Vascular Brant & Helms Ques

Question 1

What are the types of endoleaks?

Answer 1

Endoleaks are categorized into four
types:
Type 1 is a leak at the superior or inferior attachment site

Type 2 represents AAA filling via a patient arterial side branch such
as a lumbar or the inferior mesenteric artery

Type 3 is loss of
integrity of the stent graft

Type 4 is a leak through the porous
graft material.

Question 2

What is the commonest organism involved in mycotic abdominal aneurysms

Answer 2

Salmonella (74%)

Question 3

What are the commonest causes for renal artery stenosis?

Answer 3

1: Atherosclerosis
2: FMD (<40yr)

Question 4

Which part of renal artery is affected by FMD ?

Answer 4

The middle and distal portions

Question 5

What is the commonest cause of hypertension in children?

Answer 5

FMD is the most common cause of hypertension in children

Question 6

What is the primary therapeutic management for FMD?

Answer 6

Angioplasty

Question 7

Which part of the renal artery is affected by atherosclerosis ?

Answer 7

The proximal renal artery and the adjacent abdominal aorta

Question 8

What sized arteries are affected by PAN (a necrotising vasculitis)

Answer 8

small and medium-sized arteries. Commonly the renal and hepatic arteries

Question 9

What are the angiographic features of PAN?

Answer 9

multiple,
small,
saccular microaneurysms -
Microaneurysms are seen in 50% of patients, range in size from 1 to 12
mm, and are typically located at branch points

occlusions;
irregular stenoses

Question 10

What is the DDx for microaneurysms (1-12mm)?

Answer 10

PAN,
Wegener granulomatosis,
systemic lupus erythematosus, rheumatoid vasculitis
Drug abuse

Question 11

DDx for hypervascular liver mets?

Answer 11

Neuroendocrine 
Carcinoid
Choriocarcinoma
Renal cell carcinoma
Thyroid

Question 12

DDx for hypovascular liver mets?

Answer 12

Lung
Oesophagus
Pancreas

Question 13

What is the min rate of bleeding, so that it can be seen on angiography?

Answer 13

0.5 ml/min

Question 14

What is the commonest cause of bleeding in the small bowel ?

Answer 14

Tumours (20-50%)

Question 15

Tumours are the commonest cause of small bowel bleeding, but what are the other causes?

Answer 15

1: Aortoenteric fistula - accounts for 10%. Usu occurs post AAA repair from the duodenum
2: Vascular malformations - Accounts for about 20% of cases. Can be solitary or multiple eg HHT
3: Diverticula - uncommon usu jejunum
4: Meckel diverticulum - arises on the anti mesenteric border of the ileum. Pts present with painless bleeding. Best test is a Meckel’s scan.
5: IBD

Question 16

What are the causes of acute mesenteric ischaemia?

Answer 16

The commonest causes of acute mesenteric ischaemia are:
1: Arterial embolism
Acc. for 75%. The embolic source, is most commonly cardiac in origin. The angiographic appearance
is of an abrupt cutoff of the SMA at the site of its most proximal
branches—typically 4 to 6 cm from its origin

2: Arterial thrombosis,
3: nonocclusive ischemia,
4: mesenteric venous thrombosis

Arterial
. Symptoms of
postprandial abdominal pain, weight loss, and altered bowel habits are
typical. Intra-arterial infusion with thrombolytics such as tissue
plasminogen activator allows for the dissolution of the clot and
subsequent intervention on vascular lesions such as an ostial stenosis.
Surgical intervention may be needed if bowel infarction is present.
Nonocclusive ischemia accounts for 10% of acute ischemia
and is caused by conditions that produce low flow states, such as
hypotension, dehydration, and low cardiac output. The bowel responds
with disproportionate vasoconstriction leading to ischemia. Angiography
confirms diffuse vasoconstriction without underlying structural
abnormality. The classic appearance of alternating areas of vasospasm
has been termed sausage link narrowings.
Vasodilators such as papaverine can be used to improve bowel perfusion
and maximize recovery. Mesenteric venous occlusion generally affects
the medium-sized veins of the middle small bowel and accounts for about
10% of cases. This can be treated with catheter-directed