Chapter 8 Vascular Study Guide

Waveforms, Pseudoaneurysms,

Capillaries

tiny vessels that connect most arteries and veins

Arteries

carry blood away from the heart

Veins

carry blood toward the heart

Arterioles

smallest artery branches

Venules

smallest venous branches

Tunica Intima

(innermost layer)

layer of endothelial cells, layer of connective tissue and an elastic layer.

Tunica Media

(middle layer) smooth muscle layer with elastic and collagenous tissue

Tunica Adventitia

(outermost layer) loose connective tissue with bundles of smooth muscle and elastic tissue

Three branches that arise from the aortic arch

Brachiocephalic artery, left common carotid artery and left subclavian artery

What does the brachiocephalic artery branch into?

R CCA and R subclavian artery

4 major branches of abdominal aorta and where they arise from

Celiac Axis/trunk (anterior)

SMA (anterior)

Renal Arteries (Anterolateral)

IMA (Anterior)

The aorta bifurcates into ____ and ____, which then divide into ____ and ____

Rt and Lt CIA, Rt and L external and internal iliac arteries

5 sections of aorta

Aortic root, ascending aorta (arch), descending aorta (thoracic, abdominal and bifurcation

Ultrasound of aorta is commonly used to assess

Diameter of aorta, aortic aneurysm, possible thrombus, calcification or aortic wall dissection

What pathology is most commonly assessed with ultrasound?

AAA

Aortic ectasia

Aorta does not taper normally as it runs distally

IVC is located ____ to the aorta

to the right of

IVC crosses the diaphragm and enters where in the heart?

Right atrium

IVC should be evaluated for what?

Thrombus or other abnormality

How does the patient holding their breath change the size of the IVC?

It will cause the IVC to dilate

Dilation of the IVC may be an indication of what disease?

Heart issues, specifically right sided

In the transverse plane, the celiac axis forms what sign?

seagull sign

If the angle of the SMA as it arises from the aorta is greater than 15 degrees it couyld indicate

Lymphadenopathy or adenopathy

In longitudinal, the SMA runs how to the aorta

Parallel and anterior

The right renal artery runs how to the IVC?

Posterior, it is the only vessel to do so

What is the longest renal artery?

RRA

The abdominal aorta bifurcates into the R and L CIAs at the level of ____ to do what?

Umbilicus, to supply blood to lower extremities

Where do renal arteries branch?

Level of first lumbar vertebra, inferior to SMA

What type of organ does a low-resistance vessel supply?

A vital organ

The transverse image of the hepatic veins draining into the IVC is called what sign?

Reindeer or Playboy bunny

The portal vein is formed by the confluence of what?

SV and SMV

Where does the MPV enter the liver? What does it do afterwards in order to get to the IVC?

Porta hepatis. Branches into R and L PV, then does liver stuff, enters the R, Middle and L HV and they empty into the IVC

Hepatofugal

Flow away from the liver

Hepatopetal

Flow towards the liver

What is the normal direction of flow in the portal vein?

Hepatopedal

In the case of severe portal hypertension, the blood flow in the portal vein will be Hepato

fugal

The IMA distributes blood to the

Lt transverse colon, descending colon, sigmoid and rectum

The SMA supplies blood to the

Prox half of the colon and small intestine

Doppler is used to detect what characteristics of blood flow?

Presence/absence of flow, direction of flow, flow disturbance and tissue characterization

In the sagittal plane, what artery passes posterior to the neck of the pancreas and anterior to

the uncinate process of the pancreas?

SMA

What vessel is seen coursing between the aorta and the SMA in the transverse plane?

Lt renal vein

What factors make a person at high risk for developing an Aortic Aneurysm?

Known vascular disease, over 60 yrs of age, HTN, smoker

What are the 3 predisposing factors for developing an Aortic aneurysm? Which factor is most common?

Arteriosclerosis, syphilis, Trauma. Most common is arteriosclerosis

Aneurysm

Permanent localized dilation of the artery, with an increase in

diameter of greater than 1.5 times its normal diameter aorta =3cm

2 different descriptions used for aneurysms

Fusiform and saccular

What is the accuracy rate for ultrasound in detecting aortic aneurysms if it is done

properly?

98.8%

List the possible locations of an aortic aneurysm:

Infrarenal, suprarenal and perirenal

95% of aortic aneurysms occur where?

Infrarenal

What is the most common site of rupture of an aortic aneurysm?

Lateral wall below renal vessels

Normal aortic diameter?

Less than 3cm

Aortic dissection

Separation of the layers of the aortic wall, with blood

coursing through the false lumen

What makes a patient more likely to develop an aortic dissection? (at high risk)

Known aneurysm, sudden onset of excruciating chest pain radiating to the back, 40-60

years of age, more common in male gender

Describe the three types of Aortic Dissection:

1. most dangerous- starts at the root, can extend the length of the arch, can cut off

arch vessels blood supply

2. Associated with marfan syndrome, starts at or below the lt subclavian, extends

down the descending aorta

3. begins at the lower end of the descending aorta, extends into the abdominal aorta,

has a danger of spiraling and cutting off blood supply to the renal arteries

What is an arteriovenous fistula?

Abnormal connection between artery and vein

When the IVC is obstructed, what system takes over and “acts” as the IVC?

Azygos and/or the hemiazygos system

What condition may cause flow in the portal vein to be reversed?

Portal hypertension

What is the most common predisposing factor for portal hypertension?

Intrinsic liver disease

What are the characteristics of “plug flow?

Clear window in the spectral waveform, most of the blood cells are traveling about the same velocity across the vessel

What constitutes a normal resistive index (good perfusion)

0.7

What is Budd – Chiari Syndrome?

Thrombosis of the hepatic veins

List the clinical signs of Renal vein obstruction:

Flank pain, hematuria, flank mass, proteinuria, maybe associated with maternal diabetes and transient HTN

What are the sites of spontaneous shunting that naturally decompress portal

hypertension?

Gastroesophageal, paraumbilical vein, hemorrhoidal anastomoses, retroperitoneal anastomoses

Hepatic veins origin ____ and drain into the ____

liver, IVC