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CORE IR > misc > Flashcards

misc Flashcards

1
Q
A

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.

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2
Q

how do you treat hypothenar hammer syndrome

A

stop the repetetive trauma.

no good endovascular treatment for them

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3
Q

when would you do transjugular liver biopsy?

A

coagulopathy, thrombocytopenia, ascites, need for hepatic venous pressure gradient measurements

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4
Q

another name for paget-schroetter syndrome?

A

effort thrombosis

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5
Q

treatment for paget schroetter syndrome

A

thrombectomy, thrombolysis, surgical decrompression (surgery is gold standard)

endovascular treatments are temporizing measures

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6
Q

distal necrosis in finger tips + corkscrew vessels

A

Buerger’s disease

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7
Q

where do you ideally want to access the kidney for PCN?

A

inferior most and posterior most calyx (brodel zone). Least vascular area

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8
Q

Injection rate for kidney

A

5mL/s for a total of 10mL

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9
Q

how do splenic AVFs form?

A

trauma or diffuse hemaniomatosis

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10
Q

What type of stent is used for a TIPS?

A

Viatorr stent graft - the distal end of the stent is uncovered

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11
Q

three indications for TIPS

A

uncontrolled variceal hemorrhage, refractory ascites, hepatic hydrothorax, hepatorenal syndrome

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12
Q

absolute contraindications for TIPS

A
  • 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)
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13
Q

claudication, erectile dysfunction and decreased distal pulses

A

Leriche syndrome (aortoiliac occlusive disease)

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14
Q

how do you treat Leriche syndrome

A

aortoiliac endovascular recanalization or surgical bypass

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15
Q

What is the Milan criteria

A

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
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16
Q

best treatment for HCC

A

segmentectomy or ablation

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17
Q

Where does the left SVC drain?

A

coronary sinus

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18
Q

catheter will flush but won’t aspirate

A

fibrin sheath

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19
Q

treatments for fibrin sheath?

A

fibrin sheath stripping

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20
Q

what embolic agent is used in portal vein embolization?

A

glue (liquid embolic)

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21
Q

amount of liver you need to survive in a non-cirrhotic after portal vein embolization?

A

20%

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22
Q

amount of liver you need to survive in a cirrhotic after portal vein embolization?

A

>35%

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23
Q

treatment of choice for AML?

A

embo with EtOH or ethiodized oil or particles

don’t cage yourself out with coils

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24
Q

three category stratifications and treatments for PE?

A
  • non-massive pulmonary embolism: no heart strain
    • anticoagulation only
  • submassive: heart strain
    • anticoag +/- catheter directed thrombolysis
  • massive: hypotension
    • anticoag + thrombectomy
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25
Q

most common cause of thoracic duct injury

A

esophagectomy

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26
Q

what is the diagnostic criteria to perform a lymphangiography

A

high output chylothorax TG > 120 mg/dL

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27
Q

what is the indication for adrenal vein sampling

A

primary aldosteronism

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28
Q

what lab tests are evaluated in adrenal vein sampling?

A

cortisol and aldosterone

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29
Q

what is the common presenting syndrome in a splenic artery aneurysm?

A

no presenting symptoms. Usually truly incidental

  • they are typically TRUE aneurysms
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30
Q

treatment options for splenic artery aneurysm

A

platinum coil embo, stent graft placement, surgery

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31
Q

size criteria for splenic artery aneurysm treatment?

A

> 2 cm

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32
Q

when would you treat a splenic artery aneurysm < 2cm

A

if the patient is pregnant

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33
Q

if you see white contrast on a DSA, what agent was used?

A

CO2

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34
Q

BRTO is the treatment of choice for:

A

gastric varices

35
Q

treatment?

A

Balloon-occluded retrograde transvenous obliteration BRTO

Seen in the image are gastric varices

36
Q

treatment of FMD

A

angioplasty ALONE

37
Q

what is the pathophys of FMD?

A

non-atherosclerotic proliferation of connective tissue and muscle fibers within the arterial vessel walls

38
Q

What is segmental arterial mediolysis

A

intra-abdominal hemorrhage with fusiform aneurysms, stenoses, dissections, and occlusions within the splanchninc arterial branches

39
Q

intra-abdominal hemorrhage with fusiform aneurysms, stenoses, dissections, and occlusions within the splanchninc arterial branches

A

segmental arterial mediolysis

40
Q

treatment of segmental arterial mediolysis?

A

plantinum coil embolization or surveillance

41
Q

when you treat a pseudoaneurysm in the GDA

A

treat front and backdoor. Treat them on both sides (Eiffel tower it)

42
Q

anterior type II endoleak

A

from IMA

43
Q

posterior type II endoleak

A

lumbar artery

44
Q
A

JNA

embo with small particles

45
Q
A

standing wave

46
Q

lateral artery coming off of the external iliac

A

deep circumflex iliac artery

47
Q
A

multiple pseudoaneurysms and extrav either due to partial nephrectomy or biopsy

48
Q
A

hepatic abscess.

Place drain most inferior to ribs so B is right

49
Q

what angiographic views are used?

A

A: LAO

B: RAO

50
Q

what is a megacava?

A

IVC > 28mm

51
Q

IVC > 28mm

A

megacava

52
Q

procedure if CF pt with massive hemoptysis

A

bronchial artery embo with particles

never ever ever use coils

53
Q

massive hemoptysis definition

A

>300 mL/day

54
Q

treatment for May Thurner syndrome

A

place a stent across the left iliac vein

55
Q

status post cholecystectomy

A

post surgical stricture

56
Q

arrow heads

A

right gastro-epiploic

57
Q

at what Rutherfod category is it considered critical limb ischemia?

(teachingIR)

A

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.

58
Q

fistula rule of 6s

A

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
59
Q

A 7French sheath will make what size hole in a vessel wall?

A

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.

60
Q

Fr to mm conversion

A

3Fr = 1 mm

61
Q

if asked a question about a sheath diameter, what do you have to keep in mind?

A

The wall of the sheath adds some additional caliber, about 2Fr worth.

ex: So a ‘7Fr sheath’ is in actuality 9Fr

62
Q

needle gauge for 0.035 wire

A

18 ga

63
Q

18 ga needle accomodates what size wire

A

0.035”

64
Q

21g needle accomdates what size wire

A

0.018” wire

65
Q

what needle gauge should be used for a 0.018 wire?

A

21 g

66
Q

Regarding the great saphenous vein, what length of time for reflux at a valve is diagnostic for insufficiency?

A

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.

67
Q

Using ASA (American Society of Anesthesiolgists) guidelines, patient is considered NPO if:

A

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)

68
Q

What are best practices for removal of non-tunneled large bore CVL?

A

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.

69
Q

in an aortic dissection, the left renal artery originates from:

A

the false lumen

everything else arises from the true

70
Q

IMH mortality predictors

A

ascedning aorta > 5 cm

IMH > 2 cm

pericardial effusion

71
Q

AAS causes

  1. penetrating ulcer:
  2. dissection:
  3. IMH:
A

AAS causes

  1. penetrating ulcer: Athero
  2. dissection: HTN
  3. IMH: HTN
72
Q

When do you repair this?

A

aortic root dilation 5.5 cm

73
Q

MALS is worse during what phase of the respiratory cycle?

A

expiration.

during expiration the diaphragm gets closer to the spine and crushes the celiac

74
Q

when you see a popliteal aneurysm, next step?

A

look at other leg, and look at the abdominal aorta.

also look at the toes (high risk for embolism))

75
Q

most common type of FMD

A

medial

patients with FMD are prone to dissection

76
Q

most common cause of thoracic outlet syndrome

A

anterior scalene

(may have cervical ribs)

77
Q

pre-ductal coractation epidemiology

A

infants

78
Q

post-ductal coactation

A

adults

79
Q

what ribs are not involved in rib notching (in coarctation)?

A

Rib notching does NOT involve the first and second ribs because they are fed by the costocervical trunk

80
Q

look like coarctation but the patient doesn’t have collateral vessels and no BP differences between arms.

A

pseudo coactation

81
Q
A
82
Q
A
83
Q
A

misplaced G-tube with balloon post-pyloric

CORE IR (10 decks)

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