2015 OSU IR

Question 1

US biopsy of a pleural mass?

• Can use ultrasound
• Fluoroscopy is adequate in most cases
• FNA and biopsy have 70-79% sensitivity for cancer
• Place biopsy site up to prevent complications

Answer 1

• Can use ultrasound (True)
• Fluoroscopy is adequate in most cases (False)
• FNA and biopsy have 70-79% sensitivity for cancer (True)
• Place biopsy site up to prevent complications (False)

Question 2

Renal vascular hypertension; When to stent proximally; when to do angioplasty; success rate?

Answer 2

• Fibromuscular Dysplasia (FMD)
  
  • MC mid to distal
  • Balloon angioplasty is treatment of choice (95% CURE/IMPROVEMENT OF RENOVASCULAR HTN)
  • Primary stenting of FMD is not currently advocated.
  • Stents are used for angioplasty failure or complication.
  • Surgical bypass used infrequently-used for complex, distal involvement
  • Medical management for long standing HTN and residual HTN post revascularization
• Atherosclerosis
  
  • Focal or segmental renal artery narrowing at ostium or within 2 cm
  • Can be bilat in up to 75% pf pts
  • Post-stenotic dilation; collateral vessels
  • Percutaneous transluminal angioplasty treatment of choice when intervention indicated (80% success rate in non-ostial lesions, 30% in ostial lesions)
  • PRIMARY STENT PLACEMENT WITH OSTIAL LESIONS
  • Stents also used if suboptimal PTA result or complications