Vascular Ultrasound
Help!
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| Innominate vein course where? | anterior and lateral to the innominant artery
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| Trunk Artery flow patterns | lower end diastolic velocity
more branches
Ex. Thyrocervical, Costrocervical
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| what merges to form the MPV | Junction of the splenic and SMV
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| Sural Veins | AKA Gastricneumius
Deep Calf muscle and course along the artery, empty in pop\
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| Which vessel is posterior to the anterior scalene muscle | Subclavian artery
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| Dorsalis Pedis Artery | AKA DPA
Branch of ATA
Starts at bony promenance on foot.
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| How to find the ECA (Best view) | Angle probe medial ad anterior
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| Venous flow during inspiration | lower extremity: flow decreases
upper extremity: flow increases
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| lateral plantar artery | originates at the PTA
posterior to medial malleous
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| what artery supplies majority of blood to the hand | ulnar artery
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| which veins lack spontanety? | Calf veins and superficial veins
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| For a bypass graft, what is the preferred diameter of the GSV | 3 mm or greater
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| What branches do the occipital branches connect to? | Vertebral artery branches.
This allows for collateral flow from Ant to Post COW
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| What does increased hematocrit effect? | Viscosity/
increased viscosity decreases flow velocity. (blood is thicker)
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| T or F Resistance and pressure are directly related? | True
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| What does the ACA feed? | Corpus collosum
cavun spetum
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| Which LE veins have no valves? | IVC, Iliac, and Soleal
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| What UE veins have no valves? | SVC and Innominate
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| Allignment Sign | Alignment sign refers to AASV (anterior accessory saph vein)
AASV is aligned with fem artery in saphenous compartment. GSV = medial to femoral
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| Carotid Siphon | "S" shaped ICA at the distal ICA portion behind the transorbital view.(Transoptical) at 60-80 mm
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| Papaverne Injection | Injection used for impotence.
Normal PSV in cavernosa artery after injection is >30 cm/s
reduced PSV is a sign of impotence.
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| What does OHMs law describe in clinical setting? | Arterial blood flow volume.
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| Cocketts perforators | Posterior tibial perforatiors. 3 ankle perforators that connect to the posterior arch vein
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| what does proximal and distal augmentation assess | venous insufficiency
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| What is the normal pressure in venules? | 20 mmHg
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| What is a varient of the femoral vein? | Vein Parring. Normal femorals do not have a pair match.
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| What are the upper ext. deep veins? | Radial, ulnar, brachial and axillary.
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| What are the upper ext. superficial veins? | Cephalic, Basilic,antecubital
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| venous valve leaflets | extensions of the vessels intimal layer\
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| Venous sinusoids? | blood reservoir in calf located between soleal and gastrocnemus muscles.
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| Penile brachial Index | PBI
Normal is >0.75
Vasculogenic impotence is >0.65
0.76-0.65 is suspect for vas. impotences, but futher eval is needed.
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| ATV | Anterior Tibial Vein
Antrolaterally- courses along the space between the tibial and fibular head, empties directly into the popleteal.
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| Soleal Plexus | venous drainage system resouvier of soleal muscle in calf
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| Best Transcranial view of the basiliar and vertebral art? | Suboccipital. Pat lay decub, hand/arm under head. Flow is seen away from transducer.
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| Primary mechanism that controls arterial flow volume? | cardiac output and peripheral resistance.
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| Calf Pump | Force returning flow from LE to heart
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| Effective calf pump | decrease in pressure of the deep veins of the calf
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| ineffective calf pump | pressures in the calf increase
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| Angular artery | terminal branch of the facial artery
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| Superficial venous system | 1-2 cm below skin
easy to compress
many valves
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| Peroneal vein | Originates at ankle, courses along the medial border.
DEEP vein.
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| MCA view depth from Temporal Window | 30-60 mm Depth
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| Aorta flow profile | Plug Flow.
Low resistance Proximal. High resistance Distal
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| Corpus cavernosum | two in penis
Cavernosal artery (2) flow through each corpus cavernosum
sit outside the corpus spongiosum (mickey ears)
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| Medial Malleolus | Bony bump on the inside of ankle
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| Lateral Malleolus | Bony bump of the outside of ankle
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| PTV courses? | PTV drains blood from the plantar arch and lays anterior and post to the medial malleolus
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| perforators flow profile | Superficial to deep, unidirections
If pressure in deep exceeds pressure in superficial, the perforators will dilate and flow will become bidirectional.
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| IVC |
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| What veins form the SVC | Superior vena cava is formed by the Right and Left Innominate veins
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| Blood within the pulmonary veins are? | High oxygen
flow into left atrium.
ONLY VEIN that carries Oxygenated blood
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| What will increase spectral broading? | an increase in sample size
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| Periorbital doppler is? What does it eval? | CW doppler. Evaluated Frontal artery.
Placed near inner cantus.
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| Where does the CCA bifurcate? | At the level of they thyroid cartiledge.
Right bifurcates lower then left.
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| Superficial Epigastric Vein? | Tributary of the GSV
Drains the lower abdomen and can cause superficial varicies in the lower abd if valves are incompetent.
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| What is the Mesenteric to Aortic Ration? | Normal: 1.0 or less
Ratio increases with SMA stenosis.
SMA/AO ration of >3.0 is significant stenosis
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| Pitfall of transducer pressure during a venous exam? | increased pressure can negative eff. exam by compressing normal vessels, making them non visualized.
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| Venae Comitantes | Paired veins that accompany an artery of the same name.
Soleal veins do not have accom. art.
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| Venous flow in the Portal System? | There is no cardiac pulsatility.
Minimum respiratory phascity due to the thickness of portal walls and location in abdomen.
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| Gastrcnemus Vein | Part of the venous system of the calf muscles.
Provide a venous reervior for extremity blood along with soleal sinus.
Empties into the popliteal vein
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| Hunterians perforators | drain blood from GSV in the proximal mid thigh to fem vein.
Prox-Thigh perforators.
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| Effects of Norephnephrine in vein | Vasoconstriction
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| effects of adrenaline in vein | Vasodilation
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| Stocking seam vein | SSV Superficial saphenous vein
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| What effect does eating have on the CA | None. It remains unchanged at low resistance, it feeds the spleen and liver.
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| What effect does eating have on the SMA | Pre-Prandial is high resistance.
Post -Prandial is low resistance as it feeds the diagestive tract
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| arc of riolan and marginal artery of drummond. | Connect the SMA/IMA
Offer mesenteric collaterial if obstr. occurs
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| Gonadal vein drains blood to - (r/L) | Right Dumps into the ivc
left into the left renal vein
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| Does the Splenic vein drain into the IVC< | No, splenic vein is part of the portal system
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| The ACA branches feed what lobes? | Frontal and parietal lobes
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| Internal thoracic artery | Originates from subclavian art.
Can be used as coronary bypass graft
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| first branch off the ascending aorta | coronary
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| allen test | used to evaluate the palmar arch when removing radial artery
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| posterior arch vein | connects the posterior tibial perforators (cocketts) to the GSV in mid/up calf.
This vein usually plays major role in disease caused by venous stasis
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| superficial venous drainage system | comprised of the greater and smaller saphenous system
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| Innominate veins also are known by what name? | Braichialcephalic.
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| Brachiocephalic (rt/lt) | Major veins in upper chest.
Formed at union of the IJV and Subclavian at the level of the stenoclavicular joint.
Left is longer then the right
Innominate
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| antecubital vein | Median cubital vein
forms connection at the elbow between basilic and cephalic.
Superficial vein
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| Reynold number | Low reynolds number is laminar flow (<2000)
High reynolds number is turbulent flow (>2000)
splenic artery is the most tortuous artery and has a very high reynolds number
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| Posterior Communicating Artery (PCoS) | Connects the anterior and posterior cerebral system - MCA and PCA
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| SSV Origin | Posterior to the lateral malleous
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| capillaries | smallest vessel
allows for exchange on nutrients and waste products between blood and tissue
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| Deep Sniff Test | Manual Compression is limited at the subclavian vein due to location. Sniff test is used to compress vessel
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| IVC/AO visualized in the same image | Coronal/Trans in decub
best way to get the IVC and Aorta in long
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| Supraorbital Artery | Branch of the ophthalmic artery.
Branches connect with the superficial temporal artery branches
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| What flow is normal flow in the IVC, Hepatic and prox renal vein | Respiratory phasicity and mild cardiac pulsatility.
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| what flow is normal flow at the renal hilu | Continuous and minimal respiratory phasicity.
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| Where does the bilateral ICA join the circle of willis? | Lateral aspect. Terminates at the MCA/ACA
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| Valsalva maneuver | Baredown on abdominal muscles.
This will increase the intraabdominal pressure and the intrathoracic pressue.
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| Doppler Shift | Change in wavelength and frequency.
Tran freq is directly related to doppler velocity. increased freq will increase the detected doppler shift.
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| Autoregulation | vascular beds alter flow to maintain normal function.
Ex. Vasoconstriction or Vasodilation
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| Cephalic Vein | Origin at the lateral wrist and travels laterally up the side of the arm to the subclavian
Superficial vein
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| Basilic Vein | Origin at the medial wrist and travels medially up the side of the arm to the axillary
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| Brachial Veins | FOrm from the radial and ulnar veins at the elbow
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| Clenching fist causes an increase in distal resistance? tre or false | True
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| Intracranial artery waveforms | low resistance
Show spectral broadening due to small size of the vessel
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| ECA | External Carotid Artery
Anterior branch of CCA
Supplies neck, thyroid face and scalp.
normalPSV <150cm/s
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| Temporal Tap | Creates oscillatations in diastole when in the ECA. ICA will have no effect on the wave form during a temp. tap
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| Branches of the ECA | Sup. thyroidal (first branch. visable)
lingual, ascending pharyngeal, facial, occipital, posterior auricular, superficial temporal
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| ICA | Internal Carotid Artery
Larger then ECA, Supplies 75% of blood to the brain
Siphon area distal ICA, forms "S", turbulence
No visable branching
terminates at the bifurcation into the ACA and MCA at the circle of willis.
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| Branches of the ICA | Ophtalmic Artery - first branch from siphon area.
Ant chorodial artery and posterior comm. art are two main branches off distal.
Supplies eye, nose, forehead, corpus callosum, frontal and parietal
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| Periorbital artery | Supraorbital artery- origin, opthalmic. Joins at the sup. temporal art.
Frontal artery- supratrochelear. origian ophth.
Lacrimal Artery-
All provide collaterals for ica/eca
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| Vertebral Artery | 10-25% of blood to cerebrum
25% blood to the brain
Converge at basilar artery at the base of the skull
Left is larger in diameter
Branches off subclavian
Velocities <50cm/s
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| Subclavian Artery | Vertibral and arm
rt- origin - Innominate
lt origin - 3rd branch off the AO arch
Becomes axillary artery
triphasic/high resistance.
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| Branches of the Subclavian artery | Vertibral
internal mammary artery / Thoracic Artery
Thyrocervical trunk
Costocervical trunk
Trunks have many brances and lower diastolic velocities.
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| Basilar Artery | Left and Right Vertebrals merge to form singular basilar.
Supply superior cerebellum and portions of brain stem
bifircates at the circle to form both Posterior cerebral
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| Circle of Willis | Network of arteries seated on the inferior cerebrum surface.
Supplies all lobes of verebrum
Complete in only 50% of patients, normal in only 20%
Potential for collaterals in diesease
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| Anterior cerebral artery (ACA) | Supplies frontal and parietal
corpus collosum and covum spetum pellucidum
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| Middle Cerebral Artery (MCA) | supplies frontal and parietal and temporal lobes
MCA= 30-60 mm depth at temporal window
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| Posterior cerebral Artery (PCA) | Supplies temporal and occipital lobes
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| Cerebral circulation | Superficial branches spread over surfave of brain (Circle of willis)
Penetrating branches enter brain tissue for nutrient exchange and neureal function
Intracrandial venous sinuses.
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| Intracranial venous sinuses. | re located between duramater and periosteum and drain cerebral blood into the ijv.
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| Polycythemia vera | Stroke Mechansim
Thickening of the blood reduces flow and may lead to ischemia daily
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| atherosclerosis formation | No.1 cause of vascular disease
Accumulation of atheroma smooth muscle, collagen, fiberin and platelets
Forms within and beneath intima
>1.2 mm IMT
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| Most common places for Atherosclerosis | CCA bifurcation and CCA origin.
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| TIA | Transient Ischemia Attack
Lasts <24 hours
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| CVA | Cerebrovascular accident
lasts longer then 24 hours
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| Brain Infarction | insufficent blood supply to brain due to stenosis and occlusion
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| subarachnoid hemorrhage | Rupture of the intracranial vessels
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| Hemispheric Symptoms | Specific sympt related to the rt/lt brain with loss of fuctionality
RICA stenosis = Left Paresis
LICA Stenosis = Right Paresis
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| Carotid Sinus Massage | Dr. performed.
Access cause of syncope. level of the cricoid cart 5-10 seconds
will cause bradycardia and hypotension if sinus hypersensitivy exists.
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| paresthesia | Tingling of the skin
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| Hemiparesis | weakness
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| Brocaaphasia | expressive aphasisa
can understand and follow directions, can not speak
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| hollenhurst plaques | Choleserol emboli- effects ipsilateral CA/AO
lodges in small branch of retna artery
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| homonymous hemlanopia | Visual defect in half the eye
more common with post circulatry issues and occipital lobe infarct
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| amaurosis fugax | Temp/partial or total blindness.
TIA of eye. Opthalmic art branch off ICA, ipsilateral stenosis.
RICA, RIght eye
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| MCA Disease | Wernicke Aphasia
Unable to understand or follow directions.
Dysphasia, behavioral change, severe hemiparesis in contralat face/arm
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| ACA Disease | loss of cooridination, incontinence
severe leg hemiparesis, hemiplegia in contralateral face, drooping
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| vertebral/Basilar disease | Bil. blurred vis, homoymous hemianopia, paresthesia
vertigo, syncompe, ataxia, dysphagia, drop attack
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| Drop Attack | Falling to floor with no loss of consciousness
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| PCA Disease | Dyslexia
Coma
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| Intracranial Anat. | 1. ICA, 2. MCA, 3. ACA, 4. PCA, 5. Vertebral 6. Basilar 7. ACoA 8. PCoA
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| TCD | Transcranial Doppler
2 mhz
TAMV velocities, non-imaging
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| TCCD | Transcranial Color Doppler aka TCI
1.8 -3.5 mHz phased array.
PSV instead of TAMV
Evals- ACA, PCA, MCA, Siphon, Vert and Basilar.
PW- Flow towards Trans., abv baseline red. Flow away trans, below baseline, blue
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| Intracranial artery Anatomy ICA | Cervical ICA (Carotid)
Petrous ICA- Petrous portion of temporal bone, not 2d
Cavernous ICA- tortuous from petrous to CoW. Distal end is called supraclinoid
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| Intracranial artery Anatomy MCA | Bif of ICA
3 Segments
Teminates at ACA and PCA
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| MCA Segments | M1- Sphenadal
M2- Sylvian
M3- Cortical
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| Intracranial artery Anatomy ACA | Bifurcation of ICA
2 segments
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| ACA Sements | A1 - ICA and Ant Communication
A2 - Distal to the Ant. Communication
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| Intracranial artery Anatomy PCA | orginates top of basilar
2 segments
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| PCA segments | P1 - Between Basilar and Post Comm
P2 - Distal to Post Comm
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| Intracranial artery Anatomy Vertebral | Two vessels
R/L
Course from Subclavian, enter cranium at foramon magnum
Prox - seen on CCA, Dist seen on TCD
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| Intracranial artery Anatomy Basilar | Formed at junc. of vertebrals.
bifurcates into 2 PCA after the supcerebellar art branch of baislar
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| anterior communication artery (ACoA) Posterior communication Artery (PCoA) | most common anomaly is absence of one or more of this
ANT: single vessel, connects two ACA
most common location fo intracranidal aneursym
POST. Two vessels, connects pca and mca on each side (r/L)
2nd most common anuerysm location.
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| Critical ICA stenosis | Diastolic/Systolic flow
Low velocity with blunted waveform
slow AT, Tardus parvus
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| myointimal hyperplasia | an abnormality that cause turbulence in a vessel.
Occurs when a stent or bypass graft placement
atherosclerosis or grafts area aquired causes of turbulance
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| Posterior auricular artery | Branches from the ECA and supplies the ear with oygenated blood
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| Vein of giacomini | superficial vein connecting the GSV/ SSV
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| May Turner Syndromw | Anatomic course of the left iliac vein, increased risk of extrinsic compression
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| Flow in siphon obstruction | High Resistance in mid/distal ICA
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| inguinal ligament | Connects the superior edge of the iliac crest to the anterior bone
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| termination point of the peroneal artery | external calcaneal artery
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| Normal AO PI vs Pop Art PI | PI in Aorta should be lower then in Pop
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| Temporal window evaluation of ACA depth | 65 mm anterior window
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| Subclavian steal | SSS occulsion or stenosis of the subclavian artery proximal to the vertebral origins
Normal branchial pressures should not differ in each arm more then 20 mmHz or SSS should be suspected
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| Profunda Artery | Branches off the CFA and supplies blood to muscles is thigh and hip. COurses posterior and laterally to the femoral
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| AT of the CFA | Acceleration Time- 110 m/s is normal. >140 iliac disease
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| Interosseous membrane | connects medial tibia and anterior fibular and seperates the calf. ATA and ATV courses just ant to the membrance
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| internal pudendal artery | branch of the internal iliac artery and supplies the penis with blood through the penile artery
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| which veins receive blood from both superficial and deep veins? | Subclavian vein- Cephalic and Axillary
Popliteal - Lesser sapheneuous and deep calf
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| Highest velocities in CCA/ICA are normally found where? | 3 cm from the bulb or proximal portions
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| arm veins- | Cephalic is lateral, Brachial is mid and basilar is medial
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| ext. iliac artery courses? | along the medial psoas muscle and lateral to the ingunial
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| internal iliac artery is also called? | Hypogastric artery
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| TAMV | Time average max velocity
TCD uses this to evaluate cerebral vessels
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| Where do plantar arteries originate | the PTA posterior to the medial malleolus
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| the most common normal variant in the external/internal carotid artery anatomy is: | the ECA lies posterior and lateral to the ICA.
(The ECA is the anterior medial branch in most patients)
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| What type of flow is normal in the lower extremity (legs) | high resistance triphasic waveform
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| what veins form the subclavian? | Cephalic joins the axillary to form the subclavian
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| Dorsalis pedis artery is a branch of the | anterior tibial artery
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| Where does the p2 segment extend? | posterior and lateral. Flow will move toward transducer at the suboccipital window. Transtemporal the flow is moving away (posterior)
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| The profunda artery courses: | posterior and lateral to the femoral artery
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| The GSV attaches to what part of the CFV | medial aspect of the CFV
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| What small pair of veins with accompany artery lies DEEP within the calf muscle AND connect to the popliteal vein. | Sural veins/Gastrocnemius veins
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| What will be evaluated using temporal window and anterior probe angulation at 56 mm depth | ACA
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| What is the proper technique for evaluating the ACA through the temporal window | anterior probe angulation set at 65 mm depth
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| What branches meet and connect to allow collateral flow fro the anterior circulation to the posterior circulation, or obstruction in the verterbral system or ICA on same side? | Branches of the occipital artery (eca) connect to the vertebral artery (ica).
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| Sonographic landmark used to identify the distal end of the common iliac artery | the bifurcation into the external and internal iliac arteries
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| Which lower extremity vein does not contain valves? | IVC, Iliac and Soleal sinuses.
The IVC may still show the Eustachian valve, but it does not function in adults.
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| What is the pulsatility index of the extremities? | >5.0 is normal
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| what is the pulsatility index in most organs? | <1.5 is normal in organs.
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| The pulsatility index in normal aorta should be? | lower then the PI in the normal popliteal artery, because the flow is lower resistance. Aorta <1.5 since it feeds organs, Popliteal, >5.0 as it feeds extremities (high resistance)
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| brachiocephalic vein is formed at what junction? | internal jugular and subclavian veins.
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| what does the right and left brachiocephalic vein form? | superior vena cava.
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| What side of the body has a brachiocephalic artery? | Right. There is no artery on the left side.
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| During a arterial duplex if the patient is cold, how does this effect the waveforms? | vasoconstriction occurs, this leads to increased resistance and pulsatility of flow.
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| Which veins do NOT normally demonstrate spontaneous flow? | calf veins and superficial veins lack spontaneity.
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| What can you do to significantly decrease or stop flow toward the heart in the deep veins? | valsalva maneuver.
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| Where does the internal mammary artery originate from? | subclavian artery
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| The superficial venous system of the arm is the primary what? | drainage system of the extremity.
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| The deep venous system of the legs is the primary what? | drainage system of the lower extremity.
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| Normal hepatic venous flow demonstrates ? | two large antegrade diastolic and systolic waves followed by a small retrograde compondent that cooresponds with atrial contractions.
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| the tiny network of vessels that supply/drain blood to/from the vessel wall? | vasa vasorum
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| The produnda artery course ________________ to the superfical femoral artery? | posterior and lateral to the superficial femoral artery.
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| the innominate veins lie ________________ to the innominate artery | anterior and lateral.
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| 2D transverse view of lower extremities is used for evaluating? | compressibilty
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| What system adjustment would increase the size of the spectral window? | decreasing/reducing sample size.
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| Which two vessels are palpated to assess the pulse when peripheral arterial disease is suspected? | PTA and DPA
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| The most common congenital anomaly of the circle of willis is? | the absences of one or more communicating arteries.
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| The peroneal artery terminates at what artery? | External calcaneal artery
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| What is the preferred patient position for performing an upper extremity arterial duplex exam? | arm abducted 45 degrees and externally rotated.
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| Are repeat ABI measurements taken after injection of papaverine? | No
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| Which veins receive blood from the superficial and deep venous system? | subclavian vein receives from cephalic and axillary
popliteal receives lesser saphenous and deep calf.
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| Poiseuilles Law | pressure gradient in a vessel is equal to the flow volume multiplied by the resistance.
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| Bernoullis equation | flow velocity determines the pressure gradient at a specific location within the circulatory system.
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| The normal MCA will demonstrate flow in which direction when viewed from the transtemporal window? | Towards the probe.
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| Which venous valves are closed in the lower extremity during calf muscle relaxation? | proximal thigh veins. Proximal valves close due to hydrostatic pressure forcing blood back down the veins.
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| Analog Doppler | Graphical recording of pulsatile doppler in a non spectral or strip chart recording
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| What type of doppler does not display a range of frequency shifts, but displays average shift as single line? | analog doppler
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| Normal Analog doppler waveform | triphasic, rapid upslope, sharp peak, rapid downslope, small peak below baseline(diastolic flow reversal) followed by a small peak above baseline.
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| A change in analog waveform to biphasic or monophasic flow between segments indicates? | disease between the two sites of evaluation
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| Segmental pressure exam of lower extremity | 8-10 mhz cw doppler probe., angled at 45 degrees with skin.
Blood pressure cuffs placed at different levels (3 or 4 cuff method)
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| Normal pressures found in segmental pressure exam: 4 cuff method | High thigh pressure > brachial pressure by 30-40 mmHg
(30-40=4= 4 cuff method)
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| Normal pressures found in segmental pressue exam: 3 cuff method | thigh pressure very similar to brachial pressure.
most accurate way to obtain thigh pressure
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| What disease should be suspected if both thigh pressures are below the highest brachial pressure? | aorto-iliac diease
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| What type of mass can cause a decrease in one or both thigh pressures? | Pelvic mass
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| What is abnormal pressure difference between two adjacent levels in the same leg? | >30 mmHg
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| What is abnormal pressure difference betwenn the same level on each leg? | >20 mmHg
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| Rest pain is seen in patients with what ankle pressure? | <50 mmHg
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| How does ABI detect disease progression on serial exams? | > 0.15 reduction on ABI from each exam to the next.
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| PVR - Pulse Volume Recording | AKA arterial plethysmography or volume plethysmography
measures volume changes from ALL vessels under the cuff
Not normally used on its own for disease diagnosis, usually performed with segmental pressure exam
Commonly used for Digital or penile flow
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| What test can differentiates between TRUE Claudication/vascular disease and nonvascular causes? | PVR
Plethysmography
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| Photoplethysmograpy (PPG) | infrared light released into tissues, red blood cells reflect the light to photocells where it is measured.
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| Intravascular ultrasound | 10-30 mHz transducer, allows 360 degree imaging of the atery lumen. Only 2D, no doppler capabilties. Used to locate most narrow segment that would benefit from stent.
Used during and after angiography to eval stent placement.
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| Corpus Cavernosa (cc) | two main erectile structures of penis, sinusoids fill with blood during erection.
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| Corpus spongiosum | urethra and urethral arteries travel through this portion.
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| What supplies the penis with blood? | internal iliac art supplies through the internal pudendal artery
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| What does the pudendal artery branch into? | penile artery
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| Penile artery branches into | dorsal artery and cavernosal artery
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| Dorsal artery | Corse along dorsal side of penis, lateral to midline vein. Supplies blood to the glans penis and corpus spongiosum
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| Cavernosal artery | Courses through the corpus cavernosum, supplies blood to cavernosal sinusoids via the helicine arteries
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| What veins provide the primary venous outflow routes in the penis | superficial dorsal vein and deep dorsal vein
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| Erection is produced by? | resistance must decrease in the penile arteries. the cavernosal arteries flow increased, venous outflow decreases. Sinusoids fill with blood.
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| What are two things that limits the ability to have an erection? | aortoiliac disease can cause flood disturbance to iliac,
stenosis can inhibit the increase in flow and limit the ability
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| Priapism | Painful, prolonged erection that occurs without sexual stimuli. Can last longer then 4 hours. Can be caused by venocclusive disease in pelvic vein or AV fistula in pelvic region.
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| Protocol for penile doppler | supine, 7-10 mhz transducer.
obtain CFA and tibial artery waveforms, bilateral ABIs.
2.5 cm cuff is used for pressures.
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| Penile brachial index | >0.75 NL
0.65 - 0.75 marginal reduction
<0.62 ABNL
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| Penile blood pressure | obtained flaccid penis, compared to the systolic BP.
<60 mmHg indicated impotence due to inflow disease.
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| Penile doppler Evaluation steps | image pre and post injection; cavernous and dorsal veins doppler.
measure diameter of cavernous artery and doppler.
injection - proximal lateral shaft of penis. PSV/EDV repeated after 1-2 minutes after injection. Dorsal vein doppler to assess velocity.
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| Arterial disease in penile doppler is reported when? | >15 cm/s difference in PSV between right and left cavernosal arteries.
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| peyronie diease | scar tissue and fibrous plaque formation that usually involves the tunica albugeinea,
causes restriction and curvature when erected. painful.
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| arteriography | invasive procedure that uses contrast to demonstrate vessel patency during fluro techniques. Not used much anymore due to improved 3D on CT and MRI
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| most common entry point for catheter insertion during arteriography | CFA. Axillary and brachial can also be used.
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| seldinger technique | puncture of an artery and insertion of a small cath. (LE= SFA)
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|
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| Gold standard for stenosis/occlusion. collateral eval | arteriography,
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|
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| Gold standard for graft evaluation | Doppler
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|
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| Arteriography complications | pseudoaneurysm, hematoma, nerve damage, AV fistula
A sandbag is placed over the site of puncture to prevent formation of pseudoaneurysm
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| CTA (CAT Angiography) | uses contrast.
provides very accurate info on AAA size and location
Very helpful in diagnosis of arterial dissection.
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|
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| MRA | magnetic resonance angiography
phased contract can be used - for patients with contrast allergy or renal failure.
most commonly used to evaluate arteries in calf or foot.
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| CIV | common iliac vein
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| EIV | external iliac vein
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| Per | peroneal vein
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| AASV | anterior accessory greater saphenous vein
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| Giacominis vein AKA | intersaphenous vein
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|
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| posterior arch vein or leonardo veins AKA | posterior accessory GSV
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|
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| Hunterian perforator AKA | mid thigh perforator
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|
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| dodds perforatior AKA | distal thigh perforator
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|
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| Cocketts Perforatior AKA | posterior tibal perforators
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|
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| Boyds perforator AKA | Paratibial perforatiors
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|
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| Mays Perforators AKA | ankle perforators.
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| Confluence of Iliac VEINS | IVC
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|
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| Central veins | IVC, Hepatic, SVC, portal vein confluence of SMV and Splenic
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|
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| DEEP Veins | Originate at the confluence of deep digital veins.
Deep Digital - metatarsal - deep venous arches - PTV and Peroneals - Tibioperoneal trunk - ATV - Pop - femoral - CFV - EIV
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| Metatarsal veins drain the blood from | the foot and merge into deep venous arches
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| What veins do the deep venous arches empty into | the empty into tibial veins
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| Which two deep veins are referred to Venae Comitantes | Calf and Forearm veins
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|
||||
| ATV | drain from anterior calf
2 veins originate at the plantar arches
course cephalad anteror lateral to the tibial bone
travels between tibal head and fibular to join PopV
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| PTV | Drain blood from post calf.
2 veins originate at teh confluence of the plantar arches
medial malleolus and anterior to achilles tendon
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| PER | drain from lateral calf
in the lower calf/ankle 2 veins course lateral to the PTV and medial to fibular
merge with PTV to form tibo=peroneal trunk.
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| POP Vein | tibio merges wtih the two ATV forms pop.
posterior to the artery.
becomes femoral at adductor hiatus in distal thigh
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| FV | extendsf rom adductor hiatus to join profunda at groin
courses posterior to the FA
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|
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| PFV | deep femoral. drains the muslce in the thigh (quad)
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|
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| CFV | formed by the juncyion of the FV and PFV below inguinal ligament.becomes EIV at groin crease
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|
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| IIV | courses medial to EIV
Drains pelvic organs
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|
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| EIV | extremal courses lateral to the IIV joins the IV to form CIV
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|
||||
| CIV | anterior to artery, r/l merge to form IVC at level L5 IVC empties into R Atrium
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|
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| kippel trenaunay weber | congenital absence of deep veins
numerous superficial varicosities and clusters of varicosities.
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|
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