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IR Flashcards

1
Q

Arc of Beuhler

A

collat arter between celiac and SMA

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2
Q

Arc of Barkow

A

free edge of omentum anast R and L gastroepiploic

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3
Q

Marginal artery of Drummond

A

anast between SMA and IMA (R, M, and L colic artery)

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4
Q

Large vessel vasculitis with inflamm infiltrates

A

GCA

  • temporal arteries/branches of the ECA.
  • headache, scalp tenderness, and jaw claudication.
  • Polymyalgia rheumatica: pain and stiffness in the shoulder or pelvic girdle, coexists in up to 40% of cases.
  • Females (2:1) males, >age 50.
  • GCA also affects noncranial vessels: ascending aorta and its tributaries: brachiocephalic, L CCA, L SCA.
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5
Q

What drug is administered during an adrenal vein sampling procedure?

A

Cosyntropin.

synthetic subunit of ACTH

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6
Q

What agent is used for embolization for fibroids?

A

microspheres are used in uterine artery embolization

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7
Q

How common is bovine arch and what does it look like?

A

15%

common origin of brachiocephalic and L common carotid

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8
Q

Where is most common origine for adamkiewicz?

A

L (70%) between T8-L1 (90%)

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9
Q

First branch of SMA?

A

inf. pancreaticoduodenal

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10
Q

Who makes up Arc of Riolan?

A

L colic (IMA) to middle colic (SMA)

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11
Q

Vessel in the fissure of the ligamentum venosum?

A

replaced L hepatic artery arising from the L gastric artery

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12
Q

difference in position between proper right hepatic a and replaced right hepatic a?

A

proper is anterior to the RPV and replaced is posterior to the MPV

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13
Q

which internal iliac branches are part of the posterior division?

A

iliolumbar, lateral sacral, glueteal

(I like sex in the butt)

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14
Q

from where do the ovarian arteries usually arise?

A

ant. med. aorta 80-90% of the time

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15
Q

What makes up the corona mortis?

A

obturator and external iliac- basically any vessel you see coursing over the superior pubic rim

could hypothetically cause a type 2 endoleak.

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16
Q

where does the subclavian vein run in respect to the anterior scalene muscle?

A

anterior.

SCA runs within the triangle made by the ant scalene and middle scalene muscles

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17
Q

what landmark is the proximal end of the axiallary artery?

A

1st rib

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18
Q

what landmark is the start of the brachial artery?

A

lower border of the teres minor

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19
Q

what marks the beginning of the common femoral artery?

A

onces the external iliac gives off the inferior epigastric

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20
Q

what marks the start of the popliteal artery?

A

exiting of the SFA from the adducter/Hunter’s canal

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21
Q

what forms most gastic varices?

A

left gastric (coronary vein)

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22
Q

MC congenital venous anomaly in the chest?

A

L sided SVC

90% of the time its duplicated

MC assoc CHD is ASD

92% of the time it drains into the coronary sinus

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23
Q

absence of hepatic segment fo the IVC?

A

azygous continuation: hepatic veins drains directly into RA

also, IVC is usually duplicated with L IVC terminating in L renal vein

think: polysplenia

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24
Q

MC cause of aortic dissection?

A

HTN (70%)

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25
Q

boundary of stanford A dissection?

A

proximal to L subclavian

SURGICAL

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26
Q

boundary of Stanford B?

A

distal to take off of the L subclavian

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27
Q

Name top alt causes of dissection besides HTN.

A

Marfans, Turners, infxn, pregnancy, coke

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28
Q

circumferential dissection of the intimal layer with subsequnt invagination?

A

intimo-intimal intussesception

usually tear starts near coronary orifices

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29
Q

strongest predictor for aortic dissection in intramural hematoma?

A

diameter of 5cm or more

intramural hematoma: T2 bright if acute and T1/T2 bright when subacute

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30
Q

causes of ascending aortic calcs?

A

Takayasu and syphilis.

athero usually spares ascending

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31
Q

size of “aneurysm” in aorta?

A

>4 cm ascending

>3.5 descending

>3.0 Abdominal

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32
Q

cystic medial necrosis?

A

Marfans

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33
Q

buzzwords for sinus of valsalva aneurysms

A

asian men

right sinus

congenital or acquired

assoc with VSD

rupture -> tamponade

Bentall procedure

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34
Q

warning signs of impending abdominal rupture

A

peri-aortic stranding, rapid enlargement (10mm+/year), pain, hyperdense crescent sign, draped aorta

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35
Q

Vascular complication of NF-1?

A

RAS- classicl will be stenosis swith HTN in teen/child

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36
Q

Aneurysm assoc with loss of fibrillin 1 gene?

A

Annuloaortic ectasia

leads to aortic valve insufficiency

“tulip bulb”

Marfan’s will also get “triple barreled dissection” and pulmonary artery root enlargement

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37
Q

wide eyed shitteir version of Marfan’s?

A

Loeys Dietz Syndrome

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38
Q

What is the blood supply to carotid body glomus tumors?

A

typically ascending pharyngeal artey

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39
Q

What qualifies a PE as “massive”?

A

systemic arterial hypotension

aggressive tx for : hypoTN, RV failure, and need for intubation

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40
Q

In which genetic vascular situation (collagen) should angio and other percutaneous procedures be avoided 2/2 arterial dissection risk?

A

Ehlers Danlos.

they’ll have aortic aneurysms like Marfans, often involving the aortic root. abdominal visceral artery aneurysms are common as well.

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41
Q

Aneurysm that involves ascending aorta/arch, saccular, heavily calcified “tree bark” intimal calcifications

A

syphilitic (Luetic) aneurysm

teriary untx syphilis

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42
Q

How can you tell if there is an aorto-enteric fistula?

A

IV contrast will be in the duodenum

-seen after surg, gas is normally present around graft for 4 weeks

will ask which portion of the duodenum- answer will be 3rd or 4th

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43
Q

Young male has pain, elevated ESR, smokes, and has hydro. Abdominal aorta looks plump

A

Inflammatory aneurysm: increased risk of rupture, 1/3 cases have hydro because inflammatory process involves ureters, thickening of aortic wall

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44
Q

complete occlusion of the aorta distal to the renal arteries

A

Leriche Syndrome

bad atherosclerosis

Triad:

ass claudication, absent/decreased fem pulses, limp pene

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45
Q

higher/longer segment of aortic narrowing than Leriche

A

Mid Aortic syndrome

zebra

young adults

Triad:

HTN, claudication, renal failure

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46
Q

infantile aortic coarc

A

pre-ductal

have pulm edema

blood supply via PDA

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47
Q

Ductal coarc

A

adult

not symptomatic until later in childhood

differential arm/leg blood pressures

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48
Q

Coarc assoc with what syndrome?

A

Turners

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49
Q

Most common assoc card defect of aortic coarc?

A

bicuspid aortic valve (80%)

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50
Q

CXR “figure 3” sign, rib notching, and berry aneurysms?

A

aortic coarc

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51
Q

psuedo coarc

A

looks like coarc, but no pressure gradient, collateral formation, or rib notching

follow the distal dilatation

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52
Q

Thoracic outlet syndrome + venous thrombus in SCV

A

Paget Schoetter

athletes who raise their arms a lot

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53
Q

What causes pulm art aneurysm/pseudoaneurysm in patient in the ICU?

A

swan ganz cath

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54
Q

pulm artery aneurysm and mouth and genital ulcers?

A

Behcets

Turkish descent

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55
Q

Behcets with recurrent thrombophlebitis, pulm art aneurysm and rupture

A

Hughes-Stovin Syndrome

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56
Q

MC visceral art. aneurysm?

A

Splenic

assoc. with HTN, portal HTN, pregnancy, cirrhosis, liver transplant

more likely to rupture in pregnancy

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57
Q

features of splenic art aneurysm that would make you treat?

A

>2cm, false aneurysm (kind assoc with pancreatitis), pregnancy

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58
Q

Median Arcuate Ligament Syndrome/Dunbar Syndrome?

A

compression of celiac by median arcuate ligament

20-40yo

“hooked appearance”

worse with expiration

tx surg

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59
Q

MC cause of colonic arterial bleeding

A

diverticulosis

colonic angiodysplasia #2

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60
Q

Angio shows cluster of small arts along border of colon with early opacification of dilated draining veins that persist late

A

Colonic angiodysplasia

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61
Q

colonic angiodysplasia + aortic stenosis

A

Heyde syndrome

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62
Q

AD disorder with multiple pulmonary and hepatic AVMs

A

Osler Weber Rendu (Hereditary Hemorrhagice Telangiectasia

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63
Q

MC cause of RAS?

A

atherosclerosis

2nd: FMD

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64
Q

string of beads in renal artery in young white woman?

A

FMD

can also affect carotid and iliac arts.

medial type is most common

spontaneous dissection

tx: balloon WITHOUT stent

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65
Q

smashing of renal vein by SMA

A

nutcracker syndrome

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66
Q

Right sided varicocele can be caused by__?

A

pelvic or abdominal malignancy, RCC, retroperitoneal fibrosis, adhesions

Non-compressible= bad

Right = bad

Left = Ok

Bilateral = Ok

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67
Q

Uterine AVM

A

can be life threatening

after D&C/abortion/multiple pregnancies

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68
Q

DVT of L common iliac 2/2 compression by R common iliac

A

May Thurner

swollen left leg

thrombolysis and stenting

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69
Q

What is strongly associ with popliteal art aneurysms?

A

AAA 30-50%

10% of pts with AAA have pop A

50-70% bilat

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70
Q

most dreaded complication of a pop art aneurysm?

A

acute limb from thrombosis and distal embolization of thrombus pooling in the aneurysm

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71
Q

Young man with normal pulses that decrease with plantar flexion or dorsiflexion of the foot

A

popliteal entrapment

medial head of gastroc

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72
Q

corckscrew config of superficial palmar arch/occlusion fo the ulanr artery, or PSA off the ulnar artery in manual laborer?

A

hypothenar hammer- jack hammering against hammate

can cause distal small emoboli which can be confused with Buergers

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73
Q

diff b/w low and high flow peripheral vasc malforms?

A

low flow: venous, lymphatic, capillary

high flow: arterial

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74
Q

You are shown MRA/MRV of a leg with a bunch of superficial vessels and no deep drainage

A

Klippel-Trenaunay Syndrom

Parkes-Weber is high flow- often combined

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75
Q

What causes re-stenosis 3-12 months after angioplasty?

A

intimal hyperplasia

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76
Q

Vasculitis

Large vessel- aorta

Young Asian Girl

Wall thickening and wall enhancement

A

Takayasu

dick move: MC type 3 with arch and AA involved

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77
Q

Vasculitis

MC

Large vessel- aorta and temporal artery

Old medn (70-80yo)

Wall thickening

A

Giant Cell

You’ll be shown temporal artery U/S with wall thickening or CTA/MRA of armpit demonstrating wall thickening/occlusions/dilatation/aneurysm

ESR and CRP elevated

gold standard temporal artery biopsy

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78
Q

Vasculitis

zebra

Large vessel

young kids

optic neuritis, uveitis, adiovestibular symptoms, aortitis

A

Cogan syndrome

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79
Q

Vasculitis

medium vessel- renal, cardiac, GI

man

microaneurysms at brachpoints

A

PAN polyarteritis nodosa

assoc with Hep B and meth

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80
Q

Vasculitis

MC vasc in children

medium vessel- coronary - can be clac

aneurysms

A

Kawasaki disease

mucocutaneous lymph node syndrome

“fever for 5 days”

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81
Q

Vasculitis

Small vessel

ANCA+ (c)

nasal perforation

cavitary lung lesions

A

Granulomatosis with polyangiitis

aka Wegeners

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82
Q

Vasculitis

Small vessel

ANCA+ (p)

necrotizing pulmonary vasculitis

asthma/esosinophilia

transient peripheral lung consolidation

A

Churg Strauss

83
Q

Vasculitis

Small vessel

ANCA+ (p)

diffuse pulmonary hemorrhage

A

Microscopic polyangiitis

84
Q

Vasculitis

MC in children

Small vessel

ANCA-

GI symptoms most common

A

HSP (henoch-Schonlein Purpura)

lead point for intussecption, scrotal edema

85
Q

Vasculitis

Small vessel

ANCA-

mouth and genital ulcers

Turkish descent

pulm art aneurysm

A

Behcets

86
Q

You are shown hand angiogram of a smoker with autoamputation

A

Buergers

more common in legs

arterial occlusive disease

87
Q

Segmental arterial mediolysis

A

media of vessel turns shitty and you get a bunch of aneurysms.

abdominal splanchnic artery saccular in elderly and coronaries in young adults

88
Q

cystic adventitial disease

A

young man, popliteal artery gets surrounded by mucoid filled cysts -> compression

89
Q

What carotid waveforms will you see with aortic regurg?

A

reversal of diastolic flow and pulsus bisferiencs (double systolic peak)

90
Q

Filling defects in biliary tree after transplant?

A

Biliary cast syndrome

OR stone

91
Q

Multiple fusiform aneurysms of the visceral arteries in young patient?

A

Ehler’s Danlos (type 4)

ddx: PAN, NF-1, and FMD

92
Q

MC ductal biliary ductal variant anatomy?

A

right posterior segment branch draining the left hepatic duct

2nd MC is trifurcation of the intrahepatic radicles

93
Q

1st line in biliary draininge (strictures, sclerosing cholangitis, malignant cbd obstruction, dilated ducts, etc)?

A

Endoscopic internal biliary catheter draininge

percutaneous is 2nd line. unless a Klatskin tumor?

94
Q

what should you give before perc chole tube?

A

abx

95
Q

pros and cons to transperitoneal and transhepatic perc chole tubes?

A

transperitoneal: avoids liver, but bile can spill everywehre
transhepatic: less chance of bile leak

96
Q

How long do you have to leave a perc chole tube in for?

A

2-6 weeks (until tract matures) because you get bile like otherwise

97
Q

What is the normal difference (portosystemic gradient) between the portal vein and IVC?

A

3-6 mmHg

portah HTN: portal vein mmHg > 10 or gradient >6 mmHg

98
Q

MC cause of portal HTN?

A

EtOH

99
Q

What is enlarge diam of MPV?

A

1.3-1.5 cm

splenic vein 1.2

100
Q

What are the accepted indications for TIPS?

A
  1. variceal hemorrhage refractory to endocopic tx
  2. MELD score <18 (higher melds die)
101
Q

What Childs-Pugh scores are at risk for variceal hemorrhage?

A

B & C

102
Q

What needs to be done before TIPS?

A
  1. ECHO to eval for heart failure
  2. imaging to eval for portal vein patency
103
Q

What is a normal right heart pressure? What is the limit for a TIPS?

A

Normal = 5 mmHg

if elevated to 10-12 mmHg, you stop

104
Q

What do you want the pressure gradient to be after TIPS?

A

9-12

105
Q

What direction do you turn the cather when you are moving from the R hepatic vein to the R portal vein?

A

anterior

106
Q

What are the main acute procedural complications of TIPS?

A

cardiac decompensation (increase R heart filling pressures), accelerated liver failure, and worsening hepatic encephalopathy

107
Q

What is typical velocity within TIPS?

what are some bad signs on f/u doppler?

A

90-190 cm/sec

bad if greater than 200 cm/sec

portal vein velocity below 30 cm/sec bad too

increase by more than 50 cm/sec between exams bad

new or increased ascites

108
Q

what can you do with a TIPS to improve hepatic encephalopathy?

(gradient too low in stent)

A

tighten stent down with another stent

109
Q

What are the absolute contraindications for TIPS?

A
  1. severe heart failure
  2. biliary sepsis
  3. isolated gastic varices with splenic vein occlusion

Relative: cavernous transormation of the portal vein, severe hepatic encephalopathy

110
Q

What is a peritoneovenous shunt?

A

Exactly what it sounds like. Gross. Puts ascites back into Jugular.

111
Q

What is BRTO?

A

balloon occludd retrograde transverse obliteration

  • treats gastric varices (not esophageal like TIPS)
  • drives blood into liver (instead of divert like TIPS)
  • esophgeal varices and ascites can get worse
  • improves hepatic encephalopathy
112
Q

What is the most common side effect of BRTO?

A

gross hematuria

113
Q

What are contraindications for liver biopsy?

A

uncorrectable coagulopathy, thrombocytopenia (<50,000), RUQ infections

Transjugular approach can b performed if massive ascites or severe coagulopathy

carcinoid bx has caused crisis and death before, otherwise, bleeds are the main prob (check morrison’s pouch)

114
Q

85% of upper GI bleeds come from what arter?

A

L gastric

115
Q

if UGI bleed source is duodenal ulcer, which artery?

A

GDA

116
Q

What is dieulafoy’s lesion?

A

monster artery in submucosa of stomach which can tear lesser curvature mucosa-> bleeds heavy and can be endoscopically clipped or endovascularly embolized

117
Q

MC cause of lower GI bleed?

A

diverticulosis - usually L

angiodysplasia will rebleed after embo- will need surgery

118
Q

1st line tx for lower GI bleed in stable patient?

A

colonoscopy

reasonable alts:Tc-99 RBC scan and CT angio

Tagged RBC more sensitive than CTA.

0.1 mL/min RBCs vs 1.0 mL/min CTA

119
Q

1st line therapy in lower GI bleed

A

vasopressin inj.

contraindicated in large art, severe CAD, severe HTN, dysrhythmias

embos are for failed vasopressin: coils or gelfoam

120
Q

pancreatic arcade bleeding aneurysm…

A

celiac artery stenosis

*known assoc of celiac art compression and dilation of pancreatic duodenal arcades-> PSA

121
Q

How does TACE work?

A

iodized oil transports anticancer drugs to HCC-> ischemia-> coagulative necrosis

if there is enhancement and/or washout around the treated site, viable tumor present that needs tx

TACE can cause tricky beam hardening

122
Q

How does RFA work?

A

tissue heated to 60 deg C.

any focal or nodular peripheral enhancement afterwards is residual or recurrent dz

indicated in HCC and colorectal mets

123
Q

Which prolongs survival better- TACE or chemo?

A

TACE

124
Q

Who is an appropriate candidate for liver transplant?

A

patient less than 65yrs with small tumor burden:

1 tumor <5cm or 3 less than 3cm

125
Q

Pre Y90 tx, how do you evaluate the lung shunt fraction?

A

Tc-99 MAA to hepatic artery. Any fraction that would give 30 Gy to the lungs is too much.

126
Q

How does Y-90 work?

A

Yttrium 90 is a high energy B emitter.

energy 0.93 MeV. no gammas

half life 64 hrs

94% of the radiation is delivered over 11 days (4 half-lives). Each bead has a range of 1.1 cm.

127
Q

What do you embolize pre Y-90?

A

R gastric and GDA (prevent non-healing ulcers)

128
Q

In respect to the rib, where do you enter for a thora?

A

just above

129
Q

What happens if you pull too much fluid off in a thora?

A

pulmonary edema fro re-expansion

130
Q

If the pleur-evac has continuous air bubbles, what’s going on?

A

Air leak- from draining tube or the lung

“bronchopleural fistula”

131
Q

What are some pros/cons to lung RFA?

A

pros: limited effect on pulm fxn, no need to worry about prior radiation therapy
cons: ptx, pna, psa, bronchopleural fistula, nerve injury

132
Q

How common is ptx after lung bx?

A

25%

133
Q

What is a risk factor for thoracic angio?

A

LBBB because LBBB+iatrogenic RBBB = asytole

pace these patients ahead of time

pulm HTN w/ elevated R heart pressures (greater than 70/20)

134
Q

can you inject contrast into a swan ganz to eval pulm arteries?

A

no. it explodes.

135
Q

When do you treat a pulm AVM?

A

once afferent vessel is 3 mm

136
Q

What is first line therapy for massive hemoptysis (>300 mL)?

A

bronchial artery embolization

*worry about infarcting the cord

particles >325 micrometers, avoid coils

137
Q

what embolic material is usually used in UAE?

A

PVA or embospheres for fibroids

Gel foam or glue for post partum hemorrhage/vaginal bleeding

138
Q

When is the normal post-embolization fever (uterine and hepatic)?

A

within 1st 3 days

139
Q

what constitutes pelvic congestion syndrome?

A

gonadal vein diameter of 10mm (nml 5 mm) + clinical symptoms

140
Q

What do you do if a thyroid biopsy doesn’t work?

A

try again in 3 months

141
Q

indication for emergent perc nephrostomy tube?

A

sepsis

142
Q

contraindictions to perc nephrostomy?

A

bleeding, renal CA

143
Q

Where are you aiming for a perc nephrostomy?

A

lower pole posterior oriented calyx- looking to attack Brodel’s Avascular Zone

144
Q

possible complications from perc nephrostomy?

A

bleeding and urosepsis

hematuria normal for 24-48 hours, but rapid bleeding abnml

145
Q

how often do you need to change PNTs?

A

at least every 2-3 months- urine crystallization

146
Q

when placing PNT for lithotripsy, how does site differ?

A

sometimes upper pole instead of lower to make stone access easier

tube is bigger- increased risk of bleeding

147
Q

where should you stick for suprapubic cath?

A

just above pubic symph (avoid bowel/peritoneal cavity) and midline (avoid inferior epigastics)

148
Q

When can you do renal RFA? Cryo?

A

RFA can be used on AMLs (>4cm), AVMs, and even RCCs.

In general RFA is for superficial stuff and cryo is for stuff near the collecting system.

no effect on GFR

smaller lesions may initially get bigger (<3cm)

149
Q

what kind of needle is typically used for renal bx?

A

14-18 gauge cutting needle

avoid renal sinus

small AV fistulas and PSAs are common, but resolve, some hematuria is common

150
Q

renal mass bx- what special test should you get if you think its lymphoma?

A

flow cytometry

151
Q

projection of choice for looking at renal arteries?

A

LAO

152
Q

Risks of angioplasty of renal arteries?

A
  1. thrombosis
  2. vessel spasm (can give calcium channgel blockers to decrease risk of spasm)

give heparine to reduce risk of thrombosis

153
Q

When do you stop heparin prior to a procedure?

A

2hrs

PTT of 1.2x control or less (nml 25-35 sec)

154
Q

You need INR of what? for most IR procedures?

A

1.5

155
Q

When do you stop coumadin prior to IR procedure?

A

5-7 days prior

you can also give vitamin K 25-50mg IM 4 hrs prior, FFP/cryo

156
Q

platelet count should be ___?

A

>50k (sometimes >75k)

157
Q

when should you stop ASA or plavix pre procedure?

A

5 days prior

158
Q

do you need Abx pre procedure in angio or thrombolysis?

A

nope. “clean”.

159
Q

how long do you compress art access site post-procedure?

A

15 mins

160
Q

usual wire size?

A

0.035

micro is 0.018 and 0.014

161
Q

Type 1 endoleak

A

type A: coming from top of graft

type B: coming from bottom or graft

162
Q

Type 2 endoleak

A

MC

filling of the sac via a feeder artery

IMA or lumbar arts MC

majority spontaneously resolve

163
Q

how many French in 1 mm?

A

3

164
Q

French is a measurement of what?

A

external diameter of a catheter

165
Q

How are sheaths sized?

A

by the largest cather they will accomodate internally.

diameter of a sheath is usually 1.5-2 Fr larger than sheat size

166
Q

Preference of veins for a PICC?

A

basilic>brachial>cephalic

don’t place if patient is on or going to be on dialysis

place in non-dominant arm

167
Q

Pros and cons to grafts and fistulas?

A

Pro fistula: durable, less neointimal hyperplasia at graft-vein anastomosis

con fistula: 3-4mos to mature

Pro graft: ready to go in 2 wks, easier to declot

con graft: less longevity, more infxns

168
Q

Normal flow rate in fistula and graft?

A

700-800 mL/min graft and 500 mL/min fistula

169
Q

fistula “thrill”, “pulsatile”, “bruit”?

A

Thrill: normal, but if only in systole, prob a stenosis

pulsatile: central stenosis
bruit: low pitched over outflow is normal

170
Q

what is the ideal dilation for angioplasty?

A

10-15% over the normal artery diameter

171
Q

after placing a stent, what meds are on board?

A

1-3 months of anti-platelets

172
Q

adding a stent after balloon angio is helpful except in___?

A

FMD

173
Q

Where should self expandable stents go?

A

areas that might get compressed (carotid, SFA)

174
Q

Where should a baloon expanding stent go?

A

places where precise depolyment is important. (renal ostium)

175
Q

what material is used in self-expanding stents (thermal memory)?

A

Nitinol

176
Q

On physical exam of a threatening limb (gasp), what is audible?

A

only venous doppler… arterial peaces out

177
Q

what is critical limb ischemia?

A

rest pain for two weeks

or

ulcer

or

gangrene

178
Q

how do you decide if you take art. thrombus to surgery or thrombolysis?

A

less than 14 days better with us, more than 14 days, better with surg

179
Q

ABI equation

A

[DP vs PT (whichever mmHg is higher)]/Brachial mmHg

  1. 3= rest pain
  2. 5-0.9= claudication
180
Q

who gets falsely elevated ABIs?

A

diabetics (art calcs)

181
Q

what is a contraindication for vein ablation?

A

DVT

182
Q

Type 3 endoleak

A

defect or fracture of the graft - usually failure to overlap

183
Q

Type 4 endoleak

A

porosity

“4 is for the pore”

184
Q

Type 5 endoleak

A

endotension

185
Q

30 day mortality is better in which AAA repair?

A

endovascular

186
Q

long term mortality difference between endovascular and open AAA repair?

A

same

187
Q

graft related complications and reinterventions are higher with which AAA repair?

A

endovascular

188
Q

when are some times you would place an IVC filter above the renal veins?

A

pregnancy

renal or gonadal clot

duplicated IVCs

circumaortic L renal vein

189
Q

What kind of IVC filter do you place if the cava is bigger than 28mm? (mega cava)

A

birds nest works up to 40mm

OR bilat iliac

190
Q

contraindications to vertebroplasty?

A

fxs with spinal canal compression, pain improving without augmentation

cement can embolize to the lungs

5% risk of local neurologic complications

191
Q
A
192
Q

How many Gy for early transient erythemia?

chronic erythemia?

telengiectasia?

dry desquamation?

moist desquamation?

A

2 Gy

6 Gy

10 Gy

13 Gy

18 Gy

193
Q

how do you determine “sidedness” in angio? LAO, RAO etc?

A

where the image intensifier is. You want aorta LAO etc

194
Q

what is a rapid heparine antidote?

A

protamin sulfate

can cause bradycardia and flushing

195
Q

how should you anticoagulate someone in HIT?

A

with a thrombin inhibitor (ends in rudin and gatran)

196
Q

antidote for versed/midazolam?

A

flumazenil

197
Q

MOA aspirin?

A

(-) TXA2

irreversible, works for the lifespan of the platelet

198
Q

MOA heparin

A

binds antithrombin 3, increases activity

monitored by PTT

reversed by protamine sulfate

199
Q

MOA clopidogrel (plavix)

A

(-) binding of ADP to receptors -> inhibition of GP IIb/IIIa

200
Q

MOA coumadin/warfarin

A

(-) vit K dependent facotrs

2,7,9,10

monitored by INR

201
Q

MOA tPA?

A

converts plasminogen to plasmin (cleaves fibrin)

short half live 2-10 mins

202
Q

max doese lido?

A

4-5mg/kg

203
Q

Who gets DQ’d from TACE?

A
  • hyperbilirubinemia (> 2 mg/dL)
  • liver parenchyma involvement > 50%
  • lactate dehydrogenase (LDH) > 425 IU/L
  • AST > 100 IU/L
  • Child-Pugh Class C liver disease
  • hepatic encephalopathy
  • refractory ascites
  • Eastern Cooperative Oncology Group (ECOG) performance score > 3 which = end-stage disease.

*Treatable hepatic metastasis include melanoma, colorectal, breast neuroendocrine, sarcoma, and renal cell.

204
Q

What is a therasphere?

A

Glass microbead containing Y-90

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