Week 11: LE arterial angioplasty & stent assessment & duplex

Question 1

What are the 4 treatment options for PAD?

Answer 1

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

Question 2

What do the type of interventions depend on?

Answer 2

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

Question 3

Stents are being used________in LE.

Answer 3

More frequently.

Question 4

What is the duplex protocol for LE stents?

Answer 4

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

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

Question 5

What are the 2 types of endovascular treatment types?

Answer 5

1. Percutaneous transluminal angioplasty
2. Endovascular Intervention.

Question 6

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

Answer 6

Endovascular intervention.

Question 7

What are some percutaneous transluminal angiplastly treatment?

Answer 7

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

Question 8

What are some endovascular interventions?

Answer 8

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

Question 9

What is the main mechanism for a balloon angioplasty?

Answer 9

Lumen dilation.

Question 10

What is the lesion anatomy for a balloon angioplasty?

Answer 10

Focal, <5 cm stenosis or occlusion.

Question 11

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

Answer 11

40-50%

Question 12

What is the “failure mode” for a balloon angiplasty?

Answer 12

1. Plaque dissection.
2. Myointimal hyperplasia.

Question 13

What is the mechanism for a stent angioplasty?

Answer 13

Lumen dilation.

Question 14

What is the lesion anatomy for a stent angioplasty?

Answer 14

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

Question 15

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

Answer 15

50-60%

Question 16

What us the “failure mode” for a stent angioplasty?

Answer 16

1. Myointimal hyperplasia.
2. Stent fracture.

Question 17

What is the mechanism for atherectomy?

Answer 17

Plaque excision.

Question 18

What is the lesion anatomy for atherectomy?

Answer 18

Focal & longer (>10 cm) stenosis.

Question 19

What is the “failure-mode” for atherectomy?

Answer 19

1. Myointimal hyperplasia
2. Atherectomy site thrombosis.

Question 20

What is the mechanism of subintimal angioplasty?

Answer 20

Lumen dilation.

Question 21

What is the lesion anatomy for subintiml angioplasty?

Answer 21

>10 cm stenosis or occlusion.

Question 22

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

Answer 22

55-60%

Question 23

What is the “failure-mode” for subintimal angioplasty?

Answer 23

1. Myointimal Hyperplasia
2. Angioplasty site thrombosis

Question 24

What is the mechanism for stent-graft angioplasty?

Answer 24

Lumen dilation.

Question 25

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

Answer 25

Long, \>15 cm stenosis or occlusion.

Question 26

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

Answer 26

60-70%

Question 27

What is myointimal hyperplasia?

Answer 27

Abnormal proliferation of smooth muscle cells.

Question 28

What should you look for when scanning a stent?

Answer 28

Look for bright lines/circumferential dots in trans.

Question 29

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

Answer 29

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

Question 30

Velocity ration\_\_\_\_\_\_\_ indicates 50% stenosis.

Answer 30

\>2

Question 31

What can also be used to classify stenosis?

Answer 31

End diastolic volume.

Question 32

How will a waveform look if: ## Footnote **\<50% DR** **\<180 PSV** **\<2 Vr**

Answer 32

Normal

Question 33

How will a waveform look if: **\>50% DR** **180-300 PSV** **2-3.5 Vr** **\>0 EDV**

Answer 33

Monophasic

Question 34

How will a waveform look if: ## Footnote **\>77% DR** **\>3.5 Vr** **\>300 PSV** **\>45 EDV**

Answer 34

Damped, monophasic, low velocity.

Question 35

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

Answer 35

Doesnt remove plaque which causes: - plaque dissection - stent geometry - myointimal hyperplasia - decreased arterial wall compliance

Question 36

What is angioplasty failure defined as?

Answer 36

occlusion. \>70% stenosis

Question 37

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

Answer 37

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

Question 38

What is the LE stent critera?

Answer 38

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.

Question 39

How should you report an image with disease?

Answer 39

Either inside stent or outside stent.

Question 40

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

Answer 40

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

Question 41

What is considered a post-intervention failure?

Answer 41

\>70% DR stenosis or occlusion. ## Footnote **Requires further intervention.**

Question 42

The rationale for surveillance testing is to?

Answer 42

Identify PTA site abnormalities before failure occurs.

Question 43

What are 4 post-intervential abnormalities?

Answer 43

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