Abdominal Aorta waveform(s)
Low resistance proximal, Higher resistance beyond renals
Celiac Artery supplies
Liver, spleen, stomach, & proximal
... [Show More] small bowel
Branches of the Abdominal AO
1st major-Celiac artery (trunk/axis)
2nd major-SMA
Renals
3rd major-IMA (after renals)
Celiac Axis
Branches into Common Hepatic (to right), Splenic, & Left Gastric (off left)
Common Hepatic Arteries
Gives rise to the Gastroduodenal artery in PANC head & divides into Rt & Lt Hepatics
Splenic Artery
Branches left and posteriosuperior to PANC body/tail
SMA/IMA waveforms
High resistance preprandial/Low resistance postprandial
SMA supplies
Bowel from duodenum to prox small bowel
IMA supplies
Bowel descending & rectosigmoid colon
Right Renal Artery
Branches anterolateral, posterior to IVC
Left Renal Artery
Branches posterolateral
Renal Artery waveform
Low resistance
Portal vein is usually formed by the confluence of
SMV & Splenic veins
*It also receives blood from the inferior mesenteric, gastric, and cystic veins
Portals walls/waveforma
echogenic walls & phasic waveforms
Renal veins are formed by
renal tributaries
Left Renal Vein
Longer than Rt.; Receives suprarenal/Gonadal vein
Left Renal pathway
Anterior to AO; Posterior to SMA
Right Renal Vein
No tributaries; shorter
Hepatic Veins
Hepatofugal flow; from liver to IVC
Patient status for Abdominal Vascular Imaging
NPO 8-12 hours
Ectasia
Local diameter increase with small bulge
(20% increase for Ao <3cm)
AAA growth rate
1-2mm/year until 3-4cm; 5 mm/yr >4cm
Aneurysm classification
2-3cm; 3-4cm for AAA
AAA Intervention
5.5cm (high risk for rupture-catastrophic)
Fusiform
Concentric enlargement; All 3 layers intact
Saccular
Eccentric enlargement; All 3 layers compromised; Less common (<1%); Usually in Thoracic Ao
Types of Saccular AAA
1-Cannula Placement
2-Mycotic aneurysm (bacterial infection Ao wall)
3-Vasculitis (Inflammatory process)
4-Penetrating ulcer rupture into media
Vasculitis/Aortitis
Inflammatory process in wall of Ao beginning with outer (adventitia) layer and moving inward; ie: Takayasu's
Dissection
Intimal wall compromised resulting in 2 lumens
false>true; flow reversal
Type 1 (a/b) endoleak
Leak in anastamosis of graft at (a) prox or (b) distal end
Type 2 endoleak
Aorta branch vessel; exhibits retrograde flow; more dangerous b/c internally bleeding
Type 3/4 endoleak
(3) Junction of modular components; (4) Trans graft flow-graft defect
Chronic Mesenteric Ischemia
"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
Celiac >200cm/s
SMA >275cm/s
Median Arcuate Ligament Syndrome (MALS)
Arch impedes on Celiac during EXPIRATION (non-compressed during inhalation)
Measurement(s) of Splenic Vein
7-17 cm long; 5-10mm diameter [Show Less]