Vascular Ultrasound Registry Review: Arterial, Venous, and Cerebrovascular

What is the origin of the right subclavian artery?

It originates at the innominate (brachiocephalic) artery.

What does the subclavian artery become at the outer border of the first rib?

It becomes the axillary artery.

What are the branches of the abdominal aorta?

1st: Celiac trunk, 2nd: Superior mesenteric artery (SMA), 3rd: Renal arteries.

What is the significance of the 'seagull sign' in ultrasound?

It indicates the transverse view of the celiac trunk and its branches.

Where does the aorta bifurcate?

It bifurcates into the right and left common iliac arteries.

What is the function of the internal iliac artery?

It provides blood to the pelvis, pelvic muscles, and organs.

What does the external iliac artery become at the inguinal ligament?

It becomes the common femoral artery.

What is the trifurcation of the popliteal artery?

It bifurcates into the anterior tibial artery and the tibioperoneal trunk, which further bifurcates into the posterior tibial artery and peroneal artery.

What anatomical landmarks help identify the left renal artery?

The left renal vein crosses posterior to the SMA and anterior to the aorta.

What are the layers of a blood vessel?

Intima (innermost), media (thickest), and externa/adventitia (outermost).

What is hemodynamics?

The study of blood movement through the circulatory system, influenced by pressure gradient and resistance.

What is the relationship between pressure gradient and blood flow?

A greater pressure gradient results in greater blood flow.

What happens to blood flow during systole?

Blood is ejected from the heart, creating a high pressure that drives flow.

What is Poiseuille's Law?

It describes the relationship between resistance, pressure gradient, and flow in a vessel.

What factors determine resistance in blood vessels?

Vessel size, length, diameter, blood viscosity, and external forces on the vessel.

How does vessel diameter affect blood flow?

Decreasing diameter increases resistance and decreases flow; flow is directly proportional to diameter.

What is the role of arterioles in blood flow regulation?

Arterioles can change size to adjust resistance and meet the demands of the vascular bed.

What is the anatomical position of the renal veins relative to the renal arteries?

Renal veins run anterior to the renal arteries.

What is the definition of 'relational anatomy' in vascular ultrasound?

It describes the positional relationships of structures in the body, such as anterior, posterior, superior, and inferior.

What is the significance of the common femoral artery?

It is the continuation of the external iliac artery and bifurcates into the superficial and deep femoral arteries.

What is the function of capillaries in the circulatory system?

Capillaries are the sites of microcirculation and have walls that are one cell layer thick.

What is the primary driving force behind blood flow?

The pressure gradient, which is the difference in pressure from high to low.

How does hydrostatic pressure affect blood flow in different positions?

In a supine position, hydrostatic pressure is uniform; in standing, it increases at the ankle due to gravity.

What is the significance of the deep palmar arch?

It is the termination point of the radial artery.

What is the anatomical term for 'closer to the front of the body'?

Anterior.

What does the term 'proximal' refer to in vascular anatomy?

Closer to the heart or the point of origin.

What is the anatomical term for 'away from the heart'?

Distal.

What is the effect of vaso-constriction on vessel radius and resistance?

Vaso-constriction results in a smaller radius and higher resistance.

What is the effect of vaso-dilation on vessel radius and resistance?

Vaso-dilation results in a larger radius and less resistance.

How does diastolic flow indicate resistance in blood vessels?

High resistance is indicated by little or no diastolic flow, while low resistance shows more diastolic flow.

What physiological factors can cause vaso-dilation?

Vaso-dilation can occur due to heat, stress, exercise, and smoking.

What is the Law of Conservation of Mass in relation to blood flow?

It states that when vessel size decreases and volume is constant, velocity must increase.

What does the Bernoulli Effect describe?

The relationship between pressure and velocity when the radius of a vessel changes; pressure and velocity are inversely related.

What is laminar flow?

Normal flow that moves in concentric streamlines or layers, seen as organized and indicated by a clear spectral waveform.

What is turbulent flow?

Abnormal, disorganized flow characterized by disturbed patterns and eddies, often occurring distal to stenosis.

What is the critical value of Reynolds number that predicts turbulent flow?

A Reynolds number greater than 2000 indicates turbulent flow.

How does stenosis affect blood flow proximal to the obstruction?

Proximal to stenosis, there is a decrease in diameter which increases resistance, resulting in a high resistance waveform.

What happens to blood flow at the site of stenosis?

At the stenosis, there is an increase in peak systolic velocity (PSV) and end diastolic velocity (EDV) due to decreased area.

What is 'post-stenotic turbulence'?

Turbulent flow patterns that occur after stenosis when the vessel diameter is larger but velocity is increased.

What are the symptoms of moderate chronic peripheral arterial disease?

Claudication, which is pain and muscle fatigue during activity, relieved by rest.

What is rest pain in the context of severe chronic peripheral arterial disease?

Pain in the feet and heels at night or when the limb is at heart level, relieved by dependency.

What physical signs indicate severe chronic peripheral arterial disease?

Trophic changes, pale skin, cool to touch, dry ulcers, diminished pulses, dependent rubor, and delayed capillary filling.

What are the 6 P's of acute arterial occlusion?

Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia.

What is the most common type of arterial disease?

Atherosclerosis, characterized by hardening and thickening of the arterial wall.

What are the risk factors for chronic peripheral arterial disease?

Diabetes, hypertension, hyperlipidemia, smoking, age, family history, and male gender.

What does 'tardus parvus' indicate in vascular assessment?

A monophasic, continuous waveform with a rounded peak and slow upstroke, indicating proximal disease.

What is the significance of a bruit in vascular assessment?

A bruit indicates high velocity turbulent flow but does not definitively confirm disease.

What are the classic signs of thrombosis in a vessel?

Pain, pallor, polar, pulselessness, paresthesia, paralysis.

What is an embolism?

An air, liquid, or solid that travels and lodges distally, often originating from the heart.

What condition is characterized by blue toe syndrome?

Embolism, typically affecting the big toe.

What is primary Raynaud's phenomenon?

A functional disease in young women with bilateral symptoms, causing vasospasm when cold or stressed.

What differentiates secondary Raynaud's from primary Raynaud's?

Secondary Raynaud's is caused by an underlying condition and is often unilateral, with symptoms worsening in cold conditions.

What is Takayasu arteritis?

An inflammation of the vessel wall affecting larger vessels like the aorta, commonly seen in young Asian women.

What is Buerger's disease?

Also known as thromboangitis obliterans, it affects young male smokers and the smallest distal vessels, causing symptoms like rest pain and gangrene.

What defines a true aneurysm?

Dilatation of all three layers of the vessel wall, often presenting with a bounding pulse.

What is the most common cause of abdominal aortic aneurysms (AAA)?

Atherosclerosis.

What is a false aneurysm?

Not all three layers are dilated, leading to a high risk of rupture, often seen in the thoracic aorta.

What is a pseudoaneurysm?

A pulsating hematoma resulting from a puncture of all three layers, often post-procedure.

What is coarctation of the aorta?

A congenital narrowing of the aortic arch, leading to diminished pulses and hypertension in younger individuals.

What is popliteal entrapment?

Compression of the popliteal artery by the gastrocnemius muscle, often seen in younger athletic men.

What is thoracic outlet syndrome?

Compression of nerves or blood vessels by the shoulder, ribs, and muscles.

What is compartment syndrome?

Compression of an artery by swelling trapped inside fascia, commonly in the anterior tibial region.

What are the key components of arterial testing?

Capabilities and limitations, physical principles, technique, and interpretation.

What is the difference between qualitative and quantitative testing?

Qualitative assesses quality, while quantitative measures specific metrics like velocities and indices.

What does CW Doppler analysis assess?

Presence/absence of arterial occlusive disease and approximate level of disease.

What are the normal and abnormal waveforms in CW Doppler?

Normal: Triphasic or Biphasic; Abnormal: Monophasic or continuous.

What does an increase in pulsatility index (PI) indicate?

Resistance increases as you go down the limb; a drop in PI suggests disease between levels.

What is the Ankle/Brachial Index (ABI) used for?

To assess the presence of arterial disease by comparing ankle pressure to the highest brachial pressure.

What ABI value indicates severe arterial disease?

An ABI of less than 0.5 indicates severe disease with rest pain.

What is the purpose of exercise testing in vascular assessments?

To produce physiological stress on circulation and distinguish true claudication from pseudo claudication.

What does reactive hyperemia testing assess?

It induces ischemia and measures the body's ability to vasodilate in response to cut-off flow.

What is hyperemia in the context of vascular testing?

Hyperemia refers to an increase in blood flow, which is observed when the cuff is released after being inflated.

What is the normal response of ankle pressures after cuff release?

A transient drop in pressure that returns to resting levels within 1 minute, with a drop of less than 34%.

What indicates an abnormal response in ankle pressures after cuff release?

A significant drop in pressures, with a drop of less than 50% indicating single-level disease and greater than 50% indicating multi-level disease.

What is the purpose of the Allen test?

To evaluate the patency of the palmar arch and assess the usability of the radial artery for surgical modifications.

What is the interpretation of a normal Allen test?

Color returns to normal after releasing pressure on the radial artery.

What does a 50% drop in pressures during the Allen test indicate?

An incomplete palmar arch.

What is plethysmography used for in vascular testing?

To evaluate functional aspects of disease, though it is not vessel specific and can underestimate disease severity.

What is the technique for performing plethysmography?

Using pneumatic cuffs to detect changes in volume, with the cuff inflated to 40-65 mmHg.

How is plethysmography interpreted?

Qualitatively, based on waveform contour; a change in contour between levels indicates disease.

What does a high amplitude PVR contour with abnormal pressures suggest?

Severe disease with collateral development.

What is the significance of the Penile/Brachial Index (PBI)?

A normal PBI is ≥ 0.65; abnormal PBI indicates disease isolated to internal iliac vessels.

What does a normal TcPO₂ reading indicate?

A reading greater than 50 mmHg suggests good wound healing potential.

What is Leriche syndrome?

Terminal aorta obstruction leading to impotence and claudication in the hip and thigh.

What is the technique for evaluating compression disorders like popliteal entrapment syndrome?

PPG on toes during plantar flexion and dorsiflexion to assess waveforms.

What is the normal interpretation of pressures in the Allen test?

Normal resting pressures and waveforms indicate no obstructive disease.

What is the purpose of duplex ultrasound in vascular testing?

To localize stenosis, occlusion, or aneurysm and for hemodialysis access graft surveillance.

What are the two types of hemodialysis access grafts?

Autologous (e.g., Brescia-Cimino) and synthetic (e.g., straight or looped grafts).

What is the significance of a thrill during hemodialysis access evaluation?

A thrill indicates high velocity, turbulent flow, suggesting a patent graft.

What is the interpretation of stenosis in duplex ultrasound?

Stenosis is qualitatively assessed without specific velocity criteria.

What does a drop in pressures and dampened waves indicate in digital pressure testing?

Fixed arterial disease.

What is the difference between primary and secondary Raynaud's phenomenon?

Primary Raynaud's shows normal resting waves and pressures, while secondary shows dropped pressures and dampened waves.

What is the role of PPG in digital pressure testing?

To obtain digital pressures and assess pulsation return.

What does a normal Finger-Brachial Index (FBI) indicate?

A normal FBI is greater than 0.8.

What is the interpretation of abnormal pressures in the context of vascular disease?

Abnormal pressures indicate proximal disease relative to the lower pressure.

What does a drop of 20 mmHg or more between consecutive vertical levels indicate?

Disease between those levels.

What does the term 'obstructive disease' refer to in vascular testing?

A condition where arterial disease decreases pressures and affects blood flow.

What is the normal characteristic of hemodialysis waveforms in the proximal artery?

Low resistance with increased end-diastolic velocity (EDV).

What indicates a graft occlusion in a fistula graft?

Thumping high resistance in the proximal artery or graft.

What does low velocity dampened continuous flow suggest in a graft?

A proximal inflow problem.