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The innominate artery is a branch of the Aortic arch
When the external iliac artery passes underneath this structure, it becomes the common femoral artery Inguinal Ligament
This artery passes forward above the interosseious membrane and distally comes to lie on the front of the tibia Anterior tibial artery
Tunica intima refers to one of the following in the arterial wall The inner layer
All of the following vessels are palpable except Peroneal artery
The three branches of the aortic arch are: Right innominate, left common carotid, left subclavian
According to Bernoulli what is not true about pressure/velocity relationships? Pressure is higher at the region of stenosis
All of the following cause vasodilatation of a high resistance bed EXCEPT Hyperventilation
a 75% area reduction equates to a 50% diameter reduction
All of the following are true about post-stenotic turbulence EXCEPT No heat loss
Exercise induces peripheral vasodilatation in the microcirculation which: Decreases the distal peripheral resistance
All of the following are characteristics of claudication EXCEPT Always vascular in origin
All of the following apply to a high resistance signal EXCEPT: Continuous
All of the following are true about analog recordings EXCEPT Displays amplitude of all frequencies
Utilizing Duplex Scanning, the criteria for determination of a 50-99% diameter reduction of the femoral artery is Ratio of stenotic to pre-stenotic PSV is greater than 2:1
A high resistance blood flow pattern is normally NOT found in one of the following Post prandial SMA
The External Carotid Artery is high resistance and the Internal Carotid Artery is low resistance. The extremity arteries are usually high resistance. The SMA is high resistance in the fasting state, but changes to low resistance post prandial (after eating).
All of the following are characteristics of claudication EXCEPT Always vascular in origin
One of the following statements is correct about “primary Raynaud’s" Occurs when ischemia is due to distal arterial spasm
The most important differential diagnostic parameter for pseudoaneurysm is: Communication tract between artery and aneurysm
A patient presenting with ischemic rest pain complains of Foot pain when supine, relieved by standing
Waveforms as the result of Raynaud’s phenomena have this “unique” characteristic: Peaked
The most common site of stenosis or occlusion of the hemodialysis access graft is Outflow Vein
The Adson maneuver is performed for the assessment of thoracic outlet syndrome
Which of the following is not a common complication of arteriography; Nerve damage
Balloon agioplasty is more commonly used in all of the following arteries EXCEPT: gastrocnemius artery
All of the following are true about analog recordings EXCEPT Displays amplitude of all frequencies
Which one of the following can be determined by the doppler pressure evaluation? Be difficult to interpret in the presence of multilevel disease
An ABI of .65 places the patient into the category of Claudication
The Allen Test is most often utilized to assess patency of these vessels Radial artery, ulnar artery, and palmar arch
Vasculogenic impotence can be caused by all of the following except Carotid artery stenosis
The following are characteristic of an abnormal plethysmographic waveform except: Dicrotic notch
The toe pressure should be what % of the ankle pressure: 60% - 80%
Waveforms as the result of Raynaud’s phenomena have this “unique” characteristic: Peaked
The most common site of stenosis or occlusion of the hemodialysis access graft is Outflow Vein
What is one difference between a CW Doppler and a pulsed Doppler? A CW Doppler cannot sample flow at a discrete point
Arterioles assist with regulating blood flow through contraction and relaxation. (Varying the degrees of resistance.) This process is called autoregulation
innermost layer in contact with blood, made of an endothelial lining. Intima
muscle, elastic connective tissue, consists of smooth muscle cells Media
outer layer of supporting connective tissue-provides significant portion of total strength to the arterial wall. Adventitia(externa)
The adventitia layer contains the _____ which are the tiny vessels that carry blood to the walls of the arteries themselves. vasa vasorum,
It divides into the right common carotid and right subclavian arteries. The Innominate(Brachiocephalic) Artery is the first major branch of the aortic arch
The right vertebral artery arises from the right subclavian artery.
is the next branch of the aortic arch Left common carotid
is the third branch of the aortic arch. left subclavian
The left vertebral artery is a branch of the left subclavian artery.
Suppplies stomach,liver,pancreas,duodenum,and spleen Branches into L Gastric artery , splenic artery, and common hepatic arteries Celiac Artery(Celiac Axis)-(CA)
Supplies the small intestine, cecum, parts of colon Located about one cm distal to the celiac artery There can be a common trunk of the celiac artery and the SMA** Superior mesenteric artery (SMA)
Supply blood to the kidneys, suprarenal glands, and ureters. Multiple renal arteries are not uncommon Renal Arteries
Supplies transverse, descending colon and part of the rectum Inferior mesenteric artery (IMA)
ususally have a higher pulse amplitude than the Aorta. The lower extremity arteries
At the inguinal ligament, the external iliac artery is called the common femoral artery
The Femoral artery can be palpated.
The popliteal artery can be popliteal artery
passes above the interosseious membrane and distally comes to lie on the front of the tibia. The ATA can be palpated anterior tibial artery
runs behind the bone,also terminates at the foot, but instead of being at the front of the ankle, the landmark is at the side of the foot. The posterior artery is palpated slightly behind and below the medial maleolus, or inner ankle bone. It can be palp PTA The posterial tibal artery(PTA)
moves through the deep muscle compartment on the posterolateral aspect of the calf.It can not be palpated peroneal artery
Is usually due to ischemia, but is not always vascular in origin. Claudication
Rest pain can be relieved in part by dependency of the limb (hanging feet off bed or standing- gravity helps). Ischemic Rest Pian
There is always a Communication Tract between the artery and the aneurysm
Blood flow is the result of differences in energy levels. In the arterial system this energy difference is in the form of pressure
The three branches of the aortic arch are: Right innominate, left common carotid, left subclavian
In the cervical carotid, the internal carotid artery (ICA) can be differentiated from the external carotid artery (ECA) by all of the following except; The ICA has only one branch
The ICA distributes blood to all of the following areas except; Thyroid
The ECA branches into all of the following arteries EXCEPT Basilar
The vertebral arteries arise from which vessels: Subclavian
The circle of Willis is composed of all of the following arteries except: Anterior choroidal arteries
The major branches of the ophthalmic artery that exit the orbit include all of the following except; facial
Bernoulli's principle explains which phenomenon of the carotid bulb areas of flow separation
A symptom of a CVA is Aphasia for 72 hours
The cause of a right hemispheric infarct may be Right ICA Occlusion
The ICA flow differs from ECA flow in what way? ICA has less peripheral resistance than the ECA
In a carotid duplex exam, what is the most frequent reason for under-estimation of the amount of stenosis? Improper placement of the sample volume
In a carotid duplex exam, overestimation of a stenosis occurs because of all of these reasons EXCEPT? Calcification enhances amount of disease
The acoustic windows providing access to the intracranial vessels in TCD are; Transorbital,transtemporal, transforaminal
Which artery is not routinely evaluated in a TCD exam? Posterior communicating
In a TCD exam, what is the normal direction of flow in the middle cerebral artery? antegrade
Utilizing duplex scanning, the criteria for determining a 80-99% diameter reduction of the ICA is Peak >125 cm/sec End >140cm/sec
stroke or cerebrovascular accident (CVA): permanent ischemic neurological deficit (Symptoms last more than 72 hours)
There are eight named branches of the external carotid artery: the superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, and the terminal branches, the superficial temporal, and the internal maxillary artery
The Right ICA feeds the right hemisphere of the brain.
The left ICA feeds the left hemisphere of the brain.
The ICA versus ECA The ECA has multiple branches. The ICA has no branches in the neck. The ICA is usually more lateral while the ECA is usually more medial. The ICA is bulbous at it’s origin. The ICA is usually larger in diameter than the ECA The ICA has a low resistan
Vertebrobasilar or Posterior portion of the circle of Willis This portion of the circle of Willis is formed by Vertebral arteries Basilar artery Posterior Cerebral arteries Posterior Communicating arteries
Carotid or Anterior portion of the circle of Willis,This portion of the circle of Willis is formed by Internal Carotid Artery Middle Cerebral Artery Anterior Cerebral Artery Anterior Communicating Artery
Middle Cerebral Arteries (MCA) Courses laterally towards the temporal bone
Anterior Cerebral Arteries (ACA Courses medially towards the midbrain Gives rise to the anterior communicating artery
Basilar Artery Formed by the confluence of the intracranial vertebral arteries Bifurcates into the two posterior cerebral arteries (PCA)
Posterior Cerebral Arteries (PCA) Perfuse the posterior hemispheres
Posterior Communicating Arteries Arise from the right and left PCAs respectively
Transcranial Doppler Used to evaluate the circle of Willis
Three windows are used to try to pass sound waves into the brain Transtemporal Transorbial Suboccipital
Disadvantages of indirect physiologic testing Can be difficult to interpret in the presence of multilevel disease.
Normal Waveforms Slow upstroke, rounded peak, and prolonged downslope are charcteristic of abnormal waveforms. will be triphasic
Abnormal waveforms distal to a stenosis or occlusion will exhibit low velocities and have a single flow component that becomes increasingly rounded and more dampened as disease severity increases.
Intermittent claudication ABI .2 to 1.0
The toe pressure should be 60%- 80% of the ankle pressure
If the patient complains of arm pain./numbness/or weakness that is related to position, perform Thoracic Outlet Evaluation
Allen Test Evaluates the integrity of the palmar arch, radial and ulnar arteries.
Raynaud’s Disease, Intermittent pallor, cyanosis, and rubor that is caused solely by digital arterial spasm.
Autoregulation, the body will dilate its arterial capillaries and arterioles when there is a decrease in the oxygen level in the blood,As a response to hypercapnia(too much carbon dioxide),when there is a decrease in local supply of blood (such as ischemia due to stenosis. When tissues become ischemic (deprived of blood flow) sub
Factors effecting resistance to flow- Viscosity Vessel Diameter(Radius) Vessel Length Inertial Energy Loss
Vessel Diameter or Radius Change has the most dramatic effect on resistance
When a vessel first begins to narrow, the increase in pressure gradient has the dominant effect on the flow rate. The body tries to deliver the same amount of blood across the stenotic area that it was delivering when the artery was wide open. To accompl the flow rate has to increase
Poiseuille’s Law Defines the relationship between pressure,volume flow and resistance
Peripheral Resistance-Low Resistance Flow Flow-Continuous flow feeding a dilated vascular bed. Significant flow through out diastole. Example: ICA, Renal artery, Vertebral Artery, Non-fasting SMA
High Resistance Flow Flow-Flow of a pulsatile nature. Characteristic flow reversals in diastole.Example;ECA, Ao
Spectral broadening usually represents turbulent flow
Flow separations result in regions with stagnant or little movement. These seperations are explained by Bernoulli’s principle
Important features of blood flow illustrated by Spectral Analysis
Spectral Broadening is caused by one of following things Doppler gain is set too high Doppler angle is incorrect Sample volume size is too large Sample volume is placed incorrectly "Turbulent flow"
CW can not sample flow at a discrete point.
A ratio of stenotic to prestenotic PSV greater than 2:1 indicates hemodynamically significant stenosis.
A stenosis causes flow abnormality or turbulent flow immediately past the stenosis
Flow accerlerates through the stenosis
Post stenotic turbulence Energy is expended as heat. There is post stenotic turbulence- Flow quality is comprised of multiple changes in direction and spectral broadening occurs. Flow is disturbed and can even be bidirectional. Spectral broadening is present. Disturbed flow w
A diameter reduction of 50% = A cross sectional area reduction of 75%
3cm distal to the stenosis laminar flow is usually reestablished
According to the Bernoulli principle Pressure is lower in an area of high velocity such as a stenosis.
The lower the pressure in a hurricane, the faster the velocity of the wind.
Created by: yovana2011