Angio

Question 1

Answer 1

Vitelline artery (blue arrow)

Will typically be show in combo with Nuc med scan (tagged RBC) showing a Meckel diverticulum

Question 2

Answer 2

meckel diverticulum

persistent collection of radiotracer in the RLQ, WITHOUT movement through the GI tract
angiography shows a prominent vitelline artery

Meckel’s diverticula are a persistent outpouching due to periistent non involuting omphalomesenteric (vitelline) duct. 50% contain gastric mucosa

Question 4

Answer 4

IVC stenosis and stent placement

the presence of venous collaterals indicates hemodynamically significant stenosis

Question 5

what is a potential complication of embolization of the selected vessel?

Answer 5

ovarian artery is selected in the right image.

Potential complication of ovarian failure

This is a pt with uterine fibroids with some blood supply coming from an enlarged ovarian artery

Question 6

Answer 6

Question 7

Answer 7

hypothenar hammer syndrome with distal embolus

Question 8

Answer 8

vasospasm

Question 9

what is the most commonly involved artery in FMD?

Answer 9

renal artery followed by carotids

Question 10

what are the two methods for splenic artery embolization?

Answer 10

1) proximal SAE: splenic artery is occluded distal to the dorsal pancreatic artery with the use of coils or vascular plug
2) distal SAE: peripheral branch is occluded with coils, gelform, or other embolic agents

Question 11

Answer 11

HCC

Question 12

Answer 12

polyarteritis nodosa(PAN)

multiple small aneurysms in the right renal arterioles

this is an Aunt Minnie and diagnostic of PAN

associated with HBV and HCV

Question 13

Answer 13

leriche syndrome (aorto-occlusive disease)

Question 14

Answer 14

leriche syndrome

Question 15

ideal femoral access location

Answer 15

enter skin inferomedial to the femoral head

femoral head provides a hard surface for hemostasis

at the level of the femoral head, the femoral artery and nerve are side by side

Question 16

Injection rate for inferior vena cavogram

Answer 16

20 for 30

(20 cc/s for a total of 30 cc)

Question 17

Injection rate for aortogram (abdominal aorta)

Answer 17

20 for 20

(20 cc/s for a total of 20 cc)

Question 18

Injection rate for aortogram (aortic arch)

Answer 18

20 for 30

(20 cc/s for a total of 30 cc)

Question 19

Which vessel has an aberrant origin?

Answer 19

A

replaced right subclavian artery which arises last. This is considered the most common aortic arch anomaly, with incidence 0.5-2.0%. In right-sided arches an aberrant left subclavian artery is a common finding, possibly 50%. The CT image demonstrates the replaced right subclavian origin with 2 things to note. First, the caliber is large which is termed Kommerell diverticulum. Secondly, note how the esophagus is pinched in there by this vascular sling; this scenario can result in dysphagia lusoria.

Question 20

the microcatheter is selected into which artery?

Answer 20

middle colic

Question 21

A patient has celiac axis chronic occlusion as the only site of disease. What would be the expected clinical presentation?

Answer 21

asymptomatic

Generally speaking, there are 3 main connections from the aorta to the viscera: celiac, SMA, IMA. There is a lot of collateral communication between these vessels. If 1 is occluded, there will virtually never be any clinical consequence, provided it’s a gradual process (which allows for hypertrophy of the collateral system). If 2 of the 3 are occluded, this classically presents with post-prandial pain from the stress-ischemia to the bowel.

Question 22

Answer 22

anterior tibial

Question 23

Answer 23

lateral sacral artery

The iliolumbar travels in a cephalad direction which is an identifying feature. It may arise directly off of the internal iliac, rather than a posterior trunk. The lateral sacral artery travels medially and posteriorly in its relationship with the sacrum. There may be more than one lateral sacral branch.

Question 24

Answer 24

obturator artery

Helpful is the characteristic inverted ‘Y’ at the obturator foramen. This can be a site of bleeding with pelvic trauma. An interesting and important variant is worth mentioning here. The obturator artery can also arise from, or anastomose with, the inferior epigastric artery, running along the posterior aspect of the superior pubic ramus. It can be an unwelcome surprise to a surgeon and can be difficult to control, earning the moniker ‘corona mortise’ or crown of death.

Question 25

what artery is arising from the left renal artery?

Answer 25

left gonadal artery (variant)\

Also arising from the renal arteries can be the gonadal artery (seen here), inferior adrenal branches, or kidney capsular branches.

Question 26

A patient with PAD presents with claudication and has only 1 level of hemodynamically significant atherosclerotic narrowing which is in the SFA. What would you expect the ABI to be?

Answer 26

normal

A person with physical symptoms of claudication (Rutherford 1-3) would typically have the equivalent of 1 level of disease with an ABI generally 0.7-0.9. If there is more than 1 level of disease and the ABI continues to drop, one may encounter rest pain or tissue loss.

Question 27

self expanding stent locations

Answer 27

SFA or carotids (below injuinal ligament)

Question 28

Balloon exapnding stents: more or less accurate placement compared to self expanding stents?

Answer 28

balloon expanding stents are more accurate placement. less chance of migration.

good for renal arteries

Question 29

Answer 29

floating viscera sign

Question 30

Answer 30

floating viscera

aortic dissection. only opacification of the true lumen

Question 31

Answer 31

colonic angiodysplasia

SECOND most common cause of colonic arterial bleeding (Diverticulosis is number one)

early opacification of dialted draining veins that persists late into the venous phase

Question 32

Answer 32

colonic angiodysplasia

SECOND most common cause of colonic arterial bleeding (Diverticulosis is number one)

Question 33

what is the syndrome associated with the finding

Answer 33

Heyde syndrome

colonic angiodysplasia + AORTIC stenosis

Question 34

If IVC diameter is >28 mm

Answer 34

bird’s nest filter

Question 35

when is a bird nest filter used?

Answer 35

when IVC measures between 28-40 mm

Question 36

bilirubin level for yttrium treatment

Answer 36

bilirubin < 2.0 mg/dL

Question 37

IVC > 40 mm in diameter filter

Answer 37

separate filteres in each common iliac vein

28-40mm IVCs get a birds nest filter

Question 38

Answer 38

cavernous transformation 2/2 portal vein thrombosis