misc Flashcards
colonic hemorrhage at splenic flexure
A tagged RBC study demonstrated uptake with migration in the expected region of the left colon nearthe splenic flexure (Fig. 1-1). The patient was then referred urgently for mesenteric angiography.
contrast extravasation from a middle colic branch supplying the splenic flexure.
how do you treat hypothenar hammer syndrome
stop the repetetive trauma.
no good endovascular treatment for them
when would you do transjugular liver biopsy?
coagulopathy, thrombocytopenia, ascites, need for hepatic venous pressure gradient measurements
another name for paget-schroetter syndrome?
effort thrombosis
treatment for paget schroetter syndrome
thrombectomy, thrombolysis, surgical decrompression (surgery is gold standard)
endovascular treatments are temporizing measures
distal necrosis in finger tips + corkscrew vessels
Buerger’s disease
where do you ideally want to access the kidney for PCN?
inferior most and posterior most calyx (brodel zone). Least vascular area
Injection rate for kidney
5mL/s for a total of 10mL
how do splenic AVFs form?
trauma or diffuse hemaniomatosis
What type of stent is used for a TIPS?
Viatorr stent graft - the distal end of the stent is uncovered
three indications for TIPS
uncontrolled variceal hemorrhage, refractory ascites, hepatic hydrothorax, hepatorenal syndrome
absolute contraindications for TIPS
- heaptic encaphalopathy (profound confusion)
- coagulopathy (INR > 1.5, plt < 50K)
- intrahepatic lesions because can bleed a lot
- profound right heart pressure (could cause pressure overload in the Right heart and push them into heart failure)
claudication, erectile dysfunction and decreased distal pulses
Leriche syndrome (aortoiliac occlusive disease)
how do you treat Leriche syndrome
aortoiliac endovascular recanalization or surgical bypass
What is the Milan criteria
Used to decide who can have liver transplant
- HCC < 5 cm
- not more than three foci of tumor, each one not > 3cm
- no vascular invasion
- no extrahepatic spread
best treatment for HCC
segmentectomy or ablation
Where does the left SVC drain?
coronary sinus
catheter will flush but won’t aspirate
fibrin sheath
treatments for fibrin sheath?
fibrin sheath stripping
what embolic agent is used in portal vein embolization?
glue (liquid embolic)
amount of liver you need to survive in a non-cirrhotic after portal vein embolization?
20%
amount of liver you need to survive in a cirrhotic after portal vein embolization?
>35%
treatment of choice for AML?
embo with EtOH or ethiodized oil or particles
don’t cage yourself out with coils
three category stratifications and treatments for PE?
-
non-massive pulmonary embolism: no heart strain
- anticoagulation only
-
submassive: heart strain
- anticoag +/- catheter directed thrombolysis
-
massive: hypotension
- anticoag + thrombectomy
most common cause of thoracic duct injury
esophagectomy
what is the diagnostic criteria to perform a lymphangiography
high output chylothorax TG > 120 mg/dL
what is the indication for adrenal vein sampling
primary aldosteronism
what lab tests are evaluated in adrenal vein sampling?
cortisol and aldosterone
what is the common presenting syndrome in a splenic artery aneurysm?
no presenting symptoms. Usually truly incidental
- they are typically TRUE aneurysms
treatment options for splenic artery aneurysm
platinum coil embo, stent graft placement, surgery
size criteria for splenic artery aneurysm treatment?
> 2 cm
when would you treat a splenic artery aneurysm < 2cm
if the patient is pregnant
if you see white contrast on a DSA, what agent was used?
CO2
BRTO is the treatment of choice for:
gastric varices
treatment?
Balloon-occluded retrograde transvenous obliteration BRTO
Seen in the image are gastric varices
treatment of FMD
angioplasty ALONE
what is the pathophys of FMD?
non-atherosclerotic proliferation of connective tissue and muscle fibers within the arterial vessel walls
What is segmental arterial mediolysis
intra-abdominal hemorrhage with fusiform aneurysms, stenoses, dissections, and occlusions within the splanchninc arterial branches
intra-abdominal hemorrhage with fusiform aneurysms, stenoses, dissections, and occlusions within the splanchninc arterial branches
segmental arterial mediolysis
treatment of segmental arterial mediolysis?
plantinum coil embolization or surveillance
when you treat a pseudoaneurysm in the GDA
treat front and backdoor. Treat them on both sides (Eiffel tower it)
anterior type II endoleak
from IMA
posterior type II endoleak
lumbar artery
JNA
embo with small particles
standing wave
lateral artery coming off of the external iliac
deep circumflex iliac artery
multiple pseudoaneurysms and extrav either due to partial nephrectomy or biopsy
hepatic abscess.
Place drain most inferior to ribs so B is right
what angiographic views are used?
A: LAO
B: RAO
what is a megacava?
IVC > 28mm
IVC > 28mm
megacava
procedure if CF pt with massive hemoptysis
bronchial artery embo with particles
never ever ever use coils
massive hemoptysis definition
>300 mL/day
treatment for May Thurner syndrome
place a stent across the left iliac vein
status post cholecystectomy
post surgical stricture
arrow heads
right gastro-epiploic
at what Rutherfod category is it considered critical limb ischemia?
(teachingIR)
4
The Rutherford scaleis an important guideline to the progression of PAD as well as the need for intervention. If the symptoms progress beyond claudication to rest pain (category 4), medical management is no longer adequate and some sort of revascularization intevention is required.
fistula rule of 6s
Fistula maturation is a combination of an outflow vein that can be found/accessed which can tolerate the flow rates required for hemodialysis.
The rule of 6s help predict this.:
- Size >6mm
- <6mm from the skin help to be able to find it and access it.
- Flow rate >600mL/min (graft), > 500 mL (AVF)
- 6 weeks after surgery
A 7French sheath will make what size hole in a vessel wall?
3mm
2 part question. 1st is conversion from Fr to mm, 3Fr = 1mm. 2nd part deals with sheath nomenclature. A sheath is termed for what the lumen will accommodate. The wall of the sheath adds some additional caliber, about 2Fr worth. So a ‘7Fr sheath’ is in actuality 9Fr when measured from outer wall to outer wall which is 3mm.
Fr to mm conversion
3Fr = 1 mm
if asked a question about a sheath diameter, what do you have to keep in mind?
The wall of the sheath adds some additional caliber, about 2Fr worth.
ex: So a ‘7Fr sheath’ is in actuality 9Fr
needle gauge for 0.035 wire
18 ga
18 ga needle accomodates what size wire
0.035”
21g needle accomdates what size wire
0.018” wire
what needle gauge should be used for a 0.018 wire?
21 g
Regarding the great saphenous vein, what length of time for reflux at a valve is diagnostic for insufficiency?
500ms
As part of the evaluation for venous insufficiency, ultrasound is utilized to see the direction of blood flow. Specifically, if the flow of venous blood is retrograde upon standing or valsalva, the valves will be considered incompetent. >500ms is required to diagnose superficial venous insufficiency.
Using ASA (American Society of Anesthesiolgists) guidelines, patient is considered NPO if:
Using ASA (American Society of Anesthesiolgists) guidelines, patient is considered NPO if they have not consumed ‘clears’ in the past 2 hours or ‘solids’ in the past 6 hours prior. Liquids with particulate matter, including pulp or added milk/cream are considered in in the ‘solids’ category.
ex) jell-o 4 hours prior is considered NPO (clears >2 hr ago)
What are best practices for removal of non-tunneled large bore CVL?
The risk of air embolus during removal of a non-tunneled line must be respected.
- Best practice is positioned flat or trendelenburg.
- Patient should Valsalva or hum to increase intrathoracic pressure.
- An occlusive (non air-permeable) dressing should be placed on completion.\
If you think an air embolus has occurred, positioning of the patient left-side down can help keep the air in the right atrium.
in an aortic dissection, the left renal artery originates from:
the false lumen
everything else arises from the true
IMH mortality predictors
ascedning aorta > 5 cm
IMH > 2 cm
pericardial effusion
AAS causes
- penetrating ulcer:
- dissection:
- IMH:
AAS causes
- penetrating ulcer: Athero
- dissection: HTN
- IMH: HTN
When do you repair this?
aortic root dilation 5.5 cm
MALS is worse during what phase of the respiratory cycle?
expiration.
during expiration the diaphragm gets closer to the spine and crushes the celiac
when you see a popliteal aneurysm, next step?
look at other leg, and look at the abdominal aorta.
also look at the toes (high risk for embolism))
most common type of FMD
medial
patients with FMD are prone to dissection
most common cause of thoracic outlet syndrome
anterior scalene
(may have cervical ribs)
pre-ductal coractation epidemiology
infants
post-ductal coactation
adults
what ribs are not involved in rib notching (in coarctation)?
Rib notching does NOT involve the first and second ribs because they are fed by the costocervical trunk
look like coarctation but the patient doesn’t have collateral vessels and no BP differences between arms.
pseudo coactation
misplaced G-tube with balloon post-pyloric
