US Guided Procedures Flashcards
(41 cards)
You are evaluating a patient that had a balloon angioplasty on the proximal superficial femoral artery 3 years ago. The acceleration time in the common femoral artery is 230ms. This finding is most suggestive of:
A. recurrence of stenosis in the proximal superficial artery
B. normal arterial flow
C. obstruction in the distal superficial femoral artery
D. iliac artery stenosis
D
Increased acceleration time indicates a proximal stenosis. There is probably an iliac artery stenosis and the arteries proximal to the CFA should be evaluated.
Which of the following is true regarding the initial post-op examination of a transjugular intrahepatic portosystemic shunt placement?
A. marked ascites is a common finding for the initial post-op exam on a TIPS patient
B. CTA is most commonly performed for the initial evaluation of the TIPS procedure
C. it should be performed within 30 days following the procedure
D. it helps to establish baseline velocities for upcoming follow up exams
D
When performing serial evaluations of a TIPS, it is important to establish a baseline for the patient very soon after the shunt placement. The initial evaluation should be performed with Doppler ultrasound within 24 hrs of shunt placement.
Which of the following procedures allows patients to continue their normal course of anticoagulant therapy before and after the procedure? A. ascending venography B. carotid endarterectomy C. compression therapy of pseudoaneurysm D. percutaneous transluminal angioplasty
A
Venography is performed using a venous puncture. Surgical procedures and invasive procedures that require an arterial puncture have an increased risk of hemorrhage when the blood is thinned by anticoagulants. Patients having these procedures must discontinue their anticoagulant therapy before the procedure. Thinned blood will also inhibit the clot formation in a pseudoaneurysm.
Which of the following statements correctly describes an endovenous laser ablation of the GSV?
A. the procedure is much more easily performed if the patient already has DVT
B. the procedure is considered a success if thrombus fills the GSV from the ankle to the SFJ
C. the physician injects a halo of anesthesia medicine around the GSV
D. intravascular ultrasound is performed after the procedure to confirm success
C
Physician injects anesthesia around the vein being treated = tumescent anesthesia. A 1cm ring of anesthesia medicine should surround the vein for the appropriate level of patient comfort during the procedure. The catheter is inserted in the distal vein and advanced to the most proximal point that will be treated. The laser is turned on and the physician slowly retracts the catheter until it reaches the insertion point. A follow up ultrasound exam is performed in a week or two to evaluate the success of the procedure. The deep system should be evaluated for thrombus, the treated vein should be evaluated for diameter measurements and with color flow. The distance between the SFJ and most proximal point of closure of the GSV should be measured. If thrombus extends into the deep system, the GSV must me ligated. DVT is a contraindication for the procedure.
Which of the following is a contraindication of US guided compression therapy for a pseudoaneurysm at the groin?
A. a pseudoaneurysm that measures 3.2cm in diameter
B. a pseudoaneurysm that has been present for more than 72hrs
C. infection at the puncture site
D. patient that stopped taking Coumadin 3 days ago
C
Contraindications for US guided compression therapy for a pseudoaneurysm:
Patient unable to tolerate the procedure due to pain
Infection at the puncture site and surrounding tissues
Diameter >4cm
Stalk diameter > 5mm
Present for more than 1 month
Patients on anticoagulant therapy (must be stopped before compression).
Which of the following is a treatment for a pseudoaneurysm? A. thrombin injection B. compression stockings C. Coumadin D. IV Heparin
A
A Thrombin injection is used to treat pseudoaneurysms with large stalks. Ultrasound guidance is used to make the injection that promotes thrombosis of the stalk and body of the pseudoaneurysm. Coumadin is a blood thinner that would decrease the ability of clot formation in the pseudoaneurysm. IV Heparin is used to treat DVT.
A physician orders a vein mapping of the left upper extremity for potential arterial bypass harvesting but does not indicate when vessel he plans to use. Which vein should you evaluate because it is the most commonly used for bypass? A. antecubital vein B. radial vein C. brachial vein D. cephalic vein
D
The cephalic vein is most commonly harvested for use as a bypass.
Which of the following measurements should be obtained to evaluate the success of a percutaneous angioplasty performed on the left superficial femoral artery?
A. femoral artery diameters proximal to the treated area, the treated area and distal to the treated area
B. peak systolic velocity and velocity ratio
C. acceleration time and pulsatility index
D. more than one of the above
D
You are assisting with a mesenteric stent placement procedure for a patient with 75% SMA stenosis.
You are assisting with a mesenteric stent placement procedure for a patient with 75% SMA stenosis. The physician is using intraoperative US to intermittently monitor the flow in the SMA while performing angioplasty on the vessel. He asks you to watch the tracings and let him known when the flow improves. What are you watching for?
A. change from monophasic to peaked triphasic
B. increased resistance and decreased diastolic flow
C. decreased resistance and increased diastolic flow
D. change from peaked triphasic to monophasic
B
Normal pre-prandial flow in the SMA is high resistance with low levels of diastolic flow (monophasic). 75% SMA stenosis would cause a low resistance waveform with increased systolic and diastolic velocities. The resistance would increase in the mesenteric vascular beds as normal flow levels resume after angioplasty. Diastolic flow levels would reduce because the mesentery is now receiving enough blood during systole. Peak systolic and end diastolic velocities are reduced.
A patient presents for a follow up for the TIPS located between the right portal vein and right hepatic vein. The chart indicates an abnormal bruit and stenosis is suspected. Where should you look first for the stenosis because it is the most common site of stenosis in a TIPS? A. biliary anastomosis B. hepatic artery anastomosis C. portal vein anastomosis D. hepatic vein anastomosis
D
The hepatic vein anastomosis is the most common site of stenosis in a TIPS.
In most cases, a peripherally inserted central catheter (PICC) line is inserted in the basilic vein exam and advanced until the tip reaches: A. brachiocephalic vein B. proximal subclavian vein C. axillary vein D. atriocaval junction
D
The terminal tip of the venous catheter is positioned in a central vein, most commonly the distal 1/3 of the SVC (atriocaval junction). High blood flow volume in this location allows for infusates to be rapidly distributed.
What is an absolute contraindication for sclerotherapy?
A. vein location above the inguinal ligament
B. polycythemia vera
C. patient allergy to injectate
D. vein location immediately over a bony prominence
C
Absolute contraindications are situations which make a particular treatment or procedure absolutely inadvisable. The risk of complications cause by the patient allergy to the injected substance (sclerosant) far exceed the benefits of the procedure. The patient will be treated using other methods.
All of the following correctly describe proper behavior related to a sterile field, except:
A. when in doubt about sterility, discard the potentially contaminated item and begin again
B. sterile gloves must be used to open the procedure tray
C. sterile individuals must pass each other back to back when moving around the procedure room
D. hands and elbows must be kept above the level of the table
B
Steile packages can be opened with non-sterile gloves but if any items inside the tray will be touched, sterile gloves must be used. Sterile gloves must be used to remove items for the tray to prepare them (lidocaine, needle, syringe, biopsy instrument).
When preparing the sterile tray for an invasive procedure, the cover on the tray should be opened:
A. by pulling the far cover of the wrapper toward you
B. by the radiologist
C. while wearing sterile gloves
D. no more than 2 hours before the procedure begins
A
The Sonographer should prepare the supplies for an ultrasound guided procedure. The tray should not be opened until just before the procedure begins. The cover can be opened without wearing gloves but should be pulled toward you to expose the products facing away from you. This prevents your arm from hovering over the supplies to prevent any “debris from your person from falling into the tray. Sterile gloves must be used to remove items for the tray to prepare them (lidocaine, needle and syringe).
Which of the following is a contraindication for harvesting of the great saphenous vein?
A. chronic obstruction of the femoral vein
B. chronic obstruction of the peroneal veins
C. Baker’s cyst in the ipsilateral popliteal fossa
D. valvular incompetence in the great saphenous vein
A
IT IS VERY IMPORTANT to evaluate the venous outflow system of a patient prior to removal or closure of the saphenous vein. If the deep system is obstructed and the superficial system is the main outflow for the leg, the saphenous vein cannot be removed/closed.
Which of the following describes the sonographic appearance of a TIPS?
A. shunts are not easily evaluated Sonographically and CTA is the preferred method for evaluation
B. strongly reflective curved structure connecting the right portal vein and right hepatic vein
C. requires color Doppler evaluation for visualization of the graft within the liver
D. anaechoic tube, without distinctive wall reflection, that connects the right hepatic vein to the right portal vein
B
The shunt is constructed of metallic substances with increased reflectivity in order to allow for better sonographic visualization. The sonographic appearance of a TIPS is a strongly reflective curved structure connecting the right portal vein and right hepatic vein.
Which of the following is not an expected finding with an AV fistula caused by an interventional procedure?
A. direct connection between a single artery and vein
B. low resistance arterial inflow
C. dilated venous collaterals adjacent to the fistula
D. pulsatile venous outflow
C
An AVM is a congenital malformation with multiple connections between the arterioles and venules without a capillary bed in between. Venous collaterals will develop and dilate over time. An AVF is a direct connection of an artery or vein caused by trauma or interventional procedure. Due to the acute formation of the connection, there are no collaterals present. The arterial inflow and venous outflow will demonstrate the same hemodynamic characteristics in an AVM and AVF, increased arterial flow volume, low resistance arterial inflow and pulsatile, turbulent venous outflow.
Which of the following is NOT a part of the information required on an informed consent form for an interventional vascular procedure?
A. possible complications that the patient may experience
B. signature line to indicate patient consent
C. description of the procedure
D. percentage of patients that have experienced complications after the same procedure at the facility
D
The informed consent must include a description of the procedure and list the possible complications that the patient may experience. The patient must be of sound mind when giving consent by signature.
Which of the following is true regarding compression techniques used to treat a pseudoaneurysm of the femoral artery in the groin?
A. compression should be performed in 30 second intervals with color Doppler evaluation in between compressions
B. pressure equivalent to 100mmHg should be performed in three ten minute intervals and if this does not close the stalk, alternative treatment must be considered
C. blood pressure evaluation cannot be performed anywhere on the legs until the stalk to the pseudoaneurysm is closed
D. thrombin injection is more effective than compression techniques in pseudoaneurysms with large diameter stalks
D
Thrombin injection is more effective than compression techniques in pseudoaneurysms with large diameter stalks. Ankle pressure should be monitored during compression techniques to avoid changes in distal flow from extrinsic compression. Compression should be performed in 10 - one minute intervals with color Doppler evaluation in between compression.
Which of the following techniques cannot be used to monitor distal flow in the leg while compression therapy for a pseudoaneurysm is performed? A. Doppler evaluation of the PTA or DPA B. pressure monitor on the great toe C. PPG senor on the great toe D. PPG sensor on the ankle
D
When PPG is used to evaluate arterial flow, the sensors are placed on the great toes. When PPG is used to evaluate venous reflux, the sensor is placed on the lower calf near the ankle. It is contraindicated to obtain an ankle pressure in a patient with an acute pseudoaneurysm. A toe monitor can be used because the inflation of the cuff has little to no effect on pressure in the femoral artery.
Which of the following is an advantage of intraoperative vascular ultrasound compared to intraoperative angiography?
A. provides real time flow evaluation
B. can be performed during the surgical procedure
C. technique does not require vessel puncture to obtain flow information
D. can assess flow in all branches of the intracerebral vessels
C
Angiography is an invasive procedure that requires a vessel puncture to administer contrast. Intraoperative IS is performed by placing the transducer on the artery, no punture required to obtain flow information. Both ultrasound and angiography can provide real time blood flow information because the contrast flow is evaluated live with fluoroscopy on angiography. Ultrasound does not evaluate all branches of the intracerebral vessels while angiography can visualize all patent branches in the FOV. Both techniques can be performed during the surgery.
Which of the following statements is false regarding intraoperative duplex evaluation during a carotid endarterectomy?
A. the technique is used to assess the immediate flow changes within the vessel undergoing the endarterectomy
B. the probe is placed in direct contact on the vessel that is being evaluated so the sterile technique is required
C. due to the increased attenuation of sound caused by air in the extracranial vessels, the lowest probe frequency available is preferred for the exam
D. the highest probe frequency available is preferred for intraoperative duplex evaluation
C
The technique is used to assess the immediate flow changes within the vessel undergoing the endarterectomy. The highest probe frequency available is preferred for intraoperative duplex evaluation. The probe is placed in direct contact on the vessel that is being evaluated so the sterile technique is required. The vessel should not contain air because it would become a cerebral embolism.
Which of the following requires the use of sterile technique? A. vein mapping B. laser ablation for telangiectasia C. sclerotherapy D. radiofrequency venous ablation
D
Radiofrequency ablation requires the sterile technique because the procedure requires the puncture of the saphenous vein to insert a catheter into the length of the vein. The other choices do not require the sterile technique. Telangiectasia refers to dilated very small superficial veins that are treated with external application of laser treatment. Sclerotherapy refer to the injection of a solution into spider veins to cause them to atrophy and requires aseptic technique. Vein mapping is performed with ultrasound.
Which of the following is a contraindication for endovenous laser ablation of the great saphenous vein?
A. valvular incompetence in the great saphenous vein
B. Baker’s cyst in the ipsilateral popliteal fossa
C. chronic obstruction of the peroneal veins
D. chronic obstruction of the femoral vein
D
