powered by
Center for Curriculum and Transfer Articulation
Advanced Vascular Technology
Course: DMS286

First Term: 2015 Spring
 Lecture   2 Credit(s)   2 Period(s)   2 Load  
Subject Type: Occupational
Load Formula: S - Standard Load


Description: Vascular evaluation of the abdominal vicera and small parts. Normal and pathologic sonographic imaging and Doppler evaluation of the venous and arterial systems of the abdominal organs and small body parts. Capabilities, limitations, protocols and techniques required for diagnosis of the systemic, hepatoportal, and collateral systems, and extremities. Preoperative mapping of the radial, mammary, and epigastric arteries.



MCCCD Official Course Competencies
1. Identify the arteries and veins of the abdomen and list the major branches of the abdominal aorta. (I)
2. Differentiate the anatomy and blood flow patterns of pseudoaneurysms and arteriovenous fistulae. (I, III, V)
3. List the common risk factors for abdominal arterial and venous disorders. (II, III)
4. Relate the clinical presentation of patients with abdominal aortic aneurysm, portal hypertension, and chronic mesenteric ischemia. (II, III, IV)
5. Describe the mechanisms of disease for renovascular hypertension, renal fibromuscular dysplasia, abdominal aortic aneurysm, portal hypertension, and chronic mesenteric ischemia. (III, IV)
6. Describe the variations in vascular resistance in the mesenteric arterial system during fasting and post-prandial states. (III, V)
7. Differentiate normal and abnormal Doppler spectral waveforms from the hepatic and portal veins and the inferior vena cava. (III, V)
8. Relate the noninvasive vascular test procedures and provocative maneuvers used for detection of thoracic outlet syndrome. (III, V)
9. Relate the technical protocols for assessment of dialysis access grafts and fistulae. (V)
10. Detail the sonographic evaluation of liver, pancreas, and renal transplants. (V)
11. Describe the tests procedures and modalities used for evaluation of vasculogenic impotence. (V)
12. Differentiate the signs and symptoms of congenital and acquired lymphedema and deep vein thrombosis. (V)
13. Describe the capabilities, limitations, patient positioning, protocols/techniques, and current diagnostic criteria for duplex sonography of the abdominal aorta, renal and mesenteric arteries, and the hepatoportal system. (V, VI)
14. Describe the correlating imaging modalities used for confirmation of abdominal vascular disease. (VI)
15. Describe the current treatment options for patients with renovascular hypertension, mesenteric ischemia, abdominal aortic aneurysm, and portal hypertension. (VII)
16. Describe the protocols and techniques used for preoperative mapping of the extremity veins, and the radial arteries. (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. Abdominal pelvic arterial
      1. Components
         a. aorta
         b. celiac artery (trunk, axis)
            (1). hepatic arteries
            (2). splenic artery
            (3). left gastric
         c. superior mesenteric artery (SMA)
         d. renal arteries
         e. inferior mesenteric artery (IMA)
         f. gonadal arteries
         g. iliac arteries
   B. Abdominal pelvic venous
      1. Components
         a. iliac veins
         b. gonadal veins
         c. inferior mesenteric vein (IMV)
         d. renal veins
         e. splenic vein
         f. superior mesenteric vein (SMV)
         g. portal vein tributaries
            (1). superior mesenteric vein
            (2). splenic vein
               (a). Inferior mesenteric vein
         h. hepatic veins
         i. inferior vena cava (IVC)
   C. Common Congenital Anomalies
II. Risk Factors
   A. Arterial
      1. Diabetes
      2. Hypertension
      3. Hyperlipidemia
      4. Smoking
      5. Atrial fibrillation
   B. Venous
      1. Prior thrombosis
      2. Malignancy
      3. Liver disease
III. Mechanisms of Disease
   A. Renovascular hypertension
      1. Consistent clinical features
         a. hypertension
         b. renal artery stenosis/occlusion/fibromuscular dysplasia
         c. renal ischemia
      2. Etiology
         a. atherosclerosis
         b. fibromuscular dysplasia
         c. arteritis
         d. post-irradiation fibrosis
         e. neurofibromatosis
         f. thrombosis/embolism
   B. Mesenteric angina/ischemia
      1. Chronic celiac, SMA, IMA stenosis or occlusion
         a. consistent clinical features
            (1). post prandial pain
            (2). "fear of food" syndrome
            (3). weight loss
         b. Etiology
            (1). atherosclerosis
            (2). thrombosis/embolism
      2. Acute mesenteric ischemia
         a. consistent clinical features
            (1). acute, severe abdominal pain
            (2). result of delayed diagnosis
               (a). potential for catastrophic gastrointestinal ischemia
         b. etiology
            (1). embolism
            (2). thrombosis
   C. Portal hypertension
      1. Portal splenic vein thrombosis
      2. Cirrhosis
      3. Budd-Chiari syndrome
   D. Abdominal aortic aneurysm
      1. Size
      2. Location
      3. Classification
         a. fusiform
         b. saccular
         c. dissecting
         d. mycotic
      4. Etiology
         a. atherosclerosis
         b. aging
         c. infection/inflammation
         d. trauma
         e. congenital anomalies
            (1). Ehler-Danlos syndrome
            (2). Marfan`s syndrome
            (3). others
         f. medial degeneration
         g. arteritis
IV. Signs and Symptoms
   A. Arterial
      1. Acute mesenteric ischemia
         a. abrupt onset of severe abdominal pain
         b. gastrointestinal tissue injury
      2. Chronic mesenteric ischemia
         a. triad of symptoms
      3. Renal
         a. renovascular hypertension
         b. renal artery stenosis/occlusion
         c. renal ischemia
      4. Aneurysm
         a. incidental finding
         b. "pulsatile abdominal mass"
         c. abdominal or back pain
         d. embolization/blue toe syndrome
            (1). digital arteries
            (2). end-arterial occlusion
   B. Venous
      1. Portal
         a. portal hypertension
            (1). cirrhosis
            (2). Gastrointestinal (GI) Bleed
            (3). ascites
            (4). jaundice
      2. Hepatic
         a. Budd-Chiari syndrome
            (1). hepatomegaly
            (2). ascites
            (3). abdominal pain
            (4). portal hypertension
      3. IVC
         a. lower extremity edema
V. Noninvasive Test Procedures
   A. Direct-duplex imaging/color flow imaging
      1. Patient positioning
      2. Examination protocol
      3. Imaging and spectral Doppler techniques
         a. aorta
         b. celiac, splenic, and hepatic arteries
         c. mesenteric arteries
         d. renal arteries
         e. IVC
         f. hepatic veins
         g. portal, splenic, and mesenteric veins
         h. renal veins
      4. 2-D interpretation
         a. normal characteristics
         b. abnormal characteristics
         c. measurements
            (1). diameter versus area reduction
      5. Spectral Doppler interpretation
         a. normal characteristics
         b. abnormal characteristics
         c. measurements
            (1). peak systolic velocity
            (2). end diastolic velocity
            (3). velocity ratio
            (4). pitfalls of measurements
      6. Waveform analysis
         a. triphasic
         b. monophasic
         c. continuous, non-phasic
         d. pulsatile
      7. Color Doppler interpretation
         a. presence/absence of flow
         b. direction of flow
         c. flow characteristics
   B. Pseudoaneurysm/Arteriovenous Fistula
      1. Pseudoaneurysm
         a. examination protocols
         b. imaging and spectral Doppler techniques
            (1). sonography-guided probe compression repair
            (2). sonography-guided thrombin injection repair
         c. characteristics
            (1). multilobar
            (2). concomitant arteriovenous fistula
         d. measurements
            (1). pseudoaneurysm diameter
            (2). neck length and diameter
         e. spectral Doppler interpretation
         f. color Doppler interpretation
      2. Arteriovenous fistula
         a. classification
            (1). traumatic
            (2). congenital
         b. noninvasive test procedure
            (1). direct-duplex scanning and color flow imaging
         c. patient positioning
         d. examination protocols
         e. imaging and spectral Doppler techniques
         f. 2-D interpretation
            (1). characteristics
            (2). measurements
               (a). location
               (b). diameter/length
         g. spectral Doppler interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements/waveform analysis
               (a). characteristic low resistance Doppler signal
               (b). proximal and distal venous flow signals
         h. pitfalls of measurements
         i. color Doppler interpretation
            (1). presence/absence of flow
            (2). direction of flow
            (3). flow characteristics
         j. capabilities
         k. limitations
   C. Dialysis access
      1. Direct-duplex scanning and color flow imaging
         a. patient positioning
         b. examination protocols
            (1). pre-operative mapping of inflow and outflow vessels
            (2). dialysis fistulae
            (3). dialysis grafts
            (4). catheters
         c. imaging and spectral Doppler techniques
      2. Interpretation
         a. normal characteristics
         b. abnormal characteristics
         c. spectral Doppler measurements/waveform analysis
            (1). peak systolic velocity
            (2). end diastolic velocity
            (3). velocity ratios
            (4). Flow volume
         d. color Doppler interpretation
            (1). presence/absence of flow
            (2). direction of flow
            (3). flow characteristics
   D. Organ Transplants
      1. Types
         a. kidney
         b. liver
         c. pancreas
      2. Examination protocols
      3. Imaging
         a. normal characteristics
         b. abnormal characteristics
         c. measurements
      4. Spectral Doppler interpretation
         a. normal characteristics
         b. abnormal characteristics
         c. measurements
            (1). peak systolic velocity
            (2). end diastolic velocity
            (3). velocity ratios
            (4). pitfalls of measurements
      5. Color Doppler interpretation
         a. presence/absence of flow
         b. direction of flow
         c. flow characteristics
   E. Impotence Testing
      1. Indirect
         a. pressures
            (1). penile-brachial index
      2. Direct-Duplex sonography and color flow imaging
         a. patient positioning
         b. examination protocols
         c. imaging and spectral Doppler techniques
            (1). techniques for cavernosal artery injection
         d. image interpretation
            (1). characteristics
            (2). measurements
               (a). pre and post-injection
               (b). anterior-posterior dimensions
         e. spectral Doppler interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). post-injection timing
               (b). peak systolic velocity
               (c). end diastolic velocity
               (d). duration of erection
      3. Color Doppler interpretation
         a. presence/absence of flow
         b. direction of flow
         c. flow characteristics
   F. Thoracic Outlet Syndrome Evaluation
      1. Indirect
         a. plethysmography
         b. patient positioning
         c. examination protocol
            (1). provocative maneuvers
         d. techniques for indirect assessment
            (1). arterial inflow
            (2). arterial outflow
         e. interpretation of waveforms and pressures
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). qualitative
               (b). quantitative
      2. Direct-duplex sonography with color flow imaging
         a. patient positioning
         b. examination protocols
         c. imaging and spectral Doppler techniques
         d. 2-D interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). arterial/venous diameter proximal to thoracic outlet
               (b). arterial/venous diameter distal to thoracic outlet
         e. spectral Doppler interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). peak systolic velocity
               (b). end diastolic velocity
               (c). velocity ratio
               (d). pitfalls of measurements
         f. color Doppler interpretation
            (1). presence/absence of flow
            (2). direction of flow
            (3). flow characteristics
   G. Giant Cell Arteritis
      1. Classification
         a. temporal arteritis
         b. takayasu`s arteritis
      2. Direct-Duplex sonography with color flow imaging
         a. patient positioning
         b. examination protocol
         c. imaging and spectral Doppler techniques
         d. 2-D Interpretation
            (1). normal characteristics
            (2). abnormal characteristics
               (a). halo sign
            (3). measurements
         e. spectral Doppler interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). peak systolic velocity
               (b). end diastolic velocity
               (c). velocity ratio
         f. color Doppler interpretation
            (1). presence/absence of flow
            (2). direction of flow
            (3). flow characteristics
   H. Trauma/Arterial Injury
      1. Indirect testing
         a. Continuous Wave (CW) Doppler
         b. plethysmography
      2. Direct testing-Duplex sonography with color flow imaging
         a. patient positioning
         b. choice of instrumentation and transducer frequencies
         c. examination protocol
         d. imaging and spectral Doppler techniques
         e. 2-D Interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). diameter
               (b). length
         f. spectral Doppler interpretation
            (1). normal characteristics
            (2). abnormal characteristics
            (3). measurements
               (a). peak systolic velocity
               (b). end diastolic velocity
               (c). velocity ratio
               (d). pitfalls of measurements
         g. color Doppler interpretation
            (1). presence/absence of flow
            (2). direction of flow
            (3). flow characteristics
   I. Lymphedema
      1. Definition
      2. Classification
         a. congenital/primary
         b. acquired/secondary
   J. Limitations
VI. Correlative and/or Prior Imaging
   A. Conventional arteriography
      1. Interpretation
         a. stenosis
         b. occlusion
         c. collaterals/intracranial cross-filling
   B. Digital subtraction arteriography
      1. Interpretation
         a. stenosis
         b. occlusion
         c. collaterals/intracranial cross-filling
      2. Limitations
   C. Computed tomographic arteriography
      1. Interpretation
         a. stenosis
         b. occlusion
         c. collaterals/intracranial cross-filling
      2. Limitations
   D. Magnetic resonance arteriography (MRA)
      1. Current clinical use
      2. Interpretation
         a. stenosis
         b. occlusion
         c. collaterals/intracranial cross-filling
      3. Limitations
VII. Treatment
   A. Indications for treatment
   B. Medical
      1. Antihypertensives
      2. Anticoagulation
   C. Surgical
      1. Bypass graft
      2. Endarterectomy
   D. Endovascular
      1. Aortic endograft (stent graft)
      2. Angioplasty/stent
      3. IVC interruption device (filter)
VIII. Preoperative Venous and Arterial Mapping
   A. Potential vessels for use as bypass conduits
      1. Saphenous veins, cephalic, and basilic veins
      2. Radial artery
      3. Internal mammary artery
      4. Epigastric artery
   B. Patient positioning
   C. Examination protocols
   D. Imaging and spectral Doppler techniques
   E. 2-D interpretation
      1. Normal characteristics
      2. Abnormal characteristics
      3. Measurements
         a. diameter
         b. length
   F. Spectral Doppler interpretation
      1. Normal characteristics
      2. Abnormal characteristics
      3. Measurements/waveform analysis
         a. venous
            (1). phasic versus non-phasic
         b. arterial
            (1). triphasic/biphasic/monophasic
            (2). peak systolic velocity
            (3). end-diastolic velocity
            (4). velocity ratios
      4. Pitfalls of measurements
   G. Color Doppler interpretation
      1. Presence/absence of flow
      2. Direction of flow
      3. Flow characteristics
   H. Capabilities
   I. Limitations

 
MCCCD Governing Board Approval Date: November 25, 2014

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.