UEA

the wall of an artery is made up of (outer to inner)

tunica adventitia, tunica media, tunica intima

what layer of the artery wall consists of smooth muscle and connective tissue that provides structure for the vessel

tunica media

where does the ascending aorta originate

left ventricle

what are the branches (in order) as they arise from the aortic arch

brachicephalic, left common carotid, left subclavian

what is a continuation of the subclavian artery

axillary artery

where does the axillary artery become the brachial artery

lower border of the tendon of the teres major muscle

where does the brachial artery typically terminate

below the antecubital fossa

what does the radial artery terminate into

deep palmer arch

what does the ulnar artery terminate into

superficial palmer arch

what do the two arches supply blood to

digital arteries

what causes a reduction in arterial lumen that causes the PSV to be elevated in the area

PAD

when using muscles of an extremity the tissue requires ___ arterial perfusion to meet the increased oxygen demand

more

when the muscles can not receive enough blood when being used what is this known as

intermittent claudication

what is the primary disease leading to PAD

atherosclerosis

what is characterized by the build up of atherosclerotic plaque on the arterial endothelium as a result of excess lipids present in the blood

atherosclerosis

atherosclerosis can cause a _____ that occurs when plaque dislodges from the arterial wall and propagates distally in the arterial system and can eventually go to the brain and cause a stroke or cause ischemia by occluding arteries

arterial embolism

vessel diameter has the greatest affect on _______

flow volume

a decrease in the artery diameter causes an _____ of the arterial resistance

increase

an increase in ____ can be a marker for arterial pathology

PSV

how can we stop the progression of atherosclerosis through management of our life / medical

no Tabaco use, eating healthier, exercise and medications

what is the treatment for PAD that involves the use of a catheter in the artery at the site of the atherosclerotic lesion where percutaneous transluminal angiography, endograft, atherectomy, and thrombin injections can be done

endovascular treatments

what is the most common surgical treatment for PAD

making a bypass graft - making an alternative route for the blood

in severe causes of atherosclerosis what is typical done for treatment

limb amputation

what are signs of peripheral occlusive arterial disease

elevation pallor, dependent rubor, ischemic ulcers, gangrene, bruit, decreased peripheral pulses

what information is given during a segmental doppler of pressures

a quantitative value that offers physiologic info from the segment of the vessel under the cuff

how long should a patient rest before having a segmental doppler pressure performed

15 minutes

why would a pressure cuff not be placed on a certain part of the limb

they cannot be placed on grafts or stents

what position is the patient when getting segmental pressures taken

supine

how much more should a cuff be inflated above the systolic before it is slowly deflated

20-30 mmHg

when getting the segmental doppler pressures the CW transducer should insonate at an angle of ____ to get best signal

45 to 60 degrees

to get the best pressures the cuff must have a width ___ greater than the diameter of the limb

20%

if the width of the cuff is too small this might cause a ____ of the values

elevation

if there is a difference of >20 mmHg between the arm pressures what does this mean

arterial obstruction of the innominate, subclavian, axillary, or proximal brachial artery is suspected on the side with a lower value

when comparing values within the same limb there should be a difference of a value no greater than ___ between two adjacent segments

20 mmHg

are segmental pressure gradients able to distinguish between arterial stenosis and occlusion

no

can segmental testing be done on the upper extremity

yes

how is pressure testing performed on the upper extremity

three cuffs placed at the upper arm, forearm, and wrist

what arteries does the upper extremity pressure testing check

brachial, radial, ulnar

what is a plethysmography

it measures the changes in blood volume as a method to obtain arterial waveform

what is pneumoplethysmography commonly known as

pulse volume recording (PVR)

what does a PVR measure

changes in segmental limb volume that occurs during each cardiac cycle

during a PVR each cuff is inflated between ____ and ____ above the systolic pressure before deflating

20; 30 mmHg

what is the normal PVR waveform

a rapid rise (acceleration) to a sharp peak during systole followed by a slower fall (deceleration) during diastole, with a cardiac notch showing the retrograde flow that occurs during diastole

a PVR waveform shows progressive occlusive arterial disease

the loss of a dicrotic notch followed by a delayed upstroke and downslope time

what PVR waveform suggests severe arterial occlusive disease

no pulse amplitude (flatline)

what should be done when segmental pressures are taken and show noncompressible vessels

PVR waveforms

what is a photoplethysmography PPG test done for

detecting cutaneous microcirculation arterial pulses by showing the PPG waveform

what is PPG testing normally done on

digits or in situations of severe arterial disease like wound healing and ischemia

what is characterized by the compression of neural or vascular structures by bone, ligament, or muscular obstacles at the thoracic outlet

thoracic outlet syndrome (TOS)

TOS results in ___ especially when raising the arms

ischemic reactions

TOS has symptoms like _______

cramping or pain in the arm that is relieved by rest or change in position

TOS can also cause the loss of ___ in the hand

muscle volume

to check TOS where is the PPG sensor placed

on the index or middle finger bilaterally

what is the first position of the patient while getting PPG waveform for checking TOS

upright with the arms in the lap while resting

what are the maneuvers that the patient might have to do with the PPG sensors on checking for TOS

head to the left, head to the right, exaggerated military position(chest pushed out arms to the side), military position with the head to the left then right

after performing the maneuvers while testing for TOS what is the patient asked to do

do the position that is most uncomfy

during testing for the TOS what indicates a flow reduction

any position that causes a decrease, abnormality, or absence of PPG waveforms

what is characterized as intermittent digital ischemia in response toto cold or emotional stress causing color changes white or blue in the digits

primary raynaud phenomenon

what is caused by vascular occlusion or stenosis in the digits also in response to cold or emotional stress

secondary raynauds phenomenon

where is the typical place of arterial upper extremity obstruction

subclavian artery

no more than a ___ difference should be observed between adjacent segments of the ipsilateral arm

10-15 mmHg

normal digital pressures will be within ___ of the brachial pressure

20 mmHg

what does the allens test evaluate

flow in the sperficial and deep palmer arches

where should the PPG sensors be placed for the allens test

the thumb and fifth digit

how do we know adequate pressure has been applies in the allens test

when the flow becomes absent

during the allens test after the radial artery does not have pressure to block it what should happen

normal flow should return indicating both have pressure applied again but release of the ulnar artery

during the allens test after the radial artery does not have pressure to block it what is the result when the normal flow does not return

the palmer arch is not intact between the superficial and deep systems

_____ imaging is able to distinguish between stenosis from occlusion

duplex

the sample gate for imaging of the arteries uses a ___ angle

60 degree

no increase in PSV relative to the adjacent segment and no waveform abnormalities is normal and suggests _____

no stenosis

no increase in PSV relative to the adjacent segment but flow disturbances are noted on CD or SD is suggestive of _________ vessel narrowing

1-19%

an increase in PSV from 30-100% relative to the adjacent segment is suggestive of ______ vessel narrowing

20-49%

an increase in PSV greater than 100% relative to the adjacent segment is suggestive of _____ vessel narrowing

50-99%

no identifiable signal by CD or SD is suggestive of _______vessel narrowing or occlusion

100%

in the presence of an occlusion the CD can reveal ____ near the blocked segment

collaterals

what are the three major changes in SD arterial waveform that occurs as a result of stenoses

1. increase in PSVs >100%

2. marked spectral broadening caused by turbulence

3. loss of reversal flow during diastole

in a bypass graft what should be imaged

entire length of the graft, native inflow and outflow vessels, proximal and distal anastomosis

in a bypass graft findings of a PSV greater then 180 cm/s or velocity ratio greater than 2 are considered

abnormal

in a bypass graft the PSV greater than 300 cm/s and EDV greater than 20 cm/s and a velocity ratio greater than 3.5 suggest

diameter reduction of greater than 70%

where are dialysis grafts typically placed

in the forearm to create an AVF in patients undergoing hemodialysis

what is the brescia-cimino AVF

connection of the radial artery and cephalic vein

the failure rate for dialysis grafts is ___ within the first year

40%

what are the characteristics of a normal dialysis graft

increased flow velocity that has continuous forward diastolic flow with notable spectral broadening

the normal PSV are typically ____ in a healthy graft

200 cm/s or higher

what PVS in a bypass graft causes a suspected abnormality

between 100 and 200 cm/s

a __________ is a perivascular collection (hematoma) containing pulsatile flow entering through a communication with an artery or a graft

pseudoaneurysm

in a pseudoaneurysm what does the tract/neck connect

native vessel to the blood flow collection

an increased risk of rupture in a pseudoaneurysm is more common when measuring over ____

3 cm

what must first be identified to complete the compression therapy in a pseudoaneurysm

the neck of the pseudoaneurysm

how is the compression therapy done for pseudoaneurysms

compression cycles of 15-20 minutes while evaluating the process between cycles

it will take ______ minutes for before successful thrombosis of a pseudoaneurysm

30-60

it is important to make sure _____ does not occlude when compressing a pseudoaneurysm

the native blood flow

to make sure the native vessel does not occlude what should be done during the compression of the pseudoaneurysm

distal blood flow should be monitored during the exam

what is another treatment option for a pseudoaneurysm besides the compression therapy

ultrasound guided thrombin injection

how is a ultrasound guided thrombin injection complete

thrombin is injected with its effects continuously being monitored with CD imaging and the injection is stopped when blood flow is no longer injected