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Fluoro and angio > Angio C and D > Flashcards

Angio C and D Flashcards

1
Q

basic instruments needed in seldinger technique

A
  • puncture needle
  • guidewire
  • vascular sheath
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2
Q

2 types if puncture

A

double wall puncture
- soft tissue posterior to artery provides tamponade to stop bleeding
- less chance of intimal dissection

single wall puncture
- graft
- abnormal clotting profile
- risk of dissection

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3
Q

type of puncture needle

A
  • double wall needle (with a sharp stylet)
  • single wall needle (without a stylet)
  • 18G needle for 0.035inch GW
  • 21G needle for 0.018inch GW
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4
Q

what needles are used for a double wall puncture

A
  • blunt outer cannula: 18G, thin walled, 8cm
  • sharp bevelled stylet
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5
Q

basic properties of guidewires

A
  • steerable or non-steerable
  • length
  • stiffness
  • diameter
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6
Q

why use steerable GW

A
  • shaped tips
  • provide a good torque control
  • for selective cannulation
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7
Q

why use non-steerable GW

A
  • allow the catheter to be positioned for CM injection
  • not designed to negotiate stenosis or select branch vessels
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8
Q

length of standard GW

A

150cm
must be longer than the length of catheter

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9
Q

what happens if GW are longer than 150cm

A

need more time during the interchange of catheters/ guidewires; risk of contamination

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10
Q

what happens if GW are shorter than 150cm

A
  • easy to slipped into the vessel/ catheter
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11
Q

explain the stiffness of guidewires

A
  • stiffness gives support during advancement of catheter
  • however, increased stiffness = increased risk
  • a very stiff GW used to negotiate a tortuous vessel = more likely to dissect
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12
Q

diameters of guidewire

A

0.018GW - for small vessel work
0.035GW - for most of the vascular works, will fit most of the 4Fr or 5Fr catheters
0.038GW - for 7Fr catheter

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13
Q

what is vascular sheath

A
  • consists of hollow plastic tube connected to a hemostatic valve with a side-arm for flushing
  • sized by the caliber of catheter it will accept
  • thin walled –> may kink in obese patient
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14
Q

benefits of vascular sheath

A
  • provide an atraumatic vascular access route
  • used in cases where it is likely to have many times of catheter exchange
  • better management of puncture site
  • to give extra support GW/ catheter at the puncture site
  • prevent blood clot forming - the side arm of a vascular sheath, has a hemostatic value, is used for flushing saline and/or heparin
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15
Q

where does the french size measure for catheter and vascular sheath

A
  • Fr size of catheter means outer circumference
  • Fr size for vascular sheath means inner circumference
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16
Q

max catheter flow rate tolerant depends on

A
  • french size
  • length
  • number of side holes
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17
Q

typical maximum flow rate for pigtail catheters

A

3Fr - 6-8ml/sec
4Fr - 16-18ml/sec
5Fr - 20-25ml/sec

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18
Q

types of catheter

A
  • diagnostic angiographoc catheters
  • micro catheters
  • drainage catheter
  • balloon catheters
  • central venous catheters
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19
Q

what is non-selective catheter used for

A
  • non used for vessel negotiation
  • used to inject contrast in large-medium size vessels and have multiple side- holes in high rate and volume
  • this can be pigtail or straight catheters
  • for diagnostic angiogram
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20
Q

what is selective catheters

A
  • shaped to a wide variety of angles to allow selective cannulation of branch vessels of aorta
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21
Q

what is microcatheter

A
  • only 2Fr to 3Fr
  • initially developed for cerebral catheterization
  • now increasingly used for super-selective hepatic, visceral and peripheral catheterisation
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22
Q

five common type of interventional instruments

A
  • balloon angioplasty
  • vascular stents
  • embolisation agents
  • thrombolytic agents
  • atherectomy
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23
Q

purpose of balloon angioplasty

A
  • mechanically widening a narrowed or obstructed blood vessel
  • crushes the fatty deposits
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24
Q

applications of balloon angioplasty

A
  • peripheral angioplasty
  • renal artery angioplasty
  • carotid angioplasty
  • cerebral arteries angioplasty
  • coronary artery
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25
Q

contraindications of balloon angioplasty

A

absolute
- recent thrombosis

relative
- patient with uncontrolled bleeding tendency
- aneurysmal dilatation adjacent to a stenosis
- long occlusion

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26
Q

factors reduce the success of angioplasty and long term patency

A
  • increased length of lesions
  • stenosis vs occlusion
  • concentric vs eccentric
  • ostial stenosis vs vessel stenosis
  • calcified lesions vs noncalcified lesion
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27
Q

choice of angioplasty balloon selection

A
  1. balloon diameter
  2. balloon length
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28
Q

different types of stenting

A
  • urethral/ prostatic stent
  • urinary tract stent
  • biliary stent
  • peripheral vascular stent
  • coronary arteries stent
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29
Q

indications for stent employment

A
  • long segment stenosis
  • total occlusion
  • unsuccessful PTA
  • recurrent stenosis
  • ulcerated plaque
  • renal ostial lesion
30
Q

based on lesion characteristics, what are some stent selection criteria

A
  • type of stent
  • diameter
  • length
  • location
  • calcification and eccentricity
31
Q

different types of vascular stents

A
  • balloon expanded stents/ drug eluting stents
  • self-expanding stents
  • covered stents
32
Q

when is embolisation agents used

A
  • to control severe internal bleeding
  • for blockage of patency
  • suppress the cells growth
33
Q

general complication of using embolization agents

A
  • post-embolisation syndrome
  • infection at the embolised area
  • reflux of embolic material
34
Q

two main types of embolic agents

A
  • temporary
  • permanent
35
Q

what permanent embolisation agents is used for a large vessel

A

metal coils

36
Q

what permanent embolisation agents is used for a small vessel

A
  • particle
  • liquid agents
37
Q

what temporary embolisation agents is used for a large vessel

A

gelfoam sponge sheet

38
Q

what temporary embolisation agents is used for a small vessel

A

gelfoam particles

39
Q

objective of a thrombolytic agent

A
  • break down clot
  • make clot more soluble
40
Q

indications of a thrombolytic agent

A
  • myocardial infarction
  • ischemic stroke
  • massive pulmonary embolism
  • acute limb ischemia
41
Q

contraindication to thrombolytic agents

A
  • previous intracranial bleeding
  • uncontrolled high blood pressure
  • major or minor hemorrhage
42
Q

advantages of atherectomy

A
  • less procedure time
  • ease of use
  • faster patient recovery
  • decreased systemic complications
43
Q

what is renal artery stenosis

A
  • the narrowing of the inner surface of renal artery
  • most often caused by atherosclerosis or fibromuscular dysplasia
44
Q

objective of renal arteriogram

A
  • control hypertension
  • prevent deterioration in renal function
45
Q

indication for renal arteriogram

A
  • acute renal ischemia
  • unexplained hematuria
  • intrarenal microaneurysm
  • evaluation of donour of kidney before transplantation
  • identifying source of bleeding after kidney biopsy
46
Q

contraindications for renal arteriogram

A
  • related to CM and coagulation problems
47
Q

what is carotid stenosis

A
  • narrowing or constriction of the inner surface of carotid artery, usually caused by atherosclerosis or fibromuscular dysplasia
48
Q

S&S of carotid stenosis

A
  • carotid bruit indicate a 70% stenosis of carotid artery
49
Q

advantages of carotid arteriogram

A
  • evaluate entire carotid arterial system
  • assess flow dynamics and collateral flow
50
Q

disadvantages of carotid arteriogram

A
  • invasive
  • expensive
  • radiation exposure
  • potential for ischemic stroke
51
Q

indication of carotid artery stenting

A
  • assessment of non atherosclerotic disease is suspected
  • treatment with stent
52
Q

objective of IVC filter

A

placed to prevent significant PE from DVT of the leg, pelvis or IVC

53
Q

indications for IVC filter

A
  1. contraindication to anticoagulation
  2. complication to anticoagulation
  3. recurrent PE despite adequate therapeutic anticoagulation
54
Q

contraindications to IVC filter

A
  • large clots in the vena cava or iliac veins
55
Q

IVC filters fall into 2 basic categories

A
  • permanent IVC filters
  • retrievable IVC filters
56
Q

disadvantage of a femoral vein approach

A
  • iliofemoral thrombus obstructing the vein
  • possible IVC thrombus extension
57
Q

advantage of femoral vein approach

A

air embolism is much less likely

58
Q

advantage of jugular vein approach

A
  • avoid the possibility of attempt catheterization of an occluded femoral vein
59
Q

disadvantage of a jugular vein approach

A
  • higher chance of air embolism
  • eustachian valve can sometimes cause difficulties in GW navigation
60
Q

how to prevent air bubble from going into brain

A

table head down

61
Q

disadvantage of using temporary IVC filters

A
  • anchoring catheter may provide a pathway for introduction of blood borne pathogens
  • cause some degree of patient immobility
  • catheter may serve as a nidus for thrombus formation proximal to the filter
62
Q

complications of IVC filters insertion

A

at insertion
- puncture site bleeding/ thrombosis
- deployment problems

upon removal
- risk of IVC laceration

late complications
- filter migration/ embolisation
- IVC thrombosis

63
Q

blood supply to liver

A
  • hepatic artery
  • portal vein
64
Q

objective of TOCE

A

use of oily CM to induce tumour necrosis

65
Q

benefit of using TOCE

A
  • increase drug conc in the tumour
  • HCC cell has affinity for oily contrast
66
Q

curative indication of TACE

A
  • when first-line treatments are contraindicated
67
Q

palliative indications of TACE

A
  • for multifocal tumour
  • after post-surgical recurrence
68
Q

contraindications of TACE

A
  • significant liver disease
  • occlusion of portal vein
  • marked AV shunting from hepatic artery to portal or hepatic veins
69
Q

TACE after care

A
  • bed rest for 8 hours
  • vital signs are monitored
  • regularly observe the punctured site
  • infusion of IV fluid and antibiotics
  • stop metformin for 2 days
  • blood test 1 day after
70
Q

what are the embolisation agents used in TOCE

A
  • lipiodol
  • gel foam
  • coils
71
Q

why add gelfoam in the mixture

A
  • lipiodol washed out by rapid blood flow
  • gelfoam to decrease blood flow of feeder

Fluoro and angio (9 decks)

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