Vascular/IR

Question 1

What is most common type of endoleak?

What type of endoleaks need urgent attention?

Answer 1

Type 2 - where there is a feeding vessel

Most IR Consultatnts will watch type 2 leaks for up to a year. If sac is increasing in size they will intervene

High flow endoleaks require urgent attention - Type 1 and type 3

Question 2

RFA vs Microwave therapy

What are the differences?

Answer 2

RFA

• cooks tumour to 60 degrees
• patient needs ‘ground pad’ on their leg
• lesions must be smaller than 4cm IF for CURE
• can still do larger lesions but this will be debulking
• must have margin of 1cm around lesion
• Suffers from Heat sink - where treatment of lesions near vessels is less effective as flowing blood cools temperature and takes heat from lesion*

Microwave

• cooks tumour also
• requires less time
• doesnt require ground pad

Question 3

Is it normal to get low grade fever and body aches post ablation?

Post ablation syndrome

Answer 3

Yes - normal for a few weeks

If persistent for >2 weeks - work up for infection

Question 4

What are 3 main types of ablation of liver masses in IR?

Answer 4

1. RF ablation
2. Cryoablation
3. Microwave

Question 5

What is cryoablation of masses?

Answer 5

Freeze thaw cycle using compressed argon gas

• Less painful for patient
• Risk of bleeding is higher (arent ablating small vessels)

Question 6

What is most common vessel to bleed in UGI bleeds?

What about duodenal ulcer?

Answer 6

Left gastric artery - UGI

GDA if duodenal ulcer

Question 7

What can compression or occlusion of celiac artery cause?

Answer 7

Compression will cause redirection of blood through pancreatic duodenal arcades (collateral network)

This can result in aneurysm within pancreatic arcade and bleeding

If you see retrograde filling of hepatic artery from SMA with collateral vessels - think Celiac stenosis/occlusion

Question 8

What is main culprit artery in massive haemoptysis?

Answer 8

90% of cases it is bronchial artery

Bronchial artery arises directly off aorta at T5-6 level

You will not see extravasation in lungs - instead you see tortuous enlarged brocnhial arteries

Main concern in embolising bronchial artery is that it can be in close relation to artery of Adamkiewicz which supplies the anterior spinal cord