Mesenteric Arteries Multiple choice and fill in blanks

What is the first major branch arising from the abdominal aorta

celiac artery

What is the most common indication for mesenteric artery duplex evaluation

chronic mesenteric ischemia

How many mesenteric arteries are typically involved in atherosclerotic occlusive disease before a patient become symptomatic

2

When does the abdominal pain many patients feel, which is associated with chronic mesenteric ischemia, typically occurs

after eating

Because of the abdominal pain, which of the following do patients often experience

fear of food and weight loss

Which of the following is a collateral system that is present in the mesenteric vascular system.

Pancreaticoduodenal arcade

Arc of Riolan

Internal iliac to inferior mesenteric artery connections

All of the above

all of the above

From which vessel does a replaced right hepatic artery originate most often

superior mesenteric artery

With a patient in a fasting state, what should the superior mesenteric artery exhibit

high-resistance flow pattern

Standard criteria for determining velocity thresholds for identifying stenosis in the celiac and superior mesenteric arteries were determined with the patient in what state

fasting

Which of the following vessels does the term "seagull sign" describe

celiac, hepatic, and splenic arteries

What should Doppler waveforms obtained from the celiac, splenic, and hepatic arteries demonstrate

low-resistance flow

During a mesenteric artery evaluation, retrograde flow is noted in the common hepatic artery. What does this finding suggest.

celiac artery occlusion

Which technique can NOT be used positively identify and differentiate the celiac and superior mesenteric vessels

Visualizing aliasing with color flow in the superior mesenteric artery

What can turning color flow imaging off help identify

Arterial dissection

Characterization of atherosclerotic plaque

Stent placement within the vessel

All of the above

all the above

During duplex evaluation of the mesenteric vessels, the SMA is noted to have velocities of 350 cm/s proximally with velocities of close to 300 cm/s in the mid-segment. No spectral broadening or turbulence is noted. With which of the following are these findings consistant.

Compensatory flow through the SMA likely caused by occlusion of the celiac artery

Which of the following describes the velocity criteria for diagnosis of >70% in the celiac and superior mesenteric arteries

>200 cm/s PSV in the celiac and >275 cm/s PSV in the superior mesenteric artery

Why may standard duplex ultrasound velocity criteria for mesenteric vessels NOT be accurate after treatment by stent placement

Velocities in treated vessels are typically higher than standard criteria

What is transient compression of the celiac artery origin during exhalation, which is relieved by inhalation

median arcuate ligament compression syndrome

Visceral artery aneurysms are rate; however, the greatest incidence of aneurysms occurs in which of the following vessels

splenic artery

What is the general role of the vascular laboratory in the diagnosis of acute mesenteric ischemia

No role due to the emergent nature of the illness

The celiac artery is best visualized with the transducer oriented in a ________________ plane, whereas the superior mesenteric artery is best visualized with the transducer oriented in a ________________ plane.

Transverse, Longitudinal

The diagnosis of chronic mesenteric ischemia is often ________________ because the disorder is rare and the symptoms may be due to a vast number of abdominal disorders.

overlooked

Postprandial abdominal pain that occurs when there is insufficient visceral blood flow to support the increased oxygen demand required by intestinal motility, secretion, and absorption is often termed ________________.

Chronic mesenteric ischemia

The inferior mesenteric artery arises from the aorta just proximal to the ________________.

Aorta bifurcation

A replaced right hepatic artery originating from the superior mesenteric artery should be suspected when the SMA demonstrates a ________________ flow pattern.

low resistance

It is critically important for the patient to fast for at least 6 hours prior to mesenteric artery evaluation because the superior mesenteric artery changes dramatically from ________________ resistance to ________________ resistance after eating.

high; low

When performing spectral Doppler and high velocities are noted in a mesenteric artery, it is important to document ________________ to confirm a flow-limiting stenosis.

post stenotic turbulence

The term “seagull sign” refers to the sonographic appearance of the ________________ artery and its branches, the ________________ and ________________ arteries.

celiac, hepatic, splenic

The celiac artery and its branches typically display and ________________ resistance flow pattern, whereas the superior and inferior mesenteric arteries demonstrate a ________________ flow pattern.

low; high

A technique that can be used to decrease movement of mesenteric vessels and help capture Doppler waveforms with a correct angle is to have the patient ________________.

pause breathing

In the presence of celiac artery occlusion, the common hepatic artery almost always demonstrates ________________ flow.

retrograde

An important technique to use when evaluating the mesenteric vessels that can help detect vessel wall abnormalities or vessel tortuosity is to inspect the image with ________________ imaging only.

B-mode

In preparation for a duplex scan after mesenteric revascularization, the ________________ note will detail the location of the proximal and distal anastomoses and type of graft or other intervention.

operative

When following-up on a mesenteric bypass graft, if the PSV is >300 or <50 cm/s, it is recommended to ________________ the time between surveillance scans.

decrease

Increased velocities in the absence of stenosis could be the result of ________________ flow.

compensatory

According to one study, a PSV in the celiac artery of >200 cm/s and a PSV in the SMA of >275 cm/s corresponded to a stenosis of less than ________________ %

70

According to one study, when end-diastolic velocities are used as thresholds for >50% stenosis the corresponding velocities are ________________ cm/s in the celiac artery and ________________ cm/s in the superior mesenteric artery.

55, 45

Recent studies suggest velocity guidelines for IMA stenosis, with a PSV of greater than 200 to ________________ cm/s corresponding to a >50% stenosis.

250

Percutaneous visceral artery intervention has lower morbidity/mortality rates than traditional surgical repair; however, it is associated with higher ________________ rates and the requirement for re-intervention.

Restenosis

An advantage of using duplex ultrasound to evaluate median arcuate ligament compression syndrome is that Doppler waveforms can be obtained during changes in ________________

Respiration

Splenic artery aneurysm, when discovered during pregnancy, is associated with a 95% ________________ rate, leading to high maternal and fetal mortality.

Rupture

Visceral artery dissections are most common in the ________________ and are often extensions of aortic dissection.

SMA

In patients with suspected MALS, if velocities fail to normalize with inspiration, the patient can be put in a ________________ position.

standing

Embolus to or thrombosis of the mesenteric arteries can lead to ________________.

Acute mesenteric ischemia

Symptoms associated with the above mentioned pathology are typically described as pain ________________ to physical findings.

out of proportion