ABD Doppler Flow PT  4
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Questions and Answers

What is a common clinical sign associated with Arteriovenous Fistulas?

  • Skin rash
  • Headache
  • Lower back/Abdominal Pain (correct)
  • Loss of appetite

Which of these are potential causes of acquired Arteriovenous Fistulas?

  • Trauma
  • Surgery
  • Inflammation
  • All of the above (correct)

Which of the following is NOT a common characteristic of Arteriovenous Fistulas on ultrasound?

  • Solid, echogenic mass (correct)
  • Multiple Anechoic Tubular Structures
  • Enlarged Renal Artery & Vein
  • Dilated IVC

What condition is often mistaken for a Retroperitoneal Sarcoma?

<p>Echogenicity varies depending on tissue type (A)</p> Signup and view all the answers

What is the most common non-aneurysm cause of a pulsatile abdominal mass?

<p>Lymphadenopathy (C)</p> Signup and view all the answers

Which of the following conditions is a possible cause of a pulsatile abdominal mass that may be mistaken for an aneurysm?

<p>Lymphadenopathy (D)</p> Signup and view all the answers

Which of these is a characteristic appearance of a Cirsoid Arteriovenous Fistula?

<p>Cluster of tubular anechoic structures within the kidney (C)</p> Signup and view all the answers

What is a major reason why Arteriovenous Fistulas may be difficult to diagnose?

<p>They are not commonly visualized on ultrasound (B)</p> Signup and view all the answers

What is the most common site of rupture for an infrarenal abdominal aortic aneurysm?

<p>Lateral wall below the renal vessels (C)</p> Signup and view all the answers

Which of these structures is the least likely to be compressed by a large aortic aneurysm?

<p>Spleen (B)</p> Signup and view all the answers

What is a potential complication of an abdominal aortic aneurysm repair with a graft?

<p>All of the above (D)</p> Signup and view all the answers

What does the term 'pseudoaneurysm' refer to in the context of aortic repair?

<p>A localized collection of blood between the graft and the aorta (B)</p> Signup and view all the answers

What characteristic of the graft material makes it visible on ultrasound?

<p>The material is very echogenic. (C)</p> Signup and view all the answers

Which of these statements is TRUE regarding the endovascular graft technique for repairing aortic aneurysms?

<p>The graft can be placed in the aorta, iliac bifurcation, or femoral artery. (D)</p> Signup and view all the answers

What is the name of the complication that can occur immediately after the endovascular graft is placed, characterized by no outflow?

<p>Endoleak (C)</p> Signup and view all the answers

What factors can influence the rate of endoleak complications in endovascular graft repair?

<p>All of the above (D)</p> Signup and view all the answers

Flashcards

Aortic Aneurysm

A localized dilation or bulge in the wall of the aorta, the main artery carrying blood from the heart.

Lateral Wall below Renal Vessels

The most common site of aortic aneurysm rupture, often causing bleeding into surrounding tissues like the pararenal space.

Aortic Graft

A surgical repair of an aortic aneurysm using flexible graft material, usually Dacron, attached to the healthy aorta.

Pseudoaneurysm

A potential complication after aortic graft surgery where a localized collection of blood forms outside the repaired aorta due to a leak.

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Endovascular Graft Treatment

A newer technique for repairing aneurysms where a rolled up graft is inserted through the femoral artery to the aneurysm site.

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Endoleak

A complication of endovascular graft placement where blood leaks around the graft, potentially compromising its effectiveness.

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New Aneurysm After Surgery

A potential complication of aortic graft surgery where a new aneurysm forms at the site of the graft attachment.

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Hematoma

A potential complication of aortic graft surgery where a collection of blood develops near the surgical site.

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Lymphadenopathy

A type of pulsatile abdominal mass that is usually caused by lymphoma and appears as a homogeneous mass surrounding the aorta on ultrasound.

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Retroperitoneal Sarcoma

A rare malignant tumor that can cause a pulsatile abdominal mass.

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Arteriovenous Fistula

An abnormal connection between an artery and a vein, commonly caused by trauma.

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Signs of an Arteriovenous Fistula

Clinical signs of an arteriovenous fistula include low back or abdominal pain, progressive cardiac decompensation, an abdominal mass with a bruit, and massive swelling of the lower trunk or extremities.

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Renal Arteriovenous Fistula

An arteriovenous fistula in the kidney, which may be congenital or acquired.

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Ultrasound Findings of an Arteriovenous Fistula

Ultrasound findings of an arteriovenous fistula include multiple anechoic tubular structures, an enlarged renal artery and vein, and a dilated IVC. It may mimic hydronephrosis or a parapelvic cyst.

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Diagnosing an Arteriovenous Fistula

To diagnose an arteriovenous fistula, ultrasound should identify one or more channels entering the mass that suggest an association with the renal vessels.

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Cirsoid Arteriovenous Fistula

A characteristic appearance of a cluster of tubular anechoic structures within the kidney, supplied by an enlarged renal artery and drained by an enlarged renal vein.

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Study Notes

Rupture of Aortic Aneurysm

  • Lateral wall below renal vessels is the most common rupture site.
  • Rupture can cause hemorrhage into the pararenal space, displacing the kidney and obliterating the psoas muscle (seen on sonograms).
  • Rupture can also cause hemorrhage into the perirenal space, displacing vessels at the renal hilum and compressing the aortic walls together.

Large Aortic Aneurysm

  • A large aneurysm may compress adjacent structures.
  • Possible complications include biliary obstruction (CBD), hypertension and renal ischemia (renal artery compression), and ureteral issues due to fibrosis.

Abdominal Aortic Rupture

  • Images show the different stages of abdominal aortic rupture, with one stage showing a ruptured aneurysm.

Aortic Graft

  • Abdominal aortic aneurysms can be repaired using a flexible graft material (like Dacron) attached to the healthy portion of the aorta.
  • The graft material is highly echogenic.
  • Post-surgery, the attached aortic walls can swell and form a pseudoaneurysm, a vascular collection like a "mass" due to leaks through the aortic/graft wall.

Aortic Graft Techniques (Page 10)

  • Initial techniques placed grafts in the aorta, at the bifurcation (iliac), or within the femoral artery.
  • Enhanced techniques have extended graft placement from the aorta to the femoral artery and even into renal arteries.

Complications of Endovascular Graft

  • Endoleaks (no outflow) can occur immediately after graft placement.
  • The type of graft, placement technique, and aortic anatomy affect the occurrence of these complications.

Other Pulsatile Masses

  • Lymphadenopathy: May pulse with the aorta, often a result of lymphoma. Retroperitoneal nodes are a common cause of pulsatile abdominal mass seen on ultrasound as homogenous masses surrounding the aorta. This can obscure viewing of the aortic wall.
  • Pancreatic Tumor: A hypoechoic mass that may displace the pancreas.
  • Retroperitoneal Sarcoma: A rare malignant tumor that occupies the same space as lymphadenopathy; however, echogenicity varies based on the tissue composition—fatty sarcomas are more echogenic than fibrous or myomatous sarcomas.

Arteriovenous Fistulas

  • An abnormal connection between an artery and a vein.
  • Not usually visible on ultrasound.
  • Most commonly caused by trauma.
  • Some occur due to arteriosclerotic aortic aneurysms.
  • Clinical Signs: Low back/abdominal pain, progressive cardiac decompensation, abdominal mass with bruit (increased sound), massive swelling of the lower trunk/lower extremities.
  • Clinical Signs are caused by altered hemodynamics due to high velocity shunts between the artery and vein leading to: increased blood volume, increased venous pressure, and potential cardiac failure/cardiomegaly
  • Renal AV Fistulas: Can be congenital (e.g., cirsoid, aneurysmal) or acquired (due to trauma, surgery, inflammation, or neoplasm).
  • Ultrasound Findings: Multiple anechoic tubular structures, enlarged renal artery and vein, mimicking hydronephrosis/parapelvic cyst, and dilated IVC (inferior vena cava).
  • Diagnosis involves finding channels entering the mass suggesting connection with the renal vessels.
  • Look for pulsations!
  • Types of Fistulas:
    • Cirsoid: Cluster of tubular anechoic structures within the kidney, supplied by enlarged renal artery and drained by enlarged renal vein.
    • Aneurysmal: Presence of thrombus in the periphery of the mass with a tubular anechoic lumen, often pulsating, sometimes associated with renal cell carcinoma due to vessel invasion.

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Description

This quiz covers the critical aspects of aortic aneurysms, including rupture sites, complications, and surgical repair options. It highlights the implications of both large and ruptured abdominal aortic aneurysms and their management. Test your knowledge on this important cardiovascular topic.

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