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Core Vascular/IR > Core Vascular/IR > Flashcards

Core Vascular/IR Flashcards

1
Q

Femoral structure relationships

A

From lateral to medial, the mnemonic NAVL helps to localize the femoral nerve, artery, vein, and lymphatics.

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2
Q

Where to access femoral artery

A

Inferomedial margin of the femoral head. Can compress against the femoral head for hemostasis and vein/artery at this level are side by side. Lower down the vein can overly the artery making it more likely to form an AV fistula.

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3
Q

When to treat pseudoaneurysm

A

* When >1 cm; use thrombin injection * Under 1 cm monitor.

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4
Q

PTA balloon size

A

10-20% larger than vessel diameter

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5
Q

Balloon expandable vs self expandable stents

A

* Balloon expandable have higher radial forces but are crushable. * Self expandable have lower radial forces but are more flexible and can are more traceable through vessels.

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6
Q

Catheter and sheath sizing

A

* Measured in French * 1 Fr = 0.33 mm * Catheter = external diameter * Sheath = internal diameter and the external diameter is usually 1-2 Fr larger.

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7
Q

Giant cell arteritis

A

* Medium and large vessel vasculitis that generally affects those >50 * Medium-sized UE arteries most commonly affected including subclavian, axillary, and brachial arteries * Image: There is complete occlusion of the axillary/brachial artery at the origin of the brachial artery (yellow arrow) and an irregular appearance of the posterior circumflex humeral artery (red arrow).

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8
Q

Classic cross sectional finding in abdomen in SVC syndrome

A

Increased enhancement of segment IVa due to collateral opacification of the vein of Sappey. Communicates with internal thoracic veins.

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9
Q

Why get ECG before pulmonary artery angiography?

A

Make sure no LBBB is present because angiography could cause RBBB and therefore complete heart block. In this case would insert a temporary pacer.

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10
Q

HHT

A

* Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). * Multiple pulmonary AVMs * HHT can clinically present with brain abscess, stroke, or recurrent epistaxis (due to nasal mucosa telangiectasia) * Coil asymptomatic lesions when feeding artery >3 mm.

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11
Q

Most common causes of chronic inflammation/hypertrophied bronchial arteries in USA and rest of world

A

* Causes hemoptysis * USA = cystic fibrosis and thoracic malignancy * Rest of world = tuberculosis and fungal infection

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12
Q

Nontarget embolization complication of bronchial artery embolization

A

Anterior spinal artery or smaller tributaries arising from bronchial and intercostal arteries.

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13
Q

Replaced left hepatic artery

A

Arises from left gastric artery. Occurs in 11-12%.

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14
Q

Celiac/SMA anastomotic pathways

A

* Arc of Buhler is an uncommon, persistent embryological remnant. * Superior (gastroduodenal)/inferior (SMA) pancreaticoduodenal arteries * Arc of Barkow composed of left (splenic)/right (gastroduodenal) gastroepiploic arteries

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15
Q

SMA/IMA anastomotic pathways

A

* Marginal artery is major pathway and lies in the peripheral mesentery of the colon, adjacent to the mesenteric surface of the colon * Arc of Riolan also runs through colonic mesentery, more medial than marginal artery

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16
Q

Replaced right hepatic artery

A

* Arises from SMA * Occurs in 10-18% * Can be inadvertently injured during laparoscopic cholecystectomy

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17
Q

External iliac/thoracic aortic anastomosis

A

Inferior epigastric from external iliac to superior epigastric from internal mammary

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18
Q

External/internal iliac artery anastomosis

A

Deep circumflex iliac artery from external iliac to iliolumbar artery from posterior division of internal iliac artery.

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19
Q

Internal iliac/IMA anastomosis

A

* The inferior/middle rectal arteries arise from the internal iliac artery and anastomose with the IMA via the superior rectal artery * This collateral pathway is the path of Winslow (rectal arcade)

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20
Q

Polyarteritis nodosa

A

* Necrotizing vasculitis of small and medium-sized arteries that causes multiple peripheral aneurysms * P-ANCA elevated * Typically affects renal, hepatic, and mesenteric end arterioles * Associated with CLASH (cryoglobulinemia, leukemia, RA, sjogren’s syndrome, hepatitis B).

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21
Q

Indications for treatment of splenic artery aneurysm

A

* Symptomatic * Asymptomatic but >2.5 cm * Prior to pregnancy

22
Q

Angiographic finding in liver cirrhosis

A

Corkscrewing of hepatic artery

23
Q

Angiodysplasia

A

* Acquired vascular anomaly * Common cause of intermittent LGI bleeding usually in right colon/cecum * Rarely see active extravasation * See tangle of vessels on angiography * Treatment is with endoscopy because abnormal vessels make endovascular options non-effective.

24
Q

Most common cause of LGI bleeding in adults

A

Diverticulosis

25
Q

Fibromuscular dysplasia

A

* Idiopathic vascular disease affecting primarily renal + carotid arteries * Young/middle-aged women * 80% is medial fibroplasia subtype (string of pearls) * Intimal fibroplasia subtype more common in children and shows smooth stenosis * Responds well to angioplasty

26
Q

Disease that can cause renal artery stenosis in children

A

Neurofibromatosis

27
Q

Angiographic features of RCC

A

* Hypervascular often with AV shunting and venous lakes * Bizarre neovascularity

28
Q

Definition and angiographic features of oncocytoma

A

* Oncocytoma is a benign renal mass that cannot be reliably distinguished from renal cell carcinoma on cross-sectional imaging * Angiography classically shows a spokewheel appearance with a peritumoral halo * In contrast to RCC, bizarre neoplastic vessels are absent

29
Q

Definition and angiographic features of angiomyolipoma

A

* Hypervascular hamartoma containing blood vessels, smooth muscles, and fat * Diagnosed on cross-sectional imaging as a renal mass containing macroscopic fat * Angiography shows tortuous feeding arteries, which have a sunburst appearance on the parenchymal phase * Occasionally, small aneurysms are visible, which predispose to risk of hemorrhage, especially if the AML is >4 cm in diameter * In contrast to a renal arteriovenous fistula, AMLs do not feature arteriovenous shunting; that is, no veins will be opacified during arterial phase imaging * Can’t always be reliably distinguished from RCC on angiography so need to diagnose with cross-sectional imaging

30
Q

Median arcuate ligament syndrome

A

* Celiac artery compressed by median arcuate ligament * Worsens with expiration * Typically in young/thin females * Treatment is surgical release of MAL

31
Q

May-Thurner syndrome

A

* Thrombosis in L common iliac vein caused by compression from R common iliac artery * Over time compression leads to fibrous adhesion within the vein that predisposes to thrombosis * Treatment is thrombolysis + stenting

32
Q

Portosystemic gradient

A

* = (wedged hepatic vein pressure) - (free hepatic vein pressure) * Represents sinusoidal resistance to portal flow * Portal hypertension = portosystemic gradient > 5 mm Hg

33
Q

Absolute contraindications to TIPS

A

* R-sided heart failure * Severe hepatic failure * Severe hepatic encephalopathy

34
Q

Interruption of IVC

A

* Rare * Blood from lower IVC flows into azygos/hemiazygos then into thorax/right atrium * Associated with polysplenia and congenital heart disease

35
Q

Varicoceles more common on which side and why?

A

* L side b/c L gonadal vein drains into L renal vein * R gonadal vein drains directly into IVC

36
Q

Primary sclerosing cholangitis

A

* Chronic inflammatory and fibrosing process leading to multifocal strictures of intra- and extrahepatic biliary tree * Associated with UC * Ultimately leads to biliary cirrhosis and increases risk of developing cholangiocarcinoma * Cholangiogram shows multifocal biliary strictures

37
Q

Klatskin tumor

A

* Hilar cholangiocarcinoma that can block both left and right bile ducts * Requires two drains be placed to drain both sides of the biliary system

38
Q

Absolute contraindications to percutaneous gastrostomy

A

* Lack of appropriate window * Extensive gastric varices * Uncorrectable coagulopathy

39
Q

Leriche syndrome

A

* Chronic occlusive atherosclerotic disease of the distal abdominal aorta * Causes quartet of impotence, buttock claudication, absent femoral pulses, and cold LEs * Collaterals form from thoraco-abdominal aorta to external iliac arteries * Anterior, middle, and posterior collaterals.

40
Q

Leriche syndrome anterior collaterals

A

Thoracic aorta > internal thoracic (internal mammary) artery > superior epigastric artery > inferior epigastric artery > external iliac artery

41
Q

Leriche syndrome middle collaterals

A

Abdominal aorta > SMA > IMA > superior rectal artery (terminal branch of IMA) > middle/inferior rectal arteries via the path of Winslow > retrograde through the internal iliac artery anterior division > external iliac artery

42
Q

Leriche syndrome posterior collaterals

A

Abdominal aorta > intercostal and lumbar arteries > superior gluteal and iliolumbar arteries (branches of internal iliac artery posterior division) > deep circumflex iliac artery > external iliac artery

43
Q

Iliac artery aneurysm

A

* >1.5 cm in diameter * Repair indicated >3.0 cm * Associated with atherosclerotic disease and abdominal aortic aneurysms * Can also occur secondary to connective tissue diseases such as Marfan

44
Q

Persistent sciatic artery

A

* Very rare * Fetal sciatic artery persists to supply majority of the blood supply to the leg * Arises from internal iliac artery and continues distally to the popliteal artery * A rudimentary femoral artery may be present

45
Q

Indications for and complications of uterine artery embolization

A

Indications: * Symptomatic treatment of fibroids * Postpartum hemorrhage Complications: * Abscess * Endometritis * Ovarian necrosis due to non-target embolization

46
Q

When to slow/stop tPA infusion

A

* Slowed when fibrinogen reaches <150 mg/dL * Stopped when <100 mg/dL

47
Q

Popliteal aneurysms

A

* >8 mm * 20% have aortic aneurysms * Up to 50% have bilateral popliteal aneurysms * Treatment for all symptomatic and asymptomatic >2 cm

48
Q

Buerger disease

A

* Medium/small vessel occlusive vasculitis * Affects LE > UE * Suspect in male smokers with claudication * Angiography shows segmental stenoses of medium/small arteries in the legs with corkscrew patterns seen in the vaso vasorum * Treatment = stop smoking

49
Q

PICC placement

A

* Basilic vein > cephalic vein > brachial veins * Risk of damage to the median nerve if placed into brachial veins (lies superficial to the veins)

50
Q

Paget-Schroetter syndrome

A

* Subclavian vein compression and thrombosis as it enters the thorax Usually seen in muscular young men

51
Q

Hypothenar hammer syndrome

A

* Chronic repetitive trauma causes ulnar artery to be chronically traumatized at the hamate, leading to intimal injury, thrombus, aneurysm, or pseudoaneurysm * Imaging shows occlusion of the ulnar artery, often with distal embolic occlusions due to distal thrombi, usually in the 4th and 5th fingers * Treatment is surgical.

52
Q

Subclavian steal syndrome

A

* Proximal stenosis or occlusion of subclavian artery which leads to retrograde flow from vertebral artery into subclavian * Clinically presents with vertebrobasilar insufficiency or syncope exacerbated by arm exercise * Best diagnoses with angiography; early arterial phase shows proximal subclavian flow-limiting lesion and later arterial phase shows retrograde flow from vertebral artery

Core Vascular/IR (2 decks)

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