Flashcards in Interventional radiology Deck (138)
What are the branches of the celiac artery?
Left gastric, common hepatic, splenic
What is the collateral flow to the spleen?
Short gastrics (via left gastroepiploic)
where does the GDA originate and what does it become?
Originates from common hepatic (which becomes proper hepatic beyond that) and branches into right gastroepiploic and superior pancreaticoduodenal
what connects the SMA and celiac?
Pancreaticoduodenal arcade: superior pancreaticoduodenal artery comes from GDA, inferior pancreaticoduodenal artery comes from SMA
(Dorsal pancreatic artery: splenic artery to superior pancreaticoduodenal a)
Give two routes to access a lesion in the gastroepiploic artery
From the right: celiac -> GDA -> gastroepiploic, from the left: celiac -> splenic -> left gastroepiploic
What do you have to remember when treating an upper GI bleed?
Bracket the bleed because of collateral supply
In any patient with GI bleed, including BRBPR, especially if shocky, what should you ask?
Has an NG tube been placed (to check for upper GI blood)?
What agents can be used for upper GI bleeds?
gelfoam, coils - rich vascular supply
what agents can be used for lower GI bleeds?
Coils (no gelfoam, no particles, would lead to necrosis)
What causes hemobilia s/p ERCP?
extrav from injury to (right) hepatic artery
Bronchial artery bleeds - causes?
Bronchiectasis (many causes, including CF), fungus/TB, tumor
What material is used to embolize bronchial artery bleeding?
particles (not coils)
What are the risks to remember before doing bronchial artery embo?
Paralysis from anterior spinal artery embo, also remember to go past the takeoff of intercostal branches
What is a Rassmusen's aneurysm?
A pulmonary artery aneurysm in or adjacent to a tuberculous cavity
What do you do when there's a lot of hematuria following perc nephrostomy tube placement?
1st upside the tube to tamponade. If still bleeding, do renal arteriogram to look for fistula
How large do visceral aneurysms (e.g. splenic or renal) need to be before most people would treat them?
What's the cause of diffusely small, abnormal mesenteric vessels?
Shock/hypotension (everything is vasoconstricted), pt may be "bleeding on the bed"
What's the first vital sign to check to evaluate for blood-loss/pt becoming unstable
Heart rate (blood pressure only drops after tachycardia cannot compensate)
What material to embolize an AML?
Particles (you want necrosis), or glue
Why are AMLs prone to bleeding?
Abnormal arteries, prone to aneurysm formation
What patients get aortoenteric fistulas? How are they treated?
S/p aortic endograft or open AAA repair. Rx is surgery.
GI bleeding arteriogram - blush but it washes out rather than persisting indicates what?
How many types of endoleak are there and what are they?
1a - Leak from top of graft
1b - leak from bottom of graft
2 - retrograde flow from a collateral vessel
3 - fabric tear or at overlap points
4 - porosity of the material
5 - "endotension" aka "we have no idea"
Where do type 2 leaks usually come from?
Type 2 is retrograde flow from a collateral, usually the IMA or a lumbar artery originating from the internal iliac
How can you identify CO2 angiograms?
*sometimes* they are white, in general lower resolution, don't travel very far, always below diaphragm
Contraindications to CO2 angiography?
Anything above the diaphragm, L->R shunt
How to treat bilateral common iliac artery stenoses?
Kissing stents, deployed simultaneously to avoid embo from one side to the other
Why would you see celiac filling on an SMA injection?
Backfilling due to proximal celiac occlusion
What are the conditions necessary for chronic mesenteric ischemia?
2 of 3 mesenteric vessels must be occluded or severely stenosed