Interventional Radiology Flashcards
(205 cards)
Indication for treatment of AVF in pregnant pt
Bleed
High flow cardiac failure
Indications for treatment of visceral artery aneurysm
larger than 2 cm in diameter
demonstrate rapid growth
when patients present with symptoms attributable to the aneurysm
therapy is often advocated for VAAs in women of childbearing age, pregnant women, and liver transplant recipients irrespective of their size and presence of symptoms
Indications for uterine embolization in post partum hemorrhage
Uterine atony refractory to medical treatment
Cervical uterine hemorrhage
Vaginal thrombus
Cervical vaginal tear after failed surgical repair
Pseudoaneurysm
Persistent bleed post hysterectomy
What is minimum size of particles when embolizing bronchial art. circulation
325microns
If you use smaller, risk of distal embolization with complications such as tracheal and pericardial necrosis
Why shouldn’t you embolize with particles a pulmonary AVF in HHT?
NEVER use particles in this situation as they will go into the systemic circulation with high risk of stroke
What type of ablation technique could you use if you want to treat a tumor surrounding a vessel or duct that you want to preserve?
Irreversible electroporation.
Structures surrounded by collagen are preserved.
Particularly useful for pancreas tumor ablation. Other ablation techniques cause pancreatitis
What is the largest tumor size amenable to tumor ablation?
Maximum number?
4cm
If it’s larger, ablation is non curative and not indicated
No more than 5 lesions
What is the major complication of an intra-atrial central line placement in neonates?
Cardiac tamponnade (0.1-0.18% incidence in NICU PICCs)
What is the reversal agent for opiate overdose?
Naloxone 0.4-0.8mg IV
What is the reversal agent for benzodiazepine overdose?
Flumazenil 0.2mg IV
Why is it not recommended to use a glidewire (terumo) as an initial wire after arterial puncture?
When doing a single wall puncture, if there is intima tenting at the tip of the needle, using a glidewire as an initial wire can cause a dissection. Other wires have a lower risk of causing arterial dissection in these situations.
What are the contraindications for the use of an arterial closure device?
Puncture too high/low Femoral artery too small <5mm Patient too thin/too heavy Severe atherosclerosis at the site of puncture Multiple prior punctures at access site Allergy Double wall puncture
At what size should you treat a postprocedure femoral pseudoaneurysm? How?
> 1cm in diameter
Ultrasound-guided thrombin injection is the treatment of choice
What type of femoral puncture increases the risk of retroperitoneal hemorrhage?
A high arterial puncture, above the pelvic brim
What type of femoral puncture increases the risk of AVF?
Low femoral arterial puncture, because the femoral vein often times passes posterior to the artery distally.
In comparison, at the inferomedial aspect of the femoral head, the standard puncture site, the vein passes medial to the artery.
If an air embolism is suspected, what are the necessary steps for treatment?
Position patient in left lateral decubitus (left side down).
100% oxygen administration, stimulates resorption of air
If air bubble is large, catheter aspiration can be attempted.
In conventional angiography, what is the typical injection rate (cc/sec) of these vessels:
1- Aorta 2- IVC 3- Mesenteric artery 4- Renal artery 5- Peripheral arteries
1- 20cc/sec (arch: 20 for 30, abdo: 20 for 20) 2- 20cc/sec (20 for 30) 3- 5cc/sec (5 for 25) 4- 5cc/sec (5 for 15) 5- 3cc/sec (3 for 12)
(cc/sec for total cc)
When performing percutaneous transluminal angioplasty, what should the balloon size be?
10-20% larger than the vessel diameter.
TRUE OR FALSE
Anticoagulation should always be used with angioplasty
TRUE
What is the difference in radial force and flexibility (rebound) between balloon-expandable and self-expandable stents?
Balloon-expandable stents have a higher radial force but will not rebound if crushed.
Self-expandable stents are more flexible and trackable through vessels.
In what situations are self-expandable stents preferred over ballon-expandable stents?
Because self-expandable stents are more flexible, their use is favored when:
- The route to the lesion is tortuous
- The anatomy is prone to external compression (creases in the body)
What is the general approach to choosing a stent size for the treatment of a stenosis?
Stent should be 1-2cm longer than the stenosis
Diameter should be 1-2mm wider than the unstenosed vessel lumen
10% oversizing of arterial stent
20% oversizing of venous stent
In what situations should you use a covered stent instead of a fenestrated stent?
Pseudoaneurysm
Dissection
TIPSS
What are the permanent embolic materials?
coils
particles
glue
sclerosing agent