Peripheral Arterial Flashcards
A normal spectral waveform of the brachial artery is A. Triphasic B. Biphasic C. Monophasic D. Both A and B
D. The normal spectral waveform of the brachial artery is high resistant and can either be triphasic or biphasic. The only difference between the two is the third component of the waveform that can be lost with age due to decrease in the elasticity of the arteries.
Which of the following is a pathology specific to the upper extremity arteries? A. Thoracic outlet syndrome B. Carotid body tumor C. Raynaud's syndrome D. Embolus
A. Thoracic outlet syndrome is specific to the upper extremities. Carotid body tumors only occur at the carotid bifurcation, and the other two choices can occur in the upper or lower extremities.
The type of flow pattern in which the velocities increase toward the center of the vessel and is found in most of the normal peripheral arteries is known as A. Turbulent B. Plug C. Laminar D. Occluded
C. Laminar blood flow is the normal flow found in most of the peripheral arteries and consists of a parabolic velocity profile which means that flow increases toward the center of the vessel and decreases toward the vessel walls.
What blood vessel is most likely to have a high resistive waveform? A. Common femoral artery B. Common carotid artery C. Renal artery D. Hepatic artery
A. The common femoral is a peripheral artery and should have high resistant flow in normal patients.
The dorsalis pedis artery is a continuation of which artery? A. Anterior tibial artery B. Posterior tibial artery C. Popliteal artery D. Common femoral artery
A. The dorsalis pedis artery is a continuation of the anterior tibial artery.
All of the following are true regarding spectral broadening EXCEPT
A. Spectral broadening is commonly associated with stenosis
B. Spectral broadening refers to the filling of the spectral window with disturbed flow
C. Spectral broadening refers to a decreased in bandwidth with disturbed flow
D. Spectral broadening occurs with turbulent blood flow
C. Spectral broadening does not refer to a decrease in bandwidth with disturbed flow. It refers to an increase in bandwidth with disturbed flow.
What is the first branch originating from the aortic arch that is only present on the right side? A. Subclavian artery B. Brachiocephalic artery C. Lateral thoracic artery D. Internal mammary artery
B. The brachiocephalic artery is the first branch originating from the thoracic aortic arch and is only present on the right side.
Which artery is a continuation of the superficial femoral artery as it passes through the adductor canal below the knee? A. Popliteal artery B. Tibioperoneal trunk C. Profunda femoris artery D. Posterior tibial artery
A. The popliteal is a continuation of the superficial femoral artery as it passes through the adductor canal below the knee into the popliteal fossa.
Which artery runs along the medial aspect of the lower leg and courses posterior to the medial malleolus? A. Peroneal artery B. Anterior tibial artery C. Dorsalis pedis artery D. Posterior tibial artery
D. The posterior tibial artery runs along the medial aspect of the lower leg and courses posterior to the medial malleolus.
A patient is sent to your laboratory to have his lower extremity bypass graft evaluated with duplex. While performing the examination you notice that the velocity at the proximal anastomosis is 80 cm/s. You continue the examination and obtain a pulse wave Doppler signal about 1 cm distal to the proximal anastomosis and you get a velocity of 210 cm/s. What do these findings suggest?
A. Normal flow present within this bypass
B. 1% to 19% narrowing of this bypass
C. 20% to 49% narrowing of this bypass
D. 50% to 99% narrowing of this bypass
D. A doubling in peak systolic velocity between adjacent segments is consistent with a hemodynamically significant stenosis greater than 50%. The velocities obtained within these segments more than doubles going from 80 to 210 cm/s.
The following is a type of lower extremity bypass
A. Brachial artery to cephalic vein
B. Common femoral artery to popliteal reversed saphenous vein
C. Cephalic vein to brachial vein
D. Femoral vein to internal iliac vein
B. Reversed vein grafts are common lower extremity bypasses. None of the other choices are lower extremity bypass grafts.
Which statement is true about the symptom of claudication?
A. Exercise-induced pain caused by too much blood flow to the legs
B. Varies each time regarding distance the patient is able to walk
C. Always relieved by rest
D. Only occurs in the calves
C. Claudication is pain in the lower extremities as a result of hypoxia that is reproducible and induced by exercise. After a patient rests, they are then able to walk the same distance before the pain reoccurs.
Rest pain can be relieved by A. Standing B. Elevating legs C. Exercise D. Taking deep breaths
A. Ischemic rest pain can be relieved by lowering the legs dependently, such as standing or dropping the legs off the side of the bed. The arterial inflow is so poor, gravity is needed to get the blood to the feet.
The peak systolic blood pressure in an area of a limb distal to a significant obstruction or stenosis A. Will increase B. Will decrease C. Will remain the same D. Will double
B. The peak systolic blood pressure in an area of a limb distal to a significant obstruction or stenosis will decrease.
Which is the most common cause of peripheral arterial disease of the lower extremities? A. Arteritis B. Arterial spasm C. Atherosclerosis D. Embolism
C. Atherosclerosis is the most common cause of peripheral arterial disease of the lower extremities.
The most common site of atherosclerosis in the lower extremities is
A. The bifurcation of the common iliac arteries
B. The origin of the profunda femoris artery
C. The trifurcation of the tibial arteries
D. The distal superficial femoral artery through the adductor canal
D. The most common site of atherosclerosis in the lower extremities is the distal superficial femoral artery through the adductor canal.
An obese patient is sent to your laboratory to be evaluated for arterial disease of the lower extremities. When performing their PVR and segmental pressure study you notice that their thigh PVR waveform indicates moderate disease but the pressure index at this level is 1.14. How do you explain this?
A. The disease is not severe enough to lower the pressure
B. The technologist had to have made a mistake
C. It is most likely the result of cuff artifact
D. This is fine because a pressure of 1.14 is in the range of moderate disease
C. Pulse volume recordings in general are more accurate than segmental pressures because they are not affected by the limitations of segmental pressures such as cuff artifact or calcified vessels. An obese patient will most likely have falsely elevated pressures due to the cuff size being too small for the limb. In an obese patient with underlying peripheral arterial disease these elevated pressures may appear to be at a normal level. If the cuff size were appropriate for the limb in this same patient it would result in a much lower pressure.
If a patient has a steal from an AVF graft with no underlying atherosclerotic disease the pre-graft compression digital PPG waveforms obtained during non-invasive arterial testing would show
A. Normal blood flow to the digits
B. Reduced blood flow to the digits
C. No difference in blood flow to the digits
D. Increased blood flow to the digits
B. The pre-graft compression study in a patient with an AVF steal will have reduced blood flow to the arm and hand because the fistula is stealing that blood flow. When the graft is manually compressed during the post study there should be an increase in blood flow in order to confirm the diagnosis of a steal.
What is the procedure in which a balloon-tipped catheter is advanced to the level of a focal stenotic lesion under fluoroscopic guidance and a balloon is inflated to push the plaque up against the walls of the artery in an effort to restore normal blood flow to the limb? A. CT angiography B. Angioplasty C. Digital subtraction angiography D. MR angiography
B. Angioplasty is the procedure in which a balloon-tipped catheter is inflated within a stenotic lesion in an attempt to restore normal blood flow to an area.
The brachial artery bifurcates just below the atecubital fossa into which two arteries?
A. Subclavian and axillary arteries
B. Deep and superficial palmar arteries
C. Brachiocephalic and subclavian arteries
D. Radial and ulnar arteries
D. The brachial artery bifurcates just below the antecubital fossa into the radial and ulnar arteries. The radial artery runs along the lateral side of the forearm while the ulnar artery runs along the medial side.
Noninvasive physiologic testing that involves placing a PPG on one of the digits of each hand recording waveforms and pressures while the arms are moved through a series of positions is used to evaluate for which syndrome? A. Subclavian steal syndrome B. Thoracic outlet syndrome C. Raynaud's syndrome D. Fibromuscular dysplasia
B. Noninvasive testing for thoracic outlet syndrome involves performing physiologic testing with the use of pulse volume recordings or photoplethysmography while moving the patient’s arms in several positions in an attempt to reduce the perfusion to the hand. The symptomatic position should be attempted; however, there are many common positions used during this examination such as the Adson maneuver with arms abducted out to sides, the costoclavicular maneuver with chest pushed forward and shoulders back, military position with elbow pointing to the rear and arms almost upright with palms facing forward, the hands straight up 180 degrees, and the arms straight out and abducted toward the rear.
In a blood vessel with a nonhemodynamically significant stenosis, if the diameter decreases what happens to the flow volume?
A. Flow volume increases
B. Flow volume decreases
C. Flow volume remains unchanged
D. Volume increases but velocity decreases
C. As the diameter of a blood vessel decreases, the flow remains a constant as long as the stenosis is not hemodynamically significant.
Which statement is accurate related to a vessel that has a hemodynamically significant stenosis?
A. There is an increased pressure gradient across the segment
B. There is a decreased pressure gradient across the segment
C. There is an increase in velocity at area of stenosis
D. There is a decrease in velocity at area of stenosis
E. Both A and C
F. Both A and D
E. In a normal vessel the velocity of blood flow and the pressure do not change significantly. When a hemodynamically significant stenosis is present within an artery there is an increase in the pressure gradient across the segment as well as increase in the velocity of blood flow within the stenosis. The turbulent flow that exists past the stenosis caused the pressure distal to the stenosis to drop resulting in a pressure that is now lower than the pressure proximal to the stenosis. The difference between these two pressures is what is known as a pressure gradient and is what increases with a stenosis due to the change in pressures.
Which surgical procedure has the highest potential for problems such as arteriovenous fistulas and retained valves? A. Aorta-femoral bypass B. In-situ saphenous vein bypass C. Reversed saphenous vein bypass D. Synthetic bypass
B. An in-situ saphenous vein bypass is created by leaving the native vein in its normal anatomical position, removing the internal valves and ligating the accessory branches, and finally attaching each end to the proximal and distal native arteries. This type of surgical bypass has the highest potential for a missed branch and retained valves because the vein is not being completely removed and reversed, unlike the reversed saphenous vein bypass in which the valves do not have to be removed. There would be no concern for missed branches or retained valves with an artificial bypass graft.
An abnormal connection between an artery and a vein that can occur spontaneously or as a result of trauma is known as A. Anastomosis B. Pseudoaneurysm C. Arteriovenous fistula D. Dissection
C. An arteriovenous fistula occurs when there is an abnormal connection between a native artery and vein resulting in a high volume jet of flow passing between both systems. They can occur spontaneously or traumatically.
What is the name of the most widely utilized ratio used to evaluate overall perfusion to the lower extremity arteries? A. Resistive index B. Pulsatility index C. Ankle-brachial index D. Pressure gradient index
C. The ankle-brachial index or ABI is the most widely utilized ratio used to evaluate overall perfusion to the lower extremity arteries and is calculated by taking the ankle pressure and dividing it by the higher of the two brachial pressures.
Which of the following may be used to diagnose the severity of a stenotic lesion with duplex? A. Peak systolic velocity B. Resistive index C. Pulsatility index D. Ankle-brachial index
A. Peak systolic velocity, end diastolic velocity, and peak systolic velocity ratios are all used to determine the severity of a stenosis. RI and PI are indices used to quantify the distal bed. The ankle-brachial index is not performed with duplex sonography.
