Abdominal Vasculature

What's the largest artery in the body?

aorta

Where does the aorta originate?

at the left ventricle

when is the aorta considered the abdominal aorta?

once it passes thru the aortic hiatus of the diaphragm

is the aorta retro or intraperitoneal?

retroperitoneal

Aorta is ___ to the spine

anterior

Is the aorta on the right or left?

left

"You left your aorta at home"

Name the arteries & veins wall layers

tunica intima

tunica media (muscular layer)

tunica adventitia aka externa

Arteries have a __ tunica media

thicker

What's the first branch of the aorta?

celiac trunk

Celiac trunk is aka (2)

- celiac artery

- celiac axis

celiac trunk arises off the anterior aspect of aorta between..

crura of diaphragm

Celiac trunk branches into which 3 arteries?

- splenic

- common hepatic artery

- left gastric

Branching of the CHA and splenic artery off the celiac artery is what sonographic sign?

seagull sign / T-shape

Flow in the celiac artery characteristics (2)

continuous + forward

Splenic artery is tortuous. True or false?

true

splenic artery is __ to pancreas and may be confused with the __

superior

confused with main panc duct

Splenic artery should be low or high resistance?

low

common hepatic artery branches into ___ at the level of ____

- gastroduodenal artery

- level of panc head

After this point of branching, the common hepatic artery becomes the...

proper hepatic artery

proper hepatic artery enters at the ___ and becomes R & L hepatic arteries

porta hepatis

What branches from the right hepatic artery? what does it do?

the cystic artery, supplies the gb

hepatic artery waveform characteristics (2)

low resistance

hepatopetal

What is the 2nd branch of the aorta?

SMA

SMA supplies the (3)

small intestine

some colon

pancreas

SMA appearance on ultrasound

seen with echogenic fat surrounding it

SMA is __ to splenic vein and pancreas

posterior

SMA is ___ to SMV

left lateral

just like aorta to ivc

Left renal vein should be posterior to..

SMA

Left renal vein should be anterior to..

Aorta

SMA resistance when fasting vs postprandial

fasting: high resistance

postprandial: low resistance

What is the 3rd branch of the aorta??

renal arteriesw

Right renal artery travels __ to IVC

posterior

Which renal art is longer?

right

Lt renal art travels __to left renal vein

posterior

What resistance should renal arteries be?

low

What is the 4th branch of aorta?

gonadal arteries (ovary or testicle arteries)

Do you usually see gonadals with ultrasound?

no

Inferior mesenteric artery (IMA) supplies blood to (3)

- transverse colon

- descending colon

- rectum

IMA is usually only seen by ultrasound in what type of patient?

very slender patients

Aorta bifurcates near the umbilicus and becomes the..

right and left common iliacs

As you work your way down the abdomen, the aorta should get __ and __

smaller and more anterior

Normal measurements for prox, mid, distal aorta

prox - 2.5cm or less

mid - 2.0 cm or less

distal - 1.8cm or less

Normal measurements of the iliacs

8-10mm but should not exceed 2cm or it's aneurysmal

Prox aorta is ___ resistance

Mid and distal is ___ resistance

low

high

What is a true aneurysm?

involves all 3 layers of wall, MORE COMMON

AAA is diagnosed when the aorta exceeds

3cm

Most common AAA shape

fusiform (both sides bulge out)

What is a saccular AAA? due to.. appearance..

due to sudden dilation of vessel

one side bulges out

Most common location for AAA

infrarenal (below kidneys)

What is the most common cause of AAA in USA?

atherosclerosis

What may also cause an AAA? (4)

- Marfan syndrome

- syphilis

- genetic

- infection

What is an aneurysm called caused by an infection?

myocotic aneurysm

AAAs are asymptomatic or(5)

- pulsatile ab mass

- ab bruit

- back pain

- ab pain

- lower extremity pain

What is the true lumen vs false lumen in the presence of thrombus?

true - measurement includes thrombus

false = measurement excludes thrombus

What are 4 complications of AAA?

- distal embolism

- infection

- dissection

- rupture

What is treatment for an AAA?

endovascular aortic stent graft repair (EVAR)

How does a graft appear on US?

bright walls

__ results from failure of the graft to isolate the aneurysm from circulation. blood gets around the graft

endoleak

What are 3 types of EVARs?

- straight tube graft

- bifurcated tube graft

- uni-iliac graft

What should the waveform be in a graft? mono, bi, or tri

triphasic

__ is a separation of the layers of the arterial wall, disturbing the intima

Aortic dissection

How does aortic dissection appear on US?

linear line called intimal flap

5 symptoms of dissection

- intense chest pain

- hypertension

- ab pain

- lower back pain

- some neurologic symptoms

What condition is at an increased risk of dissection?

marfan syndrome

AAAs above __cm are at risk for rupture

7cm

2 signs of AAA rupture along with AAA symptoms

- hypotension

- decreased hematocrit

sonographic appearance of rupture

AAA with an adjacent hematoma

__ is a contained rupture of a blood vessel, secondary to disruption of one or more layers of the vessel wall

pseudoaneurysm / false aneurysm

4 potential causes of pseudoaneurysm

- IV procedures

- surgery

- trauma

- infection

Where is a common site for a pseudoaneurysm

within the groin at the femoral artery area

Sonographic appearance of pseudoaneurysm (3)

- perivascular hematoma with swirling blood

- ying yang sign (blue and red side by side)

- turbulent flow

2 treatment options for pseudoaneurysm

prolonged compression or thrombin

What's the largest vein in the body?

IVC

IVC is created by the union of __ and terminates at __

- common iliacs

- right atrium

IVC is retroperitoneal and on the __ side

right

IVC has the same wall layers as aorta but one difference...

tunica media is thinner

4 sections of IVC

hepatic, prerenal, renal, postrenal

IVC brings ________ blood to the heart

deoxygenated

What is the most superior portion of IVC?

hepatic veins -- rt, middle, lt

Hepatic veins characteristics (2)

pulsatile and triphasic

bc close to heart

__ is the occlusion of hepatic veins, possibly the IVC too

Bud-Chiari syndrome

Enlargement of the hepatic veins is seen with..

right sided heart failure

Which renal vein is longer?

left

the left renal vein courses __ to left renal artery and aorta

anterior

left renal vein goes __ to SMA

posterior

What is it called when the left renal vein travels posterior to aorta?

retroaortic left renal vein

Renal veins should be __ velocity and continuous

low

Gonadal arteries are called ___ based on gender

ovarian or testicular artery

Right gonadal vein dumps into...

Left gonadal vein dumps into...

right = into ivc directly

left = left renal vein

Where can you see the IVC vs where does it become difficult?

seen - prerenal and renal

not seen - post renal

IVC should not exceed ___ cm

2.5

Respiration can alter IVC size. What causes it to close vs enlarge?

sniffing/deep inspiration = close

prolonged inspiration = enlarge as blood builds up

IVC is ___ near heart and __ near iliacs

pulsatile near heart

phasic near iliacs

3 sono signs of IVC thrombus?

- IVC enlargement

- absence of flow

- material seen in IVC

acute vs chronic IVC thrombus appearance?

acute - anechoic, might be missed

chronic - echogenic, may calcify and shadow

What might be placed if IVC thrombus is present and at risk for PE?

IVC filter aka greenfield IVC filter

tumor invasion of IVC is seen with (3)

- RCC mostly

- TCC

- Wilms tumor

Which side is more likely to have IVC invasion?

right bc it is shorter

What's the most common cause of IVC enlargement?

right sided heart failure

Main portal vein is created by the union of..

SMV and splenic vein