Arterial Duplex Following Intervention

Question 1

2 stenosis/occlusion treatment options

Answer 1

bypass graft
angioplasty with or without stent

Question 2

bypass graft

named for the type of graft and ___

Answer 2

location

aorto-bifemoral
femoral-popliteal
femoral-tibial

Question 3

anatomic bypass graft follows ___

Answer 3

the course or normal anatomy

Question 4

extra-anatomic bypass graft is placed where ___

example:

Answer 4

a vessel does not typically run

example: femoral-femoral cross-over bypass graft

Question 5

femoral-femoral cross-over bypass graft routes blood from ___

Answer 5

one CFA to the contra-lateral leg CFA to treat iliac artery occlusion

Question 6

2 types of synthetic bypass grafts

Answer 6

polytetrafluorethylene (PTFE)
Dacron

Question 7

autogenous vein uses ___

Answer 7

the patient’s own vein or artery as a conduit

examples:
in-situ saphenous vein graft
reversed saphenous vein graft

Question 8

in-situ saphenous vein graft

1. vein remains in ___
2. proximal and distal ends are ___ and ___ into artery
3. large end remains ___, small end remains ___
4. ____ are destroyed
5. ___ are ligated, if not ligated well, AVF happens

Answer 8

1. vein remains in normal anatomic position
2. proximal and distal ends are ligated and sutured into artery
3. large end remains proximal, small end remains distal
4. vein valves are destroyed
5. tributaries are ligated

Question 9

reversed saphenous vein graft

1. ___ is removed
2. ___ are ligated
3. ___ sutured into artery
4. large end is ___
5. vein valves stay open due to ___

Answer 9

1. vein is removed
2. tributaries are ligated
3. ends sutured into artery
4. large end is prox
5. vein valves stay open due to arterial pressure

Question 10

5 areas to examine of bypass graft

Answer 10

inflow artery
proximal anastomosis
body of graft
distal anastomosis
outflow artery

Question 11

4 things to evaluate of arterial duplex following intervention

Answer 11

open lumen
expanded stent
stent wall apposition
presence of stenosis

Question 12

bypass graft interpretations - velocity

1. overall low graft velocity ___
2. decrease of ___ in any graft segment
3. reduction of PSV ___ compared to previous

Answer 12

1. overall low graft velocity < 45cm/sec
2. decrease of >30cm/sec in any graft segment
3. reduction of PSV 30-45cm/sec compared to previous

Question 13

bypass graft interpretations

1. changes in waveform ___ along the length of graft
2. retained ___, presence of ___
3. dilatation or aneurysm particularly at ____
4. ___ occlusion

Answer 13

1. changes in waveform phasicity along the length of graft
2. retained valves, presence of tributaries/AV fistula
3. dilatation or aneurysm particularly at anastomotic sites
4. graft occlusion

Question 14

most common sites of stenosis

vein grafts -
synthetic grafts -

Answer 14

vein grafts - retained valves
synthetic grafts - anastomoses

Question 15

what is an angioplasty?

Answer 15

balloon catheter that is passed into an artery and positioned within the stenosis to be inflated and open lumen

Question 16

angioplasty

often, a ___ is expanded in the area of stenosis as a scaffold to hold the artery lumen open

Answer 16

metal wire mesh stent

Question 17

aneurysm treatment

1. aneurysmal segment is replaced with a ___
2. native arterial walls are typically ___, covering the graft

Answer 17

1. aneurysmal segments is replaced with a synthetic bypass graft
2. native arterial walls are typically closed, covering the graft

Question 18

what is endovascular aneurysm repair (EVAR)?

Answer 18

catheter is used to position a graft inside of the aneurysm, expanded and then hooked into place with stents

Question 19

EVAR is developed for (3) repairs

Answer 19

thoracic
AAA
peripheral aneurysm

Question 20

EVAR

aneurysm is not removed, but simply ___

Answer 20

excluded from the main artery

Question 21

____ and ____ require surveillance for life due to potential of developing leaks late

Answer 21

EVAR and AAA

Question 22

EVAR evaluation consists of (7)

Answer 22

1. patency
2. stenosis
3. stent dislodgement/migration
4. graft limb compression
5. twisting
6. endoleak
7. measurement of aneurysm sac

Question 23

what is an endoleak?

Answer 23

persistent flow outside the graft and within the aneurysmal sac

Question 24

type I endoleak

Answer 24

leak from attachment site

1a - proximal
1b - distal

Question 25

type II endoleak

Answer 25

patent branch with retrograde flow into the aneurysm (lumbar or IMA)

Question 26

type III endoleak

Answer 26

graft defect

Question 27

type IV endoleak

Answer 27

graft porosity - flow through the wall of the material

Question 28

type V endoleak

Answer 28

endotension - enlarging aneurysmal sac with no detectable leak

Question 29

what is intravascular ultrasound (IVUS)?

Answer 29

tiny ultrasound transducer at the tip of a catheter provides an image from inside-out

Question 30

IVUS is used for (5)

Answer 30

1. evaluate plaque formation 2. post-procedure 3. determine the correct placement of a stent 4. identify aortic dissection 5. venous applications