VASCULAR REGISTRY CCI REVIEW
QUESTIONS & ANSWERS 100%
CORRECT!!
Abdominal Aorta waveform(s) - ANSWERLow resistance proximal, Higher resistance
beyond renals
Celiac Artery supplies - ANSWERLiver, spleen, stomach, & proximal small bowel
Branches of the Abdominal AO - ANSWER1st major-Celiac artery (trunk/axis)
2nd major-SMA
Renals
3rd major-IMA (after renals)
Celiac Axis - ANSWERBranches into Common Hepatic (to right), Splenic, & Left
Gastric (off left)
Common Hepatic Arteries - ANSWERGives rise to the Gastroduodenal artery in
PANC head & divides into Rt & Lt Hepatics
Splenic Artery - ANSWERBranches left and posteriosuperior to PANC body/tail
SMA/IMA waveforms - ANSWERHigh resistance preprandial/Low resistance
postprandial
Portal vein is usually formed by the confluence of - ANSWERSMV & Splenic veins
*It also receives blood from the inferior mesenteric, gastric, and cystic veins
Portals walls/waveforma - ANSWERechogenic walls & phasic waveforms
Renal veins are formed by - ANSWERrenal tributaries
Left Renal Vein - ANSWERLonger than Rt.; Receives suprarenal/Gonadal vein
Left Renal pathway - ANSWERAnterior to AO; Posterior to SMA
Right Renal Vein - ANSWERNo tributaries; shorter
Hepatic Veins - ANSWERHepatofugal flow; from liver to IVC
Patient status for Abdominal Vascular Imaging - ANSWERNPO 8-12 hours
Ectasia - ANSWERLocal diameter increase with small bulge
(20% increase for Ao <3cm)
,AAA growth rate - ANSWER1-2mm/year until 3-4cm; 5 mm/yr >4cm
Aneurysm classification - ANSWER2-3cm; 3-4cm for AAA
SMA supplies - ANSWERBowel from duodenum to prox small bowel
IMA supplies - ANSWERBowel descending & rectosigmoid colon
Right Renal Artery - ANSWERBranches anterolateral, posterior to IVC
Left Renal Artery - ANSWERBranches posterolateral
Renal Artery waveform - ANSWERLow resistance
AAA Intervention - ANSWER5.5cm (high risk for rupture-catastrophic)
Fusiform - ANSWERConcentric enlargement; All 3 layers intact
Saccular - ANSWEREccentric enlargement; All 3 layers compromised; Less
common (<1%); Usually in Thoracic Ao
Types of Saccular AAA - ANSWER1-Cannula Placement
2-Mycotic aneurysm (bacterial infection Ao wall)
3-Vasculitis (Inflammatory process)
4-Penetrating ulcer rupture into media
Vasculitis/Aortitis - ANSWERInflammatory process in wall of Ao beginning with outer
(adventitia) layer and moving inward; ie: Takayasu's
Dissection - ANSWERIntimal wall compromised resulting in 2 lumens
false>true; flow reversal
Type 1 (a/b) endoleak - ANSWERLeak in anastamosis of graft at (a) prox or (b)
distal end
Type 2 endoleak - ANSWERAorta branch vessel; exhibits retrograde flow; more
dangerous b/c internally bleeding
Type 3/4 endoleak - ANSWER(3) Junction of modular components; (4) Trans graft
flow-graft defect
Chronic Mesenteric Ischemia - ANSWER"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 - ANSWERCeliac >200cm/s
SMA >275cm/s
,Median Arcuate Ligament Syndrome (MALS) - ANSWERArch impedes on Celiac
during EXPIRATION (non-compressed during inhalation)
Measurement(s) of Splenic Vein - ANSWER7-17 cm long; 5-10mm diameter
Portal vein diameter - ANSWER<13mm
Blood supply to liver - ANSWER75% from Portal VEIN; 25% from Hepatic ARTERY
Portal vein carries ____________ to the liver - ANSWERNutrients
Hepatic artery carries ______________ to the liver - ANSWEROxygen
Portal Hypertension - ANSWERExtrahepatic, Hyperdynamic, Intrahepatic (more
common)
Extrahepatic Portal HTN - ANSWERPrehepatic (Portal/splenic vein thrombus,
Extrinsic compression of Potral vein)
Posthepatic (IVC/Hepatic vein obstruction)
Hyperdynamic Portal HTN - ANSWERAV malformation causing arterial portal fistulas
Intrahepatic (within liver) - ANSWERPresinusodial (less common)
Postsinusoidial (more common)
Cirrhosis/Venoclusive disease
Small liver, large spleen, ascites
LaPlace's law - ANSWERLarger vessel radius, larger wall tension to compensate for
extra pressure
Hydrostatic pressure - ANSWERGravitational
Large vessels serve as - ANSWERPressure reservoirs
Vasodilation - ANSWERStretch to absorb
Vasoconstriction - ANSWERshrink/squeeze
Energy and stenosis - ANSWERProx- 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) - ANSWER
Brain - ANSWERSupplied by ICA & Vertebrals
2% of Body's weight
, 15% CO
20% Total blood supply
3-8 minutes of oxygen deprivation results in - ANSWERcellular death
Bovine Arch - ANSWERCommon origin of Lt. CCA and Innominate
ICA - ANSWERTerminates into MCA/ACA and feeds the brain, forehead, eyes, &
nose-70-80% from CCA
ECA - ANSWERDoes not feed brain unless needed as collateral circulation
ECA supplies - ANSWERNeck, face, scalp
ECA Branches - ANSWERSuperior Thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Maxillary
Superficial Thyroid
Vertebral supply - ANSWERMedulla/Inferior cerebellum
Basilar supply - ANSWERPons/superior anterior cerebellum
Circle of Willis has atleast ____ variations with the most common being
___________________ - ANSWER9; the absence of one or both communicating
arteries
What portion of the population has an incomplete CofW? - ANSWER50%
What portion of the population has a complete Cof W? - ANSWER20-25%
Anatomic interrogation - ANSWERB-mode/2D best
Physiologic/hemodynamic interrogation - ANSWERSpectral/Doppler best
Hemorrhagic Stroke - ANSWERBleed; HTN
Ischemic Stroke - ANSWEROxygen interruption; Blood clot/emboli from
Atherosclerosis
Which stroke is known to be the 3rd leading cause of death? - ANSWERIschemic
Stroke
Small perforating artery obstruction - ANSWEROccurs in elderly/diabetics
QUESTIONS & ANSWERS 100%
CORRECT!!
Abdominal Aorta waveform(s) - ANSWERLow resistance proximal, Higher resistance
beyond renals
Celiac Artery supplies - ANSWERLiver, spleen, stomach, & proximal small bowel
Branches of the Abdominal AO - ANSWER1st major-Celiac artery (trunk/axis)
2nd major-SMA
Renals
3rd major-IMA (after renals)
Celiac Axis - ANSWERBranches into Common Hepatic (to right), Splenic, & Left
Gastric (off left)
Common Hepatic Arteries - ANSWERGives rise to the Gastroduodenal artery in
PANC head & divides into Rt & Lt Hepatics
Splenic Artery - ANSWERBranches left and posteriosuperior to PANC body/tail
SMA/IMA waveforms - ANSWERHigh resistance preprandial/Low resistance
postprandial
Portal vein is usually formed by the confluence of - ANSWERSMV & Splenic veins
*It also receives blood from the inferior mesenteric, gastric, and cystic veins
Portals walls/waveforma - ANSWERechogenic walls & phasic waveforms
Renal veins are formed by - ANSWERrenal tributaries
Left Renal Vein - ANSWERLonger than Rt.; Receives suprarenal/Gonadal vein
Left Renal pathway - ANSWERAnterior to AO; Posterior to SMA
Right Renal Vein - ANSWERNo tributaries; shorter
Hepatic Veins - ANSWERHepatofugal flow; from liver to IVC
Patient status for Abdominal Vascular Imaging - ANSWERNPO 8-12 hours
Ectasia - ANSWERLocal diameter increase with small bulge
(20% increase for Ao <3cm)
,AAA growth rate - ANSWER1-2mm/year until 3-4cm; 5 mm/yr >4cm
Aneurysm classification - ANSWER2-3cm; 3-4cm for AAA
SMA supplies - ANSWERBowel from duodenum to prox small bowel
IMA supplies - ANSWERBowel descending & rectosigmoid colon
Right Renal Artery - ANSWERBranches anterolateral, posterior to IVC
Left Renal Artery - ANSWERBranches posterolateral
Renal Artery waveform - ANSWERLow resistance
AAA Intervention - ANSWER5.5cm (high risk for rupture-catastrophic)
Fusiform - ANSWERConcentric enlargement; All 3 layers intact
Saccular - ANSWEREccentric enlargement; All 3 layers compromised; Less
common (<1%); Usually in Thoracic Ao
Types of Saccular AAA - ANSWER1-Cannula Placement
2-Mycotic aneurysm (bacterial infection Ao wall)
3-Vasculitis (Inflammatory process)
4-Penetrating ulcer rupture into media
Vasculitis/Aortitis - ANSWERInflammatory process in wall of Ao beginning with outer
(adventitia) layer and moving inward; ie: Takayasu's
Dissection - ANSWERIntimal wall compromised resulting in 2 lumens
false>true; flow reversal
Type 1 (a/b) endoleak - ANSWERLeak in anastamosis of graft at (a) prox or (b)
distal end
Type 2 endoleak - ANSWERAorta branch vessel; exhibits retrograde flow; more
dangerous b/c internally bleeding
Type 3/4 endoleak - ANSWER(3) Junction of modular components; (4) Trans graft
flow-graft defect
Chronic Mesenteric Ischemia - ANSWER"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 - ANSWERCeliac >200cm/s
SMA >275cm/s
,Median Arcuate Ligament Syndrome (MALS) - ANSWERArch impedes on Celiac
during EXPIRATION (non-compressed during inhalation)
Measurement(s) of Splenic Vein - ANSWER7-17 cm long; 5-10mm diameter
Portal vein diameter - ANSWER<13mm
Blood supply to liver - ANSWER75% from Portal VEIN; 25% from Hepatic ARTERY
Portal vein carries ____________ to the liver - ANSWERNutrients
Hepatic artery carries ______________ to the liver - ANSWEROxygen
Portal Hypertension - ANSWERExtrahepatic, Hyperdynamic, Intrahepatic (more
common)
Extrahepatic Portal HTN - ANSWERPrehepatic (Portal/splenic vein thrombus,
Extrinsic compression of Potral vein)
Posthepatic (IVC/Hepatic vein obstruction)
Hyperdynamic Portal HTN - ANSWERAV malformation causing arterial portal fistulas
Intrahepatic (within liver) - ANSWERPresinusodial (less common)
Postsinusoidial (more common)
Cirrhosis/Venoclusive disease
Small liver, large spleen, ascites
LaPlace's law - ANSWERLarger vessel radius, larger wall tension to compensate for
extra pressure
Hydrostatic pressure - ANSWERGravitational
Large vessels serve as - ANSWERPressure reservoirs
Vasodilation - ANSWERStretch to absorb
Vasoconstriction - ANSWERshrink/squeeze
Energy and stenosis - ANSWERProx- 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) - ANSWER
Brain - ANSWERSupplied by ICA & Vertebrals
2% of Body's weight
, 15% CO
20% Total blood supply
3-8 minutes of oxygen deprivation results in - ANSWERcellular death
Bovine Arch - ANSWERCommon origin of Lt. CCA and Innominate
ICA - ANSWERTerminates into MCA/ACA and feeds the brain, forehead, eyes, &
nose-70-80% from CCA
ECA - ANSWERDoes not feed brain unless needed as collateral circulation
ECA supplies - ANSWERNeck, face, scalp
ECA Branches - ANSWERSuperior Thyroid
Ascending Pharyngeal
Lingual
Facial
Occipital
Posterior Auricular
Maxillary
Superficial Thyroid
Vertebral supply - ANSWERMedulla/Inferior cerebellum
Basilar supply - ANSWERPons/superior anterior cerebellum
Circle of Willis has atleast ____ variations with the most common being
___________________ - ANSWER9; the absence of one or both communicating
arteries
What portion of the population has an incomplete CofW? - ANSWER50%
What portion of the population has a complete Cof W? - ANSWER20-25%
Anatomic interrogation - ANSWERB-mode/2D best
Physiologic/hemodynamic interrogation - ANSWERSpectral/Doppler best
Hemorrhagic Stroke - ANSWERBleed; HTN
Ischemic Stroke - ANSWEROxygen interruption; Blood clot/emboli from
Atherosclerosis
Which stroke is known to be the 3rd leading cause of death? - ANSWERIschemic
Stroke
Small perforating artery obstruction - ANSWEROccurs in elderly/diabetics
