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Vascular Registry CCI Exam Review With
100% Correct Answers 2023
Abdominal Aorta waveform(s) - Correct Answer-Low resistance proximal, Higher resistance beyond renals Celiac Artery supplies - Correct Answer-Liver, spleen, stomach, & proximal small bowel Branches of the Abdominal AO - Correct Answer-1st major-Celiac artery (trunk/axis) 2nd major-SMA Renals 3rd major-IMA (after renals) Celiac Axis - Correct Answer-Branches into Common Hepatic (to right), Splenic, & Left Gastric (off left) Common Hepatic Arteries - Correct Answer-Gives rise to the Gastroduodenal artery in PANC head & divides into Rt & Lt Hepatics Splenic Artery - Correct Answer-Branches left and posteriosuperior to PANC body/tail SMA/IMA waveforms - Correct Answer-High resistance preprandial/Low resistance postprandial SMA supplies - Correct Answer-Bowel from duodenum to prox small bowel IMA supplies - Correct Answer-Bowel descending & rectosigmoid colon Right Renal Artery - Correct Answer-Branches anterolateral, posterior to IVC Left Renal Artery - Correct Answer-Branches posterolateral Renal Artery waveform - Correct Answer-Low resistance Portal vein is usually formed by the confluence of - Correct Answer-SMV & Splenic veins *It also receives blood from the inferior mesenteric, gastric, and cystic veins Portals walls/waveforma - Correct Answer-echogenic walls & phasic waveforms Renal veins are formed by - Correct Answer-renal tributaries Left Renal Vein - Correct Answer-Longer than Rt.; Receives suprarenal/Gonadal vein
Left Renal pathway - Correct Answer-Anterior to AO; Posterior to SMA Right Renal Vein - Correct Answer-No tributaries; shorter Hepatic Veins - Correct Answer-Hepatofugal flow; from liver to IVC Patient status for Abdominal Vascular Imaging - Correct Answer-NPO 8-12 hours Ectasia - Correct Answer-Local diameter increase with small bulge (20% increase for Ao <3cm) AAA growth rate - Correct Answer-1-2mm/year until 3-4cm; 5 mm/yr >4cm Aneurysm classification - Correct Answer-2-3cm; 3-4cm for AAA AAA Intervention - Correct Answer-5.5cm (high risk for rupture-catastrophic) Fusiform - Correct Answer-Concentric enlargement; All 3 layers intact Saccular - Correct Answer-Eccentric enlargement; All 3 layers compromised; Less common (<1%); Usually in Thoracic Ao Types of Saccular AAA - Correct Answer-1-Cannula Placement 2-Mycotic aneurysm (bacterial infection Ao wall) 3-Vasculitis (Inflammatory process) 4-Penetrating ulcer rupture into media Vasculitis/Aortitis - Correct Answer-Inflammatory process in wall of Ao beginning with outer (adventitia) layer and moving inward; ie: Takayasu's Dissection - Correct Answer-Intimal wall compromised resulting in 2 lumens false>true; flow reversal Type 1 (a/b) endoleak - Correct Answer-Leak in anastamosis of graft at (a) prox or (b) distal end Type 2 endoleak - Correct Answer-Aorta branch vessel; exhibits retrograde flow; more dangerous b/c internally bleeding Type 3/4 endoleak - Correct Answer-(3) Junction of modular components; (4) Trans graft flow-graft defect Chronic Mesenteric Ischemia - Correct Answer-"Fear of Food" 95% of Bowel Ischemia cases
Energy and stenosis - Correct Answer-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) - Correct Answer- Brain - Correct Answer-Supplied by ICA & Vertebrals 2% of Body's weight 15% CO 20% Total blood supply 3-8 minutes of oxygen deprivation results in - Correct Answer-cellular death Bovine Arch - Correct Answer-Common origin of Lt. CCA and Innominate ICA - Correct Answer-Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose-70-80% from CCA ECA - Correct Answer-Does not feed brain unless needed as collateral circulation ECA supplies - Correct Answer-Neck, face, scalp ECA Branches - Correct Answer-Superior Thyroid Ascending Pharyngeal Lingual Facial Occipital Posterior Auricular Maxillary Superficial Thyroid Vertebral supply - Correct Answer-Medulla/Inferior cerebellum Basilar supply - Correct Answer-Pons/superior anterior cerebellum Circle of Willis has atleast ____ variations with the most common being ___________________ - Correct Answer-9; the absence of one or both communicating arteries What portion of the population has an incomplete CofW? - Correct Answer-50% What portion of the population has a complete Cof W? - Correct Answer-20-25%
Anatomic interrogation - Correct Answer-B-mode/2D best Physiologic/hemodynamic interrogation - Correct Answer-Spectral/Doppler best Hemorrhagic Stroke - Correct Answer-Bleed; HTN Ischemic Stroke - Correct Answer-Oxygen interruption; Blood clot/emboli from Atherosclerosis Which stroke is known to be the 3rd leading cause of death? - Correct Answer-Ischemic Stroke Small perforating artery obstruction - Correct Answer-Occurs in elderly/diabetics Transient Ischemic Attack (TIA) - Correct Answer-HTN; Up to 24 hours; Unilateral symptoms-Contralateral hemipharesis Reversible Ischemic Neurological Defects (RIND) - Correct Answer-Atherosclerosis; more then 24 hours; Unilateral symptoms-Contralateral hemipharesis Vertebrobasilar Insufficiency (VBI) - Correct Answer-Obstruction of posterior circulation; Elderly/diabetic/poorly controlled HTN; Bilateral symptoms (DROP ATTACKS) Cerebrovascular Accident (CVA) - Correct Answer-Complete stroke with permanent lasting neurological deficits Plaque descriptions - Correct Answer-1-Fatty streak 2-Fibrous (soft) plaque 3-Complicated lesions 4-Ulcerative 5-Intraplaque Hemorrhage Fatty Streak - Correct Answer-Homogenous/thin lipid Fibrous (soft) Plaque - Correct Answer-Homogenous/lipid, collagen, elastic fibers Complicated Lesions - Correct Answer-Heterogenous/fibrous, collagen, calcium, cell debris Ulcerative - Correct Answer-Deteriorating smooth "craterlike" embolis? Intraplaque hemorrhage - Correct Answer-High rupture risk NASCET - Correct Answer-Distal/Residual
Supraclinoid - Correct Answer-Ophthalmic, distal MCA - Correct Answer-Longer and more lateral; 75-80% from ICA ACA - Correct Answer-Medial/midbrain Basilar - Correct Answer-3cm long TCD - Correct Answer-Freehand, 2MHz PW XDR at 0° TCI - Correct Answer-1.8-2.5MHz XDR with transtemporal & suboccipital windows Carotid plaque is mostly found in the - Correct Answer-bifurcation Most common cause for stenosis - Correct Answer-Plaque in bifurcation Most common region stenosis - Correct Answer-Prox ICA after bifurcation To be truly at the center of the artery you - Correct Answer-should visualize intimal lining very clearly ICA/CCA ratio - Correct Answer-Fastest ICA/Distal CCA Trickle flow - Correct Answer-95% stenosis Carotid Body Tumors - Correct Answer-AKA Chemodactoma/Paragangliomas; more common at higher altitudes Hollenhurst Plaque - Correct Answer-Ulceration in ICA causing negative affects in retinal artery Distal carotid dissections - Correct Answer-are very narrow and have no visible plaque Physiologic/Arterial Doppler - Correct Answer-Indirect approach Duplex Imaging - Correct Answer-Direct approach All segmental pressures - Correct Answer-should be equal or slightly greater than brachial with <20-30mmHg change in pressures ABI - Correct Answer-Highest of brachials and highest DPA/PTA of each leg A/B=I Reactive Hyperemia - Correct Answer-Pump 20-30 above brachial to occlude for 3-5min (normal=90% return after a min)
Complicated Lesions - Correct Answer-Heterogenous/fibrous, collagen, cal Complicated Lesions - Correct Answer- ICA - Correct Answer-Terminates into MCA/ACA and feeds the brain, forehead, eyes, & nose-70-80% from CCA ICA - Correct Answer- What is the first branch of the aortic arch? - Correct Answer-Innominate artery/ Brachiocephalic Name the three branches of the aortic arch? - Correct Answer-a. Innominate artery/ Brachiocephalic b. Lt CCA c. Lt Subclavian artery The radial artery runs on what side of the forearm? - Correct Answer-Lateral side The radial artery branches to form what part of the palmar arch? - Correct Answer- Superficial palmar arch Where does the radial artery terminate? (Just remember that the ulnar branch and termination is opposite of the radial artery) - Correct Answer-Terminates in the deep palmar arch What vessel is the predominate source of blood flow to the hand come from? - Correct Answer-Ulnar artery The Deep Palmar arch is a branch of the? - Correct Answer-Ulnar artery What are the three branches of the celiac trunk? - Correct Answer-a. Left Gastric artery b. Splenic artery c. Common Hepatic artery What organs does the celiac trunk supply? - Correct Answer-Stomach, Liver, Pancreas, Spleen, & Duodenum The SMA is located 1cm below the celiac trunk and supplies what? - Correct Answer- Small Intestines, cecum, and parts of colon, Is it an uncommon finding to see multiple renal arteries bilaterally? - Correct Answer-No it is not uncommon at all. What vessel runs anterior to the aorta? - Correct Answer-Left Renal vein
Arteries progressively decrease in size from the largest being __ and the smallest being ___? - Correct Answer-A. Largest = Aorta B. Smallest = Arterioles Arterioles are considered what type of vessels and assist in regulating what? - Correct Answer-a. Arterioles are considered resistance vessels b. They assist in regulating blood flow through contraction and relaxation. Where does the exchange of nutrients and waste products between blood and tissue take place? - Correct Answer-Capillaries What is the inner thin layer of the arterial wall called? - Correct Answer-Tunica intima, which consists of smooth endothelium and connective tissue What layer of the arterial wall is thickest and made up largely of elastic type of smooth mucsle and connective tissue? - Correct Answer-Tunica media / intermediate layer Which layer of the arterial wall is made up of fibrous connective tissue? - Correct Answer-Tunica externa / outer layer (adventitia) What layer of the arterial wall contains the vasa vasorum? What is the vasa vasorum? - Correct Answer-The vasa vasorum tiny vessels found in the adventitial layer of the arterial wall, that carry blood to the walls of the largest arteries. Proximal to aortic arch, what are the first branches of the ascending aorta? - Correct Answer-Coronary Arteries What events lead up to the beginning of cardiac contractions? - Correct Answer-1. Pressure in left ventricle begins to rise
- Left ventricle pressure exceeds that in the aorta
- Aortic valve opens; blood is ejected, blood pressure rises What generates the pressure wave to move the blood? - Correct Answer-Pumping Heart What governs the amount of blood that enters the arterial system? - Correct Answer- Cardiac output What determines the amount of blood that leaves the arterial system? - Correct Answer- Arterial pressure and total peripheral resistance Where is pressure greatest in the arterial system? - Correct Answer-Pressure is greatest at the heart, gradually decreasing as blood moves further away.
What 2 things is required for movement of any fluid medium between 2 points? - Correct Answer-1. Pathway for fluid to flow
- Pressure difference / Energy gradient Low resistance yields what type of flow rate? - Correct Answer-High flow rate The total energy contained in moving fluid is the sum of what 3 energies? - Correct Answer-1. Potential (Pressure)
- Kinetic
- Gravitational What type of energy is stored energy and is the major form of energy for circulation of blood? - Correct Answer-Pressure (Potential) Energy, measured in mmHg. What form of energy id equivlent to the weight of the column of blood extending from the heart to the level where pressure is measured? - Correct Answer-Gravitational energy or Hydrostatic Pressure (HP) What is the tendency of a fluid to resist changes in its velocity? - Correct Answer-Inertia What 2 things affect the movement of fluid? - Correct Answer-1. Physcial properties of the fluid
- What the fluid is moving through Internal friction within a fluid is measured how? - Correct Answer-It's measured by its Viscosity What is an example of something that would increase blood viscosity? Decrease blood viscosity? - Correct Answer-1. Elevated hematocrit increases viscosity
- Severe anemia would decrease viscosity Viscosity measures what of a fluid? - Correct Answer-Viscosity measures the thickness of a fluid. What type of energy loss is due to increased friction between molecules and layers? - Correct Answer-Viscous energy loss What type of energy loss occurs with deviation from laminar flow, due to changes in direction and / or velocity? - Correct Answer-Inertial energy loss Whose equation define the relationship between: pressure, resistance, and volume flow? - Correct Answer-Poiseulle's Equation: Q = P/R ; it helps answer the question of how much fluid moves through a vessel
At what point in a stenosis is spectral broadening and elevated velocities seen? - Correct Answer-Entering the stenosis, with the high velocity at the narrowest part of the stenosis. At what point in a stenosis is flow reversals, flow separation, and vortices / eddy currents seen? - Correct Answer-Exiting the stenosis, post-stenotic turbulence. What is pain in muscles usually occurin during exercise; subsides with rest? - Correct Answer-Claudication What arterial condition has symptoms of the 6 P's: pain, pallor (white), pulselessness, paresthesia, paralysis, and polar; it may result from thrombus, embolism, or trauma? - Correct Answer-Acute Arterial Occlusion What coniditon exists when symptoms of intermittent digital ischemia occur in response to cold exposure or emotional stress? - Correct Answer-Raynaud's phenomenon What form of Raynaud's is seen as ischemia due to digital arterial spasm and is commonly seen in young women? - Correct Answer-Primary Raynaud's What form of Raynaud's is also known as obstructive Raynaud's syndrome and may be the first manifestation of Buerger's disease? - Correct Answer-Secondary Raynaud's What word (color) results from deficient blood supply; skin pale? - Correct Answer- Pallor What word (color) suggests dilated vessels secondary to reactive hyperemia; skin is reddened? - Correct Answer-Rubor What word (color) results from a concentration of deoxygenated hemoglobin, causing bluish discoloration? - Correct Answer-Cyanosis Name a few areas where palpable pulses can be felt. - Correct Answer-Aorta, femoral, popliteal, DPA, PTA What is most common arterial pathology? - Correct Answer-Thickening, hardening, loss of elasticity of the artery wall What syndrome occurs in males and is caused by obstruction of the aorta, resulting in fatigue in the hips, thighs, and calves during exercise, absense of femoral pulse, and impotence? - Correct Answer-Leriche Syndrome What are 2 examples of types of true aneurysms? - Correct Answer-1. Fusiform
- Saccular
What is a common location for a dissecting aneurysm to occur? - Correct Answer- Thoracic Aorta What is most common location for a true aneurysm? - Correct Answer-Infrarenal What are the 2 most frequent complications of Aneursyms? - Correct Answer-1. Rupture of the aortic aneursym
- Embolization of the peripheral aneurysms What is a non-atherosclerotic lesion, with Buerger's disease (thromboangitis obliterans) as a form of the condition, which is when LE arterial vessels become inflammed and lead to thrombosis of the vessels - Correct Answer-Arteritis What is a congential anomalie of the arterial system that is seen as congential narrowing or stricture of thoracic aorta called? - Correct Answer-Coarctation of the aorta What layer of the aortic wall develops a tear, which allows for blood to leak through and form a false lumen? - Correct Answer-Intimal layer tears and allows blood to leak into the media layer which weakens the media layers. What occurs when the frequency of the wave received is different from the transmitted wave, which is relative motion between the source (blood) and the receiver of sound (transducer)? - Correct Answer-Doppler shift What Doppler method uses individual frequencies displayed by FFT (Fast Fourier Transform) method? - Correct Answer-Spectral analysis What 5 arterial vessels in upper extremities are evaluated in arterial study? - Correct Answer-Subclavian, axillary, brachial, radial, and ulnar. Analog Doppler are not capable of portraying velocities less than what cm/sec? - Correct Answer-No velocities < 6cm/sec What are somethings you can do to reduce noise on a spectral trace? - Correct Answer-
- Decrease gain
- Increase wall filter
- Turn machine on/off
- Try another wall plug What is the difference between the 4 cuff method vs the 3 cuff method? - Correct Answer-3 cuff method only has one cuff on thigh while the 4 cuff method has 2, high thigh and above knee (low thigh). The 3 cuff method provides more accurate pressure readings. What frequency probe and what Doppler angle should you have for arterial studies? - Correct Answer-8-10 MHz probe with a Doppler angle 45-60 degrees to the skin.
In the normal patient, will the ABI increase or decrease post-exercise? - Correct Answer-In a normal patient the ABI's should increase, while in an abnormal patient ABI's will decrease. How many minutes does it take the ABI's to increase back to resting levels in a patient with single level disease? - Correct Answer-Takes 2-6 minutes How many minutes does it take the ABI's to increase back to resting levels in a patient with Multi-level disease? - Correct Answer-Takes 6-12 minutes What's an alternative method for stressing the peripheral circulation, for patients with PVOD, ones that use a cane or walker, have pulmonary problems, or bad heart? An how does it work? - Correct Answer-Reactive Hyperemia, which is done by inflating bilateral thigh cuffs to suprasystolic pressure levels and maintianing the pressure for 3- minutes. This produces ischemia and vasodilation distal to the occluding cuffs. How is single vs multi-level disease determined with the use of reactive hyperemia? - Correct Answer-a.Single level has < or =50% drop in ankle pressure b.Multi-level has >50% drop in ankle pressure. c. Normal limbs may show a transient drop of 17-34% What test is used to evaluate the patency of the palmar arch? - Correct Answer-Allen test How is the Allen test performed? - Correct Answer-Tech compresses patients radial artery while the patient clenches fist for at least a minute or until pallor. Then the patient relaxes hand while the tech continues to compress radial artery. A normal finding would be to see color return; an abnormal finding would be for the color not to return which would either mean an ulnar artey occlusion or palmar arch obstruction. What pressure difference from one brachial to the other suggests >50% stenosis of subclavain artery? - Correct Answer-15-20mmHg difference What penile arteries and veins are measured during the imaging technique to determine whether impotence is related to peripheral vascular insufficiency? - Correct Answer- Cavernous arteries and Dorsal veins. What is the normal response of the cavernous arteries post-injection? Increase or decrease? - Correct Answer-They normally should increase in size. What is a normal PSV range for the cavernous arteries of the penis? - Correct Answer- Normal PSV range is approx 30 cm/sec or higher, anything less is often considered abnormal. What is plethysmography used to help determine? - Correct Answer-It helps to differentiate true claudication from non-vascular sources.
What is PPG used to evaluate mainly? - Correct Answer-Digits and Penile vessels What instrument is used for measuring changes in volume within an organ or whole body (usually resulting from fluctuations in the amount of blood or air it contains)? - Correct Answer-Plethysmography What is pledge position, in reference to upper extremity exams? - Correct Answer-Arm is at 45 degree angle from body, & externally rotated. Brescia-Cimino fistula, straight, & looped synthetic graft are all types of what? - Correct Answer-Dialysis access examples Which end of a hemodialysis access graft is stenosis more commonly seen? - Correct Answer-At venous anastomosis and outflow vein What is a "steal syndrome" in reference to hemodialysis - Correct Answer-It's when the distal arterial blood flow is reversed into the lower resistant venous circulation and can cause pain in hand/fingers on exertion, pallor and coolness of the skin distal to the shunt. What is the ideal Angle for Vasucalar studies? - Correct Answer-60 degrees, obtained centerstream, parallel to vessel walls In reference to stenotic vessels, where is the highest PSV seen? Where is turbulence usually seen? - Correct Answer-a. Narrowest part within stenosis will have highest PSV b. Post stenosis will usually have turbulenct waveform What is the mechanism for hypertension? - Correct Answer-Renal ischemia triggers the release of renin and a secondary increase in BP. Renin converts angiotensin I into angiotensin II, which causes severe vasoconstriction. Give examples of low resistive abdominal vessels? - Correct Answer-Renal, celiac, hepatic, and splenic arteries. Give examples of high resistive abdominal vessels? - Correct Answer-Aorta, as are a fasting SMA and IMA How do you calculate the renal to aorta ratio (RAR)? - Correct Answer-Divide the highest renal artery PSV by the aorta PSV. Whats considered a normal renal to aorta ratio?Abnormal? - Correct Answer-a.Normal = < 3.5. b.Abnormal = > or equal to 3.
If a fistula is found close to the heart, what issue is the patient at an increased risk for? - Correct Answer-Cardiac failure What 2 things predict the resistance an AVF will offer? - Correct Answer-Diameter and length of the AVF predict the resistance it offers. Describe the arterial flow seen proximal to an AVF. - Correct Answer-Proximal arterial flow has increased diastolic flow because the fistula reduces resistance. What is Compartment Syndrome - Correct Answer-Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow. How is anterior compartment syndrome treated? - Correct Answer-Fasciotomy, which is a procedure where the fascia is cut to relieve tension or pressure. What is the key to success when it comes to compression of pseudoaneurysms? - Correct Answer-The key to success is whether aneurysm "neck" between native artery and pseudoaneurysm can be Uniformly and Completely compressed. What is popliteal artery entrapment syndrome? - Correct Answer-Its when the popliteal artery can be compressed by medial head of gastronemius muscles, or fibrous bands, which results into claudication or chronic leg ischemia. What is referred to as the TRAM flap and what is it used for by surgeons? - Correct Answer-TRAM- Transverse Rectus Abdominis Myocutaneous Flap, which consist of the rectus abdominis muscle, sub-q fat, arteries, perforators, and overlying skin. Surgeon's use the TRAM flap for autogenous breast reconstruction. What are the reasons for mapping the internal mammary artery (internal thoraic artery)?
- Correct Answer-a. Utilized as a recipient site for free flaps in breast reconstruction. b. Second important use for this artery is as graft to the left anterior descending (LAD) coronary artery. What is Radial artery mapping used for? - Correct Answer-To determine suitability for use as graft for coronary artery bypass. What are some indications for preoperative vein mapping? - Correct Answer-a. Extremity or coronary artery bypass b. Use in dialysis access/graft What veins do you map for LE and UE? - Correct Answer-a. LE- GSV b. UE- Basilic and Cephalic veins What is thoracic outlet syndrome (arterial component)? - Correct Answer-Occurs with neurovascular bundle compression by shoulder structures (cervical rib, clavicle, scalene
muscle); occurs in certain arm positions. Most symptoms are due to neurogenic compression of brachial plexus; which cause numbness/tingling of arm or pain/aching of shoulder/forearm. What is described as multiple arterial stenoses caused by medial hyperplasia, appearing as "string of beads"? - Correct Answer-Fibromuscular Dysplasia What are the most common arteries used for an Angio exam? - Correct Answer-CFA (safest approach), Axillary, or Brachial arteries What are some complications that can follow an angio exam? - Correct Answer- Puncture site hematoma, pseudoaneurysm, local arterial occlusion, or possible neurologic complications What type of arterial study uses radio fequency energy and a strong magnetic field to produce images in multiple planes that quantitate blood flow and distinguish it from soft tissue without using contrast agents? - Correct Answer-MR Angiography (MRA) What is one benefit of performing and MRA study instead of and angiogram? - Correct Answer-MRA's dont require contrast agents so patients with renal failure or patients that are allergic to the contrast agents are able to have exam. What type of pharmacologic agents can be used to help treat arterial vessel issues? - Correct Answer-a.Any medication that helps decrease blood viscosity, like aspirin, which is an antiplatelet drug that decreases platelet aggregation, resulting in decreased thrombotic activitiy. b. Antihypertensive drugs may serve to decrease shearing forces against vessel walls. What is the surgical removal of atherosclerotic material, usually includes portion of intimal lining? - Correct Answer-Endarterectomy What are the 3 components that are needed to acheive a successful bypass graft? - Correct Answer-a. Good Inflow b. Conduit c. Outflow What is a PTLA (Percutaneous Transluminal Angioplasty used for and how is it done? - Correct Answer-a.Angioplasty is used to dilate focal plaque formation in a vessel. b.Same technque used as arteriography, except a balloon tipped catheter is used under fluoroscopy to region of stenosis, where the balloon is slowly inflated, pushing plaque against walls of vessl, dilating artery lumen. What is an endoleak when referring to graft complications? - Correct Answer-Endoleak is defined as a persistent blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or adjacent vascular segment being treated by the device.
