IR

Question 1

Milan Criteria

Answer 1

Liver Transplant in Context of HCC

• Pt < 65yo
• 1 tumor <= 5.0 cm
• Up to 3 tumors <= 3.0cm

Question 2

MELD Score

Answer 2

To Predict 3mo Mortality After TIPS

• Based on Bili, INR, Cr
• MELD > 18 –> high-risk early death after TIPS

Question 3

TIPS Stenosis/Malfunction

Answer 3

1) Velocities > 200 cm/s across narrowed segments
2) Portal vein velocity < 30 cm/s
3) Blood flow in portal vein away from stent
4) Worsening ascites/bleeding

Question 4

Collaterals in Portal HTN

Answer 4

1) Esophageal Varices
- Coronary vein –> Azygos
2) Gastric Varices
- Splenic vein –> Azygos
3) Splenorenal Shunt
- Splenic vein –> Inferior phrenic –> Left renal
4) Mesenteric Varices
- IMV/SMC –> Iliac
5) Caput Medusa
- Umbilical –> Epigastric
6) Hemmorhoidal Varices
- IMV –> Inferior hemorrhoidal veins

Question 5

Intimal Hyperplasia

Answer 5

Exuberant healing response following damage to vessel d/t angioplasty (3-12mo after)

Question 6

Klippel-Trenaunay

Answer 6

1) Port wine stain
2) Focal gigantism
3) Venous malformation

Question 7

Abscess Drain Size

Answer 7

1) 6-8F –> Clear fluid
2) 8-10F –> Thin pus
3) 10-12F –> Thick pus
4) > 12F –> Debris

Question 8

When to Remove Abscess Drain?

Answer 8

All of following…

1) Drainage < 10cc/day
2) Abscess resolved on imaging
3) No fistula

Question 9

Typical Flow Rates & Volumes for Catheters

Answer 9

1-2cc (4-10cc) –> Bronchial, Intercostals
4-8cc (8-15cc) –> Carotid, Subclav, Renal, Fem, IMA
5-8cc (30-40cc) –> SMA, Celiac
20-30 (40cc) –> Aorta, IVC, Pulm art

Question 10

Balloon Diameter Size for Angioplasty

Answer 10

Aorta --> 10-15mm
Common Iliac --> 8mm
External Iliac --> 7mm
CFA/Prox SFA --> 6mm
Distal SFA --> 5mm
Popliteal --> 4mm

Question 11

When Allowed to Remove Cholecystostomy

Answer 11

1) Pt clinically improves
2) Clamp tube for 48hr to ensure proper internal drainage
3) Repeat cholangiogram to ensure cystic duct + CBD patent
4) At least 2-6wk passed since placement (risk bile leak)

Question 12

When do you Need to Use Bird’s Nest Filter

Answer 12

IVC > 28mm

- If > 40mm, too large

Question 13

Indications for IVC

Answer 13

1) Absolute
- Contraindication to AC
- Recurrent VTE despite AC
- Complication of AC
- Inability to achieve therapeutic AC
2) Relative
- Ileocaval DVT
- Massive PE treated w/ thrombolysis, embolectomy
- Non compliance w/ AC
- High-risk of bleeding complication on AC
3) Prophylactic
- Trauma w/ high-risk for VTE
- Surgery pt w/ high-risk for VTE
- Medical condition w/ high-risk VTE (e.g. critically ill)

Question 14

Min Standard for Time Out

Answer 14

1) Correct pt
2) Correct procedure
3) Correct site

Question 15

Normal Size of Aorta (Aneurysm)

Answer 15

Ascending –> 4.0cm (5.0cm)
Descending –> 3.5cm (4.0cm)
Abdominal (suprarenal) –> 3.0cm
Abdominal (infrarenal) —> 2.0cm

Question 16

Splenic Artery Size for Tx

Answer 16

Splenic Artery –> 2.5cm

Question 17

Iliac Artery Aneurysm

Answer 17

1.5cm (Tx @ 3.0cm)