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IR > Things to know > Flashcards

Things to know Flashcards

1
Q

What are the borders of retroperitoneal space?

A

Anterior: posterior parietal peritoneum
Posterior: transversalis fascia
Superior: diaphragmatic fascia
Inferior: pelvic brim

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2
Q

What are the compartments of the retroperitoneal space?

A

Anterior pararenal space, posterior pararenal space, perirenal space

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3
Q

Complications associated with femoral artery access include?

A
  1. Hematoma - can be superficial or retroperitoneal (high risk with high stick - more cranial, above the pelvic brim
  2. Pseudoaneurysm - <1cm, watchful wait; >1cm, US guided thrombin injection
  3. AV fistula - increased risk if low (inferior/distal) femoral artery puncture. On doppler, arterialization of the vein, loss of normal triphasic waveform in the artery and increased diastolic flow in the artery proximal to the fistula
  4. Air embolism- riskiest part when inserting catheter into the peel away sheath. If suspect, place pt in left lateral decub and give 100% O2. Catheter aspiration if air bubble is large
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4
Q

Angiographic injection rate? cc/sec for a total cc, determined by diameter of the vessel and intravascular volume of vascular bed

A 
Aortogram (aortic arch): 20 for 30
Abd aorta: 20 for 20
IVC: 20 for 30
Mesenteric artery: 5 for 25
Renal artery: 5 for 15
Distal artery: 3 for 12
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5
Q

What is the 1st line Rx for stenosis?

A

Percutaneous transluminal angioplasty

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6
Q

What are the risks for PTA?

A

distal emboli, dissection, vessel rupture. Anticoagulation (typically heparin) should always be used before angioplasty

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7
Q

Balloons for PTA?

A

they are noncompliant, always should be 10-20% larger than the vessel diameter

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8
Q

What are the 2 types of stents?

A
  1. Balloon expandable - do not rebound if crushed, not good for sites that are prone to external compression like around joints or adductor canal in the leg
  2. Self expandable- more flexible and trackable. Used when the route of lesion is tortuous or when anatomy is prone to external compression
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9
Q

How should you select a stent?

A

1-2 cm longer than the stenosis with a diameter 1-2 mm wider than the unstenosed vessel lumen. 10% oversize for arterial; 20% oversize for venous stent

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10
Q

What are covered stents for?

A

Pseudoaneurysm, dissection, TIPS

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11
Q

What are the 2 types of embolic material?

A
  1. Permanent (coils, particles, glue, sclerosing agent)

2. Temporary (absorbable gelatin sponge, autologous clot)

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12
Q

Coils (permanent embolic material) pros and cons?

A

Thrombosis by creating vascular stasis. Very precise and quick placement without distal embolization. Con: you sacrifice distal access. Once a vessel is coiled, it can’t be reaccessed for retreatmented. General technique: first coil distal to the lesion then proximal, prevents recurrent bleeding from retrograde collaterals

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13
Q

Particles (permanent embolic material) 2 types?

A
  1. Trisacyl gelatin microsphere (embosphere, biosphere)

2. Polyvinyl alcohol

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14
Q

Sclerosing agent?

Glue?

A
  1. Sodium tetradecyl sulfate - for vascular malformation and varices
  2. Cyanoacrylate - rapidly hardens when it comes in contact with blood
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15
Q

Absorbable gelatin sponge (temporary embolic agent)?

A

Gelfoam, pfizer are examples.
Last 2-6 weeks.
Post procedure CT may show gas locules, can mimic abscess

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16
Q

What are the complications of embolization?

A
  1. Post embolization syndrome - happens within the first day after embolization (due to release of endovascular inflammatory modulators by infarcted tissue). Rx: NSAIDS, opioids when appropriate, IV fluids
  2. Non-target embolization
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17
Q

For basic IR procedures, what do you need?

A

Needle (gauge), wire (inches), sheath/catheter (Fr)

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18
Q

All about wires (inches)

A

Std: 0.035”
Microwire: 0.018”

19
Q

What are the different types of wires?

A
  1. Std wires have floppy or J tip end
    ex. Bentson (floppy); Rosen (J tip)
  2. hydrophilic: used to cross stenosis or for initial cannulation of an indwelling device
    ex. roadrunner (cook); glidewire (Terumo)
  3. Stiff: when structural rigidity is required. To dilate subcutaneous tissue (sheath, biliary drain, nephrostomy)
    ex. Amplatz
20
Q

Catheter (Fr)?

A

1 Fr= 0.33 mm

21
Q

Sheath vs Catheter, which is bigger?

A

Sheath is 2Fr bigger than a catheter

22
Q

What are the different types of catheters?

A
  1. High flow (flush): have multiple sideholes (may be coiled like pigtail/omniflush, curved, straight). Used for aorta/vena cava
  2. Selective/superselective: single hole at the end of the catheter. Ex. C2/SOS have reverse curved tip; Berenstein: angled tip
23
Q

What is the origin of SVC?

A

Left anterior cardinal vein - Left SVC (but that vein regresses) -> coronary sinus -> RA
Right anterior cardinal vein - Right SVC

24
Q

What is it called when there is persistence of both right and left anterior cardinal veins?

A

Duplicated SVC

25
Q

Left SVC originates from?

A

Left anterior cardinal vein, drains into coronary sinus -> RA; but sometimes can drain directly into LA (as a result you have a RIGHT to LEFT shunt)

26
Q

SVC obstruction can be either?

A

Acute - vascular emergency

Chronic - not an emergency; facial edema improves with standing

27
Q

SVC obstruction causes are?

A
  1. thoracic malignancy
  2. catheter associated thrombosis
  3. mediastinal fibrosis after histoplasmosis exposure
28
Q

With SVC obstruction, what would you see in the liver?

A

Increased enhancement of IVa segment due to collateral opacification of Vein of Sappey

29
Q

What is the rx for SVC obstruction?

A

Combined IJ/femoral approach. STENTING

30
Q

Before doing pulm artery angiogram, what should you ensure?

A

Make sure there is no LBBB, b/c if during PA angiogram you cause RBBB, you will have a complete block. May need pacer if there is a LBBB

31
Q

Normal right sided pressures?

A

RA: 0-8 mmHg
RV: 0-8mm Hg (D); 15-30 mmHg (S)
Pulm A: 3-12 mmHg (D); 15-30 mmHg (S)

32
Q

Pulm AV malformation causes what kind of shunt?

A

Right to left shunt

33
Q

Which pt may have multiple Pulm AVM?

A

Hereditary hemorrhagic telangiectasia (HHT)/Osler Weber-Rendu syndrome. Clinical presentation: brain abscess, stroke, epistaxis (due to nasal mucosa telangiectasia)

34
Q

Rx for Pulm AVM?

A

Coil the feeding artery.
Indication includes:
1. Asymptomatic with feeding artery >3mm
2. Symptomatic (prior infarct, abscess)

35
Q

What is the difference in treatment b/t pulm AVM vs peripheral (limb) AVM?

A

Limb/peripheral AVM requires elimination of the entire nidus, which is often fed by multiple arterial branches vs pulm AVM which is usually fed by a single feeding artery

36
Q

What is considered massive hemoptysis?

A

> 300mL/24 hr; associated with high mortality due to asphyxiation

37
Q

What arteries are involved with hemoptysis?

A

Bronchial artery (most common)
Pulm artery
Int mammary/inferior phrenic/celiac

38
Q

Most common causes of hemoptysis in the US?

worldwide?

A

US - CF, thoracic malignancy

Worldwide - TB, fungal infection

39
Q

Rx for hemoptysis?

Complication?

A

Embolization with particles; make sure there is no LEFT to RIGHT shunt to prevent cerebral embolization
Nontarget embolization of the spinal cord via anterior spinal cord artery or smaller tributaries - > do a neuro exam before procedure

40
Q

Branches of the celiac artery?

A

Left gastric artery
Splenic artery
Common hepatic artery

41
Q

In esophageal Mallory-Weiss, what is the source of bleeding?

A

Left gastric artery

42
Q

Branches of the common hepatic artery?

A

Proper hepatic artery
Right gastric artery
GDA

43
Q

Branches of GDA?

A

Superior PDA (anterior and posterior branch) and right gastroepiploic artery;

Superior PDA anastomoses with the inferior PDA (off the SMA) and the right gastroepiploic artery anastomoses with the left gastroepiploic artery off the splenic artery (greater curvature of the stomach/ arch of Barlow)

IR (1 decks)

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