Week 11: LE arterial angioplasty & stent assessment & duplex Flashcards Preview

Arterial Procedures > Week 11: LE arterial angioplasty & stent assessment & duplex > Flashcards

Flashcards in Week 11: LE arterial angioplasty & stent assessment & duplex Deck (44):
1

What are the 4 treatment options for PAD?

  1. Medical treatment
  2. Excersise therapy
  3. Endovascular therapy
  4. Surgical reconstruction/bypass graft.

2

What do the type of interventions depend on?

Depends on the severity of symptoms, disease location and extent.

3

Stents are being used________in LE.

More frequently.

4

What is the duplex protocol for LE stents?

It is the same for LE native artery duplex but ass images/velocities:

  • Pre-stent
  • Prox. stent
  • Mid. Stent
  • Distal Stent
  • Post-stent.

5

What are the 2 types of endovascular treatment types?

  1. Percutaneous transluminal angioplasty
  2. Endovascular Intervention.

6

Which endovascular treatment is preferred for focal, <5 cm in length regions of stenosis?

Endovascular intervention.

7

What are some percutaneous transluminal angiplastly treatment?

  1. Subintimal ballon angioplasty
  2. Stent-graft angiplasty
  3. Mechanical atherectomy.

8

What are some endovascular interventions?

  1. Iliac angiplasty: has a higher patency rate than femoral-pop.
  2. more severe disease has lower stenosis-free patency rate.

9

What is the main mechanism for a balloon angioplasty?

Lumen dilation.

10

What is the lesion anatomy for a balloon angioplasty?

Focal, <5 cm stenosis or occlusion.

11

What is the "stenosis-free" patency at 1 year for a balloon angioplasty?

40-50%

12

What is the "failure mode" for a balloon angiplasty?

  1. Plaque dissection.
  2. Myointimal hyperplasia.

13

What is the mechanism for a stent angioplasty?

Lumen dilation.

14

What is the lesion anatomy for a stent angioplasty?

Focal & longer (>10 cm) stenosis or occlusion.

15

What us the "stenosis-free" patency at 1 year for a stent angioplasty?

50-60%

16

What us the "failure mode" for a stent angioplasty?

  1. Myointimal hyperplasia.
  2. Stent fracture.

17

What is the mechanism for atherectomy?

Plaque excision.

18

What is the lesion anatomy for atherectomy?

Focal & longer  (>10 cm) stenosis.

19

What is the "failure-mode" for atherectomy?

  1. Myointimal hyperplasia
  2. Atherectomy site thrombosis.

20

What is the mechanism of subintimal angioplasty?

Lumen dilation.

21

What is the lesion anatomy for subintiml angioplasty?

>10 cm stenosis or occlusion.

22

What is the "stenosis-free" patency at 1 year for subintimal angioplasty?

55-60%

23

What is the "failure-mode" for subintimal angioplasty?

  1. Myointimal Hyperplasia
  2. Angioplasty site thrombosis

24

What is the mechanism for stent-graft angioplasty?

Lumen dilation.

25

What is the lesion anatomy for a stent-graft angioplasty?

Long, >15 cm stenosis or occlusion.

26

What is the "stenosis-free" patency at 1 year for a stent-graft angioplasty?

60-70%

27

What is myointimal hyperplasia?

Abnormal proliferation of smooth muscle cells.

28

What should you look for when scanning a stent?

Look for bright lines/circumferential dots in trans.

29

Areas of distrubanes or stenosis should be carefully evaluated with a spectral doppler by doing what?

-Sample volume should be "walked" through area using a 60 degree angle.

-PSV should be measured.

30

Velocity ration_______ indicates 50% stenosis.

>2

31

What can also be used to classify stenosis?

End diastolic volume.

32

How will a waveform look if:

<50% DR 

<180 PSV

<2 Vr

Normal

33

How will a waveform look if:

>50% DR

180-300 PSV

2-3.5 Vr

>0 EDV

Monophasic

34

How will a waveform look if:

>77% DR

>3.5 Vr

>300 PSV

>45 EDV

Damped, monophasic, low velocity.

35

Why might Psv be higher in area with angioplasty and stenting?

Doesnt remove plaque which causes:

-plaque dissection

-stent geometry

-myointimal hyperplasia

-decreased arterial wall compliance

36

What is angioplasty failure defined as?

occlusion.

>70% stenosis

37

What are 4 dupex findings on in-stent-stenosis?

  1. Lumen reduction 
  2. Elevated PSV values (200-300)
  3. Reduction in ABI's
  4. Damped, low velocity spectral waveform distally.

38

What is the LE stent critera?

  1. >50%
  2. PSV >180 cm/s in fem-pop stent that has a ratio of >2.5
  3. >75-80%
  4. PSV >275-300 cm/s and ratio >3.5
  5. no color, no doppler= occluded.

39

How should you report an image with disease?

Either inside stent or outside stent.

40

What 3 criteria is considered as a post-intervention success?

  1. Increase in ABI's >.15
  2. Resolution of limb ischemia sign and symptoms.
  3. <50 DR stenosis by duplex or angioplasty

41

What is considered a post-intervention failure?

>70% DR stenosis or occlusion.

Requires further intervention.

42

The rationale for surveillance testing is to?

Identify PTA site abnormalities before failure occurs.

43

What are 4 post-intervential abnormalities?

  1. In-site stenosis
  2. Stent deformation/kinking.
  3. Myointimal hyperplasia.
  4. Thrombosis/embolism.

44