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Vessels Flashcards

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1
Q

Ao enters the abdominal cavity in a ____ location and progressively becomes more ______ as it travels caudally.

A

posterior

anterior

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2
Q

The IVC mainatins a ______ course throughout the retroperitoneum.

A

horizontal

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3
Q

First major branch of Ao

A

celiac axis

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4
Q

The celiac axis is __-___cm long, located superior to the ____ and branches into what 3 arteris?

A 
2-3cm
sup to panc
CHA (common hepatic artery)
LT gastric artery
Splenic Artery
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5
Q

Describe the termintaion of the celiac axis

A

terminates with the bifurcation of the CHA and SA, which is seen as the “seagull” or “dove sign”

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6
Q

What is the largest branch of the celiac axis?

A

SA

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7
Q

The left gastric artery is usually not visible but can be seen extending ____ from the celiac axis.

A

cranially

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8
Q

As the CHA course towards the _____ it dives into what two arteries?

A

LIV

bifurcates into the PHA (proper hepatic artery) and the GDA (gastroduodenal artery)

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9
Q

The SMA branches off the Ao ____cm inferior to the ____ ____. It ______ the Ao and is seen ____/_____ to the body of the pancreas.

A

1cm
celiac axis
parallels
post/inf to body of panc

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10
Q

SMA Doppler waveform in a fasting state?

A

high resistance, low diastolic

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11
Q

SMA Doppler waveform in a postprandial state?

A

low resistance, increased velocity

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12
Q

Renal arteriesarise from where?

A

from the lateral walls of Ao, just below the origin of teh SMA

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13
Q

Which renal artery is longer?

A

right

left is shorter as the Ao lies to the left of ML

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14
Q

Course of the right renal artery?

A

passes posterior to the IVC

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15
Q

The right and left gonadal arteries arise ____from the ___ Ao and are rarely imaged.

A

directly

distal Ao - LT is slightly superior

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16
Q

The inferior mesenteric artery arises from the ___ aspect of the ____ Ao. It is typically small although easy to image

A

anterior

distal

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17
Q

In the presence of SMA and CA stenosis/occlusion, what will happen to the IMA?

A

becomes enlarged

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18
Q

IVC lies to the _____ of the Ao and posterior to the _____ and _____ _____.

A

right

liver and panc head

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19
Q

Why might the IVC dilate?

A

cardiac failure

fluid overload

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20
Q

Most common tumor to involve the IVC?

A

RCC

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21
Q

Reasons for IVC displacement (6)

A 
liver mass
RT renal artery aneurysm
lymphadenopathy
tortuous Ao
Right renal mass
Right adrenal mass
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22
Q

Retrocaval lymphadenopathy will displace the IVC _____ in a ______ formation.

A

anteriorly

arcing

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23
Q

Purpose of the Greenfield filter

A

to prevent the ascent of lower extremity vein thrombosis

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24
Q

What is the proper location for an IVC filter?

A

inferior to the renal veins

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25
Hepatics veins
RT, middle, left | -drain into the iVC
26
What is shorter, the left renal vein or right renal vein?
- right RV, drains directly into the iVC | - left RV is longer, passes b/w SMA and Ao as it travels from LT Kid to the iVC
27
Nutcracker syndrome
engoregment of the left RV due to its compression by the SMA and Ao
28
retroaortic left renal vein
anatominal variant, left RV located between the Ao and the vertebra, drains into the IVC
29
What does the right gonadal vein drain into?
IVC
30
What does the left gonadal vein drain into?
left renal vein
31
A right liver mass will displace the IVC ________
posteriorly
32
A right renal artery aneurysm will displace the IVC ______
anteriorly
33
A tortuous Ao will displace the IVC _______
right
34
A right adrenal mass will displace the IVC _____/_______
medial/anterior
35
A right renal mass will displace the IVC ______/______.
medial/left
36
Although lyphandenopathy typically surrounds longitudinal vessels in the abdomen, it commonly displaces the IVC and SMA _______
anteriorly
37
A left adrenal mass will displace the splenic vein _______
anterior
38
A hematoma in the pouch of Douglass will displace the bladder _______
anterior
39
With a gastric outlet obstruction and dilatation of the stomach, the pancreatic tail will be displaced ________
posteriorly
40
A mass in the uncinate process will displace the SMV _________
anteriorly
41
A neuroblastoma will displace the ipsilateral kidney ______
inferiorly
42
A mass in the left lobe of the liver will displace the GE junction __________
posteriorly
43
Three general types of aneurysms
true false/pseudo dissecting
44
Specific types of aneurysms (5)
``` berry mycotic athersclerotic fusiform saccular ```
45
Berry A
small saccular A | commonly located in the cerebrum
46
Mycotic A
infected aneurysm
47
Athersclerotic A
results from weakening of the media in severe althersclerosis
48
Fusiform A
spindle-shaped dilatation, the stretching process affects the entire circumference of the artery
49
Saccular A
localized spherical outpouching of the vessel wall
50
Arterial layers
adeventita media intima
51
Which layers of the artery are involved in a true aneurysm?
all three
52
MC cause of AAA (true A)?
arteriosclerotic disease
53
AAA are typically what kind of A?
fusiform, rarely saccular
54
How are A measured?
A/P and TRV from outer wall to outer wall
55
Aortic A have a ______ association.
genetic
56
Where are most Aortic A?
``` distal Ao (infrarenal) -prox Ao is infrequently involved ```
57
Aneurysms by definition are a _____ dilatation with at least ____% increase over normal aortic diameter
focal | 50%
58
What other aneurysms are associated with aortic A?
iliac and popliteal artery aneurysms
59
What do false/pseudo A reults from?
injury to the vessel wall and then extravasated blood is walled off by the surrouding tissues
60
Can false/pseudo A mimic true aortic A?
Yes | It is important to deterime the true aortic wall
61
The term "pseudoaneurysm" is typically used when dealing with ________ arteries. They are commonly associated with _______ _______ or ______ ______.
peripheral arteries angiographic punctures surgical anastomoses
62
Correction of a pseudoaneurysm may be accomplsihed by
surgical repair compression repair thrombin injection
63
Sonographically, psedo A are seen as a vascular compartment connected to the native artery. What kind of waveform is see and where should you place your caliper?
caliper should be placed at the stalk | biphasic/bidirectional
64
Where do dissecting A usally originate?
at the aortic arch in the thorax
65
What is a dissection?
separation of the intima from the media of the Aortic wall, floating intima
66
Where can an Ao dissection extend into?
carotid arteries or down to the femoral arteries
67
Etiologies of dissecting aneurysms (8)
``` Marfan syndrome chornic HTN Ao aneurysms Ao athersclerosis (cystic medial necrosis) Iatrogenic cardiac intervention Congenital Ao valve anomalies Coarctation of the Ao Chest trauma ```
68
Most frequent cause of premature death?
dissecting aneurysms
69
For patients with an AAA, what alternative treatment exists for repair?
Endovascular stent graft inserted into the groin and deplored within the Ao
70
Who qualifies for an endovascular stent graft?
Patient with AAA that os infrarenal
71
Post graft placement eval includes
monitoring for leaks the A should be measured and compared to the pre graft size -over time the A should contract down around the grafting material
72
What is MAy-Thurner Syndrome?
chronic left common Iliac vein compression against the lumbar vertebrae by overlapping right right common iliiac artery
73
What are patients with May-Thurner's syndrome at risk for?
developing DVTs in the LLE
74
Mesenteric (intestional) Ischemia
rare chronic intestional ischemia that presents as recurring postprandial ABD pain and weight loss
75
What else has symptoms similar to chronic mesenteric ischemia?
abdominal malignancy ulcerative disease cholelithiasis
76
What vessels should be evaluated is chornic mesenteris ischemia is suspected?
CA SMA IMA
77
When do symptoms of chronic mesenteris ischemia usually present pathologically?
Not until at least 2 of the major mesenteric arteries are occluded or highly stenosed.... this typically results in silatation of the IMA
78
Can symptoms result from a single mesenteric vessel occlusion?
Yes typically the SMA is occluded can occur in patient who have had previous abdomina surgery that interrupted important mesenteric collaterals
79
Criteria for mesenteric artery stenosis (mesenteric ischemia)?
SMA velocity >275cm/sec CA velocity >200cm/sec *suggests a 70% stenosis
80
MALS (median arcuate ligament compression syndrome) or celiac axis compression syndrome
compression of the proximal celiac axis by the median arcuate ligament of the diaphragm
81
What should a sonorgapher do if they discover an elevated celiac axis velocity
compare insp/exp velocities
82
MALS may present with an abdominal _____ with expiration and disappears with ispiration.
bruit
83
If a case of MALS, what happens with expiration?
the median arcuate ligament compressions the ventral aspect of the celiac axis -makes a "S" shaped axis in TRV and produces a significant stenosis
84
If a case of MALS, what happens with inspiration?
the celiac axis should straighten out and any stenosis should disappear -elevated velocities decrease to normal <200cm/sec
85
Anterior/Posterior Nutcracker Syndrome
when the left renal vein is compressed between the SMA and Ao if anterior or between the Ao and vertebra if LRV is retroaortic
86
What can Nutcracker syndrome cause?
venous HTN that results in venous collateralsand retrograde flow in the adrenal and gonadal veins..... this can then cause pelvic congestion syndrome in females and varicoceles in males
87
What is a common symptom in patients with Nutcracker syndrome?
heamturia and left flank pain
88
What is an arteriovensou shunt or fistual?
connection between an atery and vein | ex: cca and jug
89
AV shunts are commonly associated with angiographic punctures/biopsies of the _____ ______ artery just inferior to the _____.
common femoral | groin
90
What are AV shunts assoc with (6)
``` trauma surgery biopsy inflammation neoplasm congenital formation ```
91
How might an AV shunt present in patient?
bruit or thrill depending on lcoation HTN cardiomegaly heart failure
92
Sonorgaphic characteristic of an AV shunt?
color flow bruit tissue vibration..... bc it's a jet pulsatile venous flow.....doesn't have to go through cap bed low resistive arterial flow
93
intrarenal AV shunts result from what
renal biopsy percutaneous renal biopsy is the most common known acquired renal AV fistual -est 15 to 50% of biopsies result in some degree of fistual formation
94
intrarenal shunts will produce what kind of waveform?
high velocity, low resistance

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