Duplex/CDI UE

Question 1

capabilities

Answer 1

localize stenosis / occlusion
localize aneurysm
post-op f/u - BPG , AVF, STENT

Question 2

limitations (1)

limitations specific to AVF (2)

Answer 2

1. cast/ IVsite
2. graft angulation
3. increased collateral formation causes difficulty evaluating the outflow vein

Question 3

Pt. position

Answer 3

supine

pledge position, arm rotated out 45 degrees

Question 4

Physical principles:

what is ideal sample size for Doppler analysis

Answer 4

1-1.5 mm

Question 5

Physical principles:

with CDI frequency of signal is assigned a ____ or _____ of color

Answer 5

hue or shade of color

Question 6

Physical principles:

what frequency probe is used

Answer 6

5-7 MHz linear array

Question 7

it is uncommon for UE arteries to become ____. Most common artery in UE eval to have this disease process is

Answer 7

stenosed

subclavian artery

Question 8

most common indication for UE exam

Answer 8

evaluation of dialysis access grafts

Question 9

dyalysis is accomplished by

Answer 9

communication of artery and vein,

creating high blood volume situation

Question 10

a thrill is

Answer 10

vibration

it is palpated

Question 11

a bruit is

Answer 11

noise

it is auscultated

Question 12

what hemodialysis access condition commonly causes a thrill

Answer 12

stenosis

Question 13

steps for eval of dialysis access graft :

7

Answer 13

inflow artery

arterial anastomosis

body of graft

observe aneurysm, puncture sites, peri-

graft fluid

use color to observe flow changes/ turbulence

venous anastomosis

outflow vein

Question 14

Brescia-Cimino is connection of what typically

assessment sites include

Answer 14

cephalic vein and radial artery

inflow artery
anastomosis
outflow vein
radial artery Doppler

Question 15

Autogenous Fistula is

Answer 15

any artery attached to any adjacent vein that includes native vessels
eg- Brescia Cimino

Question 16

identify two types of synthetic dialysis grafts

Answer 16

loop graft _ loop connection between artery and vein

straight graft - runs through arm connects artery and vein

Question 17

Thrill is usually a sign of stenosis, but in dialysis graft it is a ____ finding

Answer 17

normal

because of the high volume of blood flowing through the anastamosis

Question 18

what are you r/o in dialysis access

annnnnd how do you accomplish that

Answer 18

steal syndrome
plaque
stenosis
patient anastamosis, inflow and outflow veins

run Doppler through

Question 19

normal AVF

Answer 19

normal PSV varries, waveform us usually multiphasic

Question 20

parameters for > 50% stenosis

Answer 20

stenosis PSV : Prox vessel PSV

2:1 ratio

flow acceleration post stenosis turbulance

Question 21

complete occlusion is proved by

Answer 21

no detection of CDI or Doppler
B-mode shows narrowing

“thump” prox to occlusion

dampened WF distal to occlusion when collateral flow is present

Question 22

Aneurysm is proved by

Answer 22

dilation of the vessel >1.5 x size of adjacent segment

Question 23

what is the most common aneurysm site

Answer 23

subclavian artery

usually associated with distal embolization of the digits

Question 24

ulnar artery aneurysm is called

Answer 24

Hypothenar Hammer Syndrome

occupational injury repetitive use
eg jack hammer
causes aneurysm or thrombosis of ulnar artery (usually at palmar arch)

Question 25

interpretation of Hemodialysis Access

normal waveform

Answer 25

disturbed , low resistance , high velocity flow

eg PSV > 150 cm/sec

comparison to previous studies is key

PHASE NOT USED TO DESCRIBE DIALYSIS AVF -either high resistant or low resistance

Question 26

interpretation of Hemodialysis Access

most common site for stenosis is

Answer 26

outflow vein

due to hyperplasia or elevated arterial pressure

Question 27

interpretation of Hemodialysis Access

low PSV in access graft can indicate ______ problems

Answer 27

inflow

will look like dampened waveform will indicate problem in the inflow artery

Question 28

other hemodynamic complications of AVF

2

Answer 28

CHF

steal syndrome

Question 29

how can AVF cause CHF

Answer 29

large blood vol in venous circulation can increase venous return
= CHF

Question 30

what is steal syndrome

Answer 30

distal arterial blood flow is reversed (shunted) into venous flow

creates pallor and coolness of the skin distal to the shunt and eventually ischemia

Question 31

explain procedure for eval of steal syndrome

Answer 31

with dialysis access open and functioning use PPG to eval flow to at least 2 digits one at a time

manually compress dialysis access and retake digit PPG tracings or Pa

Question 32

if flow improves after compressing the AVF than it is positive or negative for steal syndrome

Answer 32

positive

There will be retrograde flow in outflow arterial vessel below venous anastamosis

if flow stays the same during compression than another cause of ischemia should be investigated