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Arterial System

anatomy and function

QuestionAnswer
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 what arterial wall? The Inner Layer
The three branches of the aortic arch are? Right Innominate,Left Common Carotid,Left Subclavian
Which lower extremity arteries are palpable? Popliteal, Femoral, Posterior Tibial, Anterior Tibial
According to Bernoulli what is true about pressure/velocity relationship? Pressure is lower at the region of stenosis,velocity and pressure are inversely related
What are some causes of vasodilatation of a high resistance bed? Body heating, exercise, stenosis
A 75% area reduction equates to a 50% diameter reduction
What are some characteristics of a post-stenotic turbulence? Bi-directional flow, spectral broadening is present,energy heat loss
Excercise induces peripheral vasodilatation in the microcirculation which: decreases the distal peripheral resistance
What are some characteristics of claudication? Pain in muscle during exercise,pain usually subsides after rest
What readings do you expect with analog recordings? Low velocities are overestimated, less sensitive than spectral analysis, noisy
What will analog recordings NOT do? Display 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-stenoic PSV(peak systolic velocity) is greater than 2:1
A high resistance blood flow pattern is normally found in what arteries? ECA, Ao, Iliac, Subclavian, Fast SMA, extremity arteries
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
What are some common complications of arteriography? Puncture site hematoma, Pseudo-aneurysm, Local artery occlusion
Ballon angioplasty is more commonly used in what lower extremity arties? Femoral Artery, Popliteal Artery, Iliac Artery
An ABI of .65 places the patient into the category of? Claudication
The Allen Test is most often utilized to assess patency of what vessels? Radial artery, Ulnar artery, Palmer Arch
Vasculogenic impotence can be caused by the blockage of what arteries? Abdominal, Common Iliac, Internal Iliac
What are characteristcs of an abnormal plethysmorgraphic waveform? Slow upstroke, rounded peak, prolonged downslope, no dicrotic notch
The toe pressure should be what % of the ankle pressure: 60 to 80%
What is one difference between a CW Doppler and a PW Doppler? CW Doppler cannot sample flow at a discrete point
Differentiate the cervical carotid ICA from the ECA. ICA has no branches in the neck,ICA has a bulbous area at its origin, usually larger than ECA,usually lateral to midline, ICA has low resistance waveform w/more diastolic flow
The ICA distributes blood to what arteries? Brain, Eyes, Nose
The ECA branches into what arteries? ascending pharyngeal,facial,occipital
The verterbral arteries arise from which vessels? Subclavian
The circle of Willis is composed of what arteries? Verterbral, Basilar, terminal branches of ICA,Anterior Cerebral Artery, Middle Cerebral Artery, Posterior Cerebral Artery,Anterior and Posterior Communicating Arteries,
The major branches of the ophthalmic artery that exit the orbit are? Supraorbital, Frontal, Nasal
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 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
The criteria used for correct vessel identification in a TCD is? Depth of the sample volume, the direction of flow, the velocity of flow
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= blood flowing forward, away from the heart
Utilizing duplex scanning, the criteria for determining a 80-99% diameter reduction of the ICA is Peak >125cm/sec, End >140cm/sec
Autoregulation Arterioles assist with regulating blood flow thru contraction and relaxation(varying the degree of resistance)
What are the three layers of the arteries? Intima, Media, Adventitia
Intima Innermost layer in contact with blood, made of an endothelial lining
Media middle layer, muscle, elastic connective tissue, consists of smooth muscle cells
Adventitia(external) outer layer of supporting connective tissue-provides significant portion of total strength to the arterial wall, contains the vasa vasorum
Vasa Vasorum located in the adventitia layer, are tiny vessels that carry blood to the walls of the arteries themselves
What is the first major branch of the aortic arch? Innominate(Brachiocephalic) Artery
The Innominate Artery divides into what arteries? Right Common Carotid and right subclavian
The right subclavian artery divides into what artery? Right vertebral
The left subclavian artery divides into what artery? Left vertebral
Branches of the Abdominal Aorta are: Celiac Artery,Superior mesenteric artery(SMA),Renal Arteries,Inferior mesenteric artery(IMA),Terminal branches
Celiac artery(CA) located below diaphragm,branches into left gastric artery, splenic artery and common hepatic artery, supplies stomach, liver, pancreas, duodenum and spleen
Superior mesenteric artery(SMA) located one cm distal to the celiac artery, supplies the small intestine, cecum, parts of colon, can be a common trunk with the celiac artery
Renal arteries located below the SMA, supply blood to the kidneys, suprarenal glands and ureters, multiple renal arteries are not uncommon
Inferior mesenteric artery(IMA) located about 3-4cm above bifurcation, supplies transverse colon,descending colon and part of the rectum
Terminal branches is where the abdominal aorta terminates(approximately at umbilicus) and bifurcates into right and left common iliac arteries, which branches into external and internal iliac arteries
Internal iliac arteries/hypogastric artery goes inward and begins the blood supply to the reproduction organs
External iliac arteries travels along the medial side of the Psoas major muscle, continues the progression of blood to the lower extremities
Lower extremity arteries Usually have a higher pulse amplitude than the Aorta, Common femoral,Profunda femoral,Femoral, Popliteal,Anterior tibial,Posterior tibial,Peroneal,Dorsalis Pedis
Common Femoral Artery when the external iliac passes by the injuinal ligament(bind of hip)it becomes the common femoral artery, continues into proximal thigh, can be palpated
Profunda femoral Artery(Deep femoral artery) is a branch of the common femoral artery
Femoral Artery(superficial femoral artery) is a continuation of femoral artery after the profunda, located distal thigh, dives deeper into the leg in the adductor canal
Adductor Canal/Hiatus/Hunter's Canal The most common site of atherosclerosis in the lower extremity(bend of the leg, behind knee)
Popliteal Artery located behind the knee, can be palpated, divides three ways(anterior tibial, posterior tibial, peroneal arteries)below the popliteal fossa
Anterior Tibial Artery(ATA) is a branch of the popliteal artery, passes above the interosseious membrane and distally comes to lie on the front of the tibia, can be palpated
Tibio-peroneal trunk bifurcates into the posterior tibial and peroneal arteries
Posterior Tibial Artery(PTA) runs behind the bone, terminates at the foot,slightly behind and below the medial maleotus(inner ankle bone), can be palpated
Peroneal Artery moves thru deep muscle on the posterolateral aspect of calf, CANNOT be palpated
Dorsalis Pedis Artery(DPA) when ATA enters foot become DPA, branches to deep plantar artery, plantar arch, lateral plantar artery
Upper Extremity Arteries Subclavian, Axillary, Brachial, Radial, Ulnar, Digital
Subclavin Artery crosses under the clavicle and over the first rib, most difficult upper extremity artery to visualize, becomes axillary artery
Axillary Artery located deep in axillary fat pad(armpit),axillary becomes brachial artery after crossing the teres major muscle
Brachial Artery lies in a groove between the biceps and tricep muscles, associated w/two veins,becomes the radial and ulnar artery at the elbow joint
Profunda Brachii(deep brachial artery) is a branch off the brachial artery and is a major source of collateral flow around the elbow
Radial Artery is on the thumb side of forearm
Ulnar Artery is on the pinky side of the forearm
Digital Artery include the deep palmer arch and the superficial palmar arch and they supply blood to the hand
Claudication leg pain, ache, cramp - brought on by exercise and relieved by rest, usually due to ischemia but not always vascular in origin, pain is usually 12-15 inches distal to the site of stenosis
Most common site of claudication? Calf, can occur in buttock, thigh, foot, arms if subclavin blocked
Ischemic rest pain nocturnal pain that is severe and involves the foot distal to the metatarsals(digits and dorsum of foot),can be relieved by hanging feet off the bed or standing-gravity helps, has to be regular pain to truly be ischemic rest pain,occur when horizontal
Signs of damage from lack of blood flow? dry/scaly skin, thickened nails, rubor(redness),coolness of skin, hair loss, ulcers, gangrene
Aneurysm bulging of the wall of a vein or artery, due to a thinning or weakening by disease or congenital abnormality, cause unknown,
Dissecting Aneurysm small tear in the intima allows blood to form a cavity between the two wall layers, often occurs in the thoracic aorta, can occur consequent to HTN or sever chest trauma
Pseudoaneurysm Defect in the main artery wall-blood creates a channel of communication from the main artery to a pulsatile structure outside the vessel walls,ALWAYS has a neck,fairly common complication of cardiac cath,always a artery,treated w/thrombin or compression
6 P's of Arterial Disease Pain, Pallor, Pulselessness, Pressure, Polar sensation, Paralysis-loss of power of movement
Most common location for aneurysm is: Infrarenal Aorta
Which vessels provide flow to low resistance vascular beds? ICA, non-fasting SMA and Renal,vertebral, hepatic, splenic, celiac
Which vessels provide flow to high resistance vascular beds? ECA, Aorta,fasting SMA and Femoral Artery, Iliac, Subclavian, extremity arteries
Piseuille's Law Volume flow(Q)= Pressure(P)/Resistance(R), increase resistance=decreased flow, pressure and flow are inversely related, when Velocity increases Pressure decreases, Velocity decreases Pressure Increases
According to the Bernoulli principle Pressure is? Lower in an area of high velocity such as a stenosis, When pressure decreases, flow increases: lower the pressure in a hurrican,faster the velocity of the wind
Post stenotic turbulence flow is disturbed,may be bidirectional,spectral broadening is present, disturbed flow will return to normal(relaminarize) after the stenosis
A diameter reduction of 50% = A cross sectional area reduction of 75%
Hemodynamically significant stenosis causes a notable reduction in volume flow and pressure, a ratio of stenotic to prestenotic PSV greater than 2:1
Primary Raynaud's Disease Intermittent pallor, cyanosis and rubor that is caused soley by digital arterial spasm, brought on by cold exposure,chemicals(nicotine), emotion or trauma, cold challenge test is helpfull in identifying
Secondary Raynaud's Disease pressence of cold sensitivity complicated by fixed arterial obstruction, associated with underlying autoimmune disease or connective tissue disease such as scleroderma, characterized by abnormal doppler waveforms
Adson Maneuver positioning the arm at 90 degree angle to torso with the head turned toward arm being tested and away from the arm being tested
Thoracic Outlet Syndrome intermittent pain, numbness or weakness of arm related to a position(repetitive motion above the head),caused by compression of artery or nerve by the anterior scalene muscle, clavicle, rib or congenital muscular anomaly
What is the Adson maneuver used to evaluate? Thoracic Outlet Syndrome
Angioplasty is the mechanical, hydraulic dilation of a narrowed or totally obstructed arterial lumen
Toe pressure should be what percentage of the ankle pressure? 60 to 80%
Vasculogenic impotence blockage of any artery in the supply chain to the hypogastric artery(internal iliac artery)
Allen Test evaluates the integrity of the palmar arch, radial and ulnar arteries
What are the characteristics of an abnormal plethysmographic waveform? initial loss of the dicrotic notch w/minimal to mild disease, increased severity proximal to the sample site causes systolic upstroke delays, amplitude reduction and rounded systolic peaks.
Embolism Obstuction of vessel by foreign substance or blood clot, can be solid,liquid or gas,majority originate from the heart,most common underlying causes are Afib, MI w/mural thrombi
Thromboembolism embolism of thrombus or blood clot
Cholesterol embolism often from atherosclerotic plaque inside a vessel
Fat embolism embolism of bone fracture or fat droplets
Air/Gas embolism air bubbles
Septic embolism pus-containing bacteria
Tissue embolism small fragments of tissue
Foreign body embolism foreign materials such as talc and other samll objects
Amniotic fluid embolism amniotic fluid
Vasodilation Enlargement of vessel lumen due to relaxing of the muscular vessel walls
Resistance Opposition to flow of current in electricity and blood in the vascular system
High resistence is pulsatile,tri or bi-phasic,characteristic flow reversals in diastole, ECA, Aorta, Iliac, Subclavian, Fasting-SMA, extremity arteries
Low resistence is continuous throughout systole and diastole feeding a dilated vascular bed, ICA, renal, vertebral, hepatic, splenic, celiac,non-fasting SMA
Bernoulli's Principle Pressure is lower in an area of high velocity such as a stenosis
Flow seperation occur because of a geometry change w/wo intraluminal disease and because of curves in the vessel-results in regions w/stagnant or little movement, ex: graft anastomosis site, carotid bifurcation
What happens to blood flow in the presence of a stenosis? at entrance of stenosis there is an increase in doppler shift frequency=spectral broadening & elevated velocities,flow abnormality or turbulent flow immediately past the stenosis,flow accelerates thru the stenosis,normalizes 3cm distal stenosis
Spectral Broadening Filling in of the window or "clear area" in the spectral analysis, caused by: doppler gain set to high,doppler angle is incorrect,sample volume size is to large, sample volume is placed incorrectly,turbulent flow
Continuous Wave(CW) information is obtained at all points along a single scan line. CANNOT sample flow at a set point
Pulsed Wave(PW) Samples at a set location, must be parallel to flow, most accurate angle is 0 degrees, angle of less than 60 degrees is acceptable most prefer 45 to 60 degrees
Reynold's number is unitless, reynold's number=average flow speed X tube diameter X density, interpreted as:less than 1500=laminar flow,1500 to 2300=indeterminate, above 2300=turbulent flow
What has the most dramatic effect on blood flow? Vessel Diameter or Radius
Factors effecting resistance to flow Viscosity, Vessel Diameter,Vessel Length, Inertial energy loss
Flow is dependent on The physical properties of the blood and the properties of the vessel it's moving through
Complications of Arteriography Puncture site hematoma, pseudoaneurysm, local artery occlusion
What is the most common site of stenosis or occlusion of the hemodialysis access graft? Outflow Vein
What ABI puts a patient in the range of claudication? .2 to 1.0 at rest
What information is gathered from doppler pressure evaluation? presence or absence of peripheral arterial disease
What is difficult to interpret by the doppler pressure evaluation? The presence of multilevel disease
What is the unique waveform characteristic of Raynaud's phenomena? peaked
Distinguish ICA from ECA ICA has no branches in the neck, is usually more lateral,is bulbous at it's origin, usually larger in diamerer,has a low resistance waveform w/more diastolic flow
What structures are fed by the ICA? Eye and Brain
What structures are fed by the ECA? Face, neck, thyroid and scalp
Name the branches of the ECA ascending pharyngeal,facial, occipital
Symptoms of a CVA TIA, amuarosis fugax, hemiparesis, dysarthria, aphasia
How long do symptoms of a CVA last? More than 72 hours
Transient Ischemic Attack(TIA) ischemic neurological deficit that lasts less than 24 hours
Amuarosis fugax transient partial or complete loss of vision in one eye
Hemiparesis unilateral partial or complete paralysis
Dysarthria difficulty with speech
Aphasia inability to communicate (speech,writting)
Which part of the brain is effected by the right ICA? right hemisphere
Which part of the brain is effected by the left ICA? left hemisphere
What is the difference in the ICA and ECA flow? The ECA has a high resistance waveform with less diastolic flow, ICA has low resistance waveform with more diastolic flow
What can cause overestimation of stenosis in carotids? accelerated flow may be compensatroy for contralateral disease, turbulent flow may be from tortuous vessel, artifact may be mistaken for plaque
What is the most frequent reason for underestimation of stenosis? improper placement of the sample volume
Stenosis Criteria of a 80 to 99% diameter of the ICA is seen with PSV > 125cm/sec & EDV > 140cm/sec
In what plane do you compress the vein transverse
Why is heparin given to a patient with DVT? keeps thrombus from forming in another area
What are the branches of the ophthalmic artery? supra orbital, frontal, nasal
Name the acoustic windows for TCD Transtemporal, transorbital, suboccipital
Which vessels are evaluated in a TCD? MCA, ACA, PCA, terminal ICA, anterior and posterior communicating arteries from the transtemporal window,ICA siphon and ophthalmic from transorbital, verterbral and basilar from suboccipital
Normal direction of flow in the MCA is laterally towards the temporal bone,towards transducer,above baseline
Normal direction of flow in the ACA is medially towards the midbrain,away from transducer and below baseline
Normal direction of flow in the PCA is P1-towards transducer,P2-away from transducer
Upper extremity venous duplex doppler signal is more pulsatile, flow increases during inspiration, and the vessels are sometimes non-compressable even when normal
In a carotid duplex exam, overestimation of a stenosis occurs because of what? Accelerated flow may be compensatory for contralateral disease, turbulent flow may be from tortuous vessel, artifact is mistaken for plaque
Which vessel is not a deep vein of the lower extremity? Greater saphenous vein
What is the most important function of the venous sinuses of the lower legs? To serve as a reservoir
What is the most important criteria in identification of the deep veins? Adjacent artery
The confluence of the axillary and cephalic veins form which vessel? subclavian
The return of venous flow from the legs to the heart is assisted by the following mechanisms. venous valves, calf muscle pump, expiration
The three main risk factors for DVT(Virchow's Triad) are. Trauma, Hypercoagulability, Venous stasis
In utilizing PPG to evaluate venous insufficiency, the criteria for determining incompetence of the superficial system is A venous refill time < 20 seconds
In venous duplex scanning for DVT, list the characteristics that are of diagnostic value. Augmentation with distal compression, wall compressibility, echogenicity of the lumen
List characteristics of an acute DVT. Dilated vessel, Poor attachement to wall, Spongy texture
In venous duplex scanning, what is the preferred method of evaluating vein wall compressibility? Gentle pressure with the probe, vessel in transverse view
In transverse view, color-flow doppler shows no filling of the popliteal vein, what factors must be considered? DVT, Poor angle of insonation, Highpass filter set to high
Normal findings in a venous duplex scan of the arms that differ from those of the legs include what? doppler signals may be more pulsatile, flow increases during inspiration, more limited vessel compressibility
The most common sequelae(complication) of DVT is Valvular destruction
Why is heparin given to a patient with an acute DVT? Decreases propagation
Extrinsic compression of the celiac artery is caused by the Median arcuate ligament
Patient presents with crampy, dull abdominal pain immediately after meals. What vessel would be evaluated noninvasively? SMA
What characteristics of diagnostic value are found in venous duplex scanning for DVT? augmentation with distal compression, wall compressibility, echogenicity of the lumen
What characteristics are found with an acute DVT? dilated vessel, poor attachment to wall, spongy texture
In utilizing PPG to evaluate venous insufficiency, the criteria for determinging incompetence of the superficial system is a venous refill time of <20 seceonds
The three main risk factors for DVT(Virchow's Triad) are? trauma, hypercoagulability, venous stasis
What is the most important criteria in identification of the deep veins? adjacent artery
The return of venous flow from the legs to the heart is assisted by what mechanisms? venous valves, calf muscle pump, expiration
The deep veins of the upper extremity are? ulnar, radial, subclavian
The deep and superficial venous systems are connected at what sites? groin saphenofemoral junction, popliteal fossa saphenopopliteal junction, ankle perforators
A deep venous thrombosis could lead to what complications pulmonary embolism, venous insufficiency, venous hypertension
Is the greater saphenous a deep vein of the lower extremity? no
Extrinsic compression of the celiac artery is caused by the median arcuate ligament
Patient presents with crampy, dull abdominal pain immediately after meals. What vessel would be evaluated noninvasively SMA
A high resistance blood flow pattern is normally found in ECA, femoral artery, fasting SMA
Name the branches of the ophthamlic artery supraorbital, frontal, nasal
Name the acoustic windows for TCD transtemporal, transorbital, suboccipital
Normal direction of flow in the MCA laterally towards the temporal bone,antegrade
Normal direction of flow in the ACA medially towards the midbrain
Normal direction of flow in the PCA P1 toward, P2 away
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 what arterial wall the inner layer
Which vessels is not palpable? peroneal
What arteries provide flow to high resistant vascular beds? ICA, vertebral, renal, non-fasting SMA, hepatic ,MCA
Does the Aorta normally have a lower pulse amplitude? yes
According to Bernoulli what is NOT true about pressure/velocity relationships? pressure is higher at the region of stenosis
Extrinsic compression of celiac artery is caused by the median arcuate ligament
What causes vasodilatation of the high resistance bed? body heating, exercise, stenosis
75% area reduction equates to a 50% diameter reduction
What are the characteristics of post-stenotic turbulence Bi-directional, spectral broadening
Excercise induces peripheral vasodilatation in the microcirculation which decreases the distal peripheral resistance
What are the characteristics of claudication pain in muscle during exercise, pain usually subsides after rest
"primary Raynauds's" occurs when ischemia is due to distal arterial spasm
Most important differential diagnostic parameter for pseudoaneurysm communication tract between artery and aneurysm
Characteristic high resistance signal triphasic, pulsatile, reverse component biphasic
Characteristic recordings of analog less sensitive than spectral analysis, low velocities are overestimated, noisy
A patient presenting with ischemic rest pain complains of foot pain when supine, relieved by standing
What can be determined by the doppler pressure evaluation can 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 what vessels? radial artery, ulnar artery, palmar arch
Vasculogenic impotence can be caused by common iliac artery occlusion internal iliac artery stenosis aortic occlusion
Characteristics of an abnormal plethysmographic waveform slow upstroke, rounded peak, prolonged downslope
Toe pressure should be what % of the ankle pressure? 60% - 80%
Waveforms as the result of Raynaud's phenomena have this unique characteristic peaked
Most common site of stenosis or occlusion of the hemodialysis access graft is outflow vein
using duplex scanning, criteria for determination of a 50% - 99% diamter 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 found in the ECA, femoral artery, fasting SMA
Adson maneuver is performed for the assessment of thoracic outlet syndrome
Most common complications to arteriography puncture site hematoma, pseudo-aneurysm, local artery occlusion
Balloon agioplasty is more commonly used in what arteries? femoral, popliteal, iliac
Bernoulli's principle explains which phenomenon of the carotid bulb areas of flow seperation
According to Poiseuill's law, what has the most dramatic effect on blood flow radius of the vessel
As blood flows thru a stenosis what occurs flow accelerates thru stenosis, turbulent flow is evident,laminar flow resumes downstream from the stenosis
What are the contraindications for OPG-Gee allergies to local anesthetics, eye surgery within last 6 months, a past spontaneous, retinal detachment
What does spectral broadening usually represent turbulent flow
The ICA distributes blood to brain, eyes ,nose
ECA branches into what arteries ascending pharyngeal, facial, occipital
Vertebral arteries arise from the subclavian
A symptom of a CVA is aphasia for 72 hours
The cause of a right hemispheric infarct may be: right ICA occlusion
In a carotid duplex exam, overestimation of a stenosis occurs because of what accelerated flow may be compensatory for contralateral disease turbulent flow may be from tortuous vessel artifact is mistaken for plaque
Created by: JLC1968