Vascular Ultrasound Flashcards

Vocabulary flashcards based on the provided lecture notes on fluid hemodynamics, extracranial Doppler, lower and upper extremity veins, the peripheral arterial system, non-atherosclerotic arterial pathology and duplex ultrasound.

Blood Movement and Velocity

Blood velocity decreases as blood moves from the aorta to capillaries.

Highest Pressure in the Cardiovascular System

The highest pressure occurs in the Left Atrium at about 120mmHg.

Edema

Excess fluid accumulates in the subcutaneous tissue, often in legs and feet.

Diaphragm Movement During Expiration

The diaphragm moves upward, raising chest pressure and lowering abdominal pressure.

Subclavian Steal

Flow in the right vertebral artery is antegrade, while flow in the left vertebral artery is retrograde.

ICA Branches on Color Doppler

No, the extracranial internal carotid artery should not have visible branches on color Doppler.

Carotid Bulb Spectral Analysis

Yes, spectral analysis of the carotid bulb is part of the typical carotid protocol.

External Carotid Artery

Demonstrates a high resistance waveform.

Vaso Vasorum

Small blood vessels in the walls of large arteries and veins.

Branches of the Aortic Arch

a) Brachiocephalic artery b) Left CCA c) Left Subclavian Artery

Vertebral Artery Origin

Arises from the subclavian arteries and converge into the basilar artery to supply blood to the brain.

Carotid Artery Intimal Dissection

Linear echogenic structure with flow observed in the carotid artery after neck trauma.

Vein Adjacent to CCA

Internal Jugular Vein

Factors Falsely Elevating PSV in ICA

Post stenotic turbulence

Fibromuscular Dysplasia

Arteriopathy with overgrowth in the arterial wall, associated with stenosis, dissections, and aneurysms.

Psuedoaneurysm

To-and-fro flow with echogenic tissue in a branch of the ICA.

Pathology Increasing Carotid Artery Lumen Size

Atherosclerosis

Location of Carotid Body Tumor

At the carotid bifurcation.

Vessels Associated with Circle of Willis

a) Anterior communicating artery b) Anterior cerebral artery c) Middle cerebral artery d) Posterior communicating artery e) Superior cerebellar artery f) Pontine arteries g) Posterior spinal artery h) Anterior spinal artery i) Vertebral artery j) Anterior inferior cerebellar artery k) Internal acoustic artery l) Basilar artery m) Posterior cerebral artery n) Internal carotid artery

Carotid Lumen Narrowing After Endarterectomy

Myointimal hyperplasia, an overgrowth of cells within the artery wall in response to surgical manipulation.

Plaque in Carotid Bulb Affecting Doppler Waveform

Reduction in flow and can create turbulent flow patterns.

String Sign Flow

Severe obstruction in the distal common carotid artery with patent internal and external carotids.

Subclavian Steal Stenosis Location

Proximal subclavian artery.

High Velocities and Turbulence in ECA

Significant stenosis.

Tortuous Vessels at Base of Neck Mistaken Condition

Aneurysm

Tardus-Parvus Pattern

Delayed acceleration and a rounded peak distal to significant stenosis.

Major Forms of Arteritis Affecting Carotid System

a) Takayasu arteritis b) Giant cell arteritis

ICA PSV 240 cm/s, CCA PSV 55 cm/s

70% but less than near occlusion

ICA PSV 200 cm/s, CCA PSV 55 cm/s

50-69% stenosis

ICA PSV 200 cm/s, CCA PSV 55 cm/s, trickle of flow

50-69% stenosis

Focal Turbulent Flow in the Left Iliac Vein

Most likely May Thurner is observed.

Vein Located in the Deep Venous System at the Knee

Popliteal vein

Veins Acting as Main Conduits Surrounded by Muscle

Deep veins, ex: brachial, axillary, subclavian, popliteal, femoral

Valve Function in Perforating Veins

Allows one-way flow of blood from the superficial veins into the deep veins, preventing backflow.

Lower Extremity Veins Evaluated in Venous Duplex

Great Saphenous Vein (GSV) and Small Saphenous Vein (SSV)

Venous Flow Response During Valsalva Maneuver

Increases abdominal pressure

Primary Technique to Detect Thrombus in Lower Extremity Veins

Performing compressions

Condition Suggested by Swollen, Painful, Bluish Lower Extremity

Deep vein thrombosis

Treatment Option for Massive DVT

Thrombolysis

Vessel Drained by Small Saphenous Vein

Popliteal vein

Technique for Quantifying Reflux in Venous Flow

Duplex ultrasound with color-flow Doppler

Purpose of Venous Valves in Lower Extremity Veins

Assist blood flow against gravity

Veins Forming the Common Femoral Vein

Femoral vein and the deep femoral veins join to form the common femoral vein

Causes of Venous Distension During Pregnancy

Compression of IVC and iliac veins, hormonal changes and Increased pressure and increased compliance

Parameters Assessed Preoperatively in Superficial Venous System

a) Vein patency b) Vein depth and size c) Vein position

Vein Connecting Superficial and Deep Systems

Perforator veins

Prevalence of Chronic Venous Valvular Insufficiency

Common

Reflux Time Greater Than 1.0 Second in Deep Vein

Significant venous reflux

Quantifying Reflux During US Assessment

Automatic cuff, Valsalva, Parana maneuver, hand compression, reverse flow >0.5s for superficial, >1s for deep and >0.35s for perforators

Diagnostic Modality for CVVI

Duplex

Therapeutic Anticoagulation Offered when DVT is Identified with SVT

Yes when SVT is confirmed with DVT therapeutic anticoagulation is offered

SVT thrombus <5cm Therapeutic Anticoagulation

Therapeutic anticoagulation would be considered such as topical or system NSAIDs

Most Common Reason for Secondary Venous Thrombosis in Upper Limbs

Associated with central venous catheters and often related to aneurysm

Forearm Veins Not Routinely Evaluated During Duplex Testing

EJV, radial veins, ulnar veins

Primary Venous Thrombosis Due to Subclavian Vein Compression

Paget-Schroetter Syndrome or Effort Thrombosis

Acute Thrombus

Enlarged veins compared to contralateral side, incompressible, echogenic thrombus may fill the lumen partially or completely, thrombus: smooth surface, soft, deformable with pressure

Chronic Post-Thrombotic Change

Diminutive diameters: rigid, nondeformable, fibrous strands or webs within the lumen and veins may be tortuous, collateral veins enlarge over time with maintained compressibility, valves may be thickened

Deep vs Superficial Veins in Upper Extremity

Deep veins: travel within deep muscular components, companion vessel to an artery. EX: radial, ulnar, brachial, axillary, subclavian, brachiocephalic Superficial veins: located above muscular components, runs in superficial fascial layers, no associated artery. EX: basilic vein, cephalic vein, axillary vein, subclavian

Components of Virchow’s Triad in Upper Extremity Thrombosis

Venous stasis, hypercoagulability, and vessel wall injury

Common Sign or Symptom of Upper Extremity Venous Thrombosis

Unilateral arm or hand swelling, superficial palpable cord, erythema, pain and tenderness

Common Treatment Option for Upper Extremity Venous Thrombosis

Anticoagulation, catheter removal, thrombolytic therapy, surgical decompression of the thoracic inlet

Popliteal Entrapment Syndrome Demonstrated with US

Increased PSV with active plantar or dorsiflexion

Common Indications for Lower Extremity Duplex US for Arterial Disease

a) Intermittent claudication b) Rest pain c) Nonhealing ischemic ulcers d) Gangrene e) Hair loss, skin thinning, nail thickening f) Pallor, pulselessness, paresthesia, paralysis, pain g) Palpable pulsatile mass

Velocity Ratio Indicating Hemodynamically Significant Stenosis

Greater than 4

Waveform Pattern Indicating Severe Arterial Disease

Monophasic waveform

Advantages of Duplex Arteriography Over Contrast Arteriography

Non invasive and able to assess blood flow and characteristics better

Raynaud’s Syndrome

Idiopathic vasospasm of digital arteries, triggered by cold or stress

Takayasu’s Arteritis Affection

Aortic arch and its branches

Thoracic Outlet Border

Anterior scalene muscle

Focal Increase in PSV with Loss of Multiphasic Waveform

Severe stenosis

Primary Purpose of Duplex US Evaluation of Arterial Bypass Grafts

Post operative follow up

Common Cause of Early Vein Graft Failure

Acute thrombosis

% of PAD caused by Atherosclerosis

90%

Sonographic Feature of Giant Cell Arteritis

Anechoic “halo”

Takayasu’s Arteritis Affects

The aorta arch and its branches

Buerger’s Disease Affects

Small and medium sized arteries, digital vessels

Radiation-Induced Arteritis Distinguished from Atherosclerosis

Concentric wall thickening, increased PSV, normal adjacent arterial segments

Secondary Goal of Examination of the Extracranial Carotid Artery System

To identify patients at risk for stroke

Transducer Used to Perform Duplex Evaluation

12-3 MHz linear array

2-Week History of Intermittent Blindness

TIA

Patient's Head Position to Expedite Carotid examination

Head rotated 45 degrees away from side being examined with a pillow under shoulders

Technique Used to Identify the Vertebral Artery

View the vertebral processes and angle the transducer medially.

Term Discouraged When Qualifying the Appearance of Plaque

ulcerated

Change Expected in the Doppler Waveform As Plaque Develops

disappearance of normal flow separation

NOT Result in Symmetrical Changes in the Doppler Spectra

subclavian steal

Change to High-Resistance Pattern

distal stenosis or occlusion

Reactive Hyperemia Used to Demonstrate

a change from latent or partial to complete subclavian steal

NOT Sound Advice for Sonographers to Prevent Repetitive Stress Injuries

Avoid doing stretching exercises.

NOT a Characteristic of Normal Doppler Waveform

increased spectral broadening

display a contour suggestive of relatively low-resistance

70% of its flow supplies the ICA.

disease progresses to near occlusion

string sign flow

FALSE statement on power Doppler

It depends on the angle of insonation.

severe distal CCA obstruction

string sign lesion

peak systolic velocities noted to be 532 cm/s

80% to 99% stenosis

subclavian steal syndrome or phenomenon to occur

the left subclavian artery or brachiocephalic artery proximal to the vertebral artery origin

affect pulsed Doppler spectrum contour in all vessels of the extracranial cerebrovascular

all of the above

external carotid artery reached 250 cm/s

80% stenosis

pulsatile mass at the base of the neck

the proximal common carotid

flow in a secondary lumen created by a tear or dissection

same direction of flow as in the true lumen

likely source of the symptoms in patients under 50 years of age

dissection of one of the carotid vessels