Intro to angiography

Question 1

ideal position to access femoral artery

Answer 1

inferiomedial margin of femoral head (hemostasis, artery and vein are side by side)

Question 2

yin-yang sign on US

Answer 2

swirling high velocity flow in a pseudoaneurysm

Question 3

complication of AVF

Answer 3

enlarging –> high output cardiac failure

Question 4

normal waveform in an artery?

Answer 4

triphasic

Question 5

AVF on ultrasound, type of flow proximal to fistula?

Answer 5

increased diastolic flow proximal to fistula

Question 6

concern for air emboli, patient maneuver

Answer 6

left lateral decubitus with air bubble in antidependent position

Question 7

injection rate: 25 for 50?

Answer 7

25 cc/sec for total of 50 s

Question 8

injection rate for different vessels

• aortogram
• IVC
• mesenteric artery
• renal artery
• distal artery

Answer 8

ortogram (aortic arch): 20 for 30. Abdominal aorta: 20 for 20. Inferior vena cavogram: 20 for 30.
Mesenteric artery: 5 for 25. Renal artery: 5 for 15. Distal artery: 3 for 12.

Question 9

rule of thumb for determining injection rate

Answer 9

diameter of mm is a rough guide to injection rate in cc/sec

Question 10

controlled stretch injury to increase intraluminal cross-sectional area; disrupts intima and extension of plaque into media

Answer 10

angioplasty

Question 11

non-compliant vs compliant balloon

Answer 11

fixed diameter–overinflation will rupture

Question 12

10 x 6 balloon?

Answer 12

10 mm in diameter, 6 cm in length

Question 13

size selection for balloon

Answer 13

10-20% larger than vessel diameter

Question 14

angioplasty complications

Answer 14

distal emboli, vessel rupture, dissection

Question 15

types of stents

Answer 15

balloon-expandable and self-expandable

Question 16

pros and cons of balloon-expandable stents

Answer 16

pro: higher radial force upon deployment
con: cannot rebound if crushed; suboptimal for sites with external compression (joints, adductorcanal)

Question 17

pro and con of self-expandable stent

Answer 17

pro: flexible, trackable through vessels; good for tortuous vessels

Question 18

size selection for stent

Answer 18

10% oversize artery, 20% oversize vein

1-2 cm longer than stenosis and diameter 1-2 mm wider than unstenosed vessel lumen

Question 19

use for fenestrated vs covered stents

Answer 19

fenestrated: scaffolding support
covered: pseudoaneurysm, dissection, TIPS

Question 20

permanent embolic materials

temporary embolic material

Answer 20

coil, particles, glue (cyanoacrylate), sclerosing agents (sodium tetradecyl sulfate)

absorbable gelatin sponge (gelfoam), autologous clot

Question 21

tactic for placing coils

Answer 21

distal to lesion then proximal to prevent recurrent bleeding from retrograde collaterals

Question 22

how coils work

Answer 22

causes thrombosis by inducing vascular stasis

Question 23

types of particles

Answer 23

trisacyl gelatin microspheres (embospheres, BioSphere Medical) and polyvinyl alcohol

Question 24

absorbable gelatin sponge

Answer 24

Gelfoam causes temporary emboli for 2-6 weeks

small gas bubbles may be seen since it is a dissolved foam

Question 25

complications of embolization

Answer 25

post embolization syndrome: pain, cramping, fever, n/v; thought to be secondary to endovascular inflammatory markers; treat with NSAID, opioids, IVF non-target emoblization

Question 26

non-target embolization in UAE and bronchial artery embolization

Answer 26

uterine fibroid embolization: embolization of ovaries bronchial artery: embolization of brain causing stroke and to spinal arteries causing paralysis

Question 27

size of 1 Fr, 6 Fr

Answer 27

0.33 mm, 2 mm

Question 28

high flow/flush catheter selective/superselective catheters

Answer 28

used for large vessel angiography; have multiple sideholes single hole at end of catheter - C2/SOS reverse curved-tip - Berenstein angled tip catheter

Question 29

sizes - standard - microwire

Answer 29

standard: 0.035" microwire: 0.018"

Question 30

standard wire types

Answer 30

floppy tip: bentson | J tip: Rosen

Question 31

hydrophilic wire types and use

Answer 31

Roadrunner (Cook) or Glidewire (Terumo) hydrophilic wires are used to cross stenosis or initial cannulation of indwelling device

Question 32

stiff wires, type

Answer 32

used for structural rigidity like devices that need to be inserted over subcutaneous tissues (sheath, biliary drain, nephrostomy tube) amplatz