Misc. DI tests and Tx

Question 1

what is arteriography

Answer 1

anatomic study that looks for filling defect

Question 2

interpretation of arteriography study

Answer 2

hemodynamically significant stenosis =50% diameter reduction

extent and location of filling defect is noted

Question 3

Misc findings of arteriography

Answer 3

atherosclerotic lesions
occlusions and collaterals
vasospasm -severe swelling
fibromuscular dysplasia (medial hyperplasia)

Question 4

what is contraindicated with arteriography

Answer 4

allergic to contrast

kidney problems

Question 5

what is MRA ,
what is it used for
what is contraindicated

Answer 5

magnetic resionance arterography
uses radio waves and magnetic field

can quantify blood flow and distinguish soft tissue

bad for
metal
overestimating stenosis due to slow flow turbulance

expensive

pt are usually opposed to MRI / MRA

Question 6

CT is what
used for
contraindicated by

Answer 6

ionizing radiation to obtain cross sectional images

identifies aorta size and extent of aneurysm as well as relational anatomy
used mostly for preop eval of Aortic repair

bad for PAD due to small vessels
pt motion
one plain is used

Question 7

types of medical treatment

Answer 7

lifestyle changes

pharmacologic

Question 8

pharmacologic treatment

Answer 8

asprin - antiplatelet
statins -cholestrol
antiHTN meds
meds that decrease blood viscosity

Question 9

surgical treatment

Answer 9

endarterectomy _rotorooter
bypass graft
stent

Question 10

good bypass graft has what three things

Answer 10

good

inflow, conduit, outflow

Question 11

name 4 common bypass grafts

Answer 11

aorta -to- iliac arteries (also used for AAA)

Aorta to bi-femoral (also used for AAA)

femoral to pop

femoral to PTA / ATA/ Peroneal

Question 12

vessels used to make autogeneous bypass grafts

Answer 12

GSV
renal artery
SMA

Question 13

Endovascular treastment

3

Answer 13

Angioplasty (PTLA) (Tx of choice)

Intravascular Ultrasound ( IVUS)

stent/ stent graft

Question 14

Angioplasty brief

Answer 14

fluoroscopy used with catheter balloon inflated to push plaque against artery walls

not effective on all vessels or lesions

good on focal stenosis eg.
renal
iliac
femoral
pop 

usually procedure is followed by stent placement

Question 15

risk of catheter intervention is ___-

Answer 15

low

less than 5% have complilcations which is usually thrombus

Question 16

Intravascular Ultrasound brief

+ indications

Answer 16

images vessels from inside out
IVUS

used to 
eval plaque formation 
stent placement 
id aortic dissection 
venous-- chronic iliocaval obstruction

Question 17

Angioplasty has a high rate of what

Answer 17

re stenosis

so stent graft is used

Question 18

EVAR

Answer 18

EndoVascular Aneurysm Repair

Question 19

stent graft is what

Answer 19

graft inside the artery

Question 20

what should you expect with a stent graft

Answer 20

higher velocities

Question 21

EVAR is treatment of choice for what

Answer 21

AAA

Question 22

what probllems occur due to stent graft

Answer 22

re-stenosis due to intimal hyperplasia 
stent migrtation 
graft limb compression 
twisting 
dislodgment 

ENDOLEAK

Question 23

type of endoleaks

Answer 23

I - attachment sites (prox or dist) *most common

II- Branch vessels (IMA-lumbar) flow reverses in patient branch the reversed flow goes into the aneurysmal sac

III- graft defect: modular connections/ graft tear

IV- transgraft poracity – flow through the graft itself

V- Endotension - enlarging aneurysmal sac with no detectable leak

Question 24

which types of endoleaks are commonly observed with ultrasound

Answer 24

I, II and III

attachment sites/ retrograde patient branch/ graft defect

Question 25

what is important to image and do when endoleak is suspected

Answer 25

color
sensitivity to detect flow outside of the aneurysm
measure thrombus
r