question

Translumbar approach:

answer

Indication - nonpalpable peripheral pulses

question

Axillary artery approach

answer

Preferred - easier to access descending aorta -left side approach crosses fewer CNS arteries (when going down aorta -3J wire preferred Disadvantages: -difficult to compress - high incidence of complications -brachial plexus injury

question

Angiography complications

answer

1. Puncture site complications - groin hematoma, AVF, pseudoaneurysm, vessel thrombosis, neuritis, infection 2. Contrast reaction - anaphylaxis, renal failure, cardiac failure, phlebitis 3. Catheter related complications -dissection, cholesterol emboli, thromboembolism, cerebrovascular accident, arterial dissection 4. Therapy related complications (CNS bleed during thrombolysis)

question

Risk factors for AVF or pseudoaneurysm

answer

Low puncture heparinization large catheters

question

Complications of embolization

answer

Post embolization syndrome (fever, inc WBC) 40% Infection of embolized area Reflux of embolic material (nontarget embolization) Alcohol infarction in the periphery

question

Reperfusion syndrome

answer

oxidant production, complement activation, leucocyte-endothelial cell adhesion, platelet-leucocyte aggregation, increased microvascular permeability and decreased endothelium-dependent relaxation

question

recombinant TPA dose

answer

0.001-0.02 mg/kg/hr t1/2 = 5 minutes treatment time = 6 hrs Bleeding - 10% Arterial: 1mg/hr (total max patient dose = 100mg) Venous: same Line clearance: 0.5 mg/hr x 3-4 hours

question

Contraindications to tPA

answer

Absolute: active bleeding pregnancy intracranial lesion nonviable limb (revasc --> ARF and myoglobulinuria) infected thrombus Relative: bleeding diathesis cardiac thrombus malignant HTN recent major surgery postpartum Complications: Major hemorrhage needing transfusion / surgery = 7% minor hemorrhage 7 % distal emboli pericatheter thrombosis termination of therapy required in 10%

question

Indications for Angioplasty

answer

Claudication / rest pain Tissue loss Non healing wound Establish inflow for distal bypass graft Hemodialysis AVF or graft

question

Indications for stents

answer

Long segment stenosis Total occlusion Unsuccessful PTA recurrent stenosis after PTA Dissection flap Ulcerated plaque renal ostial lesions

question

TIPS indications

answer

POrtal hypertension with variceal bleeding Refractory ascites Budd Chiari Pre transplant

question

TIPS goal portosystemic gradient

answer

<10 mmHg decompression of varices

question

Contraindications to TIPS

answer

Absolute Severe right sided heart failure with elevated CVP Polycystic liver dz Relative Active infection Severe encephalopathy Portal vein thrombosis Hepatic hypervascular tumor hepatic failure

question

Complications of central venous catheter placement

answer

Pneumothorax Arterial puncture Hemorrhage Occlusion Mechanical problems Air embolism

question

Causes of thoracic aortic aneurysm

answer

Atherosclerosis (most common) Connective tissue disease (Marfans, Ehlers Danlos) Syphillis Post traumatic pseudoaneurysm Mycotic Aortitis (Takayasus Giant Cell, Rheumatoid arthritis, Ank Spond)

question

Cystic medial necrosis

answer

Degenerative process of aortic muscular layer (media) -involves sinuses and sinotubular junction -'tulip bulb' aorta

question

Syphilic aneurysms

answer

10-30 yrs after primary infection tree bark calcifications ascending aorta / arch assymetrical saccular involvement

question

Takayasu's

answer

Takayasu's disease (also known as "aortic arch syndrome", "nonspecific aortoarteritis" and the "pulseless disease"[1]:841) is a form of large vessel granulomatous vasculitis[2] with massive intimal fibrosis and vascular narrowing affecting often young or middle-aged women of Asian descent. It mainly affects the aorta (the main blood vessel leaving the heart) and its branches, as well as the pulmonary arteries. Females are about 8-9 times more likely to be affected than males.Some patients with Takayasu's arteritis may present with only late vascular changes, without an antecedent systemic illness. In the late stage, weakness of the arterial walls may give rise to localized aneurysms.

question

Arc of Buehler

answer

Embryonic ventral communication of celiac artery to SMA

question

Arc of Riolan; Marginal artery of Drummond

answer

SMA - IMA connection

question

IMA to internal iliac artery

answer

via superior rectal artery --> inferior rectal artery --> pudendal artery --> internal iliac artery

question

Rectal arcades

answer

Superior rectal a from IMA Middle rectal a from internal iliac Inferior rectal a from pudendal a

question

FNH arteriogram

answer

spoke wheel appearance

question

hepatic adenoma

answer

not very vascular

question

HCC

answer

inc vascularity; AV shunting; portal vein invasion

question

Indications for pulmonary angiography

answer

Suspected PE Dx and tx of pseudoaneurysms and AVM Work up of pulmonary arterial hypertension

question

Normal pressures

answer

Psyst/Pdia (mean) RA (0-5 mmHg) RV 20-25 / 0-7 PA 20-25 / 8-12 LA (5-10 mmHg) LV 120 / 10 aorta 120/80 (100)

question

Definition of pulmonary arterial hypertension

answer

mean PA pressure ; 15 mmHg Systolic ; 30 mmHg

question

Contraindications to PA cath

answer

No absolute, all relative Severe pulmonary HTn LBBB (catheter irritant may induce RBBB --> complete heart block) --> place transvenous pacer CHF

question

Collaterals in occlusive iliac disease

answer

Internal mammary --> inferior epigastric --> CFA Lumbar / iliolumbar --> circumflex iliac --> CFA Lumbar / illiolumbar --> lateral circumflex --> PFA Gluteal / Obturator --> lateral and medial circumflex --> PFA Geniculate branches

question

Persistent Sciatic artery

answer

Embryonic sciatic artery - off internal iliac, through greater sciatic forament, deep to gluteus maximus --> joins popliteal a above the knee often bilateral prone to injury at ischial location

question

Lower extremity occlusive disease

answer

Young: inflammatory diseases Takayasus' Collagen Vascular disease, autoimmune, Buergers disease Old: atherosclerosis embolism Drugs: Ergotism (long smooth narrowing) Amphetamine: speed kidney Other: spasm due to trauma (standing waves) popliteal artery entrapment radiation

question

Dog leg sign

answer

When a popliteal arterial aneurysm is present, a thrombus may prevent contrast material opacification of the entire dilated vessel. Instead, the thrombus may narrow the aneurysmal lumen so that the flowing contrast material simulates the appearance of a dog leg and thus produces the dog leg sign

question

Arterial embolism

answer

Clinical 5 Ps: pain, pallor, pulselessness, paresthesias, paralysis Multiple lesions at bifurcations. Lack of collaterals. Severe vasospasm. Menisci filling defects. Treatment: Surgical embolectomy (*** must differentiate from in situ thrombosis due to different therapy) Etiology: Cardiac - mural thrombus, Ventricular aneurysm, MI, Afib Aneurysm Iatrogenic Paradoxical embolus (DVT and L --> R shunt)

question

Buerger's disease

answer

Pan arteritis of unknown etiology thromboangiitis obliterans venous involvement in 25% Nearly all are smokers, 98% male -Calf and foot vessels most common -ulnar and radial arteries -palmar and digital arteries Abrupt segmental arterial occlusions intervening normal appearing arteries corkscrew collaterals sparing of larger inflow arteries

question

Small vessel atherosclerosis

answer

in diabetics; inc calf and foot involvement high frequency gangrene --> amputation

question

Cholesterol emboli

answer

Microemboli to ischemic digits Livedo reticularis Blue toe syndrome

question

Ergotism

answer

Bilateral, symmetric, diffuse severe vasospasm Young females on ergot medications for migraines

question

May Thurner

answer

Compression of left common iliac vein by crossing of the right common iliac artery Treatment: Stent

question

IVC filter indications

answer

DVT and/or PE AND contraindication to anticoagulation failure of anticoagulation complications of anticoagulation prophylaxis

question

Thoracic outlet syndrome

answer

COmpression of brachial plexus / subclavian vessels -Scalene triangle -costoclavicular space -pectoralis tunnel

question

Paget-Schroetter disease

answer

"effort thrombosis' of subclavian vein -mechanical compression by anterior scalene muscle, first rib, subclavius tendon or costoclavicular ligament

question

AV fistula types

answer

Brescia - Cimino fistula - side to side anastomosis of radial artery and cephalic vein at the wrist Brachial artery and cephalic vein Brachial artery and basilic vein Femoral artery and saphenous vein

question

Synthetic graft

answer

PTFE can be used earlier than fistula; less longevity

question

DDX Aneurysm

answer

Atherosclerosis Infection (staph, salmonella, syphilis) Inflammation Takayasu Giant cell Collagen vascular disease (PAN) Congenital Collagen dz (Marfan's, Homocystinuria, Ehlers Danlos) FMD NF Pseudoxanthoma elasticum Trauma

question

Pseudoxanthoma elasticum

answer

Pseudoxanthoma elasticum (PXE), also known as Grönblad-Strandberg syndrome,[1] is a genetic disease that causes fragmentation and mineralization of elastic fibers in some tissues. The most common problems arise in the skin and eyes, and later in blood vessels in the form of premature atherosclerosis.

question

Peripheral vascular disease DDX

answer

Atherosclerosis Small vessel disease (diabetics) Embolic disease (thromboemboli, cholesterol emboli, plaque emboli) Vasculitis Buerger's disease Medication

question

Popliteal artery ddx

answer

Popliteal aneurysm Tortuous artery Popliteal artery entrapment syndrome Adventitial cystic disease Baker's cyst

question

Williams syndrome

answer

Supravalvular aortic stenosis**** rare neurodevelopmental disorder characterized by a distinctive, "elfin" facial appearance, along with a low nasal bridge, an unusually cheerful demeanor and ease with strangers; developmental delay coupled with strong language skills; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia.

question

Aortic stenosis

answer

Congential: Coarctation Pseudocoarctation Williams syndrome Rubella syndrome Takayasu's (most common arteritis to cause stenosis) NF Radiation

question

Pulmonary artery stenosis

answer

Williams syndrome (infantile hypercalcemia) Rubella syndrome Takayasu's arteritis Ass'd with congenital heart disease (esp Tetralogy of Fallot) Fibrosing mediastinitis Radiation PE Extrinsic mass

question

Assymetric pulmonary artery enlargement

answer

Pulmonary valve stenosis Pulmonary artery aneurysm

question

Pulmonary venous hypertension

answer

congenital narrowing of pulmonary veins RF ablation mediastinal fibrosis left atrial obstruction

question

Diminished pulmonary artery

answer

Hypoplasia Interruption of pulmonary artery Bronchilitis obliterans / Swyer James PE

question

Pulmonary pseudoaneurysms

answer

Swan-Ganz cath Infection TB: Rasmussen's aneurysm, syphilis, fungus, bacteria Congenital heart disease Atherosclerosis Cystic medial necrosis Marfan syndrome

question

Subclavian steal

answer

Atherosclerosis Takayasu's arteritis Congenital Postsurgical Trauma NF1 Radiation

question

Hyperreninemic hypertension

answer

Decreased renal perfusion (athero, FMD) Renin secreting tumors renal compression (intrarenal tumor, Page kidney - subcapsular hemorrhage)

question

Renal arterial aneurysm

answer

Main: FMD athero NF mycotic trauma congenital Distal: PAN IVDA (septic) vasculitides (wegeners, collagen vascular) traumatic radiation tx amphetamine abuse (speed kidney)

question

Soft tissue density around aorta

answer

Hematoma Rupture / penetrating ulcer aortitis mycotic blowout angiosarcoma

Vascular Interventional Radiology – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards