Random Facts

Question 1

ABI greater or equal to 1.3

Answer 1

Noncompressible, heavily calcified vessels

Question 2

When might you place a stent after angioplasty of a EIA stenosis?

Answer 2

Greater than 30% residual stenosis

Greater than 10 mmHg gradient at rest or 20 mmHg after vasodilator

Question 3

Which kidney is generally preferred for transplant harvest?

Answer 3

Left kidney (longer artery and vein)

Question 4

Imaging findings of angiodysplasia?

Answer 4

Vascular tuft or tangle of vessels, with intense draining vein filling that persists

Question 5

Management of angiodysplasia?

Answer 5

GI first line

Angio with high rate of rebleeding and ischemia

Surgery if needed

Question 6

Indications for BAE

Answer 6

300 cc in 24 hour period

3 or more episodes of 100 cc in a week

Slowly increasing episodes

Question 7

What % of all people have cervical rib?

In patients with TOS, how many have it?

Answer 7

0.5%

70%

Question 8

What is Adson’s maneuver?

Answer 8

Deep inspiration or neck hyperextension with neck turned to symptomatic side

Used to provoke TOS

Question 9

Differences in management between iliac artery stenosis vs occlusion

Answer 9

Stenosis - plasty alone can be effective

Occlusion - usually requires stenting

Question 10

TASC A lesions

Answer 10

Unilateral or bilateral CIA stenosis

Unilateral or bilateral short (<3 cm) EIA stenosis

Question 11

Normal TIPS velocity?

Answer 11

90-190 cm/s

Question 12

Which isotherm does the outer rim of an ice all correlate with?

Answer 12

0 degree C isotherm.

-20 C required for kill

Question 13

How to approach unsuccessful PTC for biliary leak?

Answer 13

Place biloma drain, allow tract to form. Perform sinogram to opacify ducts, perform PTC for diversion

Question 14

How long to turn off heparin gtt for biopsy?

Answer 14

4 hours

Question 15

Most common cause of benign biliary strictures?

Answer 15

80% iatrogenic (liver transplant, cholecystectomy)

Question 16

Transgluteal drainage placement traverses which foramen?

Answer 16

Greater sciatic foramen

Question 17

What is the definition of pulmonary hypertension based on catheter pressure measurement?

Answer 17

> 25 mmHg at rest

Question 18

How does pulmonary capillary wedge pressure measurement work for evaluation of pulmonary HTN?

Answer 18

If PCWP normal (<15 mmHg), precapillary HTN. If elevated, post-capillary HTN

Question 19

What is Perthes test?

Answer 19

To test whether varicose veins are from superficial vein dysfxn or deep.

Tourniquet to mid thigh –> walk –> if varicose veins go away, its a superficial vein problem

Question 20

Technique with highest 1 year effectiveness for GSV reflux?

Answer 20

No difference between STS, EVLT, vein stripping

Question 21

Which arteries affected by PAN?

Answer 21

Small-to-medium sized arteries. Usually hepaticomesenteric and renal arteries

Question 22

How to treat PAN?

Answer 22

Corticosteroids and immunosuppressives

Question 23

Gastric varices - when to do BRTO instead of TIPS?

Answer 23

Pre-existing hepatic encephalopathy

Question 24

Potential complication following BRTO?

Answer 24

31% bleed from other sites (esophageal, duodenal varices)

Question 25

Describe renin-angiotensin system

Answer 25

Renin (JGA) --> cleaved by angiotensinogen --> AT1 --> ACE in the lungs --> AT2 --> constricts blood vessels and stimulates aldosterone release from adrenals

Question 26

Potential complications of renal AVM?

Answer 26

High output heart failure, hematuria, hypertension

Question 27

MC complication of popliteal artery aneurysm?

Answer 27

Thrombosis (40%)

Question 28

In patients with popliteal artery aneurysms, what else should they be screened for?

Answer 28

AAA (seen in up to 37%)

Question 29

How to treat popliteal artery aneurysms

Answer 29

Surgical bypass

Question 30

How to manage ovarian artery supply to fibroid?

Answer 30

Is safe to embolize. Usually well tolerated, with small chance of early menopause

Question 31

What symptoms are most likely to be addressed by UFE?

Answer 31

Menorrhagia. Bulk symptoms less likely.

Question 32

What to do about free floating IVC thrombus?

Answer 32

Suprarenal IVCF

Question 33

Volume-based indication for partial splenic embo?

Answer 33

Spleen:liver volume ratio is 0.5 or greater

Question 34

Aside from thrombocytopenia, when is PSE indicated?

Answer 34

Gastric varices, hepatogenic ascites when TIPS cannot or has already been performed

Question 35

Contraindication for PSE?

Answer 35

Hepatofugal portal venous flow (increased risk of PVT)

Question 36

Exam of choice for Budd-Chiari?

Answer 36

Hepatic venography

Question 37

In what medical conditions can you see Budd-Chiari?

Answer 37

Hematologic disorders like polycythemia vera

Question 38

Gastric vs. esophageal varices. Which more common? Which more dangerous?

Answer 38

Esophageal varices more common. Gastric varices more associated with bleeding, higher mortality rates

Question 39

Renal cyst sclerotherapy technique

Answer 39

Ethanol through small drain. Dwell for 15 minutes in different positions. Can leave drain to gravity for wall apposition.

Question 40

Aside from stent graft placement, what can you do for wide neck PSA?

Answer 40

Temporary balloon occlusion then direct thrombin injection

Question 41

What arteries usually arise from subclavian artery?

Answer 41

Thyrocervical Costocervical Dorsal scapular artery Subscapular artery usually from axillary artery

Question 42

Normal portal pressure?

Answer 42

Usually less than 8 mmHg | Greater than 12 mmHg associated with increased bleeding

Question 43

How do you sample for ACTH levels?

Answer 43

Inferior petrosal sinus sampling

Question 44

Most important drug to give patients with Cushing syndrome before venous sampling?

Answer 44

Heparin. They are hypercoagulable

Question 45

What type of endoleak is junctional separation?

Answer 45

Type III

Question 46

Classic involvement in Takayasu arteritis

Answer 46

Long segment stenosis of left axillosubclavian artery

Question 47

Potential complication of thoracic duct embolization?

Answer 47

Pulmonary embolism | People with respiratory insufficiency not candidates for procedure

Question 48

Where is ulnar artery most susceptible on hypothecate hammer syndrome?

Answer 48

Ulnar artery at Guyon's canal

Question 49

MC organisms in mycotic aneurysms?

Answer 49

Staph, strep, salmonella. Gram negatives can be seen 35% of cases Blood cultures positive 50-85% cases

Question 50

What infection can result in PVT in non cirrhotic patients?

Answer 50

Bacteroides bacteremia

Question 51

MC location for bronchial arteries

Answer 51

T5-T6

Question 52

Describe two subtypes of priapism

Answer 52

High flow - damage to cavernous or dorsal penile artery resulting in arteriolacunar fistula Low flow - venous outflow obstruction leading to persistent tumescence of corpus cavernosum with sparing of glans and spongiosum

Question 53

Most common primary malignant tumor of the IVC

Answer 53

Leiomyosarcoma Usually F 50-60 yo

Question 54

Abernethy Malformation

Answer 54

Congenital absence of portal vein. Splenic vein and SMV drain into IVC. Children present with confusion due to hyperammonemia

Question 55

Bright liver sign

Answer 55

Focal hepatic enhancement of left lobe in setting if SVC occusion due to cavoportal collateral pathways

Question 56

When is SVC stenting preferred?

Answer 56

Malignant strictures

Question 57

Multiple hand arterial occlusions with acro-osteolysis

Answer 57

Scleroderma

Question 58

Describe Allen's test

Answer 58

Occlude both RA and UA. Have patient make a first then open hand. Should have pallor. Then release one artery. Repeat for other artery.

Question 59

When to treat internal iliac artery aneurysms?

Answer 59

Greater than 3 cm

Question 60

Best time to do HSG

Answer 60

Follicular phase, between days 6-11

Question 61

How do you determine adequacy of adrenal vein sample?

Answer 61

Sample should have 3x higher cortisol level compared to peripheral sample

Question 62

What is typically given once the adrenal veins are selected prior to sampling?

Answer 62

ACTH to stimulate cortisol and aldosterone production

Question 63

Post whipple bilious vomiting and epigastric lain

Answer 63

Afferent loop syndrome

Question 64

Most common surgery that causes thoracic duct injury?

Answer 64

Esophagectomy

Question 65

Two types of thoracic duct embolization

Answer 65

Type I: coil embo (or other) of TD Type II: mechanical disruption of cisterna chyli with repeated needle trauma

Question 66

Childhood disease resulting in refractory HTN, claudication, renal failure

Answer 66

Midaortic syndrome: rare congenital narrowing of aorta and visceral branches

Question 67

What is the recommended FLR/TLV prior to major hepatectomy?

Answer 67

20-40%

Question 68

What adjunctive techniques have been shown to decrease incidence of spinal ischemia following BAE?

Answer 68

Increased MAP, placement of CSF drain. Either can increase the spinal perfusion pressure. Monitoring evoked potentials has not been shown to help

Question 69

Imaging criteria of pelvic congestion syndrome

Answer 69

At least 4 parametrial veins (one at least 4 mm) OR An ovarian vein > 8 mm In a patient with symptoms

Question 70

Quadrilateral space syndrome

Answer 70

Teres minor (s) Surg neck humerus (l) Long head triceps (m) Teres major (i) Compression of contents on abduction and external rotation , including Posterior circumflex humeral artery Axillary nerve

Question 71

What can you see on Doppler with hepatic artery thrombosis in liver transplantation?

Answer 71

Decreased RI (<0.5) Elevated velocities Parvus tardus waveform

Question 72

In what % of patients is the main portal confluence extrahepatic?

Answer 72

50%

Question 73

Particle size for bland embo?

Answer 73

100-300 Embosphere | Then 300-500 if needed

Question 74

DEBTACE particle technique

Answer 74

75 mg doxorubicin on 100-300 LC beads Or 150-200 um Quadraspheres