CMI 354 Test #1

Ascending aorta

1

Arch of aorta

2

Descending aorta

3

Left coronary artery

4

Right coronary artery

5

Brachiocephalic artery

6

Right subclavian artery

7

Right common carotid artery

8

Left common carotid artery

9

Left subclavian artery

10

Inferior vena cava

1

Right kidney

2

Right renal artery

3

Right renal vein

4

Abdominal aorta

5

Left renal vein

6

Left renal artery

7

Superior mesenteric artery

9

Left kidney

10

Femoral vein

1

Femoral artery

2

Deep femoral artery

3

Great saphenous vein

4

Popliteal artery

5

Posterior tibial artery

6

Anterior tibial artery

7

Arcuate artery

8

2 cm

Normal aorta diameter

Aneurysm

Vessel dilation >3 cm

Surgical aneurysm

Vessel dilation >6cm

Aneurysmal

Increased diameter greater than 50% qualifies as

infrarenal aorta

What's the most common place of an aneurysm in the abdomen?

Spectral broadening is caused by turbulence in blood flow as the normally homogeneous velocity of reflective red blood cells becomes more diverse, resulting in the apparent broadening of the spectral Doppler waveform

Doppler signal: what is spectral broadening?

triphasic: consists of forward flow in systolic peak, reversal forward flow in late disatole

biphasic: delayed acceleration, decreased systolic peak, increased flow in diastole

monophasic: delayed acceleration, decreased systolic peak, increase of flow in diastole

Doppler signal, what is the flow type: triphasic, biphasic, monophasic

behind the knee

Where is the popliteal artery?

gastrocnemius muscle, medial head

What muscle is by the popliteal artery

Subclavian artery, axillary, brachial (front), deep brachial (back), radial (thumb), ulnar (pinky)

Know the arteries from upper abdomen to the fingers

they are caused by impaired blood flow

- pain

- pallor (pale skin tone)

- paresthesia (numbness feeling)

- pulselessness (faint pulse)

- paralysis (weakness

with movements)

Know the 5 P's for an acute arterial occlusion

- evaluates patency of the wrist arteries and source of arterial supply to the fingers

-Is useful in determining hand viability if the radial artery is to be removed for use as a coronary artery bypass graft, or for various procedures such as dialysis or angiography

- used to assess the hand viability if there is an obstruction of the radial artery

What does the Allen's test for ulnar atery, L test do

-sonographer palpates radial artery at wrist and applies manual compression

-patient balls hand into a fist for one minute and then relaxes

-skin will turn pale when hand clenched and color will return when relaxed

How does a sonographer do an Allen test?

ankle/brachial (ABI) is calculated by dividing the ankle pressure (systolic) by the higher of the two brachial pressures (systolic)

Calculate an Ankle/Brachial Index & what's the equation

Doppler waveform analysis

What test is used to detect the presence and severity of arterial occlusive disease?

a reddening or dark discoloration that occurs when a limb has poor arterial flow

Rubor

bluish discoloration of the skin

Cyanosis

abnormal sensation of numbness and tingling

paresthesia

Condition that exists when symptoms of intermittent ischemia of the fingers or toes occur in response to cold exposure as well as emotional stress

Raynaud's phemomenon

Tibial area, toes, bony prominences

Where do arterial ulcers typically occur?

Severe

What is the level of pain associated with arterial ulceration?

Deep regular shape

What is the appearance of arterial ulcers?

Little

How much bleeding is typically associated with arterial ulcers?

Shiny skin, loss of hair, thickened toenails

What are some trophic changes associated with arterial ulcers?

Near medial and lateral malleolus

Where are venous ulcers typically located?

Mild to severe

What is the pain level associated with venous ulceration?

Shallow, irregular shape

What is the appearance of a venous ulcer?

Venous ooze

What type of bleeding is associated with venous ulcers?

Stasis changes: brawny discoloration, lipodermatosclerosis, varicosities often present

What are some other findings associated with venous ulcers?

-hemodynamically significant stenosis

-a critical narrowing of an artery (stenosis) that results in a major reduction in maximal flow capacity (flow volume and pressure) in a distal vascular bed.

-cross sectional area of arterial lumen is reduced 75% (diameter reduction of 50%)

What constitutes a critical stenosis?

FLOW VOLLUME INCREASES AS PRESSURE INCREASES, BUT ONLY TO A POINT.

► AS FLOW CHANGES FROM STABLE TO DISTURBED, INCREASE IN PRESSURE DOES NOT INCREASE FLOW VOLUME BUT INCREASES FLOW DISTURBANCE CAUSING THE FORMATION OF EDDY CURRENTS.

► RENOLDS NUMBER IS A DIMENSIONLESS NUMBER THAT IS EXPRESSED FOR TURBULANCE.

► TURBULANT FLOW CAUSES VESSELS TO VIBRATE. THIS VIBRATION PRODUCES VASCULAR BRUITS.

Reynold's Number

RELATIONSHIP BETWEEN VOLUME FLOW (Q), PRESSURE (P), AND RESISTANCE (R)

► MAY BE WRITTEN Q = (p1-p2)pie r 4/8 n L

► CHANGE IN THE DIAMETER AFFECTS RESISTANCE

MORE THAN EITHER VISCOSITY OR VESSEL LENGTH

► RADIUS OF A VESSEL IS DIRECTLY PROPORTIONAL TO THE VOLUME OF FLOW

Poiseuille's Law

VELOCITY AND PRESSURE ARE INVERSELY RELATED.

Bernoulli's Principle

-often called a mini-stroke. TIA is a temporary blockage of blood flow to the brain

-most TIA symptoms last from only a few minutes up to 24 hour

Tia(transient ischemic attack)

Is gradual worsening of symptoms of brain ischemia

Stroke in Evolution (SIE)

brief, transient interruption in blood flow to the brain lasting longer than 24 hours but less than a week

RIND reversible ischemic neurologic deficit

completed stroke is usually employed to signify a focal neurological disability that came on abruptly and has become stabilized

Complete Stroke

-coma, absence of brain stem reflexes, and apnea

-the irreversible loss of all functions of the brain, including the brainstem

What constitutes acute brain death

LAMINAR FLOW-->

-PARABOLIC FLOW

-Plug flow

Turbulent flow - a chaotic form of fluid transport in which velocity components randomly fluctuate.

Types of blood flow

resembles the shape of a bullet

velocity highest at lumen

Parabolic flow

rounded; all blood cells and layers travel at the same velocity

Plug flow

Ophthalmic artery

What branch of the internal carotid has clinical significance to us

True: Saccular, Fusiform

Dissecting

Pseudoaneurysm

Types of aneurysms

True - dilation of all three layers of arterial wall

Pseudo - pulsating hematoma; hole in arterial wall allows blood to escape under pressure into a contained area

True VS Pseudo - Aneurysm

Not all layers dilated; high rupture risk.

false aneurysm

determining the changes in volume of an organ part or body

Plethysmography

Caused by swelling within osteofascial compartments of the leg, arm, or abdomen

-results from ischemic injury to capillary bed within subsequent increased fluid leakage out of the circulating volume

-clinical findings include paresthesia, pain, weakness of involved muscle, and tension of the compartment

Compartment syndrome

caused by compression of the popliteal artery by the medial head of the gastrocnemius muscle or fibrous bands

-most commonly found in young athletes

-appears bilaterally in 2/3 cases

Popliteal artery entrapment syndrome

5 P's: pain, pallor, pulselessness, paresthesia, paralysis, polar (cold foot), purplish (cyanosis)

-occlusion may result from thrombus, embolism, or trauma

-consider an emergency

acute arterial occlusion

Claudication

3 areas: buttock, thigh, and calf

chronic arterial occlusion

Aortoiliac disease

What does buttock claudication suggest?

Iliofemoral disease

What does unilateral buttock claudication suggest?

Distal external iliac/common femoral disease

What does thigh claudication suggest?

Femoral/popliteal disease

What does calf claudication suggest?

pain in muscles during exercise but subsides with rest; results from inadequate blood supply to exercising muscle

Claudication

casts/bandages that can't be removed

waveforms may be affected by ambient temperature

congestive heart failure may cause dampened waveforms

continuous wave transducer is unable to differentiate occlusion from stenosis or locate it

sonographer dependent

Limitations of arterial Doppler: upper and lower extremities

can't tell the difference between stenosis and occlusion

can only identify general location of obstruction

can show falsely elevated doppler pressures in patients with calcified vessels

ABI's may appear lower in patients with congestive heart failure

ABI's may appear higher thigh pressures if thigh is too narrow

unable to perform tests on patients with certain conditions (DVT, graft, stent, e.g.)

Limitations of arterial Doppler: segmental pressures

skin must be intact for probe placement

ulcerated skin

patient must rest quietly

can only measure superficial layers of tissue

lack of availability and standardized protocols

Limitations of arterial Doppler: laser Doppler

vasoconstriction

cold

smoking

nervous

ulcerations

gangrene

extensive bandages

dry skin

Limitations of arterial Doppler: digital pressures and plethysmography

presence of dressings/staples/sutures/open wounds

IV site

cold room

obesity

anastomosis sites

Limitations of arterial Doppler: duplex scanning of upper extremities

presence of dressings/staples/sutures/open wounds

incisional tenderness/hematomas

calf vessels of obese patients are difficult to image

calcified arteries can cause artifactual shadowing

Limitations of arterial Doppler: duplex scanning and color flow imaging of the lower extremities

size of the patient, bowel gas, previous abdominal surgery, shortness of breath/rapid respiration, not fasting

Limitations of arterial Doppler: abdominal

body habitus (obesity), lack of fasting, patient can't hold breath, recent surgery and ascites

Limitations of arterial Doppler: renal Doppler

depth, scarring, effects of radiation treatment

Limitations of arterial Doppler: preoperative mapping procedures

-A difference greater than 30 mmHg between 2 consecutive levels is considered significant and would suggest obstruction

-Horizontal difference of 20-30 mmHg or more suggests obstructive disease at or above the level in the leg of lower pressure

Segmental pressures

Externa - external

Media - middle

Intima - inner most

layers of artery wall

first major branch is the ophthalmic artery

Know ICA branches

first major branch is the superior thyroid artery

Know ECA branches

-feeds the stomach, liver, pancreas, duodenum, and spleen

-branches into left gastric, splenic, and common hepatic arteries

Know the celiac trunk and its major branches

-first branch of aortic arch

-arises on right

-divides into right common carotid artery and subclavian arteries

brachiocephalic artery

-second branch of the aortic arch

-terminates at carotid bifurcation

-splits into ICA and ECA

left common carotid artery

-third branch of aortic arch

-terminates at thoracic outlet

left subclavian artery

A condition characterized by abnormal growth of cells in the arterial wall.

What is fibromuscular dysplasia?