Interventional Radiology Flashcards by Anamaria Diaz

What are the essential skills of interventional radiologists?

Diagnostic image interpretation
Manipulation of surgical tools to navigate inside the body under image guidance

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_________ uses radioactive material inside the body to see how organs or tissue are functioning or to target and destroy damaged or diseased organs or tissue

Nuclear medicine

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Medical procedure that uses a real time video of the movements inside a part of the body by passing X-rays through the body over a period of time

Fluoroscopy

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Imaging test that uses sound waves to make pictures of organs, tissues and other structures in the body

Ultrasound

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Imaging method that combines a series of X-rays taken from different angles and uses computer processing to create cross sectional images of bones, blood vessels, organs and other soft tissues in the body

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Imaging technique that uses a magnetic field and computer guided radio waves to create detailed images of the organs and tissues in the body

MRI

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Pre procedure work up consists of

Eval or previous imaging, patient assessment, pre-procedure checklist (labs, meds, antibiotics, consent)

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Who was the first person to develop successful balloon angioplasty

Andreas Roland Grüntzig

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What is the most common method used when placing a central line?

Seldinger technique- catheter insertion to obtain safe percutaneous access to vessels and hollow organs

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What are the steps of the seldinger technique?

Needle inserted through the skin into the blood vessel
Guidewire passed into the lumen
Needle withdrawn, leaving the guidewire
If placing a larger cath, enlargement of insertion site is done with a scalpel
Catheter is threaded over the guidewire and passed into the lumen
Guidewire is withdrawn, leaving the cath in position

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______________ uses fluoroscopy and X-ray images to identify and diagnose narrowing or blockages in blood vessels

angiography

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The X-ray images created during angiography are called

Angiograms

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Angiography is used to examine ______________in key areas of the body including:

Blood vessels
Brain, neck, heart, chest, abdomen, pelvis, legs and feet, arms and hands

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Angiography is used to diagnose and treat what problems?

Bleeds, dissections, stenosis/obstruction, clots, PE, vascular malformations, and aneurysms

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What is conventional catheter angiography

This is an invasive procedure that uses a catheter, X-ray guidance, and an injection of contrast to examine blood vessels for abnormalities

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T or F: the use of a catheter makes is impossible to combine diagnosis and treatment in a single procedure

False. It makes this possible

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What is computed tomography angiography?

A non-invasive procedure that uses IV injection of contrast into the blood vessels and CT scanning to diagnose and evaluated vessel disease

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What is magnetic resonance angiography?

A non-invasive procedure that uses IV injection of contrast into the blood vessels and MRI scanning to visualize blood vessels. $$$$$$ but no ionizing radiation

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Visualizes the inside of the coronary arteries to locate stenosis which could cause a heart attach.

Coronary angiography

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Images the blood vessels in the lungs to eval various conditions such as PE

Pulmonary angiography

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Images the renal blood vessels to detect any signs of blockage or abnormalities affecting the blood supply to the kidneys

Renal angiography

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Images blood vessels however, radiopaque structures such as bones are eliminated digitally from the image, allowing for accurate depiction of the blood vessels

Digital subtraction angiography (DSA)

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What are the steps of a conventional angiography procedure?

Patient is consciously sedated and small cut is made in the skin over the artery (groin or wrist)
Cath is inserted into the artery and is carefully guided to target area
Contrast is injected and xrays are taken
If needed, treatment can be done at the same time
After the procedure the cath is removed and pressure is placed on the cut to stop bleeding.

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What are systemic complications of angiography?

Allergic reaction to contrast or renal failure

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What are local complications of angiography? (Puncture site and intraluminal)

Puncture site- Hematoma, pseudo-aneurysm, AV fistula Intraluminal- subintimal dissection, thrombosis, internal bleeding

54 yo man presents to ED with a hx of high speed MVC. CT A/P shows a hepatic laceration with active bleeding from a hepatic artery branch. You have managed to stabilize his vitals but the pt is still requiring ongoing blood transfusions. What is the appropriate management?

Refer to IR for an angiogram

______________ uses fluoroscopy and X-ray to take pictures of veins in the body, mostly in the extremities, after contrast has been injected

Venography

Why is venography not used as much as angiography

It only looks at veins

Most venography is preformed in conjunction with which procedures?

IVC filters, Central venous catheters, and Renal vein sampling

Embolization

Minimally invasive procedure that blocks or closes a specific vessel

What is percutaneous transluminal angioplasty with endovascular stenting

Mechanically widening narrowed obstructed arteries and placing stents to keep the vessel open

Who places IVC filters and gets CV access

What is a pharmacological agent that is used to achieve thrombolysis? What is is most commonly used for?

Tissue plasminogen activator (t-PA) Ischemic stroke, PE, MI

Which agents act as “clot busters” by activating anti coagulation?

t-PA, Retaplase, Urokinase

Where are thrombolytics infused?

Directly into the thrombosed vessels to ensure high concentration of the drug

Relative contraindications of thrombolytics

History of GI/GU bleed Recent thoracic/abdominal surgery Recent trauma Severe uncontrolled HTN

Absolute contraindications of thrombolysis

Active internal bleeding (GI/GU) Recent intracranial hemorrhage (<2 months) Irreversible limb ischemia

What are complications of thrombolysis

Bleeding Distal embolization of thrombus

Established technique in the treatment of vascular stenoses due to atherosclerotic plaque formation

Balloon angioplasty / PTA

How does PTA work?

A specially designed cath with a tiny balloon is carefully guided through the artery to the blockage, then inflated to widen the opening and increase blood flow. A stent is often placed to keep the artery open. (80%)

What kind of angioplasty is done to open a narrowed or blocked artery in an extremity?

Peripheral angioplasty

What procedure is used to open blocked arteries in the heart?

Coronary angioplasty aka percutaneous coronary intervention (PCI)

What are aortic stent grafts used for?

Abdominal aortic aneurysms and thoracic aortic aneurysms

T or F: the aneurysm is not removed with aortic stent grafts, the graft is just inserted to strengthen the aorta via a catheter

True

What must you get before proceeding with an aortic stent graft? Why?

CT of the aorta for precise vessel measurement and localization of arterial branches

How does embolization offer temporary or permanent relief ?

Eliminating atypical connections between blood vessels Closing off blood vessels that feed tumors and other abnormal growths Stopping or preventing excessive bleeding

What are indications for embolization

Gi hemorrhage, traumatic injuries, AV malformation, cancers that cause bleeding, frequent nosebleeds, uterine fibroids

Describe an embolization procedure

Embolic agents are delivered via catheters to halt blood flow

Examples of embolic agents

Balloons, gel foam, liquid glue, liquid sclerosing agents, metallic coils, particulate agents

What are liquid sclerosing agents?

Substances that destroy tissue on contact causing abnormal blood vessels to close

What are particulate agents

Substances that permanently block small vessels

A central venous cath is used instead of a peripheral IV when treatment is expected to be longer than _____ days

The central venous catheter is used to deliver medications and therapies directly to the ________ allowing prompt access to the ____________

Heart Bloodstream

For venous access the tip of the CVC is usually placed within the _________ or the _________

Superior vena cava or right atrium

When do you use a tunneled central venous catheter?

When you need >2 weeks of access

A tunneled catheter “tunnels” under the skin for _________cm to anchor it in place

8-10

Where is a tunneled cvc usually placed

Large vein in the neck

When would you use a non-tunneled central venous cath? Where is it normally placed?

If you only need <2 weeks of access Large vein in the neck, groin, or chest

What is the most commonly used CVC and how long can it remain in place?

Peripherally inserted central catheter (PICC) Can remain in place for up to 6 weeks

Where is a PICC line placed and where does it go?

Placed in the arm and threaded to reach the superior vena cava

Why would you use a subcutaneous implanted port (Port-A-Cath)?

Common for use in chemotherapy and it’s appropriate for long term use (at least 3 months)

What are two complications of port-a-cath placement and how do you check for them?

Pneumothorax and hemithorax Check with CXR

What is an IVC filter and what is it used for? Who needs these?

A small metal device that is placed in the IVC. The filter helps reduced risk of PE by trapping large clots. Patients who have absolute contraindications to anticoagulants or don’t respond to them need these.

How are IVC filters placed

1. Small incision in the groin or neck 2. Cath inserted and moved into IVC with a collapsed filter 3. The cath is removed with the filter left in place 4. Filter expands and attaches itself to the IVC walls.

What are so,e complications of venous access?

Injury to the vessel, bleeding, need to repeat procedure, injury to adjacent structures, infection or sepsis

What are some non vascular interventions done by IR

Urological procedures, biliary procedures, feeding tube placement, abscess drainage, regional ontological therapy, MSK procedures

What procedure uses image guidance to place a small (pigtail) cath into the kidney to drain urine that has been backing up due to obstruction

Percutaneous Nephrostomy (PCN)

What procedure uses image guidance to place a stent into the ureter and hold it open so it can drain urine that has been backing up?

Ureteral stenting

What procedure uses image guidance to insert a needle into the liver and inject contrast directly into the bile ducts to produce images of the bile duct?

Percutaneous Transhepatic Cholangiogram

What us percutaneous cholecystostomy and who is this done for?

Placing a drainage tube to decompress the gallbladder This is done for poor surgical candidates or high risk patients

A gastrostomy tube is placed into the ___________

Stomach

A jejunostomy tube is placed into the ____________

Jejunum (sm. Intestine)

A gastronejunostomy connects part of the __________ to the __________ to allow food to pass without going through the ____________ first.

Stomach to the jejunum Duodenum

T or F: Feeding tubes are placed through the skin

True

What technique is used to percutaneously drain abscesses using imaging guidance

Seldinger technique

The seldinger technique is most commonly used to drain abscesses in the _______________

In the abdomen or pelvis

What procedure uses imaging guidance to place a needle into a suspicious lesion to take samples for biopsy?

Needle biopsy

What kind of Imaging is used for needle biopsies of deep structures in the chest, abdomen and pelvis?

CT guidance

What are examples of regional oncology therapy?

Radiofrequency Ablation of tumors (RFA) and Transarterial Chemoembolization (TACE)

Radiofrequency ablation is a minimally invasive procedure that uses ___________ and __________ to destroy cancer cells

Electrical energy Heat

What are suitable tumors for RFA

Hepatoma, some hepatic metastases, lung carcinoma, bony metastases, kidney carcinoma

Transarterial chemoebolization is a minimally invasive treatment for cancer that combines ________________ and _______________ into the blood vessel that feeds cancer

Direct delivery of concentrated chemotherapy and a **blocking embolic agent**

Why is the potency of chemo drugs increased in chemoembolization?

The blocking agents make the cancer more susceptible to the chemo by blocking the supply of oxygen and nutrients to the tumor

What are some procedures IR does for musculoskeletal complaints?

Steroid injections for pain Osteoid osteoma Radiofrequency ablation Vertebroplasty

How is vertebroplasty done?

Percutaneous injection of bone cement into a vertebral body fracture to stabilize the spine and decrease pain

Interventional Radiology Flashcards

(85 cards)