Odds & Ends

Question 1

Most common tumour of the aorta

Answer 1

Intimal angiosarcomas

Question 2

Most common tumour of the IVC

Answer 2

Leiomyosarcomas

Question 3

Syndrome associated with multiple skin venous malformations on the trunk, soles and palms

Answer 3

Blue Rubber Bleb Nevus Syndrome
Ddx: 
- HHT
- Mafucci
- Klippel Trenenuay

Question 4

Capillary malformations produce this skin finding

Answer 4

Port wine stain

Question 5

Features of HHT (aka Osler-Weber-Rendu Syndrome)

Answer 5

Autosomal dominant, can present with epistaxis, telangiectasia (dilated capillaries, venules and arterioles) on the lips and mouth and vascular malformations the GI tract and visceral organs

Question 6

Interventional procedures requiring prophylactic antibiotics

Answer 6

1) Biliary (can get overwhelming sepsis)
2) GU procedures - with suspicion for pyonephrosis (not for routine drain changes)
3) Abscess drainage
4) Embolization to invoke ischemia/infarction (chemoemoblization or uterine artery)
5) TIPS
6) Endovascular graft placement

Question 7

Ultrasound findings of arteriovenous fistula

Answer 7

Arterialization of the veins (pulsatile waveform)
Increased arterial diastolic flow (less specific)
Increased caliber of the veins due to increased flow

Question 8

What are the complications of percutaneous balloon angioplasty (PTA)? And what are the ideal patients for this procedure?

Answer 8

Complications - Thrombosis, dissection, vasospasm, vessel rupture, distal embolization
Patient selection - Short, solitary segment, concentric and non-calcified with good downstream flow

Question 9

3 clinical findings of Leriche syndrome

Answer 9

1) Buttock and thigh claudication
2) Absent femoral pulses
3) Impotence

Question 10

Name the different classifications of endoleaks

Answer 10

• Type 1 - leak at graft ends (proximal, distal or iliac occluder)
• Type 2 - sac filling via branch vessel (either lumbar or inferior mesenteric artery); most common after repair of abdominal aortic aneurysms; most spontaneously resolve
• Type 3 - leak through a defect in the graft (i.e. mechanical graft failure)
• Type 4 - Porous graft (intentional design of graft)
• Type 5 - Endotension

Question 11

Describe the normal U/S findings post TIPS

Answer 11

Hepatopedal flow in PV, hepatofugal flow through R/L portal veins, from tips to hepatic veins;
if occluded, see re-reversal of flow in R/L PVs (hepatopedal)

Velocities >190 cm/s or <90 cm/s suggests stenosis
Change in velocity of +/-50 cm/s from baseline study suggests stenosis
Low main PV velocities (<30 cm/s) also suggest stenosis

Question 12

Reversal agents and doses

Answer 12

• Naloxone (reversal for fentanyl) - 0.4 mg IV q2-3 minutes up to max dose of 10 mg
• Flumazenil (reversal for Benzo’s) - 0.2 mg over 15 seconds, repeat up to 1 mg
• Protamine (reversal of heparin or LMWH) - 1 mg/100 units heparin, up to max dose of 50 mg
• Vitamin K (warfarin) - 2.5-5 mg for low risk procedure (5-10 mg for higher risk procedures)

Question 13

Epi dosing in kids and adults

Answer 13

Adults:

IM 0.3 mL of 1:1,000 dilution (0.3mg): can repeat every 5-15 minutes up to 1 mL (1mg) total

IV 1 mL of 1:10,000 dilution (0.1mg); administer slowly into a running IV infusion of fluids; can repeat every few minutes as needed up to 10 mL (1mg) total

Kids:

IM 0.15 mg (EpiPen Jr)/0.3 mg (EpiPen) IM [1:1,000 concentration] - junior dose is half

IV 0.01 mg/kg slow push over 2-5 min [1:10,000 concentration – 10 ml vial] - up to 0.3 mg (3 ml) per dose

Question 14

Ways to decrease dose in fluro

Answer 14

• Last frame hold
• Pulsed fluoroscopy
• Collimation (narrow)
• Decrease patient to receptor distance
• Increase patient to source distance
• Larger FOV***
• Don’t use magnification
• kVp adjustment prior to mA adjustment will decr dose
• Incr xray beam filtration
• Larger aperture hole on I.I (smaller F#)
• Higher kVp = lower pt dose (less scatter)
• Limit time
• Remove grid