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Adv. Vas. Son.
Test 3 Abdominal Doppler Aorta
| Question | Answer |
|---|---|
| Where does the Abdominal Ao begin? | At the level of the 12th thoracic vertebra (passes through the aortic hiatus) |
| What is the Celiac artery (Celiac axis) | First major anterior branch of the aorta, Gives rise to hepatic, splenic, and left gastric arteries |
| What is the Superior Mesenteric Artery (SMA)? | Next anterior branch of the aorta, Arises just below the celiac artery |
| Renal arteries facts: | Lateral branches of aorta, Arise just below the SMA, Right renal A is longer and slightly thinner than left, Right renal A courses posterior to the IVC, Both renal As approach kidney posterior to renal Vs |
| What are the risk factors for developing an Abdominal Aortic Aneurysm (AAA)? | Smoking, Genetic, Increasing age, Male, High cholesterol, Obesity |
| The Male gender is ______ times more likely to develop AAA than women? | 5 times more likely |
| AAA may occur with what? | Atherosclerotic disease |
| What is an important modality for evaluation of the Ao? | Color duplex ultrasonography (CDU)- Used extensively for detection AAA, Has excellent correlation w/ arteriography in the detection of aorto-iliac atherosclerotic disease |
| What does CDU provide? | Anatomic and Physiologic information, Also noninvasive, nontoxic, and well tolerated by PTs |
| Incidence of AAA is what? | 60 per 100 |
| AAA facts: | 12th leading cause of death, ~15,000 deaths annually from rupture, Only 10-25% of PTs survive an aneurysmal rupture, AAAs occur more frequently in older men, Mostly located inferior to renal arteries (~90%), Commonly associated w/iliac, fem, & pop As |
| What are the indications for aorto-iliac duplex exams? | Pulsatile abdominal mass, Suspected/known Ao/iliac aneurysms, Back/adbominal pain, Claudication/ischemic rest pain, Decreased fem pulses or abdominal bruit, Blue toe syndrome, Suspected inflow disease, Follow-up exam |
| Most intact aortic aneurysms do not what? | Produce symptoms |
| What is blue toe syndrome? | Emboli in ischemic digits |
| Patients should what? | Fast overnight (8-12 hrs), Minimizes scatter & attenuation from bowel gas, PTs can take morning medication w/ H20, No gum or smoking |
| What position should the PT be in for an abdominal scan? | Supine |
| What TDs are most utilized? | 2-5 MHz curved linear most commonly used, 2-4 MHz sector phased array also helpful |
| Transverse images with diameter measurements are documented from where? | Prox aorta (near diaphragm), Mid-aorta (near renal As), Distal aorta (above bifurcation) |
| What is important to note about an aneurysm? | Length, Proximity to renal As, Extension into iliacs, Presence & extent of intraluminal thrombus, Residual lumen |
| What is also important to document about AAA? | Dissection, intimal flaps, or other wall defects, Pseudoaneurysms, Stenosis &/or occlusion w/ characterization of any plaque visualization |
| Spectral Doppler facts: | use 60 degrees or less, Parallel to vessel wall, Sample volume placed center stream |
| Where should PSV be recorded? | Prox, Mid, and Distal aorta |
| What should you not do with spectral waveform or color flow in abdominal studies? | DO NOT INVERT |
| NORMAL Aortic findings? | <2-3cm diameter, Ao tapers as it courses distally, Smooth walls W/ well defined margins |
| Doppler signal resistance for Prox Aorta: | Typically has more diastolic than distal due to visceral organ branches, Slightly lower resistance than distal Ao (below renals) |
| Doppler signal resistance for Iliacs: | High resistance, triphasic |
| AAA facts: | Ectasia, Ao diameter >2cm but<3cm, or irregular margins and nontapering profile |
| Diameter of >3cm is consistent with what? | Aneurysm or focal diameter increase by more than 50% of normal segment |
| True aneurysms involve what? | All three layers of the vessel wall |
| AAA most commonly involve what? | Distal Aorta (infrarenal), 90% of AAA occur below renals |
| Aortas should always do what as you move distally? | Taper, if it increases be suspicious of an aneurysm |
| Fusiform aneurysm facts: | Bulging which involves entire circumference of Ao, Most common type of aneurysm, All three layers expanded out |
| Saccular aneurysm facts: | ASX out-pouching dilations, Often caused by trauma or penetrating aortic ulcers |
| Iliac Artery Aneurysm facts: | Diameter ↑s by 50% when compared to normal segment, Iliac considered aneurysm with diameter >1.5 cm, Usually associated w/ atherosclerotic disease, Often bilateral |
| Aneurysm complications: | Rupture, Thrombosis/Embolus, Hydronephrosis, Bladder compression |
| Aneurysmal rupture facts: | Larger the aneurysm the greater the risk (especially over 5 cm), High mortality rate w/aortic rupture, Males over 60 y/o are the highest risk group |
| What is hydronephrosis? | Due to compression of ureter, fluid backup into kidney b/c it's sitting on the kidney |
| Wall defects: Dissection/Intimal tear: | Can protrude into vessels lumen and cause stenosis or occlusion (Hematoma forms with the wall of aorta), W or W/o aneurysm, Tear between layers of vessel wall, Associated with 2 flow channels |
| Stenosis or occlusion: | Thrombus, plaque and/or calcification may be present |
| How might plaque appear? | Heterogenous, or homogenous with smooth or irregular borders |
| How will calcifications appear? | Hyperechoic areas with shadowing |
| How will a thrombus appear? | Hmogenous with smooth borders (often found within aneurysm) |
| >50% stenosis is consistent with what? | Increase in vel of 100% (doubling) and asses presence of poststenotic turbulence, Distal waveform changes (dampened systolic compeonent and loss of reversal component) |
| What should stents be evaluated for? | Alignment, Full deployment, Relationship to vessel wall, Stent procedures have significant restenosis rates |
| Endovascular Aortic Stent Graft Repair (EVAR) | Less invasive alternative for AAA repair, Lower incidence of perioperative mortality, Improved survival &recovery rates, Involves placement of stent graft device w/in aortic aneurysm sac (catheter based procedure), Excludes aneurysm from general circ. |
| Endovascular treatment of abdominal aortic aneurysm (EVAR) involves what? | The percutaneous placement of a thin Teflon covered stent graft w/in the Ao aneurysm. Graft anchored @ each end by stents against the normal vessel wall. |
| With EVAR what is reduced? | The risk of aneurysm rupture, thrombosis, and embolization appears to be significantly reduced. |
| Is the EVAR a major or minor procedure? | EVAR is a relatively minor procedure requiring much less recover time and a shorter hospital stay compared to AAA resection |
| EVAR PTs require what? | Close surveillance post-procedure |
| What is Endoleak? | Flow present within aneurysm sac after intervention (4 different kinds) A common complication of EVAR, Presence can ↑ pressure in aneurysm sac, continuing to make rupture a risk |
| When doing an EVAR scan what should be measured? | The distance from the SMA to Prox attachment site should ne measured for detection of migration |
| What is the most common EVAR device? | Bifurcated type |
| What is visualized in an EVAR? | Graft material and metal struts are visualized (may be seen above renal arteries in some cases) |
| For EVAR aortic diameter is measured where? | Above proximal attachment site to assess for dilatation of aneurysm neck |
| For EVAR where are diameter measurements taken? | Throughout length of aorta, taking care to be perpendicular to walls (residual sac diameters are important to follow, Vessel can be tortuous) |
| What should be noted with EVAR? | Residual sac characteristics (Areas of hyperechogenicity can be evidence of endoleak) |
| EVAR diagnosis: | Residual sac size should ↓ over time, Any ↑ in sac size, pulsatility of sac or areas of echolucency in sac are suggestive of endoleak, Residual sac that appears "spongy" (heterogenous w/hypoechoic areas) w/ an ↑ in sac size = endoleak |
| What should the flow pattern be for an EVAR? | Multiphasic (high resistance) |
| Hoe many types of endoleak are there? | 4 |
| What is the 1st type of endoleak? | Type I- inadequate or ineffective seal at attachment site |
| What is the 2nd type of endoleak? | Type II- retrograde flow in branch vessel (lumbar, inferior, mesenteric, accessory renal, internal iliac arteries) |
| What is the 3rd type of endoleak? | Type III- modular disconnection or defect in graft fabric |
| What is the 4th type of endolek? | Type IV- Porous graft or microleak in graft material |
| Endoleak definition? | an inadequate seal of the proximal or distal wall that allows blood flow into the perigraft region. Or, from back flow from the inferior mesenteric artery (IMA) or lumber arteries.This can increase the size of the aneurysm. |
| What is perigraaft leaks? | Reproducible arterial wavefroms DIFFERENT from flow w/in endograft, Determine source, Identify flow direction in any visible branch vessels |
| What is Endotension? | Aneurysm continues to expand due to persistent or recurrent pressurization in the absence of endoleak |
| What to do to help identify endoleaks? | Change PT position from supine to left & right lateral decubitus, Optimize color settings (↓ PRF, &↑persistence &gain) Use power Doppler |
Created by:
EmilyGriffin
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