Interventional Radiology

Question 1

Arteries involved in hemoptysis

Answer 1

1. Bronchial aa. (90%)
2. Pulmonary aa.
3. Subclavian a.
4. Internal mammary a.
5. Inferior phrenic a.
6. Celiac a.

Question 2

MCC of hemoptysis in USA

Answer 2

Cystic fibrosis and thoracic malignancy

Question 3

MCC of hemoptysis worldwide

Answer 3

TB and fungal infections

Question 4

Bronchial artery origin

Answer 4

Aorta, near level of T5-T6

Question 5

Celiac artery origin

Answer 5

Aorta, near level of T12

Question 6

SMA origin

Answer 6

Aorta, near level of T12-L1 disc space

Question 7

Renal aa. origin

Answer 7

Aorta, near level of L1-L2 disk space

Question 8

IMA origin

Answer 8

Aorta, near level of L2-L3 disk space to left of midline

Question 9

MC branches of the celiac trunk

Answer 9

Left gastric a.

Splenic a.

Common hepatic a.

Question 10

Origin of left gastroepiploic a.

Answer 10

MC = branch of the splenic a.

Anastomoses with the R gastroepiploic a. on the greater curvature of the stomach

Question 11

Origin of the right gastroepiploic a.

Answer 11

MC = branch of the gastroduodenal a.

Anastomoses with the L gastroepiploic a. on the greater curvature of the stomach

Question 12

MC arterial blood supply to the liver and course from origin?

Answer 12

Common hepatic a.

Common hepatic a. –> becomes proper hepatic a. after take-off of gastroduodenal a.

Proper hepatic a. –> bifurcates into the R and L hepatic aa.

R hepatic a. –> gives off cystic a. to supply gallbladder

Question 13

Variant arterial blood supply to the right liver?

Answer 13

• Replaced right hepatic artery
  
  • 10-18% of people
  • R hepatic a. arises from the SMA
  • Surgeon needs to know. Can cause issues in setting of SMA dz and/or abd surgery
• Accessory right hepatic artery
  
  • Additional R hepatic a. arising from the SMA in setting of normal R hepatic a. from proper hepatic a.

Question 14

Variant arterial blood supply to left liver?

Answer 14

• Replaced left hepatic artery
  
  • 11-12% of people
  • L hepatic a. arises from L gastric a.
  • Clinically significant in setting of gastrectomy
• Accessory left hepatic artery
  
  • Additional L hepatic a. arising from left gastric a. in setting of nml L hepatic a. from proper hepatic a.

Question 15

Branches of the SMA

Answer 15

1. Inferior pancreaticoduodenal a. –> forms collaterals with celiac a.
2. Middle colic a. –> supplies transverse colon, anastomoses with marginal a. of Drummond
3. Right colic a. –> retroperitoneal, supplies R colon and hepatic flexure
4. Ileocolic a. –> terminal a. of SMA, supplies cecum, terminal ileum, and appendix

Question 16

Branches of the IMA

Answer 16

1. Left colic a. –> supplies descending colon
2. Sigmoid aa. –> variable in #, run in sigmoid mesocolon to supply sigmoid colon
3. Superior rectal (hemorrhoid) a. –> supplies upper rectum

Question 17

Divisions of the Internal Iliac a.

Answer 17

Anterior division –> supplies most of the pelvic viscera

Posterior division –> supplies musculature of the pelvic and gluteal regions

Question 18

Branches of the anterior division of the internal iliac a.?

Answer 18

1. Inferior/middle rectal a. –> anastomoses with the IMA via the “pathway of Winslow”
2. Uterine (vesicular) a.
3. Obturator a.
4. Inferior gluteal a.

Question 19

Branches of the posterior division of the internal iliac a.?

Answer 19

1. Lateral sacral a.
2. Iliolumbar a. –> anastomoses with the external iliac a. via the deep circumflex iliac a.
3. Superior gluteal a.

Question 20

Branches of the external iliac a.?

Answer 20

1. Inferior epigastric a. –> anastomoses to the superior epigastric a.
2. Deep circumflex a. –> anastomoses to the posterior division of the internal iliac a. via the iliolumbar a.
3. Femoral a. –> continues distally to supply the leg