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A comprehensive overview of vascular ultrasound principles, focusing on abdominal and cerebrovascular anatomy, physiology, and pathology. It covers key topics such as abdominal aorta waveforms, celiac artery supply, sma/ima waveforms, renal artery characteristics, portal vein formation, and hepatic vein flow. Additionally, it delves into aaa classification, endoleak types, mesenteric ischemia, and various cerebrovascular conditions like ischemic stroke, tia, and vertebral basilar insufficiency. The document also includes information on plaque descriptions, carotid exams, and arterial palpitations, making it a valuable resource for medical students and professionals in vascular imaging. Useful for university students.
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Abdominal Aorta waveform(s) Low resistance proximal, Higher resistance beyond renals Celiac Artery supplies Liver, spleen, stomach, & proximal small bowel Branches of the Abdominal AO 1st major-Celiac artery (trunk/axis) 2nd major-SMA Renals 3rd major-IMA (after renals) Celiac Axis
Branches into Common Hepatic (to right), Splenic, & Left Gastric (off left) Common Hepatic Arteries Gives rise to the Gastroduodenal artery in PANC head & divides into Rt & Lt Hepatics Splenic Artery Branches left and posteriosuperior to PANC body/tail SMA/IMA waveforms High resistance preprandial/Low resistance postprandial SMA supplies Bowel from duodenum to prox small bowel IMA supplies Bowel descending & rectosigmoid colon Right Renal Artery
Left Renal Vein Longer than Rt.; Receives suprarenal/Gonadal vein Left Renal pathway Anterior to AO; Posterior to SMA Right Renal Vein No tributaries; shorter Hepatic Veins Hepatofugal flow; from liver to IVC Patient status for Abdominal Vascular Imaging NPO 8-12 hours Ectasia Local diameter increase with small bulge (20% increase for Ao <3cm)
AAA growth rate 1 - 2mm/year until 3-4cm; 5 mm/yr >4cm Aneurysm classification 2 - 3cm; 3-4cm for AAA AAA Intervention 5.5cm (high risk for rupture-catastrophic) Fusiform Concentric enlargement; All 3 layers intact Saccular Eccentric enlargement; All 3 layers compromised; Less common (<1%); Usually in Thoracic Ao Types of Saccular AAA 1 - Cannula Placement
(3) Junction of modular components; (4) Trans graft flow-graft defect Chronic Mesenteric Ischemia "Fear of Food" 95% of Bowel Ischemia cases Atherosclerotic stenosis/occlusion in main mesenteric arteries: >70% stenosis in 2/3 of principle mesenteric arteries Ischemia diagnosis criteria via Moneta Celiac >200cm/s SMA >275cm/s Median Arcuate Ligament Syndrome (MALS) Arch impedes on Celiac during EXPIRATION (non-compressed during inhalation) Measurement(s) of Splenic Vein 7 - 17 cm long; 5-10mm diameter Portal vein diameter <13mm
Blood supply to liver 75% from Portal VEIN; 25% from Hepatic ARTERY Portal vein carries ____________ to the liver Nutrients Hepatic artery carries ______________ to the liver Oxygen Portal Hypertension Extrahepatic, Hyperdynamic, Intrahepatic (more common) Extrahepatic Portal HTN Prehepatic (Portal/splenic vein thrombus, Extrinsic compression of Potral vein) Posthepatic (IVC/Hepatic vein obstruction) Hyperdynamic Portal HTN
Vasoconstriction shrink/squeeze Energy and stenosis Prox- PE↑, KE↓(highest total energy) Within-PE↓, KE↑ (lower TE, Bernouille's) Distal-PE↑, KE↓ (lowest total energy) A-Early Systole (Forward flow to periphery) B-Peak Systole (Store PE) C-Late Systole (Temporary reversal-Peripheral resistance) D-Early Diastole (Forward-reduced resistance) E-Late Diastole (Vessel Recoil/Vasoconstrict/PE turns KE) Brain Supplied by ICA & Vertebrals 2% of Body's weight 15% CO
20% Total blood supply 3 - 8 minutes of oxygen deprivation results in cellular death Bovine Arch Common origin of Lt. CCA and Innominate ICA Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose- 70 - 80% from CCA ECA Does not feed brain unless needed as collateral circulation ECA supplies Neck, face, scalp
What portion of the population has an incomplete CofW? 50% What portion of the population has a complete Cof W? 20 - 25% Anatomic interrogation B-mode/2D best Physiologic/hemodynamic interrogation Spectral/Doppler best Hemorrhagic Stroke Bleed; HTN Ischemic Stroke Oxygen interruption; Blood clot/emboli from Atherosclerosis
Which stroke is known to be the 3rd leading cause of death? Ischemic Stroke Small perforating artery obstruction Occurs in elderly/diabetics Transient Ischemic Attack (TIA) HTN; Up to 24 hours; Unilateral symptoms-Contralateral hemipharesis Reversible Ischemic Neurological Defects (RIND) Atherosclerosis; more then 24 hours; Unilateral symptoms-Contralateral hemipharesis Vertebrobasilar Insufficiency (VBI) Obstruction of posterior circulation; Elderly/diabetic/poorly controlled HTN; Bilateral symptoms (DROP ATTACKS) Cerebrovascular Accident (CVA) Complete stroke with permanent lasting neurological deficits
Intraplaque hemorrhage High rupture risk NASCET Distal/Residual ECST Bulb/Residual Bisferious waveform in Carotid exam Double peak waveform signifying severe AI If the CCA is occluded Verterbrals supply ECA and ECA supplies ICA through retrograde flow What is the most common referral for asymptomatic cervical bruit? Fibromuscular Dysplasia (FMD)
Neointimal Hyperplasia 6 - 24months post endarterectomy Takayasu's Pulselessness (AI) Vasculitis that affects large arteries Temporal Arteritis Halo/edema Low velocity/low resistance Proximal/inflow Low velocity/high resistance Distal/outflow Arterial Palpitations Carotid
Petrous Cavernous Cervical ICA Bifurcation through petrous canal Petrous ICA Petrous of temporal bone Cavernous ICA Carotid Siphon (genu, parasellar, supraclinoid) Supraclinoid Ophthalmic, distal MCA Longer and more lateral; 75-80% from ICA
Medial/midbrain Basilar 3cm long TCD Freehand, 2MHz PW XDR at 0° TCI 1.8-2.5MHz XDR with transtemporal & suboccipital windows Carotid plaque is mostly found in the bifurcation Most common cause for stenosis Plaque in bifurcation
