MCCCD Program Description

Intermediate Vascular Technology

Course: DMS285

First Term: 2011 Fall

Lecture 2 Credit(s) 2 Period(s) 2 Load
Subject Type: Occupational
Load Formula: S

Description: Sonographic evaluation of the upper and lower peripheral vascular system and the cerebrovascular system. Normal and pathologic sonographic imaging and Doppler evaluation of the venous, arterial systems of the upper and lower extremities, and intracranial and extracranial vessels.

MCCCD Official Course Competencies
1. Identify the vessels in the vascular system. (I) 2. Describe the function of vein valve leaflets in venous physiology in the normal patient and the patient with venous insufficiency. (I, IV) 3. Differentiate fusiform, saccular, and dissecting aneurysms. (I, IV) 4. List common nonatherosclerotic vascular disorders. (I, IV) 5. Describe the role of the muscle pump in venous physiology. (I, IV, VI) 6. Relate the difference between primary and secondary Raynaud`s syndrome. (I, V, VI, VII) 7. Explain the effects of collateral flow on hemodynamics. (II, VII) 8. List the risk factors and mechanism for vascular disease. (III, IV) 9. Describe the evolution of atherosclerotic plaque. (IV) 10. List the components of Virchow`s Triad, and relate how these impact venous pathophysiology. (IV) 11. Describe the effects of stenosis and occlusion on flow characteristics in the vascular system. (IV, VII, VIII) 12. Define the clinical signs associated with acute and chronic vascular disease. (V) 13. Define transient ischemic attack, reversible ischemic neurologic deficit, stroke, and vertebrobasilar insufficiency. (V, VI) 14. List the current treatment options for patients with vascular disease. (V, IX) 15. Describe the capabilities, limitations, patient positioning, protocol/techniques, and diagnostic criteria for vascular examinations. (VI, VII) 16. Describe the capabilities, limitations, protocol/techniques, waveforms, and diagnostic criteria for vascular circulation test procedures. (VII, VIII) 17. Describe the capabilities, limitations, protocols/techniques, and diagnostic criteria for noninvasive peripheral arterial test procedures. (VII, VIII) 18. Define correlative imaging technologies of digital subtraction, computed tomographic arteriography, and magnetic resonance arteriography. (VIII)
MCCCD Official Course Competencies must be coordinated with the content outline so that each major point in the outline serves one or more competencies. MCCCD faculty retains authority in determining the pedagogical approach, methodology, content sequencing, and assessment metrics for student work. Please see individual course syllabi for additional information, including specific course requirements.

MCCCD Official Course Outline
I. Anatomy A. Aortic arch 1. Major branches a. Innominate artery (braciocephalic) b. Left common carotid artery c. Left subclavian artery 2. Origination and termination of vessels 3. Relational anatomy of vessels a. Principal arch anomalies 4. Collateral pathways B. Abdominal aorta 1. Functional division a. Supra-renal b. Infra-renal 2. Branches a. Phrenic b. Celiac c. Superior mesenteric d. Renal e. Gonadal f. Inferior mesenteric g. Lumbar C. Lower extremity arteries 1. Components a. Common iliac b. External iliac c. Internal iliac (hypogastric) d. Common femoral e. Superficial femoral f. Deep femoral (profunda femoris) g. Popliteal h. Anterior tibial i. Tibioperoneal trunk j. Posterior tibial k. Peroneal l. Plantar arteries D. Carotid artery (extracranial) 1. Components a. Common carotid artery b. Carotid bulb c. Internal carotid artery (1). Carotid siphon (2). Ophthalmic artery - 1st intracranial branch d. External carotid artery 2. Origination and termination of vessels 3. Relational anatomy 4. Collateral pathways E. Vertebral artery 1. Segments a. Pre-vertebral b. Cervical c. Horizontal d. Intracranial 2. Origination and termination 3. Relational anatomy 4. Collateral pathways F. Upper extremity deep veins 1. Components a. Deep digital and deep palmar b. Radial and ulnar c. Brachial d. Axillary e. Subclavian f. Brachiocephalic (innominate) g. Neck - Internal jugular, external jugular 2. Origination and termination of vessels 3. Anatomic anomalies 4. Relational anatomy of vessels 5. Collateral pathways G. Upper extremity superficial veins 1. Components a. Cephalic b. Basilic c. Median cubital 2. Origination and termination of vessels 3. Anatomic anomalies 4. Relational anatomy of vessels 5. Collateral pathways H. Lower extremity deep veins 1. Components a. Deep digital and metatarsal b. Calf veins (1). Soleal veins (2). Gastrocnemius (sural) veins (3). Tibial (4). Peroneal (5). Posterior tibial (6). Anterior tibial c. Popliteal d. Femoral (FV) e. Deep femoral (profunda femoris) f. Common femoral g. External and internal iliac (hypogastric) h. Common iliac i. Inferior vena cava 2. Origination and termination of vessels 3. Anatomic anomalies 4. Relational anatomy of vessels a. Significance of left common iliac vein location 5. Collateral pathways I. Lower extremity superficial veins 1. Components a. Great saphenous b. Small saphenous 2. Origination and termination of vessels 3. Anatomic anomalies 4. Relational anatomy of vessels 5. Collateral pathways J. Lower extremity perforating veins 1. Origination and termination of vessels K. Central venous system 1. Components a. Vena cava (1). Superior vena cava (2). Inferior vena cava b. Portal, hepatic, renal, and mesenteric 2. Origination and termination of vessels 3. Anatomic anomalies 4. Relational anatomy of vessels 5. Collateral pathways L. Vein walls and valve leaflets 1. Intima 2. Media 3. Adventitia 4. Valve leaflets M. Common Congenital Anomalies II. Intracranial Circulation A. Components 1. Circle of Willis and contributing arteries a. Terminal Internal Carotid Artery b. Middle cerebral artery c. Anterior cerebral artery d. Anterior communicating artery e. Posterior communicating arteries f. Posterior cerebral arteries g. Basilar artery 2. Terminal vertebral artery B. Origination and termination C. Relational anatomy D. Collateral pathways III. Risk Factors A. Pre-disposing 1. Age 2. Cancer 3. Prolonged bed rest or inactivity 4. Prior episode of deep venous thrombosis 5. Trauma 6. Hormones 7. Paraplegia 8. Surgery 9. Pregnancy 10. Thrombofilias B. Virchow`s triad 1. Stasis 2. Hypercoagulability 3. Vessel wall injury C. Controllable 1. Diabetes 2. Hyperlipidemia 3. Hypertension 4. Smoking D. Uncontrollable 1. Age 2. Gender 3. Family history 4. Hypercoagulopathy IV. Mechanisms of Disease A. Atherosclerosis 1. Definition/characteristics 2. Common locations 3. Plaque evolution a. Endothelial injury b. Sub-endothelial deposit of lipids c. Inflammatory response; smooth muscle cell proliferation d. Plaque formation B. Aneurysm 1. Definition/characteristics a. True aneurysm (1). Fusiform (2). Saccular b. dissecting c. Pseudoaneurysm 2. Common locations C. Thromboembolic events 1. Definition/characteristics D. Carotid body tumor 1. Definition/characteristics E. Nonatherosclerotic lesions 1. Arteritis a. Types b. Common locations 2. Vasospastic disorders a. Raynaud`s syndrome b. Primary - Raynaud`s disease c. Secondary - Raynaud`s phenomenon 3. Aortic coarctation a. Etiology and characteristics 4. Entrapment syndromes a. Popliteal artery entrapment b. Thoracic outlet compression syndrome 5. Popliteal cystic disease F. Fibromuscular dysplasia 1. Definition/characteristics 2. Common locations G. Subclavian (vertebral) steal 1. Definition/characteristics H. Neointimal hyperplasia 1. Definition/characteristics 2. Common locations I. Acute deep venous thrombosis J. Chronic deep venous thrombosis 1. Post-thrombotic syndrome K. Chronic venous insufficiency 1. Valvular incompetence 2. Outflow obstruction 3. Stasis ulceration 4. Ambulatory venous hypertension L. Varicose veins 1. Primary venous insufficiency 2. Secondary venous insufficiency M. Congenital 1. Absence of valves 2. Hypercoagulability N. Pulmonary embolism O. Types of Stroke 1. Hemorrhagic 2. Ischemic 3. Lacunar V. Signs and Symptoms A. Transient symptoms 1. Transient ischemic attack 2. Vertebrobasilar insufficiency B. Non-localizing (non-focal) symptoms C. Stroke 1. Minor 2. Major D. Chronic occlusive disease 1. Claudication 2. Ischemic rest pain 3. Trophic changes a. Gangrene b. Ulcers E. Acute arterial occlusion 1. Embolic 2. Thrombotic 3. Trauma 4. Six P`s a. Pain b. Pallor c. Pulselessness d. Paresthesia e. Paralysis f. Poikilothermia F. Vasospastic disorders 1. Digital cold sensitivity VI. Physical Examination A. Palpation of pulses 1. Locations 2. Relevance B. Auscultation - bruits 1. Definition 2. Location 3. Relevance C. Bilateral brachial systolic pressure measurements 1. Indication 2. Relevance D. Skin (dermal) changes 1. Color 2. Temperature 3. Thickened nails; scaly, thin, transparent-appearing skin; loss of hair E. Palpation of pulses F. Auscultation of pulses G. Acute deep venous thrombosis 1. Phlegmasia alba dolens 2. Phlegmasia cerula dolens H. Chronic deep venous thrombosis I. Venous ulceration/stasis ulcers 1. Chronic venous insufficiency a. Clinical etiologic anatomic pathologic classification (1). Venous ulcer, venous stasis VII. Noninvasive Test Procedures A. Duplex sonography 1. Patient positioning 2. Choice of instrumentation/transducer frequencies 3. Examination protocol 4. Imaging and spectral Doppler techniques 5. 2-D interpretation a. Normal characteristics b. Abnormal characteristics c. Measurements (1). Diameter versus area (2). Intimal medial thickness (3). Aneurysm size B. Spectral Doppler interpretation 1. Normal characteristics 2. Abnormal characteristics 3. Measurements a. Peak systolic velocity b. Internal Carotid Artery (ICA)/Common Carotid Artery(CCA) ratio c. End diastolic velocity d. Pitfalls of measurements e. Current diagnostic criteria C. Color Doppler interpretation 1. Presence/absence of flow 2. Direction of flow 3. Flow characteristics a. Aliasing b. Bruit D. Capabilities E. Limitations F. Intraoperative duplex sonography 1. Indications 2. Capabilities 3. Limitations G. Transcranial Doppler /Transcranial Imaging Examination 1. Patient positioning 2. Choice of instrumentation/transducer frequency a. Imaging b. Non-imaging 3. Examination protocol a. Acoustic windows b. Vessel depth c. Signal traceability d. Sample volume size e. Transmit frequency/power 4. Imaging and spectral Doppler techniques 5. Spectral Doppler interpretation a. Normal characteristics (1). Flow direction (2). Flow pattern (3). Velocity ranges b. Abnormal characteristics c. Measurements (1). Maximum of the mean velocity (2). Peak systolic velocity (3). End diastolic velocity (4). Internal Carotid Artery (ICA)/Middle Cerebral Artery (MCA) ratio (5). Pulsatility index (6). Pitfalls of measurements (7). Embolic showers H. Color Doppler interpretation 1. Presence/absence of flow 2. Direction of flow 3. Flow characteristics I. Capabilities 1. Current clinical use J. Limitations K. Indirect (physiologic) testing 1. Segmental systolic pressure measurements a. Rationale b. Cuff sizes c. Extremity (1). 3-cuff versus 4-cuff techniques (2). Advantages and disadvantages d. Digital e. Penile f. Examination protocols g. Interpretation of pressures h. Capabilities i. Limitations 2. Constant-load treadmill exercise testing a. Rationale b. Examination protocol c. Interpretation of post-exercise ankle pressure response 3. Reactive hyperemia a. Rationale b. Examination protocol c. Interpretation of post-inflation pressure response 4. Plethysmography a. Pulse volume recording b. Photoplethysmography L. Direct testing 1. Continuous wave Doppler evaluation a. Analogue waveforms b. Zero crossing detector 2. Duplex imaging/color flow imaging a. Spectral Doppler interpretation b. Color Doppler interpretation 3. Capabilities 4. Limitations M. Duplex imaging 1. Patient positioning 2. Choice of instrument/transducer frequencies 3. Examination protocol 4. Imaging and spectral Doppler techniques 5. 2-D interpretation 6. Spectral Doppler interpretation a. Normal characteristics b. Abnormal characteristics c. Flow characteristics 7. Color Doppler interpretation a. Presence/absence of flow b. Direction of flow c. Flow characteristics d. Recanalization e. Collateralization 8. Duplex imaging/color flow imaging a. Identification of valvular incompetence b. Spectral Doppler c. Color Doppler 9. Reflux plethysmography a. Photoplethysmography (1). Venous refill time b. Air plethysmography 10. Capabilities 11. Limitations N. CW Doppler 1. Patient positioning 2. Examination protocol/technique 3. Interpretation a. Normal characteristics b. Abnormal characteristics c. Measurements d. Correlative and/or Prior Imaging VIII. Conventional Arteriography A. Interpretation 1. Stenosis 2. Occlusion 3. Collaterals/intracranial cross-filling B. Limitations C. Digital subtraction arteriography 1. Interpretation a. Stenosis b. Occlusion c. Collaterals/intracranial cross-filling 2. Limitations D. Computed tomography arteriography 1. Interpretation a. Stenosis b. Occlusion c. Collaterals/intracranial cross-filling 2. Limitations E. Magnetic resonance arteriography 1. Current clinical use 2. Interpretation a. Stenosis b. Occlusion c. Collaterals/intracranial cross-filling 3. Limitations IX. Treatment A. Indications B. Medical control and reduction of risk factors 1. Lifestyle 2. Pharmacologic control a. Hypertension b. Cholesterol c. Clotting factors C. Endovascular 1. Percutaneous transluminal angioplasty 2. Stent D. Surgical 1. Endarterectomy 2. Thrombectomy 3. Embolectomy 4. Bypass graft a. In Situ Saphenous b. Reversed Saphenous c. Non-reversed translocated saphenous d. Prosthetic e. Cryo-preserved grafts f. Anastomoses (1). End-to-side (2). End-to-end (3). Interposition graft (4). Side-to-side 5. Amputation 6. Fasciotomy 7. Split-thickness skin grafts E. Acute thrombolitic therapy F. Anticoagulation G. Thrombolytic therapy H. Vena caval filters I. Compression stockings J. Surgery 1. Ligation of perforating veins 2. Stripping or local excision of varicosities 3. Sclerotherapy K. Endovascular 1. Percutaneous transluminal angioplasty 2. Stent 3. Endograft 4. Atherectomy L. Compression/thrombin injection 1. Pseudoaneurysm repair

MCCCD Governing Board Approval Date: 5/24/2011

All information published is subject to change without notice. Every effort has been made to ensure the accuracy of information presented, but based on the dynamic nature of the curricular process, course and program information is subject to change in order to reflect the most current information available.