VASC 4 FINAL REVIEW

How do you describe acute thrombus?

- Can be lightly echogenic or hypoechoic (can make it challenging to see) - Poorly attached making it more likely to embolize - Vein can appear extended/dilated (has appearance of being soft and spongy)

Be able to recognize and describe a pseudoaneurysm.

- Dilation of an artery with disruption of one or more layers of vessel wall causing a false lumen. - Must have a neck - May form at endarterectomy site or anastomotic site of carotid bypass graft - Yin/yang appearance

What causes arterial disease? (5)

- Mechanical obstruction (Throacic outlet syndrome TOS) - Embolism (obstruction of an artery, typically by a blood clot or an air bubble) - Trauma - Digital artery vasospasm (Raynaud Disease) - Digital artery occlusion

How do you describe chronic thrombus?

- Usually more echogenic or hypoechoic thrombus - Well attached to vessel walls - Rigid texture of a thrombus - Can contract the vein - Can present with large collaterals

What are the 3 components of virchow's triad?

- Venous stasis - Hypercoagulability - Vessel wall injury

What is the velocity ratio for stenosis in a bypass graft?

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Understand dialysis fistulas and grafts in regards to: Digital pressures, mapping for a fistula, hemodialysis access location, autogenous grafts, fistula volume, normal PSV of fistula, maturation time of fistula

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Understand the relationship between the diameter of the vessel lumen and the velocity

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Starting with the right side, what are the vessels off the aortic arch?

1. Brachiocephalic Artery 2. Left CCA 3. Left Subclavian

What are the blood vessel wall layers?

from inner --> outer: tunica intima, tunica media, tunica externa/adventitia

What is sensitivity?

measures the proportion of actual positive studies that are correctly identified. + The ability to correctly identify disease when disease is truly present

What connects the cephalic and basilic veins? *Q1

median cubital vein

What is a normal type of waveform for peripheral arteries? *Q1

multiphasic

What are true negatives?

number of studies performed by ultrasound in which disease is NOT present and agree with the gold standard

What are true positives?

number of studies performed by ultrasound, which state that disease is present and agree with the gold standard (REALLY POSITIVE)

Direction of flow (ADD)

refer to SG

Understand & know the waveforms for UE vessels

refer to SG

What is the role of arterioles?

smallest of the vessels to carry blood away from the heart "stopcocks" of the vascular system

How do you calculate sensitivity?

taking true positives and dividing these true positive results as determined by gold standard

What is accuracy?

the percentage of correct results overall.

What landmark can be used to distinguish the axillary from the subclavian vein? *Q1

the termination of the cephalic vein

What is the main difference between chronic and acute thrombus?

time chronic: over a couple of weeks acute: less than 14 days

What is the most common cause of thrombus in UE? *Q1

vessel wall injury (caused by introducing needles, catheters in the veins)

Which arteries make up the Y view?

Innominate CCA Subclavian

Know how to identify the Upper extremity arteries/veins (what side they are on/location)

Innominate Subclavian Axillary Brachial (midline/medial) Basilic (medial) Cephalic (lateral) Median Cubital (midline/elbow) Ulnar (medial - pinky) Radial (lateral - thumb)

What correctly describes venous thrombus? *Q1

Intraluminal echoes of varying echogenicity

What is QA?

Quality assurance - program for systematic monitoring and evaluation of the various aspects of vascular testing to ensure that standards of quality are being met + statistics are used to prove the diagnostic accuracy of vascular ultrasound testing

Which veins travel the volar aspect of the wrist and are lateral? *Q1

Radial veins

Where does the axillary terminate?

The axillary terminates at the junction of the cephalic and subclavian veins

How does the waveform look like for a pseudoaneurysm?

To and fro flow

Which vessel is labeled F?

Ulnar vein

What is the gold standard?

Used to compare one form of newer diagnostic test with another well established and reliable test

In the upper extremity, what vessels are considered deep veins? *Q1

axillary, brachial, radial, and ulnar

What are the deep veins of the upper extremity? (4)

axillary, brachial, radial, ulnar

In this image of the upper extremity, distal humerus level; what are the three structures with color? What is the imaging plane? *Q1

brachial artery, dual brachial veins, transverse image

When imaging the brachial artery in trans how many veins should we see?

2 brachial veins, basilic vein w/ the brachial artery

Where are the arterioles located?

A terminal artery branching from the main artery that continues into the capillary network

Which vessel is labeled c?

Axillary vein

Which vessel is labeled B?

Basilic

Which veins do not have partners? why?

Basilic Cephalic Median Cubital + b/c they are superficial veins (only deep veins have pairs)

The upper extremity superficial vein coursing along the medial border of the biceps muscle is the.. *Q1

Basilic Vein

The upper extremity superficial vein coursing along the medial border of the biceps muscle is the:

Basilic Vein

Where does the brachial vein become the axillary vein at the confluence of which vein? *Q1

Basilic vein

In the upper extremity, what vessels are considered superficial veins? (2) *Q1

Basilic vein and cephalic vein

In the upper extremity, what vessels are considered superficial veins? *Q1

Basilic vein and cephalic vein

What is the relationship between the diameter of the vessel lumen and the velocity?

Bernoulli's Principle - Diameter decreases, velocity increases - Diameter increases, velocity decreases

In vascular imaging, what is typically the gold standard?

angiography, vascular ultrasound 100% of the time

Which veins are difficult to compress? What do we do instead of compress?

Brachiocephalic/innominate Subclavian + Sniff test OR deep breath with pursed lips

What is the typical landmark a sonographer uses to identify the IJV? *Q1

CCA

What are the parts of the UEV protocol?

CCA Innominate Subclavian Axillary Brachial Radial Ulnar

What are the parts of the UEA protocol?

CCA Subclavian Artery Axillary Artery Brachial Artery Radial Artery Ulnar Artery

T/F Chronic thrombus that is attached to vessel wall makes it more likely to embolize *Q1

False

Which vessel is labeled H?

IJV

How do you calculate accuracy?

calculated as the total number of correct tests divided by the total number of all tests

In order to evaluate the brachiocephalic and proximal subclavian vein better which technique could be used? *Q1

curvilinear 4 MHz Tx