ABD VESEEL DOP FLOW PT 4 PDF

Rupture of Aortic Aneurysm Sites of Rupture: (infrarenal or suprarenal) Lateral Wall below Renal Vessels—most common *May hemorrhage into pararenal space, may displace kidney, obliterate psoas muscle on sonogram *May hemorrhage into perirenal space, displacing vessels at renal hilum, an...

Rupture of Aortic Aneurysm Sites of Rupture: (infrarenal or suprarenal) Lateral Wall below Renal Vessels—most common *May hemorrhage into pararenal space, may displace kidney, obliterate psoas muscle on sonogram *May hemorrhage into perirenal space, displacing vessels at renal hilum, and compressing aortic walls together 1  Rupture of Aortic Aneurysm A large aortic aneurysm may compress adjacent structures: CBD—biliary obstruction Renal Artery—causing hypertension & renal ischemia Aneurysm w/Retroperitoneal Fibrosis may affect ureter 2 Abdominal Aortic Rupture Pg. 164 Fig. 8-38  AORTIC GRAFT Abdominal Aortic Aneurysms may be repaired with a flexible graft material (like Dacron) that is attached to the healthy portion of the aorta. The graft material is very echogenic. After surgery, the attached aortic walls may swell at the site of the attachment and form another aneurysm or pseudoaneurysm– a vascular loculated “mass” created by a leak through the aortic/graft wall. 4 AORTIC GRAFT Pg. 167 Fig. 8-42 AORTIC GRAFT Pg. 167 Fig. 8-43  Page 167 Fig. 8-42 Aneurysm Psudoaneury sm 7 Complications of Aortic Graft Surgery: a.New Aneurysm b.Pseudoaneurysm c.Hematoma d. Infection 8  Aorta Graft Techniques A newer technique repairs aortic aneurysm with an endovascular graft treatment—a procedure in which the graft material is rolled up tightly and passed through the femoral artery up to the site of the aneurysm. Then the material is “released” to fix the aneurysm from the inside. (Like a tightly rolled paper unrolls a little when you turn it loose) 9  Aorta Graft Techniques The first technique could place the graft in the aorta, at the bifurcation (iliac), or in the femoral artery. Further advancements allowed graft placement to extend from the aorta all the way to the femoral artery or to extend into the renal arteries. Complications of A Endovascular Graft: Endoleak formations that have no outflow can occur immediately after the graft is placed The type of graft used, the technique used to place it, and the anatomy of the aorta all affect the rate of these complications. 11 Other Pulsatile Masses Lymphadenopathy Pancreatic Tumor Retroperitoneal Sarcoma 12  Other Pulsatile Masses Lymphadenopathy: Will “pulse” with the aorta. Usually the result of LYMPHOMA Retroperitoneal nodes are the most common “nonaneurysm” cause of Pulsatile Abdominal Mass On ultrasound, nodes appear as homogeneous masses surrounding the aorta. May make aortic wall difficult to see. 13  Other Pulsatile Masses Pancreatic Tumor: may displace pancreas. Is a hypoechoic mass Retroperitoneal Sarcoma: Rare malignant tumor Takes up same space as lymphadenopathy, but echogenicity will vary depending on the tissue making up the sarcoma—Fatty Sarcomas are more echogenic than fibrous or myomatous 14 Retroperitoneal Lymphadenopathy Pg. 439 Fig. 16-18 15  Arteriovenous Fistulas An abnormal connection between an artery and a vein Not commonly seen on ultrasound Majority are acquired due to trauma Some may occur due to arteriosclerotic aortic aneurysms 16  Arteriovenous Fistulas Clinical Signs: Low back/Abdominal Pain Progressive Cardiac Decompensation Abdominal Mass associated with a Bruit (increased sound) Massive Swelling of the lower trunk/lower extremities 17  Arteriovenous Fistulas Clinical signs are based on the altered hemodynamics produced by the high velocity shunt from artery to vein which leads to increased blood volume, increased venous pressure, and cardiac failure/cardiomegaly. If patient has lower trunk/leg edema and dilated IVC,  Arteriovenous Fistulas Renal AV Fistulas: May be congenital or acquired Congenital = Cirsoid, Aneurysmal Acquired= due to trauma, surgery, inflammation, or associated with a neoplasm 19  Arteriovenous Fistulas Ultrasound Findings: Multiple Anechoic Tubular Structures Enlarged Renal Artery & Vein May mimic hydronephrosis/parapelvic cyst IVC usually dilated 20  Arteriovenous Fistulas To diagnose—MUST identify one or more channels entering the mass suggesting that the structure is associated with the renal vessels. Look for pulsations!  Arteriovenous Fistulas Cirsoid Type=characteristic appearance of a cluster of tubular anechoic structures within the kidney. Supplied by enlarged renal artery. Drained by enlarged renal vein. Aneurysmal Type= Has thrombus in the periphery of a mass with a tubular anechoic lumen with pulsations. Occasionally associated with Renal Cell Carcinoma due to vessel invasion 22