean? | After eating |
| Postprandial SMA demonstrates what resistance flow pattern? | Low res & EDV should double |
| How far should the SMA be followed? | As distally as possible (waveforms obtained from Prox, mid, and distal) |
| What plane is the IMA identified in? | Transverse |
| Where does the IMA usually originate? | Anterior aorta, slightly to the left of midline (~1-2 o'clock) |
| The Doppler waveform is what res? | High res and does not change after eating |
| Color bruit suggests what? | Significant stenosis |
| What are the characteristics of a normal Celiac artery? | Sharp systolic upstroke, Low-res flow pattern, and PSV <125 cm/s |
| What are the characteristic of an abnormal Celiac artery? | PSV ≥ 200cm/s and EDV ≥55 m/s |
| A PSV ≥ 200 cm/s is consistent with a what % stenosis? | ≥ 70% stenosis |
| A EDV ≥55 cm/s is consistent with a what % stenosis? | ≥ 50% stenosis |
| What are the normal Doppler waveform characteristics of the SMA? | Sharp systolic upstroke and clear systolic window, High res flow pattern (in fasting patient), PSV <125 cm/s |
| What are the abnormal Doppler waveform characteristics of the SMA? | PSV ≥275 and EDV ≥ 45cm/s |
| PSV ≥275 cm/s is consistent with what % stenosis? | ≥70% stenosis |
| EDV ≥ 45cm/s is consistent with what % stenosis? | ≥50% stenosis |
| What are the normal characteristics of the IMA? | Sharp upstroke and high res |
| Is there any specific criteria for disease for IMA? | nope |
| Can elevated velocities be noted in normal vessels when they are acting as collaterals? | Yes |
| What system has extensive collateral network? | Mesenteric |
| What does true stenosis usually show? | Demonstrates ↑ flow and poststenotic turbulence/ spectral broadening |
| Prominent IMA Suggests what? | SMA occlusion with collateralization through meandering mesenteric artery |
Created by:
EmilyGriffin
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