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Radiology (Ben) > angiography & vascular interventional radiology > Flashcards

angiography & vascular interventional radiology Flashcards

1
Q

Seldinger technique: tools

A
  1. puncture needle: 18G (one-part or two-part)
  2. guidewire: atraumatic, non-thrombogen, torque control, hydrophilic coating (for difficult cases), variable diameter (0.014-0.038)
  3. diagnostic catheters: braided plastic tube, flexible, kink-resistant, torque response, outer diameter is measured in French scale - 1F = 1/3 mm
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2
Q

non-selective (flush) Vs selective angiography

A

selective has improved image quality, uses less contrast medium, has increased risk of complications.

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3
Q

puncture sites

A
  • femoral: retrograde, anterograde, bilateral
  • brachial
  • radial
  • popliteal
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4
Q

possible complications

A
  1. at the puncture site:
    - bleeding, hematoma
    - pseudoaneurysm
    - AV fistula
    - occlusion
  2. embolisation
    - selective carotid angiography: 0.1-0.3% risk for stroke
    - non-selective arch aortography: 0% risk
  3. dissection
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5
Q

closure devices

A

used for large puncture sites, especially in highly anticoagulated patients.
- Angio-Seal: absorbable collagen sponge, absorbable polymer anchor connected by an absorbable self-tightening suture.

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6
Q

arterial interventions

A
  • percutaneous transluminal angioplasty (PTA), stent implantation
  • stent-grafts (TAA and AAA) & covered stents
  • thrombolysis, aspiration, thrombectomy devices
  • embolisation (tumors, AVM, fibroif (UFE), bronchial artery, GI bleeding, bleeding from tumors, trauma, iatrogenic)
  • dialysis fistulae managements (declotting, PTA)
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7
Q

percutaneous transluminal angioplasty (PTA)

A
  • lower limb, subclavian, renal, aorta, mesenteric, carotid bifurcation, proximal CCA, innominate, coronary
  • special balloons: cutting balloon, cryotherapy
  • stent types: balloon-mounted, selfexoandable, drug-eluting
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8
Q

venous procedures/interventions

A
  • PTA/stent, TIPS
  • varicocele embolisation
  • radiofrequency or laser ablation of varicose veins
  • IVC filter placement and retrieval
  • venous access, chronic venous lines (Hickman line)
  • foreign body retrieval
  • venous sampling
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9
Q

what to do before getting access

A
  • examination of the patient
  • patient history, previous interventions, operations
  • pulse palpation
  • laboratory values
  • risk/benefit ratio
  • consenting the patient
  • plan the whole procedure
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10
Q

advantages of interventional radiological procedures over surgery

A
  1. local anesthetics - no complications from general anesthesia
    - no surgical dissections (no wound infections, no nerve injury, no suture insufficiency)
    - small amount of blood loss
    - minor burden for the patient / can be performed on severely ill patients
    - following unsuccessful intervention, surgery is still an option
    - can be repeated numerous times
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11
Q

disadvantages of interventional radiological procedures over surgery

A
  • not all surgical procedures can be substituted by an interventional procedure
  • interventional radiological procedures are also not free of complication
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12
Q

stent types

A
  1. balloon mounted:
    - premounted, stainless steel
    - easy positioning
    - rigid (external compression)
    - not comformable for different diameters (eg. carotid bifurcation)
  2. self-expandable - nitinol (nickel-titanium alloy):
    - continuous expanding force
    - conforms to different diameters
    - positioning is less precise
    - shortening - larger diameter, decreased length
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13
Q

PAD - peripheral arterial disease

A
  • largest component to the workload
  • most patients are chronic:
    a. asymptomatic
    b. intermittent claudication (IC)
    c. critical limb ischemia (CLI)
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14
Q

non-surgical treatment for PAD

A
  1. IC patients:
    - exercise
    - smoking cessation
    - aspirin
    - clopidogrel
  2. CLI patients:
    - antiplatelet therapy
    - prostanoids (PGE1, Iloprost)
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15
Q

percutaneous transluminal renal angioplasty (PTRA) - indications

A
  • severe hypertension resistant to full medical treatment
  • ACE-inhibitor induced uraemia
  • deteriorating renal function
  • flush pulmonary edema
  • acute renal failure with a good sized kidney
  • severe stenosis in a single functioning kidney
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16
Q

carotid artery stenting CAS - indications

A
  • used to decrease the risk of ipsilateral embolic stroke *
  • symptomatic patients within 6 months; patients with symptoms within 4 weeks benefit most ( >70% diameter stenosis)
    possible symptoms: hemisymptoms, amaurosis fugax, aphasia
  • periprocedure complication rate should be < 3%, otherwise the pt does not benefit from CAS/CEA (carotid endarterectomy)
17
Q

CAS - relative indications

A
  • asymptomatic, with:
  • > 90% diameter stenosis
  • > 80% stenosis and ipsilateral silent ischemia on CT
  • rapid progression of carotid stenosis
  • > 90% diameter stenosis and contralateral occlusion
  • periprocedure complication rate should be < 3%, otherwise the pt does not benefit
18
Q

stent graft - covered stent: indications

A
  • aneurysms
  • traumatic lesions
  • to decrease the risk of re-stenosis
  • to decrease the risk of distal embolisation
19
Q

abdominal aortic aneurysm (AAA)

A
  • focal widening > 3cm
  • normal size of abdominal aorta (> 50 y.o.): ~ 2 cm
  • prevalence: increases with age, greater with atherosclerotic disease
  • male predominance
  • whites:blacks = 3:1
  • risk factors: male, age > 75, white, prior vascular disease, HTN, smoking, family history, hypercholesterolemia
  • 30% asymptomatic
  • 26% abdominal mass
  • 37% abdominal pain
  • location: 91-95% infrarenal with extension into iliac arteries (66-70%)
20
Q

intraarterial thrombolytic therapy

A
  • Intravascular administration of thrombolytic agents -> for pulmonary embolism
  • Thrombolysis by means of selective catheter infusion -> for vascular occlusion
  • also for: treatment of thrombus and/or thrombosis in the coronary arteries, peripheral vascular and visceral arteries, dialysis grafts, veins, and IV catheters.
21
Q

thrombolysis

A

1) Urokinase: 2-chain Ser protease, that contains 411 am. ac/s. Like streptokinase, it lacks fibrin specificity and induces a systemic lytic state. Urokinase is typically given with full heparinisation (aPTT 1.5-2 times control values). Titration o the dose of heparin is often difficult to achieve.
2) recombinant human tissue-type plasminogen activator (tPA): Ser protease that is produced by recombinant DNA technology. Chemically identical to human endogenous tPA. Acts by stimulating fibrinolysis of blood thrombi.

22
Q

indications of thrombolysis

A
  • acute and chronic vascular occlusion
  • thromboembolus
  • native bypass graft occlusions
  • acute lower-limb ischemia -> prevention of amputation
23
Q

contraindications of thrombolysis

A
  • intracranial or GI hemorrhage in patient history

- any operation within 6 weeks

24
Q

relative contraindications of thrombolysis

A
  • coagulopathy
  • gastric/duodenal ulcer
  • liver disease, portal HTN
  • extreme HTN
  • gravidity
  • ICU care not possible
  • lack of cooperation of the patient
25
Q

complications of thrombolysis

A

bleeding - may be fatal

  • GI: 5-10%
  • puncture site: 12-17%
  • hemorrhagic stroke: 1-3%
26
Q

materials used for embolisation

A
  • coils
  • PVA particles
  • lipiodol
  • alcohol
  • tissue glue (cyanoacrilate)
  • thrombin (for pesudoaneurysms)
27
Q

uterine fibroid embolisation (UFE)

A

Indications: symptomatic leiomyoma

“ideal” candidate for UFE:

  • symptomatic premenopausal women
  • single or multifibroid uterus
  • in whom surgery is indicated
  • who does not desire to preserve fertility
  • who prefers minimal invasive treatment
28
Q

venous access - methods

A
  • chronic infusion catheters
  • peripherally inserted central infusion catheters (PICC)
  • ports
  • alternative vascular access techniques
29
Q

chronic infusion catheters

A

a) temporary (non-tunneled):
- no precise definition for time
- planned duration more than 6 weeks is considered long-term
- exit ports in close proximity to the venous puncture site

b) long-term (tunneled):
Indications:
- chemotherapy
- long-term nutrition (TPN)
- antibiotic treatment
- hemodialysis 
- plasmapheresis
30
Q

insertion techniques for venous access / chronic

A

1) right (or left) IJV:
- most common
- higher success rate
- lower complication rate
- US guidance

2) subclavian vein:
- infraclavicular or
- supraclavicular -> rare, more risky

3) femoral vein:
- easiest
- highest incidence of complications
- infection & thrombosis

31
Q

possible complications of venous access

A

1) immediate:
- PTX
- great vessel puncture or perforation
- air embolism
- catheter malposition

2) delayed:
- infection
- venous stenosis
- fibrin sheath & thrombus formation

32
Q

IVC filter insertion - absolute indications

A
  • DVT:
  • contraindication for anticoagulation
  • recurrent thromboembolic disease, despite anticoagulation therapy
  • significant complication of anticoagulation therapy
  • inability to achieve adequate anticoagulation (despite patient compliance)

Radiology (Ben) (13 decks)

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