Visceral Artery Duplex Imaging

Question 1

in the evaluation of visceral branches, the ___ is a reference and landmark

Answer 1

aorta

Question 2

acute mesenteric ischemia is often caused by ___

Answer 2

embolus

Question 3

acute mesenteric ischemia is a possible medical emergency due to possibility of ___

Answer 3

intestinal necrosis

Question 4

___ of 3 mesenteric vessels must have significant disease to result in mesenteric ischemia

Answer 4

2 of 3

Question 5

mesenteric artery duplex imaging

spectral Doppler - PSV should be obtained from (4)

Answer 5

1. aorta (juxta-renal segment)
2. celiac artery - hepatic, splenic
3. SMA - prox, mid, dist
4. IMA - prox, mid, dist

Question 6

celiac artery velocity

normal -
>70% stenosis -

Answer 6

celiac artery

normal: 50-160cm/sec
> 70% stenosis: >200cm/sec

Question 7

SMA velocity

normal -
> 70% stenosis -

Answer 7

SMA

normal: 110-177cm/sec
>70% stenosis: >275 cm/sec

Question 8

if celiac artery and SMA are normal, isolated ___ stenosis is unlikely to be symptomatic

Answer 8

isolated IMA stenosis

Question 9

IMA is often small, enlargement may suggest ___

Answer 9

collateralization

Question 10

IMA may also serve as collateral to the iliac arteries via branches of the ____

Answer 10

internal iliac artery

Question 11

food challenge

after patient ingests high-caloric liquid, document (5)

Answer 11

1. amount of liquid ingested
2. presence, time, and duration of symptoms
3. time of post-prandial study
4. PSV and EDV from SMA
5. hyperemic response (change in resistance)

Question 12

extrinsic compression is also known as (3)

Answer 12

1. median arcuate ligament syndrome (MALS)
2. arcuate ligament compression syndrome
3. celiac axis compression syndrome

Question 13

MALS

abdominal bruit disappears with ___

Answer 13

deep inspiration

Question 14

renal artery duplex indications (4)

Answer 14

1. sudden onset of HTN and/or rapidly fluctuating BP
2. renovascular HTN
3. follow up of known stenosis
4. follow up post-intervention

Question 15

renal artery duplex

obtain spectral waveforms to calculate RI from the

Answer 15

segmental/intralobar OR arcuate arteries

Question 16

renal artery duplex

PSV
normal -
60% stenosis -
occlusion -

Answer 16

PSV
normal: < 180cm/sec
60% stenosis: 180-200cm/sec
occlusion: < 10cm/sec

Question 17

renal aortic ratio (RAR)

do not use if ___ is present of if aortic PSVs are ___

Answer 17

AAA is present
aortic PSVs are <40 or >90cm/sec

Question 18

abnormal RI values indicate an increase in ___

Answer 18

distal resistance

Question 19

parenchymal resistance ratio is ___

Answer 19

end diastolic ratio (EDR) = EDV / PSV

normal > 0.2
abnormal < 0.2

Question 20

renal artery duplex

AT is obtained from the distal renal artery at the ___ or ___

normal AT -
abnormal AT -

Answer 20

hilum or segmental arteries

normal AT: <100ms
abnormal AT: >100ms

Question 21

term to describe delayed systolic upstroke and diminished systolic peak

Answer 21

tardus parvus

Question 22

note the location

stenosis at the origin of the renal artery -
lesion in the mid or distal artery segment -

Answer 22

stenosis at the origin of the renal artery - atherosclerotic

lesion in the mid or distal artery segment - fibromuscular dysplasia

Question 23

____ will decrease with increasing intrinsic kidney disease

Answer 23

cortical thickening

Question 24

ultrasound appearance of CKD

Answer 24

decrease size
thin cortex
increased echogenicity

Question 25

primary goal of renal artery treatment is to ___

Answer 25

improve blood flow with angioplasty and/or stent before patient develops CKD

Question 26

postoperative evaluation of a renal transplant includes (3)

Answer 26

1. vessel patency 2. Doppler evaluation - PSV, EDV, RI, AT 3. B-mode evaluation - size, parenchyma, cysts

Question 27

renal transplant rejection increase RI < 3 months = increase RI > 3 months =

Answer 27

increase RI < 3 months = not specific increase RI > 3 months = ominous finding

Question 28

___ is the best to determine transplant rejection

Answer 28

biopsy

Question 29

normal renal artery velocity - AT - RI - size - cortical thickness -

Answer 29

velocity: < 180cm/sec AT: < 100ms RI: < 0.8 size: 10-12cm cortical thickness: >1cm

Question 30

3 anastomoses for renal transplant

Answer 30

RA end-to-side with EIA RA end-to-side with EIV RA end-to-end with IIA