IR Flashcards by p h

phlegmasia cerulea dolens

uncommon complication of DVT
extensive thrombotic occlusion of major & collateral veins

triad:
acute limb swelling
cyanosis
severe acute pain

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pheochromocytoma biopsy prophylaxis

phenoxybenzamine (alpha blocker) to prevent catecholamine release & hypertensive crisis

α-blockade before β-blockade is essential
-lone β-blockade is dangerous: allows unopposed α-receptor vasoconstriction

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why is gonadal vein embolization performed at multiple levels in pelvic congestion syndrome?

to prevent collateral pathway formation

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treatment for pulmonary arteriovenous malformation

pulmonary artery coil embolization

particulate embolization is dangerous (non target embolization to brain, other organs)

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medication, dose & route for reversing midazolam for moderate sedation

flumazenil, 0.2 mg IV

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endoleak types

type I: leak at graft attachment site (prox=1a, dist=1b)
type II: aneurysm sac filling via branch vessel (MC IMA, lumbar a)
type III: leak through defect in graft
type IV: graft porosity
type V: endotension; continued expansion of sac w/o demonstrable leak on imaging

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May-Thurner syndrome

chronic compression of LEFT common iliac VEIN (LCIV) against lumbar vertebrae by overlying RIGHT common iliac ARTERY (RCIA)

predisposes to DVT

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Paget-Schroetter syndrome

thoracic outlet syndrome + venous thrombus in subclavian vein
“effort thrombosis”: assoc w athletes who raise arms a lot (weightlifters, pitchers)
tx: catheter directed lysis, surgical release

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cisterna chyli

dilated inferior aspect of thoracic duct
formed by confluence of intestinal & lumbar lymphatic trunks
receives fatty chyle from intestines, drains superiorly through thoracic duct
posterior to abdominal aorta, between T12-L2 levels
does not cross midline

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advantage of hemodialysis grafts over hemodialysis fistulas

grafts can be used sooner (2-3 weeks) than can fistulas (8-12 weeks)

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vertebroplasty contraindications

asymptomatic compression fractures
chronic fractures
prophylactic vertebroplasty for osteopenic patients WITHOUT acute fractures
uncorrectable coagulopathy
systemic infection with elevated WBC
significant spinal canal compromise

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causes of blocked nephrostomy tube

tube problem:

tube blocked (flush & aspirate: blood, debris, etc)
tube dislodged (no longer in collecting system, “drained well then had some blood then tube stopped draining entirely”)

kidney problem:
- AKI (renal or pre-renal)

next step: neph tube check in IR, less commonly CT

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major arteries in CT angio runoff

common iliac
int iliac a. (post): pelvic & gluteal arteries
ext iliac a. (ant): lat circumflex iliac, inf epigastric
common femoral a. (begins at inf epigastric a., divides into profounda femoris & SFA)
profounda femoris (perforated branches to thigh)
superficial femoral a. (terminates at adductor hiatus)
popliteal a. (terminates at anterior tibial origin
3 primary arteries in calf (3 vessel runoff):
- ant tibial (lateral), post tibial (medial), peroneal (middle)
at foot: ant tibial (➡ dorsalis pedis), post tibial (➡ plantar a.)

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resistive indices of non-transplant renal artery Doppler

RIs typically between 0.5-0.7
higher RI: downstream problem (kidney or beyond)
lower RI: upstream problem (typical renal artery stenosis)

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post op complications of liver abscess drainage

Hepatic artery pseudoaneursym, 
biliary injury, 
portal vein injury, 
post procedure sepsis, 
pneumothorax

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needle used for perc gastrostomy/gastrojejunostomy

gastropexy
T fastener
anchor suture

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contraindications for perc gastrostomy/gastrojejunostomy

Ascites
gastric tumour/mass
peritoneal disease
prior gastric surgery
large hiatus hernia
coagulopathy
varices
high transverse colon

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how to elicit popliteal artery entrapment syndrome?

what muscle?

plantar flex

medial head gastroc

Measurements by outer vs inner diameter

OUTER:

puncture needle
catheter
dilator

INNER:
- sheath

3 Fr = ____ mm?

3 Fr = 1 mm

Diameter in mm = Fr / 3

Sheath outer layers = 1 Fr x 2 (6Fr sheath is 8Fr hole in skin)

Wire thickness measured in ?

Wire length measured in?

Thickness in inches

0.039 inch = 1 mm
0.035 inch wire conventional

Length in cm

Needle size conversions: 16G, 20G

What G for 0.035 inch guidewire?

16G = 1.65 mm = 5 Fr catheter
20G = 0.97 = 3Fr

19 G for 0.035 *standard
18 G for 0.038

Most common cause of upper G.I. bleed?

Duodenal ulcer bleeding vessel?

85% left gastric
If source cannot be identified, left Gastric can be taken down prophylactically

Ulcer - GDA

Particle size for GI bleed

300-500 microns

Smaller = bowel infarct

Drain sizes: - clear fluid - thin pus - thick pus - collection with debris

- 6-8F clear fluid - 8-10 F thin pus - 10-12 F thick pus - 12F + Collection with debris

Bronchial artery embolization choice

``` Particles >325 micrometers NOT coils (likely rebleed & need access) ```

Rasmussen aneurysm bleed tx choice

Coils | Exception in hemoptysis- bronch art = particles

Air embolus

Left side down | Head down

Max lido dosing

4-5 mg/kg With epi 7 mg/kg Most 1% plain epi 10 mg per 1 mL - max dose 0.5 mL/kg

Ascending aorta calcifications

Takayasu | Syphilis

Most common type FMD | Most common vessels

Medial | Renal, carotid, iliac

Popliteal aneurysm % with AAA AAA % with popliteal aneurysm % popliteal aneurysm bilateral

30-50% 10% 50-70%

Micro aneurysm formation kidneys

- polyarteritis nodosa | - crystal meth

Unilateral versus bilateral parvus tardus in carotids

- unilateral = innominate | - bilateral = aortic stenosis

Normal carotid: Velocity ICA/CCA ICA end diastolic

<125 cm/s <2 <40 cm/s Less than 50% stenosis doesn’t affect peak systolic velocity

What size do these fit into? 1. 0.035 wire into what Fr 2. 0.038 wire into what G 3. 0.035 4. 0.018 5. 4 Fr into what size sheath?

1. 4 Fr or larger 2. 0.038 to 18 G 3. 0.035 to 19 G 4. 0.018 to 21 G 5. 4 Fr to 4 Fr sheath or up

Greater risk of dissection - short or long floppy tip?

Short floppy higher risk

Ankle brachial index values

``` 1 normal no symptoms 0.75-0.95 mild, mild claudication 0.5-0.75 moderate, claudication 0.3-0.5 moderate-severe, severe claudication <0.3 severe or critical, rest pain ```

Portal HTN definition

``` Portal vein >10 mmHg Portosystemic gradient (PSG) >5 mmHg ```

Yttrium 90 1. Particle type 2. Half life 3. Max range 4. Key points prior to using

1. High energy beta (no gamma) 2. T1/2 = 64 hours (94% delivered after 11 days, 4 t1/2) 3. 1.1 cm 4. MAA lung shunt: >30 Gy too much, embolise right gastric and GDA

internal iliac artery branches

3 urinary: umbilical, superior vesical, inferior vesical 3 visceral: uterine, vaginal, middle rectal 3 parietal: obturator, internal pudendal, inferior gluteal

external iliac artery branches

iliolumbar, lateral sacral, superior gluteal

subclavian artery branches

``` VIT CD vertebral internal thoracic thyrocervical costocervical dorsal scapular ```