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RVT Pathology
Exam 1 and 2 combo
| Question | Answer |
|---|---|
| Normal Perforator diameter | 2 mm >2 - reflux |
| popliteal entrapment | occurs with flex of foot, calf muscle compresses popliteal |
| klippel- trenaunay- weber syndrome | Congenital absence of the deep veins which cause numerous prominent superficial varicosities |
| What will you see just distal to a stenosis | eddy currents or vortices |
| coarctation | cogenital narrowing of the aorta./overgrowth of normal tissue in AO causing obstruction. Decreased ankle pressures, normal brachial pressures/ |
| Where is AO coarctation mostly seen? | Most commonly seen distal to the Lt SubClav Art will lead to reduced BP in arm effected (mostly left w. increase in right arm |
| What is the most accurate doppler predictor of ICA stenosis | End Diastolic velocity |
| What does insufficiency in the Post. Tibial Perforator and Post Arch vein most commonly cause? | Venous Stasis ulcer formation. |
| What degree stenosis is required for intervention in the ICA | 70-99% |
| Distal to stenosis flow characteristics are | Decreased resistance, flow will become dampened, monophasic, AT is prolonged with lower resistance flow |
| Hereditary Hemorrhagic Telangiectasia | AKA Osler Weber Rendu Syndrome. Autosomal dominant disorder leading to AVM or porto Venous AVM in the liver. Most common AVMs are in the skin |
| Cerbral Angiography protocol | Seldinger technique is used to puncture the common femoral artery in order to insert a cath that will be advanced to the Aortic Arch for contrast administration. |
| What is the normal PSV in the ICA | 125 cm/s or less |
| Where is an acute occlusive thrombus most likely identified in the femoral vein? | adductor canal |
| where is blood stasis most likely to be found in an acute occlusive thromus in the fem vein? | pop vein. SSV empties into the PV so it will become dilated with femoral obstruction. |
| Urticaria | formation of hives |
| Where do you place the cursor in a focal stenosis of an artery to obtain the highest velocity? | at the narrowest point in the vessel or immediately distal to the focal point. |
| Patient has recent onset of uncontrolled Systemic HTN with avg BP readings of 170/90. What vascular case is suspected? | Renal Artery Stenosis. Associated with Renovascular HTN |
| What can give a false positve diagnosis on a ICA? | Kinked ICA. |
| hemispheric index (HI) | calculated using MCA peak systolic and dividing it by distal ica MCA PSV / Dis ICA PSV |
| Venous Ulcers | Wet. appear on foot and/or all toes take time to form and are indicative of chroinic venous insuff. |
| arterial ulcers | dry appear on one or two toes. |
| What thrombus will have an increased risk of pulmonary embolism | venous thrombosis. Any vein that connects to the IVC which can travel to the lung ( ex Renal vein thrombosis) Portal system does not communicate with IVC, and there by portal thrombosis does not cause PE. |
| Where does arterial thrombosis travel? | travel until the become lodged in smaller arterial system (Toes) |
| ICA stenosis causes eye issues on what side of body | same side. ipsilateral |
| ICA stenosis causes body and brain issues on what side of body | opposite side, contralateral. |
| What flow patterns does significant valvular disease in the right heart lead to | pulsatile flow in LE IVC and Portal vein |
| When a velocity between two extremities in an arterial segment doubles what does this indicate? quadruples? | 50 % stenosis 75% stenosis |
| Diastolic velocity ratio | EDV ICA/ EDV CCA |
| Renal arterial stenosis is hemodynamically significant at what precent | 60 |
| carotid dissection is most common where | extracranial arteries, and should be expected in trauma |
| what is not a pathway for eca to ica to collateralize? | angular artery to facial. |
| Celiac axis stenosis is hemodynamically significant when PSV is greater then? | 2.0 m/s |
| cerebral cross over collateralization occurs when? | flow from the left ACA moves into the right ACoA |
| diastolic flow at site of stenosis may be? | significantly reduced at 90% Increased at 70% |
| Transcutaneous oximetery evaluates? | oxygen supply and consumption in tisses surround wound for healing ability. can take 15-20 min to assess. Normal pressure is 10-80 mmHg <40mmHg tissue hypoxia |
| Transcutaneous oximetry is used for? | accessing location for amputation |
| Which ulcers a very painful? | arterial ulcers. Venous are not painful. |
| Giant Cell Arterities also called temporal arteritis or vasculitis | inflammation of the lining of your arteries. It is usually associated with elevated erythtocyte sedimatation rate and c-reactive protein (CRP) use of linear. demonstrates reduced or thicken flow through artery. Low resistance |
| Symptoms of giant cell arteritis | headaches, tenderness over arteries, asym brachial blood pressures, pain, stiffness, jaw claudication, visual disturbances |
| RAS | PSV is greater then 1.8 m/s Renal Aortic ratio is over 3.5 |
| Homan Sign | nonspecific finding of DVT pain experienced upon quick dorsiflexion of the foot. |
| asher sign | refers to enlargement of the spleen that extends across the midline anterior to the abdominal aorta |
| What is an intra-aortic balloon pump? | |
| CHF causes what flow characteristics | increased pulsatility in the systemic and venous (portal) systems |
| Subclavian steal | a blockage in the proximal subclavian artery that can cause flow reversal as the distal subclavian "steals" blood from the cerebral vessels |
| Premature ventricular contractions | they are a type of cardiac arrhythmia and they will NOT effect venous flow in the LE |
| Bakers Cyst | fluid pocket in the pop fossa. this can cause extrinsic compression on the popliteal and cause the flow to become continuous. |
| Braco-Aphasia | Inability to speak, but can understand and follow directions. |
| what can infiltrate the Renal Vein and IVC to cause mass and thrombus formation? | Renal Carcinoma |
| IVC obstruction cuases what flow patterns | continuous flow in the iliacs. |
| Continuous venous flow is indicative of? | Proximal obstruction |
| What is an abnormal reaction when a proximal augmentation is performed? | Flow reversal to begin at the onset of the aumentation/valsalva maneuver |
| Medial Arcuate Ligament | connects the right and left crux of the diaphram across the anterior proximal abdominal aorta |
| Buerger disease | obstruction of the smaller arteries in the hands and feet More common in males and heavy smokers. |
| Where is the temporal artery located and how is it evaluated? | extracranially and with a high frequency probe. |
| How do you report the diameter of an anuerysm if a thrombus is present? | the true lumen should be measured |
| Leriche Syndrome | refers to an obstruction of the distal aorta. Post-Stenotic flow patterns in bilateral iliac arteries reflects proximal obstruction |
| greenfield filter | inserted into ivc below the renal veins to catch embolic materials before it reaches the heart and lungs. |
| What is evaluated at transoccipital window at 105 depth? | basilar artery |
| adson maneuver | pt postion used to evaluate thoracic outlet syndrome TOS If the radial pulse diminishes or disappears completely during this, TOS is diagnosed. |
| Renal Vein Thrombosis | Increased kidney size, hypoechoic cortex, dilated Renal Vein, no intrarenal venous flow, increased resistance in renal arteries, reduction of diastolic flow in segmental and intralobar arteries due to increased parenchymal resistance. |
| Inferior epigastric artery and deep circumflex artery supply? | the abdominal wall, muscles and skin. They provide collateral with obstruction in the external iliac artery. |
| What is a hemodynamically significant stenosis in the femoral artery | 3.2 PSV. Distal to stenosis (pop and calf) witll be monophasici |
| Budd Chiari | acute chronic obstruction of the hepatic veins. Atrophic liver |
| Fibromuscular Dysplasia | related to collagen growth in the media layer and ususally forms more distal segments of the ICA |
| atheroma | soft plaque |
| bernoulli describes? | pressure is lowest at the stenotic site |
| lemierre syndromee | refers to therombiphlebitis of the jugular veins with oropharyngeal infection (tonsillitis /pharyngitis) |
| sclerotherapy | refers to the injection of saline or other sclerosing agent that damages the vein and causes fibrosis to occur. |
| microbubbles | ultrasound contrast agent that increases the reflectivity of flowing blood. |
| what is a DOPPLER indication of renal vein thrombosis | RI >0.7 in the cortex (leads to increased resistance in the arcuate arteries) |
| What is venous HTN | an increase venous volume that causes fluid to leak into interstitial spaces between tissues |
| Which arteries will have reduced or absent flow in the presence of an occuluded left ICA | Ophthalmic artery and MCA |
| What is a high resistanc triphasic waveform in the Vertebral artery indicative of? | Distal obstruction ( maybe in Basilar artery ) |
| Unilateral visual distrubances are associated with ________ while bilateral visual distrubances are associated with ? | unilateral - ICA disease Bilateral- Vertebobasilar disease |
| Stringflow Sign | sign in carotid exam- Critical ICA stenosis |
| What does taking oral contraceptives increase your risk of? | Varicose veins |
| when ruling out venous insufficiency what is evaluated | deep veins should be evaluated for thrombus FIRST then a reflux exam should be performed. Deep and superficial should be eval for reflux |
| systemic HTN is a main risk factor for? | Stroke |
| Dysphagia is a symptomm of? | veretebrobasilar disese. this is controlled by the brainstem which is supplied blood by the vertebrobasilar system |
| Virchows triad | blood stasis trauma hypercoagulability (polycythemia vera- abn thick blood) |
| hyperpigmentation | related to chronic vascular disease |
| mycotic aneurysm | caused by infection of arterial wall |
| posterior accessory saph vein | also called the posterior arch vein Commonly related to ulcer formation |
| what vessels provide collateral pathway to redistrubute flow from one side of the brain to the other | ACoA and Basilar. |
| Which plaque has a higher risk of embolization? | soft plaque is a higher risk for embolism then Fixed "calcified plaque |
| Which vessel is most commonly involved in acute occulsion and cerebral ischemia | MCA due to its connection to the ica |
| When evaluating vertebral and a PreSteal waveform in visualized what should you do | perform arm exercises or pneumatic cuff infiltrationon effected arm for 2-3 minutes followed by rapid release to see converstion to full steal |
| Single connection between artery and vein | AV Fistula, could be from trauma |
| Multiple connections between artery and vein | congenital malformation AVM |
| where is the best location for injecting a pseudoaneurysm | as far from the neck as possible to prevent thrombin disturbance into arterial system 21-22 gauge needle |
| How much thrombin is injected into a psuedoaneurysm | 0.5 - 1.0 ml injected in small incriments and thrombus is monitored. should resolve in 5-10 seconds, and once flow is eliminated color doppler should be performed to confirm absense of flow. |
| bilateral presentation of RAS in a child is most likely due to | diffuse disorder of congenital or idiopathic origin example fibromuscular displasia |
| Bilateral tardus parvus waveforms in carotd arteries indicate | severe mitral stenosis significant stenosis can cause left atrial pressure (mitral) overload and reduce cardiac output. this causes lower resistance tardus parvus low veolocity waveforms |
| vasospasm | causes increased resistance in vessesl |
| brawny discolouration of the distal 1/3 of calf indicates | chronic dvt |
| pressure before and at stenosis | proximal - high pressure at - very low causing a pressure gradient between two sites. the higher the gradient the higher the velocity. |
| carotid compression | performed to evaluate the presence of intracranial collateral formation. |
| What causes volume overload in the chamber | severe chamber regurgitation |
| what causes volume overload at the left ventricle | significant aortic dilation and reguritation |
| pulsus bisferiens | double peak waveforms (carotid) |
| water hammer pulse | severe regeritation associated with diastolic flow reversal in the carotid |
| evaluating a stenosis in the proximal ICA will demonstrate what waveform | increased peak velocity, increased end disastole. |
| what is the most common lower extremity venous disorder | venous insufficiency |
| atherectomy | uses a catheter with a rotating head and suction capabilites to break up the plaque and remove from artery |
| angioplasty | uses a balloon tipped cath to compress the atheroma and expand the vessel lumen |
| an increased bandwidth will effect | spectral broading |
| endoarterectomy | when the cartoid artery is lacerated and the atheroma formation is scrapped for removal |
| valvulotome procedure | used to remove valves from inside the vein |
| paget schroetter syndrome | spontaneous effort thrombosis, most common cause of axillary subclavian DVT in ambulatory population higher incidence in dom arm |
| most common cause of DVT upper extremity in ill population | indwelling cath |
| most common cause of DVT upper extermity in ambulatory populations | page schroetter syndrome |
| What causes pitting edema | DVT |
| What causes non pitting edema | lymphedema |
| Can you alievate non pitting edema with elevating leg? | no, lymphedema has no effect when elevating legs |
| Lymphedema | swelling of legs, non pitting, no color changes, does not get better with raising legs |
| Complications from Fem-Pop in-situ vein grafting | graft kinking, anastomosis narrowing by aberrant suture, thrombosis around valve remnant |
| takayasu arteritis | hypertrophic areas of inflammed tissue usually found in AO branches. 90% subclavian, 50%carotid , most common young females 20-40 years old, asia/india |
| potential signs of unstable AAA | 1. echolucent areas within the sac 2. Changes in aneursym shape or sac size 3. increased pulsatility of the sac |
| WHich intracranial artery is most commonly associated with stroke | mCA- it is a continuation of the distal ICA, Embolism from the ICA will lodge in the MCA unless it is small enough to pass into the circle of willis |
| Acceleration time is used in Lower Extremity arterials how? | Measured to differentatiate inflow from outflow disease in the lower extremity |
| Area stenosis formula | area1 - area2 / area1 x 100 area stenosis is calculated by measuring the vessel areas the lumen and the area where the flow takes place. |
| PHACE Syndrome | Congenital malformations of arterial vasculature |
| Eagle syndrome | compression of the carotid |
| TOS Thoracic Outlet syndrome | compression of the vessels in the thoracic outlet. |
| hypothehar hammer syndrome | compression of the ulnar artery |
| type of flow distal to a critical carotid stenosis | decreased diastolic flow |
| SVC syndrome | progressive obstruction of the SVC which causes venous dilation of the upper extremities |
| Tricuspid regurgitation | blood flow that falls back into the right atrium. This causes swelling and dilation, chamber pressure increases and inflow from the IVC and Hep V will be disrupted. |
| What flow patterns will the CCA take on if there is an occlusion in the ICA | The cca is comprised of flow patterns from the ECA and ICA, if the ica is occluded, the CCA will take on the ECA flow patterns, dampened with increased resistance and decreased diastolic flow. |
| Chest wall varices and bilateral arm swelling are indicative of what? | SVC Thrombosis. IJV can cause facial swelling but not Arm |
| What can lead o a false negative diagnosis of ICA stenosis | CHD |
| Stump flow | doppler wave form demonstrates a low velocity, blunted waveform with no antegrade flow diastole. this indicates an occlusion distal to the current point of insonation. |
| Where should you look next if you find a dissection in the Aorta? | Proximal and Distal to dissection. including common iliacs |
| TOS Thoracic Outlet syndrome flow characteristics | decreased flow velocity - distal arm affected side with arm adduction. Low amplitude PPG digit tracings on the affected side w/ arn add. Decreased BP of the affected side w adsons maneuver. Comp of the DSUBC flow in the PSUB art will show resistance. |
| Changes if cardiac function has what effect on arterial system, and on venous system? | arterial system will show effects in the velocities venous system will show change to flow characteristics |
| What does NOT change the systolic velocities in the arterial system | mitral regurtiation |
| What can reduce the cardiac ejection fraction and FALSELY reduce the PSV in the arterial system | aortic stenosis, mitral stenosis, chf, diastolic dysfunction, dilated cardiomyopathy and CAD |
| What can FALSELY elevate the PSV in the arterial system | Systemic HTN, aortic regurgitation, Hypertrophic cardiomyopathy, and compensatory heart beats with arrthytmias |
| What are the most common characteristics of venous statis associated with chronic insufficiency | chronic swelling and brown discloration |
| What are the most common characteristics of acute DVT | Red discoluration and swelling |
| Most common site for atherosclerotic formation in the Lower Extremity | SFA in the adductor canal Second most common - origin of common iliac arteries |
| "Ripples" (pulsatility) cardiac pressure discipate as they reach the mid abdomen. IF the ripples extend to the lower extremities, what is the cause | CHF, due to increased blood Volume |
| Carotid body tumors | more common in women and people living at high altitudes chronic hypoxia leads to overactive and enlarged CB |
| How many days does it take for recanalization of a thrombus | 5 days after the formation |
| Which thormobus is somewhat pliable | Acute Thrombus |
| Chronic Thrombus will be __________ upon compression | non pliable |
| What is a potential symptom of subclavian steal | syncope. |
| Where does arterial claudication occur? | distal to the hemodynamically significant obstruction |
| Adventitial Cyst | rare, collection of mucinous material within the adventitial wall layer of the effected vessel. In men this is most common. predominantly effects the peripherial arteries at popliteal art. |
| Leriche syndrome | Extensive diffuse atherosclerotic disease causing obstruction of the distal Aorta and bilateral LE symptoms |
| Steptokinase | break up a clot in a patient with phlegmasia due to embolic formation tisk |
| Varicose vein is usually what? | a dilated tributary of the GSV |
| How to evaluate the Frontal artery | periorbital doppler |
| how to evaluate the ophtalmic artery | transorbital |
| A femoral artery stenosis of 70% will show what flow characteristics | loss of retrograde flow component in diastole. |
| What is the most common indication for a UE Arterial duplex? | evaluate hemodialysis graft plavement. |
| What is the most common complication of a peripheral arterial aneursym? | Distal embolism. |
| Carotid hemodynamically significant stenosis | 50% diameter, 75% stenosis |
| CREST | Calcinosis, Raynaud Phenom, Esophogeal dysfunction, scleroderma, and telagniectasia |
| Phlegmasia Alba Dolens | All deep vessles are occluded. (alba) A = All (Dolens)D= Deep Reduced arterial flow, legs milky white appearance, severe pain |
| systolic velocity ratio | psv ica/ psv cca |
| bernolli principal application example | decrease in pressure, increase blood flow velocity |
| Post Phlebitic syndrome | refers to valve damage in the veins after thrombus formation |
| posterior to anterior collateralization of LICA occlusion decreased flow in Left PCA P1 | Flow pattern P1 to PCoA to MCA on the effected side. |
| Left ventricular assist device | can cause doppler waveform to -= low velocity delayed upstroke and loss of pulsatility |
| An engorged vein is a sign of | acute DVT |
| Buerger Disease/Thromboangitis obliterans | occlusive disease of the small to medium size arteried cause by inflammation men and heavy smoker. Effects the plantar or palmer arteries. Dry painful ulcers |
| Oliguria | sign of renal transplant failure Unable to produce urine. |
| Bun and creatine increase, hemnaturia, new HTn, oliguria | signs of renal transplant failure. |
| Primary Raynauds | Raynauds syndromw/disease Normal vascular system, intermittent digital arterial spasm |
| Secondary Raynauds | Raynauds phenominon, Abnormal obstructed system with vasoconstriction, causes constant ischemia , can be unilateral. |
| primary varicosities | form due to abnormal values in superficial venous system |
| secondary varicosities | form if there is an associated problem in the deep system such as DVT |
| Significant Portal HTN | abnormal dilation - MPV and Left Gastric |
| If a patient is having lower extermity pain and they stand still or place legs in dependant position, what does this treat? | Arterial disease |
| Most common cardiac disorder associated with arterial embolism | artrial fibrillation |
| Most common location for intracranial aneursym | ACoA - berry or saccular |
| DVT Treatment (Blood Thinners) | Subcutaneous shot - Lovenox - immediate Heparin - 5 to 10 days- stops progression but doesnt have clot lysing properties After recanalization, warfan- prevent future clot. 1st DVT (3 months) 2nd DVT (6 plus months) |
| PAD (Periherial arterial disease) | can cause monophasic flow in the PTA Most common symptom? Claudication |
| percutaneous Transluminal angioplasty | open areas of a stenosis in an artery |
| Hepatic Artery will increase resistance in the presenance of ? | Portal HTN and Cirrhosis |
| Thrombolytic Therapy | Treat DVT or Acute arterial occlusion (does not treat chronic occlusion) |
| Blue Toe Syndrome | Seen in AAA patients |
| Primary varicose veins | Incompetant valves |
| Secondary Varicose veins | deep pressures elevated |
| Lymphedema is commonly caused ny | Radiation or cancer |
| Prox to AV fistula shows what flow patterns | low resistance, monophastic |
| Phelgmasia "C"erulea dulones | Extensive DVT of deep AND Superficial system "C" cyanosis, mottled skin |
| Subclavian steal | systolic BP, lower on affected side, due to reduce flow Reduced Flow = Reduced Pressure |
| FMD is most commonly located | mid segment of ICA |
| Pulsus Bisferiens of Carotid arteries | Double Systolic peaks |
| Aortic Regurgitation | Volume Overload in left ventricle |
| Severe Regurgitation | Diastolic flow reversal in CCA (Water Hammer) |
| Carotid Compression test | Eval the presence of collateral flow |
| Carotid Sinus Massage | reduce heart rate |
| Lt CCA Occlusion would cause which flow reversal | Left ECA |
| Tinel Sign | indicates a damage nerve at wrist and is associated with hypothenar hammer syndrome |
| Chronic insufficiency causes swelling in what body parts | ankle and calf feet swelling is not normally seen in venous disease except systemic or cardiac |
| Scimitar Sign | associated with adventital cysts the arterial lumen is compressed by the cyst and looks like a scimater (curved sword) |
| Anterior Compartment Syndrome | medical emergency caused by sever injury without intervention. can lead to perminant muscle damage. muslce weakness, paresthesia, weakness, pain when stretching calf, drop foot |
| parenchymal resistance ratio End Diastolic Ratio | used in renal transplant. PRR - EDV/PSV PRR = <0.2 indicates increased resistance and possible rejection |
Created by:
lsoboleski
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