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VASCULAR SURGERY > Vascular Lab > Flashcards

Vascular Lab Flashcards

1
Q

What are SVS guidelines for US measurement of the aorta?

A

Outerwall to outerwall

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2
Q

What does loss of respiratory variation and continuous flow in the common femoral veins indicate?

A

high grade IVC stenosis or caval occlusion

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3
Q

What is the maneuver for evaluation of popliteal artery entrapment?

A

Duplex of pedal vessels with with active plantar flexion

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4
Q

What does the SVS recommend for ultrasound measurement of the abdominal aorta?

A

Outer wall to outer wall

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5
Q

What is the axial resolution at the level of the aorta on ultrasound?

A

1-2mm

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6
Q

What are the risk factors for pseudoaneurysm development?

A

Female, obesity, calcified vessels, large sheaths, anticoagulation, and therapeutic rather than diagnostic

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7
Q

Where does do carotid body originate from and what do they do?

A

originate from neuro crest cells and monitor O2, pH, and Co2

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8
Q

What is the shamblin classification for carotid body tumors?

A

Class 1- small, can be dissection from adventitial plane
Class 2-partially surround the carotid artery
Classe 3-encircles the bifurcation

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9
Q

What nerves can carotid body tumors involve?

A

hypoglossal, glossopharyngeal, recurrent laryngeal, spinal accessory, or sympathetic chain

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10
Q

What are the findings in pseudoaneurysm?

A

ecchymosis, hematoma, pulsatile and painful mass, bruit, weakness or paresthesia secondary to nerve compression

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11
Q

What are the treatment options for pseudoaneurysms?

A

open repair, thrombin injection, ultrasound guided compression, stent placement, or coil embolization

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12
Q

What pseudoaneurysm factors make it more likely to be treated by thrombin injection?

A

small to medium size pseudoaneurysm with long narrow necks

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13
Q

What is the doppler shift equation?

A

Change in frequency = (2 x frequency x velocity of RBCs x cosine angle)/propagation speed of ultrasound in tissue

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14
Q

What duplex renal findings indicated >60% stenosis?

A

PSV 200 cm/sec or higher and ratio of 3.5 or greater. Aortic velocity has to be at least 50 cm/sec and in a non aneurysmal aorta

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15
Q

The penetration of intravascular ultrasound is…

A

Inversely proportional to ultrasound frequency. So the lower the frequency the deeper the penetration

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16
Q

Where are the blood pressure cuffs placed with 4 cuff segmental pressures?

A

Cuff at the ankle, proximal leg, above the knee thigh, and high thigh

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17
Q

What is the advantage of the four cuff technique?

A

evaluation SFA stenosis

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18
Q

How do you start the measurements with segmental pressures?

A

Start from distal to proximal

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19
Q

What is the provocative maneuver for evaluating TOS

A

arm abduction at 170 degrees with complete loss of arterial flow

20
Q

Is cystic adventitial disease more prevalent in men or women?

A

5:1 in men

21
Q

What sign do you see with cystic adventitial disease that is eccentric vs concentric?

A

scimitar sign for eccentric and hour glass sign with concentric

22
Q

What are the criteria for iliac artery restenosis?

A

Velocity > 200 cm/sec, PSV ratio of >2, monophasic CFA waveform, decreased in ABI >0.15 and recurrence of claudication symptoms

23
Q

What studies have comparable accuracy of detecting

>60% renal artery stenosis?

A

CTA and duplex

24
Q

What renal artery duplex findings would make one consider intervention for renal artery stenosis?

A

RRI

25
Q

How is the renal resistive index measured?

A

(PSV-EDV) / PSV of interlobular vessels of kidney

26
Q

What arteries are studied on the transtemporal window?

A

The middle, anterior, and posterior cerebral arteries and the intracranial ICA

27
Q

At what depth is the middle cerebral artery visualized on transtemporal doppler and which way is the flow going?

A

30-60mm and antegrade

28
Q

At what depth is the terminal internal carotid artery visualized on transtemporal doppler and which way is the flow going?

A

55-65 mm and bidirectional flow

29
Q

At what depth is the anterior cerebral artery visualized on transtemporal doppler and which way is the flow going?

A

60-80mm and retrograde

30
Q

At what depth is the posterior cerebral artery visualized on transtemporal doppler and which way is the flow going?

A

60-70 mm and antegrade

31
Q

What is normal velocity in the intracranial vessels?

A

60 cm/sec

32
Q

Treadmill testing is more positive in what kind of patients?

A

Those with aortoiliac disease

33
Q

Why is treadmill testing ineffective in infrapopliteal disease?

A

Because the sural branches to the gastroc come off at or above this level.

34
Q

What does retrograde vertebral artery flow suggest?

A

innomminate or subclavian artery stenosis

35
Q

What does flow reversal in diastole in the vertebral artery after exercise suggests what?

A

Subclavian steal syndrome

36
Q

What are low resistance circulations in the body that would have persistence of flow throughout diastole?

A

The brain, kidneys, spleen, liver

37
Q

What kind of waveform would a ICA dissection have?

A

to and fro

38
Q

What kind of flow would the SMA have after a meal

A

High resistant flow with flow throughout diastole

39
Q

What is the Nyquist limit?

A

The upper limit of the doppler shift frequency that can be accurately detected. Defined as PRF/2

40
Q

How to prevent aliasing on spectral waveform?

A

increase pulse repetition frequency

41
Q

Why should doppler angles greater than 60 degrees be avoided?

A

The cosine function changes more rapidly at larger angles

42
Q

What is the formula for blood flow velocity?

A

V= (Doppler shift x propagation speed of utlrasound)/(2x Fxcostheta)

43
Q

What is a mirror-image artifact?

A

Image findings of a struct that exists on one side of a strong reflector as also being present on the other side of the reflector due to reverberation

44
Q

Where do you typically have mirror-image artifact?

A

Common around pleura and the diaphragm because of air-filled lungs

45
Q

What happens with refraction artifact?

A

Ultrasound passing through tissues with different propagation speeds and causes a structure to be improperly positioned laterally in an ultrasound image.

46
Q

What is the recommended surveillance interval for AAA of 3-3.9cm, 4-4.4 cm, and 4.5-5.4 cm for a

A

3 years, 2 years, and 1 year respectively

VASCULAR SURGERY (8 decks)

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