IR Flashcards
phlegmasia cerulea dolens
uncommon complication of DVT
extensive thrombotic occlusion of major & collateral veins
triad:
acute limb swelling
cyanosis
severe acute pain
pheochromocytoma biopsy prophylaxis
phenoxybenzamine (alpha blocker) to prevent catecholamine release & hypertensive crisis
α-blockade before β-blockade is essential
-lone β-blockade is dangerous: allows unopposed α-receptor vasoconstriction
why is gonadal vein embolization performed at multiple levels in pelvic congestion syndrome?
to prevent collateral pathway formation
treatment for pulmonary arteriovenous malformation
pulmonary artery coil embolization
particulate embolization is dangerous (non target embolization to brain, other organs)
medication, dose & route for reversing midazolam for moderate sedation
flumazenil, 0.2 mg IV
endoleak types
type I: leak at graft attachment site (prox=1a, dist=1b)
type II: aneurysm sac filling via branch vessel (MC IMA, lumbar a)
type III: leak through defect in graft
type IV: graft porosity
type V: endotension; continued expansion of sac w/o demonstrable leak on imaging
May-Thurner syndrome
chronic compression of LEFT common iliac VEIN (LCIV) against lumbar vertebrae by overlying RIGHT common iliac ARTERY (RCIA)
predisposes to DVT
Paget-Schroetter syndrome
thoracic outlet syndrome + venous thrombus in subclavian vein
“effort thrombosis”: assoc w athletes who raise arms a lot (weightlifters, pitchers)
tx: catheter directed lysis, surgical release
cisterna chyli
dilated inferior aspect of thoracic duct
formed by confluence of intestinal & lumbar lymphatic trunks
receives fatty chyle from intestines, drains superiorly through thoracic duct
posterior to abdominal aorta, between T12-L2 levels
does not cross midline
advantage of hemodialysis grafts over hemodialysis fistulas
grafts can be used sooner (2-3 weeks) than can fistulas (8-12 weeks)
vertebroplasty contraindications
asymptomatic compression fractures chronic fractures prophylactic vertebroplasty for osteopenic patients WITHOUT acute fractures uncorrectable coagulopathy systemic infection with elevated WBC significant spinal canal compromise
causes of blocked nephrostomy tube
tube problem:
- tube blocked (flush & aspirate: blood, debris, etc)
- tube dislodged (no longer in collecting system, “drained well then had some blood then tube stopped draining entirely”)
kidney problem:
- AKI (renal or pre-renal)
next step: neph tube check in IR, less commonly CT
major arteries in CT angio runoff
common iliac
int iliac a. (post): pelvic & gluteal arteries
ext iliac a. (ant): lat circumflex iliac, inf epigastric
common femoral a. (begins at inf epigastric a., divides into profounda femoris & SFA)
profounda femoris (perforated branches to thigh)
superficial femoral a. (terminates at adductor hiatus)
popliteal a. (terminates at anterior tibial origin
3 primary arteries in calf (3 vessel runoff):
- ant tibial (lateral), post tibial (medial), peroneal (middle)
at foot: ant tibial (➡ dorsalis pedis), post tibial (➡ plantar a.)
resistive indices of non-transplant renal artery Doppler
RIs typically between 0.5-0.7
higher RI: downstream problem (kidney or beyond)
lower RI: upstream problem (typical renal artery stenosis)
post op complications of liver abscess drainage
Hepatic artery pseudoaneursym, biliary injury, portal vein injury, post procedure sepsis, pneumothorax
needle used for perc gastrostomy/gastrojejunostomy
gastropexy
T fastener
anchor suture
contraindications for perc gastrostomy/gastrojejunostomy
Ascites gastric tumour/mass peritoneal disease prior gastric surgery large hiatus hernia coagulopathy varices high transverse colon
how to elicit popliteal artery entrapment syndrome?
what muscle?
plantar flex
medial head gastroc
Measurements by outer vs inner diameter
OUTER:
- puncture needle
- catheter
- dilator
INNER:
- sheath
3 Fr = ____ mm?
3 Fr = 1 mm
Diameter in mm = Fr / 3
Sheath outer layers = 1 Fr x 2 (6Fr sheath is 8Fr hole in skin)
Wire thickness measured in ?
Wire length measured in?
Thickness in inches
- 0.039 inch = 1 mm
- 0.035 inch wire conventional
Length in cm
Needle size conversions: 16G, 20G
What G for 0.035 inch guidewire?
16G = 1.65 mm = 5 Fr catheter 20G = 0.97 = 3Fr
19 G for 0.035 *standard
18 G for 0.038
Most common cause of upper G.I. bleed?
Duodenal ulcer bleeding vessel?
85% left gastric
If source cannot be identified, left Gastric can be taken down prophylactically
Ulcer - GDA
Particle size for GI bleed
300-500 microns
Smaller = bowel infarct
Drain sizes:
- clear fluid
- thin pus
- thick pus
- collection with debris
- 6-8F clear fluid
- 8-10 F thin pus
- 10-12 F thick pus
- 12F + Collection with debris
Bronchial artery embolization choice
Particles >325 micrometers NOT coils (likely rebleed & need access)
Rasmussen aneurysm bleed tx choice
Coils
Exception in hemoptysis- bronch art = particles
Air embolus
Left side down
Head down
Max lido dosing
4-5 mg/kg
With epi 7 mg/kg
Most 1% plain epi 10 mg per 1 mL - max dose 0.5 mL/kg
Ascending aorta calcifications
Takayasu
Syphilis
Most common type FMD
Most common vessels
Medial
Renal, carotid, iliac
Popliteal aneurysm % with AAA
AAA % with popliteal aneurysm
% popliteal aneurysm bilateral
30-50%
10%
50-70%
Micro aneurysm formation kidneys
- polyarteritis nodosa
- crystal meth
Unilateral versus bilateral parvus tardus in carotids
- unilateral = innominate
- bilateral = aortic stenosis
Normal carotid:
Velocity
ICA/CCA
ICA end diastolic
<125 cm/s
<2
<40 cm/s
Less than 50% stenosis doesn’t affect peak systolic velocity
What size do these fit into?
- 0.035 wire into what Fr
- 0.038 wire into what G
- 0.035
- 0.018
- 4 Fr into what size sheath?
- 4 Fr or larger
- 0.038 to 18 G
- 0.035 to 19 G
- 0.018 to 21 G
- 4 Fr to 4 Fr sheath or up
Greater risk of dissection - short or long floppy tip?
Short floppy higher risk
Ankle brachial index values
1 normal no symptoms 0.75-0.95 mild, mild claudication 0.5-0.75 moderate, claudication 0.3-0.5 moderate-severe, severe claudication <0.3 severe or critical, rest pain
Portal HTN definition
Portal vein >10 mmHg Portosystemic gradient (PSG) >5 mmHg
Yttrium 90
- Particle type
- Half life
- Max range
- Key points prior to using
- High energy beta (no gamma)
- T1/2 = 64 hours (94% delivered after 11 days, 4 t1/2)
- 1.1 cm
- MAA lung shunt: >30 Gy too much, embolise right gastric and GDA
internal iliac artery branches
3 urinary: umbilical, superior vesical, inferior vesical
3 visceral: uterine, vaginal, middle rectal
3 parietal: obturator, internal pudendal, inferior gluteal
external iliac artery branches
iliolumbar, lateral sacral, superior gluteal
subclavian artery branches
VIT CD vertebral internal thoracic thyrocervical costocervical dorsal scapular
