IR Flashcards
1
Q
femoral arterial access –> needle enter –> at what location on skin?
A
femoral head –> infmed
2
Q
femoral arterial access –> needle –> med/lat –> what angle?
A
45 deg
3
Q
femoral NAVL –> order?
A
lat –> med:
- N
- A
- V
- Lymphatic
4
Q
common femoral A –> begin at what landmark?
A
inguinal lig
5
Q
femoral arterial access –> low access –> potential comp?
A
puncture A & V –> AV fistula
6
Q
femoral arterial access –> high access –> potential comp?
A
above pelvic brim –> retroperitoneal hemorrhage
7
Q
differentiate: pseudoaneurysm –> tx –> watchful wait vs US-guided thrombin injection?
A
- <1cm: watchful wait
- >1cm: US-guide thrombin inject
8
Q
AVF –> doppler findings? (3)
A
- V –> arterial flow
- A –> loss of normal triphasic waveform
- A –> prox to fistula –> inc diastolic flow
9
Q
venous access procedure –> #1 dangerous part?
A
catheter –> insert into peel-away sheath
10
Q
catheter –> insert into peel-away sheath –> pt acute hypoxic –> dx? next step?
A
air embolism:
- L lat decubitus
- administer 100% O2
11
Q
lrg air embolism –> possible tx?
A
aspirate w catheter
12
Q
angiographic run –> inj rate –> units?
A
cc/sec for total cc
13
Q
angiographic run –> inj rate:
- aortic arch
- abd aorta
- IVC
- mesenteric A
- renal A
- distal A
A
- aortic arch: 20 for 30
- abd aorta: 20 for 20
- IVC: 20 for 30
- mesenteric A: 5 for 25
- renal A: 5 for 15
- distal A: 3 for 12
14
Q
artery stenosis –> 1st line tx?
A
perc transluminal angioplasty (PTA)
15
Q
perc transluminal angioplasty (PTA) –> balloon size –> relative to vessel size?
A
10-20% lrger than vessel diameter
16
Q
perc transluminal angioplasty (PTA) –> balloon size –> units?
A
- diameter (mm)
- length (cm)
17
Q
perc transluminal angioplasty (PTA) –> comp? (3)
A
- distal embolus
- vessel rupture
- dissection
18
Q
stent –> 2 broad types?
A
- balloon-expandable
- self-expandable
19
Q
stent –> balloon vs self - expandable –> pro vs con
A
balloon:
- higher radial force on deploymt
- if crushed –> stay crushed
self:
- more flexible –> more trackable thru vessel
20
Q
vessels around jts –> preferred stent type?
A
self-expandable
21
Q
stent –> what size to use?
A
- 1-2cm longer than stenosis
- 1-2mm wider than normal vessel lumen
22
Q
stent size –> oversize by what %?
- arterial stent
- venous
A
- art –> 10%
- ven –> 20%
23
Q
stent –> covered –> used for what conditions? (3)
A
- pseudoaneurysm
- dissection
- TIPS
24
Q
embolic material –> 2 main categories?
A
- permanent
- temporary
25
permanent embolic material? (4)
- coil
- particle
- glue
- sclerosing agent
26
temporary embolic material? (2)
- gelatin sponge
| - autologous clot
27
embolization coils --> MOA for embolization?
vasc stasis
28
embolization coils --> pro (2) vs con (1)?
pro:
- precise & quick
- no distal embolization
con:
- lose distal access
29
bleed --> embolization coils --> general technique? why?
1) coil --> distal to lesion
2) coil --> prox
prevent recurrent bleed from retrograde collaterals
30
embolic material --> particles --> MOA?
flow distal --> occlude small capillaries
31
embolization particles (2)?
- trisacyl gelatin microspheres
| - polyvinyl alcohol
32
embolic material --> gelatin sponge (Gelfoam) --> last how long?
2-6wk
33
embolic material --> gelatin sponge (Gelfoam) --> CT appearance?
embolized organ --> numerous gas locules --> mimic abscess
34
what is sodium tetradecyl sulfate? use?
sclerosing agent:
- vasc malformation
- varices
35
what is cyanoacrylate?
glue --> harden when contact blood
36
embolization --> comp? (2)
- post-embo synd
| - non-target embo
37
what is post-embo synd? when occur after embo?
embo --> tissue infarct --> release endovasc inflamm modulators --> 1day after --> pain, cramp, fever, N/V
38
post-embo synd --> tx?
- NSAID
- IV fluid
- +/- opioid
39
what is non-target embolization?
unintentional embo structure other than target
40
uterine fibroid embo --> non-target embolization site?
ovaries
41
bronchial A embo --> non-target embolization site? (2)
- brain --> stroke
| - spinal A --> paralysis
42
1 Fr = ? mm
0.33 mm
43
catheter size --> measured by internal or external diameter?
ext
44
sheath size --> measured by internal or external diameter?
int (luminal)
45
catheter --> mult sideholes --> type of catheter?
high flow (flush)
46
high flow (flush) catheter --> used for what type of angiography?
lrg vessel:
- aorta
- IVC
47
catheter --> single sidehole --> type of catheter?
- selective
| - superselective
48
catheter --> tip shape?
- C2
- SOS
- Berenstein
- C2: reverse curve
- SOS: reverse curve
- Berenstein: angled
49
standard wire vs microwire --> size?
- standard --> 0.035"
| - micro --> 0.018"
50
wire --> size? tip type?
- Bentson
- Rosen
- Bentson: standard --> floppy tip
| - Rosen: standard --> J-tip
51
hydrophilic wire --> use? (2)
- cross stenosis
| - indwelling device --> routine check & change --> initial cannulation
52
hydrophilic wire --> 2 examples?
- Roadrunner
| - Glidewire
53
stiff wire --> 1 example?
Amplatz
54
stiff wire --> use?
require structural rigidity --> ie. dilate subQ tissue:
- sheath
- biliary drain
- nephrostomy tube
55
giant cell arteritis --> what size vessels are affected?
large & med
56
giant cell arteritis --> MC location?
UE --> med size A:
- subclavian
- axillary
- brachial
57
giant cell arteritis --> involve aorta --> T/F?
rarely
58
giant cell arteritis --> tx?
steroid
59
SVC --> embryology?
- L ant cardinal V --> regress
| - R ant cardinal V --> SVC
60
L-sided SVC --> embryology?
- L ant cardinal V --> persist
| - R ant cardinal V --> regress
61
L-sided SVC --> drain into --> MC location? rare location?
#1 coronary sinus --> RA
rarely: --> LA (R-->L shunt)
62
duplicated SVC --> embryology?
- L ant cardinal V --> persist
| - R ant cardinal V --> persist
63
SVC synd --> MOA? clinical presentation?
SVC --> acute obstruct -- face & UE --> edema, cyanosis
64
SVC synd --> vasc emergency --> T/F?
T
65
SVC --> chronic stenosis/occlusion --> ssx?
- asympt
| - face edema --> improve w standing
66
SVC obstruct --> cause? (3)
- thorax malig --> compress SVC
- catheter-assoc thrombosis
- histoplasmosis --> mediastinal fibrosis
67
SVC obstruct --> CT abd --> classic finding? why?
collateral flow --> vein of Sappey --> hep segmt IVa --> inc enhance
68
what is V of Sappey?
- region of falc lig --> drain liver
| - comm w internal thoracic V (collaterals in SVC occlusion)
69
pulm angiogram --> pre-proc eval? why?
EKG --> r/o LBBB
pulm A catheter --> can cause temporary RBBB --> LBBB + RBBB --> complete heart block --> can be fatal
70
pulm angiogram --> pre-proc eval --> EKG --> LBBB --> next step?
place temporary pacer before procedure
71
normal pressure?
- RA
- RV
- pulm A
- RA: 0-8 mm Hg
- RV: 0-8 dias / 15-30 sys
- pulm A: 3-12 dias / 15-30 sys
72
mult pulm AVM --> ddx? (1)
hereditary hemorrhagic telangiectasia (HHT) (Osler-Weber-Rendu synd)
73
hereditary hemorrhagic telangiectasia (HHT) (Osler-Weber-Rendu synd) --> clinical presentation? (3)
- brain abscess
- stroke
- recurrent epistaxis
74
pulm AVM --> embo --> general procedure?
single feeding A --> coil
75
limb AVM --> embo --> general procedure?
mult feeding A --> coil entire nidus
76
pulm AVM --> embo --> contraindicated embo material?
particles --> R-L shunt --> brain emboli --> infarct
77
pulm AVM --> embo --> indication? (1)
- asympt: feeding A --> >3mm
| - sympt --> ie infarct, brain abscess
78
massive hemoptysis --> definition?
>300mL/24hr
79
massive hemoptysis --> prognosis?
very high mortality (asphyxiation)
80
massive hemoptysis --> 2 MC affected A?
- #1 bronchial A
| - #2 pulm A
81
massive hemoptysis --> bronchial A normal --> pulm A normal --> next step?
eval:
- subclavian
- internal mamm
- inf phrenic
- celiac
82
USA --> massive hemoptysis --> MC etiology? (2)
- cystic fibrosis
| - thoracic malig
83
global --> massive hemoptysis --> MC etiology? (2)
- TB
| - fungal infx
84
massive hemoptysis --> MOA?
chronic inflamm --> bronchial A hypertrophy --> hemoptysis
85
bronchial A --> origin?
thoracic aorta --> T5-6 level
86
massive hemoptysis --> preferred embo material?
distal embolic agent --> #1 particles
87
massive hemoptysis --> embo --> general procedure?
- eval for L-R shunt --> prevent inadvertent cerebral embo
| - embo to near-stasis
88
massive hemoptysis --> should not use which embo material? why?
common to rebleed after tx
coils --> prevent repeat access
89
massive hemoptysis --> embo --> comp?
nontarget embo --> spinal cord:
| - ant spinal A --> arise from bronchial A
90
spine osseous landmark?
- celiac
- SMA
- renal A
- IMA
- celiac: T12
- SMA: T12-L1
- renal A: L1-L2
- IMA : L2-L3 --> L of midline
91
celiac trunk --> branches?
- L gastric
- common hepatic
- splenic
92
esophagus --> Mallory-Weiss tear --> possible causative A?
L gastric A
93
gastroepiploic A --> origin?
- splenic A --> L gastroepiploic
| - gastroduodenal A --> R gastroepiploic
94
what is replaced R hepatic A?
SMA --> R hep A
95
cystic A --> origin?
R hep A
96
what is accessory R hep A?
1) proper hep A --> normal R hep A
| 2) SMA --> access R hep A
97
replaced R hepatic A --> clinical significance? (3)
- lap chole --> prevent inadvertent A injury
- liver donor --> better anatomosis to recipient
- liver recipient --> small common hep A --> inc arterial comp
98
replaced L hep A --> origin?
L gastric A
99
replaced L hep A --> clinical significance? (1)
gastrectomy --> resect replaced L hep A --> predispose to liver injury
100
SMA --> supplies what?
distal duodenum --> mid-transverse colon
101
SMA --> branches?
- inf pancreaticoduodenal A
- middle colic A
- R colic A
- ileocolic A
102
SMA --> R colic A --> supplies what struct?
- R colon
| - hep flexure
103
SMA --> ileocolic A --> supplies what struct?
- terminal ileum
- cecum
- appendix
104
SMA --> inf pancreaticoduodenal A --> anastomose w what A?
celiac A
105
SMA --> middle colic A --> anastomose w what A?
marginal A of Drummond
106
IMA --> branches?
- L colic A
- sigmoid A
- sup rectal (hemorrhoidal) A
107
internal iliac A --> ant division --> branches?
- inf/middle rectal A
- uterine A
- obturator A
- inf gluteal A
108
internal iliac A --> post division --> branches?
- lat sacral A
- iliolumbar A
- sup gluteal A
109
internal iliac A --> ant division --> inf/middle rectal A --> anastomose w what A?
pathway of Winslow --> IMA
110
internal iliac A --> post division --> iliolumbar A --> anastomose w what A?
deep circumflex iliac A --> external iliac A
111
ext iliac A --> branches?
- inf epigastric A
- deep circumflex iliac A
- femoral A
112
ext iliac A --> inf epigastric A --> anastomose w what A?
sup epigastric A
113
ext iliac A --> deep circumflex iliac A --> anastomose w what A?
iliolumbar A --> int iliac A
114
what is arc of Buhler?
persistent embryologic remnant --> short segment --> connect celiac & SMA
115
what is pancreatic cascade?
1) celiac
2) SMA --> inf pancreaticoduodenoal A
collateral network at pancreatic head
116
what is arc of Barkow?
SMA & celiac anatomosis (via R & L epiploic A)
117
celiac - SMA anastomoses? (3)
- arc of Butler
- inf pancreaticoduodenal A --> pancreatic cascade
- arc of Barkow
118
SMA - IMA anastomoses? (3)
- #1 marginal A of Drummond
- arc of Riolan
- Cannon-Bohn pt
119
what is Cannon-Bohn pt? clinical sig?
splenic flexure --> pt of transitional blood supply bw SMA & IMA --> watershed zone --> susceptible to ischemia
120
ext iliac - thoracic aorta anastomosis?
- ext iliac --> inf epigastric A
| - thoracic aorta -> internal mammary A
121
ext iliac - int iliac anastomosis?
- ext iliac --> deep circumflex iliac A
| - int iliac --> post div --> iliolumbar A
122
int iliac - IMA anastomosis?
path of Winslow (rectal arcade)
123
what is polyarteritis nodosa (PAN)?
systemic necrotizing vasculitis --> small & med A --> mult small visceral aneurysms
124
mult renal A aneurysms --> ddx? (4)
- polyarteritis nodosa (PAN)
- mult septic emboli
- speed kidney (chronic meth abuse)
- Ehlers-Danlos
125
polyarteritis nodosa (PAN) --> MC location? (3)
end-arterioles:
- renal
- hep
- mesenteric
126
polyarteritis nodosa (PAN) --> assoc conditions? (5)
CLASH:
- cryoglobulinemia
- leukemia
- rheum arthritis
- Sjogren synd
- hep B
127
polyarteritis nodosa (PAN) --> tx?
steroid
128
MC visceral aneurysm? 2nd MC
```
#1 splenic A
#2 hep A
```
129
splenic A aneurysm --> epidemiology? (2)
- multiparous F
| - portal HTN
130
splenic A pseudoaneurysm --> etiology? (2)
- trauma
| - pancreatitis
131
splenic A aneurysm --> indication for tx? (3)
- ssx --> ie. LUQ pain
- >2.5cm
- expected preg
132
splenic A aneurysm --> tx?
coil embo
133
hep A aneurysm --> tx --> embo --> general approach?
embo distal to cystic A
if prox to cystic A --> inc risk for ischemic cholecystitis
134
liver cirrhosis --> classic IR finding?
hep A branches --> corkscrewing
135
mesenteric ischemia --> etiology? (4)
- acute A embolus
- chronic A stenosis
- V occlusion
- low-flow state
136
acute mesenteric ischemia --> MCC?
SMA embolus
137
acute mesenteric ischemia --> MC tx
surg:
- embolectomy or bypass --> revasc
- direct inspect bowel
- resect necrotic bowel
138
acute mesenteric ischemia --> SMA embolus --> highest risk of intestinal ischemia --> what location?
distal to middle colic A (few native distal collaterals)
139
acute mesenteric ischemia --> embolic cause --> no peritoneal signs, no ssx of bowel necrosis --> tx?
endovasc therapy:
- thrombolysis
- suction embolectomy
140
what is nonocclusive mesenteric ischemia (NOMI)?
mesenteric A --> mult branches --> spasm & narrow --> "intestinal necrosis w patent arterial tree"
141
nonocclusive mesenteric ischemia (NOMI) --> prognosis?
highly lethal (70-100% mortality)
142
nonocclusive mesenteric ischemia (NOMI) --> tx?
vasodilator (papaverine) --> direct art infuse
143
chronic mesenteric ischemia --> MCC?
atherosclerosis
144
chronic mesenteric ischemia --> how many mesenteric A affected?
at least 2 out of 3
145
chronic mesenteric ischemia --> tx?
angioplasty & stent
146
upper GI bleed --> best initial eval?
endoscopy
147
lower GI bleed --> hemodynamically stable --> best initial eval? why?
localize bleed:
- mesenteric CT angio
- nuc med tagged RBC scan
more sensitive than IR
148
GI bleed --> detectable bleeding rate?
- tagged RBC scan
- CTA
- IR angiography
- tagged RBC scan: 0.2-0.4 ml/min
CTA: 0.35
- IR angiography: 0.5-1.0
149
upper GI bleed --> IR --> no visualized extravasation --> next step?
empiric --> embo L gastric A
150
low GI bleed --> active --> alt IR tx?
vasopressin (antidiuretic hormone) --> intra-art infuse
151
low GI bleed --> vasopressin (antidiuretic hormone) --> pro vs con?
- useful if bleed from antimesenteric vessels
| - stop infuse --> very high rebleed rate
152
low GI bleed --> vasopressin (antidiuretic hormone) --> AE? (3)
- arrhythmia
- pulm edema
- HTN
153
low GI bleed --> vasopressin (antidiuretic hormone) --> how long can infuse? why?
24hr
tachyphylaxis (lack of further response)
154
what is angiodysplasia? clinical sig?
acquired vasc anomaly --> chronic intermittent LGI bleed
155
angiodysplasia --> MC location? (2)
R colon/cecum
156
angiodysplasia --> IR appearance?
tangle of vessels --> antimesenteric draining vein --> early fill --> parallel A & V opacify simult --> "tram track" appearance
157
angiodysplasia --> tx?
endoscopy:
- electrocoag
- laser therapy
- other
158
older adult --> MCC LGI bleed?
diverticula
159
differentiate: atherosclerosis --> renal artery stenosis --> tx --> angioplasty + stent vs angioplasty only --> outcome?
angioplasty + stent --> greater long-term patency
160
what is fibromuscular dysplasia? MC location?
idiopathic --> vasc dz --> renal & carotid A
161
fibromuscular dysplasia --> epidemiology?
young & middle age F
162
differentiate: atherosclerotic renal A stenosis vs fibromuscular dysplasia --> involved portion of renal A?
atherosclerosis --> ostia of renal A
FMD --> mid-distal 1/3
163
fibromuscular dysplasia --> MC subtype? less common subtype?
80% --> medial fibroplasia subtype
intimal fibroplasia
164
fibromuscular dysplasia --> medial fibroplasia subtype --> classic IR appearance?
"string of pearls/beads"
165
fibromuscular dysplasia --> intimal fibroplasia subtype --> IR appearance?
smooth stenosis
166
fibromuscular dysplasia --> intimal fibroplasia subtype --> epidemiology?
child
167
fibromuscular dysplasia --> tx? how well does it work?
angioplasty only --> 9% improved BP ctrl --> high clinical success rate
168
fibromuscular dysplasia --> angioplasty --> restenosis --> common or uncommon?
common --> 10-15%
169
fibromuscular dysplasia --> stent --> recommend or not recommend? why?
not recommend:
- complicate retx w angioplasty
- intimal hyperplasia --> in-stent stenosis
170
child --> renal A stenosis --> etiology? (1)
neurofibromatosis
171
RCC --> classic IR appearance?
"bizarre neovascularity"
172
CT --> RCC --> ddx? (1)
oncocytoma
173
oncocytoma --> classic IR appearance?
- "spokewheel" appearance --> peritumoral halo
| - no bizarre neoplastic vessels
174
what is renal angiomyolipoma?
hypervasc hamartoma --> blood vessels + smooth muscle + fat
175
CT --> renal angiomyolipoma --> how dx?
macroscopic fat
176
renal angiomyolipoma --> IR appearance?
- tortuous feeding A --> parenchymal phase --> sunburst appearance
- occasional --> small aneurysm
177
renal angiomyolipoma --> inc risk of hemorrhage --> what size?
>4cm
178
renal angiomyolipoma --> can demonstrate AV shunting --> T/F?
F
179
RCC --> can demonstrate AV shunting --> T/F?
T
180
IR angio --> renal mass --> next step? why?
CT --> differentiate RCC vs AML
181
horseshoe kidney --> inc risk of traumatic injury --> why?
- not protected by inf ribs
| - may be compresses against spine
182
renal trauma --> 3 types?
- #1 blunt
- penetrating
- iatrogenic
183
trauma --> kidney --> AAST classification? tx?
- grade I-III: nonexpanding hematoma/parenchymal lac, no collecting system injury --> conservative
- IV: deep parenchymal lac --> extend to collecting system
- V: shattered kidney --> renal hilum avulsion --> surg
184
renal trauma --> injury to renal A/V --> which AAST grade?
IV
185
renal trauma --> endovascular tx --> indication? (3)
- active extrav
- dissection
- pseudoaneurysm
186
renal AV fistula --> etiology?
acquired:
- trauma
- renal bx
187
renal AV fistula --> clinical presentation? (4)
- #1 asympt
- hematuria
- high output heart fail
- spont retroperitoneal hemorrhage
188
median arcuate lig synd --> epidemiology?
young thin F
189
median arcuate lig synd --> clinical presentation? (2)
- #1 asympt
| - crampy abd pain
190
median arcuate lig synd --> tx?
surg --> release median arcuate lig --> enlrg diaphragmatic hiatus
191
what is SMA synd (Wilkie synd)?
aorta & SMA --> compress duodenum
192
SMA synd (Wilkie synd) --> epidemiology? (3)
- child
- burn victim
- weight loss
193
what is nutcracker synd?
aorta & SMA --> compress L renal V
194
what is posterior nutcracker synd?
aorta & vertebral body --> compress retroaortic/circumaortic renal V
195
nutcracker synd --> ssx? (5)
- pain
- hematuria
- orthostatic proteinuria
- pelvic congestion
- varicocele
196
nutcracker synd --> prognosis?
resolve w/in 2 yr
197
what is May-Thurner?
R common iliac A --> compress L common iliac V --> venous thrombus
198
May-Thurner --> tx?
1) endovascular thrombolysis
| 2) stent
199
how to measure wedged hepatic vein pressure?
int jug V catheter --> equal portal V pressure
200
why not measure direct hepatic V pressure?
require traverse hepatic parenchyma --> invasive & impractical
201
what is portosystemic gradient (corrected sinusoidal pressure)? formula?
actual sinusoidal resistance to portal flow
| wedged hepatic V pressure) - (free hep V pressure
202
portal HTN --> definition in portosystemic gradient measuremt?
>5 mm Hg
203
portal HTN --> collateral pathway --> esophageal varices
coronary A --> azygos/hemiazygos V
204
portal HTN --> collateral pathway --> gastric varices
splenic V --> azygos V
205
portal HTN --> collateral pathway --> splenorenal shunt
splenic/short gastric --> L adrenal/inf phrenic --> L renal V
206
portal HTN --> collateral pathway --> mesenteric varices
SMV/IMV --> iliac V
207
portal HTN --> collateral pathway --> caput medusa
umbilical V --> epigastric V
208
portal HTN --> collateral pathway --> hemorrhoids
IMV --> inf hemorrhoidal V
209
transjug intrahep portosystemic shunt (TIPS) --> connect what & what? effect?
portal V & R hep V --> lower elevated portal pressure
210
transjug intrahep portosystemic shunt (TIPS) --> indication? (3)
- #1 variceal hemorrhage --> can't ctrl endoscopically
- refractory ascites
- Budd-Chiari (hep V thrombosis)
211
TIPS --> pre-procedure --> assess hep dysfx --> classification system? (2)
- Child-Pugh
| - model for end-stage liver dz (MELD) score
212
Child-Pugh classification --> looks at what factors? (5)
- INR
- bilirubin
- albumin
- ascites
- hep encephalopathy
213
model for end-stage liver dz (MELD) score --> looks at what lab values? (3)
- INR
- bilirubin
- creatinine
214
model for end-stage liver dz (MELD) score --> higher score --> indicates what?
higher post-TIPS mortality
215
TIPS --> absolute contraindications? (3)
- R heart fail (worsened by TIPS)
- severe active hep fail (worsen liver fx)
- severe hep encephalopathy
216
TIPS --> pre-procedure --> need to assess portal V for what?
cross-sectional or US --> portal V --> patent
217
TIPS --> covered or uncovered stent?
covered --> uss self-expanding
218
TIPS --> portosystemic gradient reduce --> goal?
<12 mm Hg
219
TIPS --> cannulate R hep V --> next step?
wedged balloon occlusion venography --> retrograde opacify portal V
220
TIPS --> wedged balloon occlusion venography --> preferred contrast?
CO2 --> less viscous than iodinated contrast --> easily pass thru hep sinusoids
221
TIPS --> stent-graft placed --> completion portal venogram performed --> next step?
embolize varices
222
IVC filter --> indication? (3)
- DVT + anticoag CI
- anticoag --> recurrent PE
- anticoag --> high risk of DVT/PE (ie multi-trauma)
223
IVC filter --> MC comp? 2nd MC?
- #1 access site thrombosis
| - #2 IVC thrombosis
224
duplicated IVC --> IVC filter --> general procedure? (2)
- above IVC confluence --> 1 IVC filter
| - each IVC --> IVC filter
225
duplicated IVC --> clue on initial cavography?
injection --> contralat side --> absence of iliac V influx
226
IVC filter --> "bird's nest" type --> for IVC diameter of?
>28 mm
227
IVC filter: IVC >40mm --> general procedure?
IVC filter --> each common iliac V
228
what is circumaortic L renal V?
L renal V --> 2 componts --> ant & post to aorta
229
what is retroaortic L renal V?
single L renal V --> post to aorta
230
what is interruption of IVC w azygos continuation?
lower IVC --> azygos/hemiazygos V --> thorax --> RA
231
interruption of IVC w azygos continuation --> assoc condition? (2)
- polysplenia
| - congenital heart dz
232
interruption of IVC w azygos continuation --> embryology?
R subcardinal V --> fail to join --> intrahep venous complex
233
what is varicocele?
pampiniform venous plexus --> dilation
234
1ary varicocele --> MOA?
prox gonadal V --> absent/incompetent valves --> venous reflu
235
2ary varicocele --> MOA?
mass --> obstruct venous return
236
1ary varicocele --> can cause infertility --> T/F?
T
237
solitary R varicocele --> next step?
eval for obstructing retroperitoneal mass
238
varicocele --> US appearance?
>2mm dilated venous plexus --> "bag of worms" appearance --> worse w Valsalva
239
varicocele --> tx?
gonadal V:
- coil embo
- surg ligate
240
perc transhep cholangiography (PTC) --> indication? (4)
- relieve biliary obstruction
- ductal injury --> biliary diversion
- trt biliary calculi
- adjunctive pre-surg tx prior to biliary anastomosis
241
perc transhep cholangiography (PTC) --> prophylactic abx required --> T/F? why?
T
biliary stasis --> risk of bact overgrowth
242
perc transhep cholangiography (PTC) --> prophylactic abx?
levofloxacin (gram neg coverage)
243
rib --> neurovasc bundle --> location --> sup or inf ribs?
inf
244
perc transhep cholangiography (PTC) --> R biliary tree --> how to access?
R midaxillary line --> 2 puncture approach
245
perc transhep cholangiography (PTC) --> L biliary tree --> how to access?
L subxiphoid approach
246
perc transhep cholangiography (PTC) --> biliary drain placed --> ok to forward flush? ok to aspirate?
Ok to forward flush
NEVER aspirate: aspirate bowel contents into biliary system --> cholangitis
247
differentiate: biliary stent --> metal vs plastic?
- placemt technique?
- removable?
- how long last?
metal:
- IR place
- can't be removed
- avg patency of 6-8mo
plastic:
- endoscopy
- can be exchanged regularly
248
metal biliary stent --> indication?
life expectancy --> <6mo --> biliary stricture
249
biliary stent placement --> alternative?
int/ext biliary drain
250
perc biliary drainage --> comp? (5)
- sepsis
- hemorrhage
- bile leak
- arterial-biliary fistula --> hemobilia
- abscess
251
perc transhep cholangiography (PTC) --> relative CI? (2) how to bypass these CI?
- intrahep tumor --> direct access an accessible bile duct
| - ascites --> therapeutic paracentesis before procedure
252
bile duct injury --> MCC? less common cause?
- #1 lap chole --> iatrogenic injury
| - orthotopic liver transplant
253
bile duct injury --> tx?
biliary diversion --> drainage bag
allow leak to heal
254
what is sclerosing cholangitis?
chronic --> inflamm & fibrose --> intra & extra-hep bile duct --> multifocal stricture
255
sclerosing cholangitis --> clinical presentation? (3)
- obstructive jaundice
- malaise
- abd pain
256
sclerosing cholangitis --> assoc condition?
ulcerative colitis
257
sclerosing cholangitis --> natural progression of dz?
biliary cirrhosis
258
sclerosing cholangitis --> inc risk of what malig?
cholangioCA
259
sclerosing cholangitis --> tx?
liver tx
260
cholangiogram --> multifocal biliary stricture --> ddx? (5)
- sclerosing cholangitis
- 1ary biliary cirrhosis
- multifocal cholangioCA
- chronic bact cholangitis
- AIDS cholangitis
261
unilat biliary obstruction --> cause? (2)
- mets
| - 1ary biliary malig
262
hilar biliary obstruction --> cause? (1)
hilar cholangioCA (Klatskin tumor)
263
perc GB drainage (cholecystostomy) --> indication?
acute cholecystitis --> not surg candidate
264
cholecystostomy --> cures calculous cholecystitis? acalculous?
- temporary tx for calculous cholecystitis before cholecystectomy
- can cure acalculous cholecystitis
265
cholecystostomy --> prophylactic abx required?
Y
266
cholecystostomy --> 2 percutaneous approaches? MC approach?
- #1 transhep
| - transperitoneal
267
cholecystostomy --> transhep approach --> pro vs con?
- inc risk liver lac
| - dec risk peritoneal bile leak
268
cholecystostomy --> transhep approach --> gen procedure?
midaxillary line --> intercostal/subcostal --> US --> toward GB fossa bare area
269
cholecystostomy --> transperitoneal approach --> pro vs con?
- dec risk liver damage
- inc risk peritoneal bile leak
- penetrate GB fundus (most mobile portion)
270
cholecystostomy --> drainage tube can be removed --> criteria? (3)
- 6wk --> allow fibrous tract form
- pt improved
- repeat cholangiogram --> cystic & common bile duct --> patent
271
cholecystostomy --> risk if drainage tube remv before 6wk?
bile peritonitis
272
perc nephrostomy (PCN) --> MC indication? emergent indication? less common indication?
- #1 stone/malig/stricture --> kidney obstructed --> urinary diversion
- emergent --> pyonephrosis
- can't place retrograde ureteral stent --> place anterograde
273
kidney --> what is zone of Brodel?
kidney --> plane bw ventral & dorsal renal A branches --> relatively avascular zone
274
perc nephrostomy (PCN) --> optimal renal entry site?
postlat kidney --> zone of Brodel --> post calyx
275
perc nephrostomy (PCN) --> MC comp? (2)
- bleed
| - infx
276
perc nephrostomy (PCN) --> pre-existing infx --> comp?
sepsis
277
gastrostomy --> MC indication? less common indication?
#1 dz:
- esophageal
- head/neck
- neurologic
less common --> long term bowel decompress:
- malig bowel obstruct
- prolonged ileus
278
gastrostomy --> absolute CI? (3)
- lack of approp window (ie. colonic interposition)
- extensive gastric varices
- uncorrectable coagulopathy
279
gastrostomy --> general procedure?
1) NG tube --> insufflate stomach
2) fluoro --> T-fastener gastropexy clips --> pexy ant gastic wall to ant abd wall
3) contrast into stomach --> confirm intra-gastric position
4) definitive gastrostomy puncture --> serial dilate
280
gastrostomy --> when can be used after placemt?
24hr eval for peritoneal signs
281
gastrostomy --> how long to form mature transperitoneal tract?
at least 1mo
282
common femoral A --> branches? (3)
- deep femoral
- superficial circumflex iliac
- superficial femoral
283
superficial femoral A --> become popliteal --> at what landmark?
adductor hiatus
284
popliteal A --> branches? (3) which is most medial? most lateral?
medial --> lateral:
- post tibial
- peroneal
- ant tibial
285
post tibial A --> branch?
plantar A
286
ant tibial A --> branch?
dorsalis pedis
287
what is Leriche synd?
chronic atherosclerosis --> distal abd aorta --> occlude
288
Leriche synd --> synd? (4)
- impotence
- buttock claudication
- absent femoral pulse
- cold LE
289
Leriche synd --> over time --> aorta --> extensive collaterals --> ext iliac A --> ant pathway?
thoracic aorta --> int thoracic A --> sup epigastric --> inf epigastric --> ext iliac
290
Leriche synd --> over time --> aorta --> extensive collaterals --> ext iliac A --> middle pathway?
abd aorta --> SMA --> IMA --> sup rectal --> path of Winslow -> mid/inf rectal --> int iliac --> ant division --> ext iliac
291
Leriche synd --> over time --> aorta --> extensive collaterals --> ext iliac A --> post pathway?
abd aorta --> intercostal & lumbar A --> sup gluteal & iliolumbar --> int iliac A post division --> deep circumflex iliac --> ext iliac
292
atherosclerosis --> aortoiliac & infrainguinal occlusive dz --> TransAtlantic Inter-Society Consensus (TASC-II) classification? recommended tx?
- type A: iliac --> <3cm --> concentric stenosis --> noncalcified --> perc transluminal angioplasty (PTA)
- B/C: 3-10cm --> PTA or surg
- D: >10cm --> surg
293
atherosclerosis --> iliac --> angioplasty --> stent placemt --> indication? (2)
- >30% residual stenosis
| - rest --> >10 mm Hg systolic pressure gradient
294
iliac A aneurysm --> definition by measuremt?
>1.5 cm
295
iliac A aneurysm --> tx at what size?
>3 cm
296
iliac A aneurysm --> epidemiology?
older M
297
iliac A aneurysm --> assoc w AAA --> T/F?
T
298
iliac A aneurysm --> MC RF? another RF?
- #1 atherosclerosis
| - Marfan dz
299
IR angio --> iliac A --> narrowing --> next step? why?
cross-sectional imaging:
- atherosclerosis
- iliac aneurysm --> intra-luminal thrombus
300
iliac A aneurysm --> preferred tx?
endovasc stent-graft
301
iliac A aneurysm --> surg --> indication?
aneurysm --> mass effect --> neuro/urologic ssx
302
what is persistent sciatic A?
very rare --> vasc anomaly --> fetal sciatic A --> persist --> major blood supply to leg
303
persistent sciatic A --> origin?
int iliac A --> usu inf gluteal A
304
persistent sciatic A --> how far does it go down?
to popliteal A
305
persistent sciatic A --> inc risk for what condition?
aneurysm
306
trauma --> pelvic fx --> active pelvic bleeding --> next step?
IR angio --> ctrl bleed
307
trauma --> active pelvic bleeding --> IR angio --> general procedure?
1) nonselective pelvic angio
| 2) selective bilat int iliac angio --> ant & post divisions
308
trauma --> active pelvic bleeding --> IR angio --> embo site? embo material?
gelfoam --> nonselective --> int iliac --> entire ant or post division
309
uterine A embo --> indication? (2)
- uterine fibroids --> sympt
| - postpartum hemorrhage
310
uterine A embo --> embo material?
polyvinyl chloride particles
311
uterine fibroids --> uterine A embo --> goal?
- hypervasc fibroids --> hemorrhagic infarction
| - endometrium/myometrium --> maintain adeq perfusion --> preserve futility
312
uterine A embo --> serious comp? (3)
- abscess
- endometritis
- non-target embo --> ovary --> necrosis --> premature menopause
313
LE --> atherosclerosis --> stenosis --> MC location? (5)
- common iliac
- superficial femoral
- popliteal
- tibioperoneal trunk
- tibial A origins
314
atherosclerotic stenosis --> Doppler waveform?
- normal: triphasic waveform
- mod stenosis: biphasic
- severe stenosis/occlusion: flat
315
what is blue toe synd?
toe --> acute thromboembolism
316
acute limb ischemia --> MC source of embolus?
LA --> thrombus
317
acute limb ischemia (acute thromboembolic dz) --> IR angio appearance?
affected vessel --> acute cutoff & "meniscus" sign
318
acute limb ischemia (acute thromboembolic dz) --> tx? (3)
- surg --> embolectomy
- surg --> bypass graft
- endovasc --> thrombolysis
319
acute limb ischemia (acute thromboembolic dz) --> endovasc thrombolysis --> general procedure?
1) hydrophilic wire --> cross lesion
2) multi-sidehole infusion catheter --> place across thrombus
3) ICU --> tPA for 48-72 hr
4) monitor hematocrit, fibrinogen
320
acute limb ischemia (acute thromboembolic dz) --> endovasc thrombolysis --> fibrinogen level --> decrease tPA infusion? stop tPA?
fibrinogen:
- <150 --> dec tPA infusion
- <100 --> stop tPA
321
popliteal A aneurysm --> size criteria?
>8mm
322
popliteal A aneurysm --> tx --> indication? (2)
- sympt
| - >2cm
323
popliteal A aneurysm --> tx? (2)
- endovasc --> stent-graft
| - surg --> bypass
324
popliteal A aneurysm --> assoc w other aneursyms --> T/F?
T
325
what is Buerger dz?
occlusive vasculitis --> med & small vessel
326
Buerger dz --> MC location? less common location?
- #1 LE
| - hands
327
Buerger dz --> epidemiology?
adult M --> smoke
328
Buerger dz --> IR angio appearance?
leg:
- med/small A --> segmental stenosis
- vasa vasorum --> "corkscrew" collaterals
329
Buerger dz --> tx?
smoke cessation
330
what is popliteal entrapmt synd?
calf muscle or fibrous band --> compress popliteal A
331
popliteal entrapmt synd --> MC involved muscle?
aberrant med head of gastrocnemius
332
popliteal entrapmt synd --> epidemiology? clinical presentation?
healthy young M --> exercise-induced claudication
333
popliteal entrapmt synd --> can be bilat --> T/F?
T
334
what is cystic adventitial dz?
popliteal A --> adventitia --> mucoid cyst --> compress lumen
335
cystic adventitial dz --> epidemiology? clinical presentation?
mid age M --> distal claudication
336
cystic adventitial dz --> best imaging modality?
MRI
337
cystic adventitial dz --> tx? (2)
surg:
- resect cyst
- bypass
338
axillary A --> landmarks?
- rib 1 --> lat margin
| - teres major --> inf margin
339
thoracic outlet synd --> clinical presentation?
UE:
- paresthesia
- pain
- numb
- cool
340
interscalene triangle --> contains what struct? (2)
- brachial plexus
| - subclavian A
341
thoracic outlet synd --> MC type?
neurogenic
342
subclavian A compression --> clinical presentation? what worsens ssx?
hand/finger:
- pain
- numb/parethesia
- cool
- Raynaud phenomenon
arm abduct
343
what is Adson's maneuver?
test for subclavian A compress at thoracic outlet:
1) palpate radial pulse
2) pt inhale --> turn head contralat
3) radial pulse reduce
344
subclavian A compression --> MC etiology?
mechanical compress:
- #1 cervical rib
- access scalene muscle
- ant scalene enlrg
- well-developed muscles
345
subclavian A compression --> potential comp?
arterial:
- thrombus
- aneurysm
- distal embolus
346
subclavian A compression --> preferred tx?
surg --> decompress thoracic outlet
347
what is Paget-Schroetter synd?
thoracic outlet --> subclavian V --> compress & thrombosis
348
Paget-Schroetter synd --> epidemiology?
young M muscular
349
Paget-Schroetter synd --> clinical presentation?
UE --> pain/swell --> worse w effort
350
Paget-Schroetter synd --> usu unilat or bilat?
bilat
351
Paget-Schroetter synd --> IR venography --> general procedure?
bilat:
- neutral position
- abduct
352
Paget-Schroetter synd --> tx?
1) thrombolysis
| 2) surg --> thoracic outlet decompress
353
what is subclavian steal synd?
1) subclavian A --> prox --> stenosis/occlusion
| 2) vertebral A --> retrograde flow --> distal subclavian A
354
subclavian steal synd --> clinical presentation?
arm exercise:
- vertebrobasilar insuff
- syncope
355
subclavian steal synd --> best imaging modality for dx?
IR angio
356
subclavian steal synd --> tx?
- surg --> bypass
| - angioplasty
357
dialysis AV fistula --> % fail to mature?
30%
358
dialysis AV fistula --> when "mature"?
several mo --> V enlrg --> allow dialysis high flow rate
359
dialysis AV fistula --> 2 MC location?
- radial A --> cephalic V at wrist
| - brachial A --> variable V at forearm
360
dialysis AV fistula --> late failure --> 2 MCC?
V --> stenosis:
- outflow
- perianastomotic
361
dialysis --> what is polytetrafluoroethylene (PTFE) graft?
synthetic graft material --> bridge bw A & V
362
differentiate: AV fistula vs graft
- start use
- patency at 2yr
- flow rate to remain patent
fistula:
- start use later
- 2yr --> 85% patency
- remain patent at low flow rate
graft:
- start use sooner
- 2yr --> 50% patency
- require higher flow rate to remain patent
363
dialysis --> graft --> fail --> 2 MCC?
V stenosis:
- anastomosis
- outflow
364
AV fistula --> pulsatile, no thrill --> dx?
venous outflow obstruct
365
AV fistula --> dialysis --> high access recirculation --> dx?
venous outflow stenosis
366
AV fistula --> weak pulse, poor thrill --> dx?
arterial inflow stenosis
367
AV fistula --> pulseless --> dx?
thrombosed fistula
368
dialysis site --> venous stenosis --> tx?
angioplasty --> high pressure or cutting balloon
369
dialysis site --> venous stenosis --> angioplasty --> goal? (2)
- restore palpable thrill & pulse
| - <0.4 venous to brachial A pressure ratio
370
dialysis site --> thrombosis --> MCC?
venous stenosis
371
what is hypothenar hammer synd?
ulnar A --> cross hamate bone --> injury
372
hypothenar hammer synd --> MOA?
chronic repetitive trauma --> ulnar A:
- intimal injury
- thrombus
- aneurysm
- pseudoaneurysm
373
hypothenar hammer synd --> epidemiology? clinical presentation?
jackhammer operator --> 4th & 5th digit --> ischemia
374
hypothenar hammer synd --> IR appearance?
- ulnar A --> occlusion
| - distal embolic occlusions --> usu 4th & 5th digits
375
hypothenar hammer synd --> tx?
surg
376
Raynaud dz --> assoc condition?
connective tissue disorders:
| - scleroderma
377
UE --> thromboembolic dz --> MC source? less common?
- #1 cardiac embolus
| - subclavian A aneurysm
378
arc of Riolan --> anasmotosis what to what?
- SMA --> middle colic
| - IMA --> L colic
379
leg --> most medial A?
post tib
380
pancreatic duodenal arcade --> dilated & pseudoaneurysm --> dx?
celiac A stenosis
381
PPD pos --> hemoptysis --> bronchial A angio --> neg --> next step? dx?
pulm A angio --> rasmussen aneurysm --> coil embo
382
HD AV fistula vs graft --> flow rate --> what is "slow" flow?
- fistula --> <500 ml/min
| - graft --> <600 ml/min
383
megacava --> size criteria?
>28mm
384
aortic arch --> angle of view?
LAO
385
common femoral bifurcation --> angle of view?
ipsilat
R --> RAO
386
iliac bifurcation --> angle of view?
contralat
R --> LAO
387
hemoptysis --> bronchial A angio --> embo material?
lrg particle
NEVER coil!
388
injection rate:
- renal A
- IVC
- aorta
- renal A: 5cc/sec for 10ml
- IVC: 15cc/sec for 3ml
- aorta: 30cc/sec for 30ml
389
percutaneous biliary drainage --> indication? (3)
- cholangitis
- pruritis
- hyperbili + need to lower for ctx
obstruction alone is NOT an indication!
390
dialysis acess --> normal flow rate?
800-1000 ml/min
391
required margin for adequate tumor ablation?
5-10 mm
392
ablation type to avoid in liver? why?
cryoablation --> cryoshock
393
pseudoaneurysm --> thrombin --> what concentration to use?
1000 IU/ml
394
renal collecting system --> obstruct --> place perc nephrostomy --> pt dev rigors --> tx?
demerol (meperidine)
395
eval required prior to pulm arteriography? why?
EKG --> look for LBBB
catheter into R heart --> can induce RBBB ==> RBBB + LBBB ==> complete heart block
396
Budd-Chiari --> tx?
TIPS or DIPS
397
central venous line --> malpositioned in artery --> next step?
do NOT remv!
surgical repair or endovasc stent-graft placement
398
components of MELD score?
- Cr
- INR
- bili
399
what MELD score? --> TIPS --> high risk death?
>18
400
normal TIPS velocity?
90-190 cm/s
401
Yttrium-90 --> what type of emission?
Beta emission
402
hemoptysis --> not treat --> cause of death? (2)
- resp compromise
| - asphyxiation
