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IR Flashcards

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0
Q

Contraindications to TIPS?

A

Encephalopathy

Polycystic liver disease

Right heart failure

MELD >17 is a relative contraindication

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1
Q

Indications for TIPS?

A
  • Prevent/treat variceal bleeding
  • Hepatic hydrothorax
  • Refractory ascites
  • Budd chiari
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2
Q

How are isolated gastric varices treated?

A

Balloon occlusion retrograde transvenous obliteration (BRTO)- sclerosing agent in placed in the draining vein

Indications- bleeding or at risk isolated gastric varices, encephalotpathy that would not tolerate TIPS

Contraindications- at risk esophageal varices, thrombosed portal vein and refractory ascites

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3
Q

What can be given to patient’s with hemophilia to increase factor VIII or vWF?

A

Desmopressin

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4
Q

Indication for embolization of pulmonary AVM?

A

Feeding vessel is > 3 mm

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5
Q

How much thrombin is injected into pseudoaneurysm?

A

1000 units of thrombin/1 cc of NS- inject 100 units at a time

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6
Q

Contraindications to finbrinolysis/thrombolysis?

A

Pregnancy

Recent neurosurgery

GI bleed

At risk limb- goes to surgery

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7
Q

What is rate of TPA for thrombolysis?

What lab is checked?

A

1 mg/hr

Fibrinogen - should remain above 150

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8
Q

Air embolus treatment?

A

Trendelenburg and LL decubitus

Hyperbaric O2

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9
Q

What size should splenic artery aneurysms be treated?

A

2 cm

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10
Q

What are anterior branches of internal iliac artery?

What is potential side effect of embolization?

What are branches of posterior division?

A

(1) Obturator, (2) Uterine, (3) Vesicle arteries (superior & inferior), (4)
Inferior gluteal – terminal branch which supplies the sciatic nerve., (5) Internal pudendal, (6) Vaginal

Impotence

1) Lateral sacral, (2) Iliolumbar, (3) Superior gluteal

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11
Q

What is most common type of FMD?

A

medial fibroplasia

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12
Q

What type of IVC filter is placed in pregnancy?

A

Suprarenal

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13
Q

Most common dialysis AV fistula?

A

Radiocephalic (brachiocephalic or brachiobasilic are next most common)

Most common issue is stenosis of the outflow vein

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14
Q

Arc of Buhler?

A

Collateral flow from Celiac to SMA

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15
Q

What is persistent sciatic?

A

Continuation of internal iliac to lower extremity (hypoplastic SFA and CFA)

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16
Q

Popliteal artery entrapment caused by?

Illicit by?

A

Gastrocnemius muscle- medial deviation of popliteal artery

Plantar flexion

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17
Q

How are bronchial arteries embolized?

A

Gelfoam or particles (no coils because of high rate of rebleed- will need treatment)

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18
Q

Treatment of Paget Schrotter?

A

Catheter guided thrombolysis (5000 units heparin) and then heparin drip infusion 0.5 mg/hr

Stent likely to get occluded

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19
Q

Subclavian Steal Criteria?

A

Stenosis of 50%

Graadient of 10-15%

Velocity Flow differential

TX- balloon expandable stent

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20
Q

Which vasculitis is associated with pulmonary artery aneurysms?

A

Bechets

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21
Q

Contraindications to pulmonary angiography?

A

LBBB- can induce RBB with procedure leading to complete heart block

Severe pulmonary artery hypertension

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22
Q

When in the respiratory cycle does celiac artery compression occur?

A

End-expiration

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23
Q

How are GI bleeds treated?

A

Gelfoam or Coil

Can use vasopression on small arteries- can cause hyponatremia

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24
What are the Milan criteria for transplant?
1 lesion of 5 cm 3 lesions of 3 cm
25
What are steps before and after Y-90?
Embolize GDA Administer MAA from hepatic artery to look of shunt of 20% or more After embolization- Bremsstrahlung scan to make sure radiation was delivered
26
How is corrected portal pressure measured with TIPS?
Portal pressure = Hepatic Wedge - IVC
27
Indications for TIPS?
- refractory bleeding - Budd-Chiari - Ascites, Hepatic hydrothorax
28
Contraindications to TIPS?
Severe liver failure (MELD >18- bilirubin, creatinine) encephalopathy Right heart failure Polycystic liver disease Portal vein thrombus Hepatitis
29
How should a patient with pheochromocytoma be treated prior to adrenal vein sampling?
Phenoxybenzamine for 3 days prior to surgery Phentolamine can be given during procedure
30
Where should percutaneous nephrostomy be placed?
Posterior lower pole calyx
31
How should AVM or hemangiomas be treated?
glue or alcohol ablation
32
What are the lower extremity arteries from lateral to medial?
Anterior tibial, peroneal, posterior tibial
33
Ankle Brachial Index?
ABI >1 is normal ABI- 0.5-0.9- pain with exercise ABI <0.4 rest pain
34
Where should Percutaneous Transhepatic Catheter be placed?
Below 10th rib, mid-axillary line
35
What are the TIPS gradients for bleeding and ascites?
Bleeding- 12 mmHg Ascites- 8 mm Hg
36
Contraindications to vaasopressin?
coronary artery and cerebrovascular disease, arrythmia, hypertension
37
DDX for small aorta?
Williams syndrome, Takayasu arteritis, giant cell arteritis, dissection, neurofibromatosis
38
Most common source of pelvic bleed after trauma?
superior gluteal and internal pudendal
39
What is massive hemoptysis?
Massive hemoptysis: > 500 mL over 24 h
40
How are bronchial arteries embolized?
Particle embolization – For pulmonary artery aneurysm or pseudoaneurysm, use coils
41
Most common cardiac abnormality associated with coarctation?
bicuspid aortic valve
42
What should be preformed after treating upper GI bleed? Most common cause of GI bleed on celiac angiogram?
Remember to do SMA A-gram afterward to check for collaterals from inferior pancreaticoduodenal Ulcer
43
Indications for suprarenal filter?
renal vein thrombosis, recurrent PE despite infrarenal filter placement (exclude upper extremity, SVC thrombus), PE after ovarian vein thrombosis, pregnancy
44
What maneuver increases popliteal artery entrapment?
Plantar flexion Typically compressed by medial head of gastrocnemius DDX: cystic adventitial disease (smooth external compression of pop.)
45
When is atherosclerotic disease in lower extremities treated percutaneously?
< 10 cm but > 3 cm, not involving SFA origin or distal popliteal, can thrombolyse and then balloon <3- balloon angioplasty only >10- surgery
46
If drainage from pseudocyst persists?
Persistence despite drainage for > 4 w = persistent pancreatic fistula – Can give octreotide 100 ug SC TID
47
When should drain be pulled?
Ouput <10 mL, improvement in symptoms, afebrile/decreased WBC
48
Blood supply of adrenal gland?
-Superior adrenal artery from inferior phrenic artery – Middle adrenal artery from suprarenal aorta – Inferior adrenal artery from proximal renal artery
49
Initial treatment for femoral artery pseudoaneurysm?
- ultrasound compression - thrombin injection (95% success): 0.1 to 1 cc of 1,000 U bovine thrombin mixed in 1 cc of sterile normal saline solution
50
What critical steps are taken in treatment of renal artery stenosis?
- ASA 325 mg and 10 mg nifedipine before procedure - Balloon diameter chosen by measuring normal part of the renal artery, usually 5 or 6 mm – Before angioplasty, 100 ug NTG intra-arterial, 5,000 U heparin IV
51
Submucosal fibroids present risk of _____ with UAE?
Delayed infection Expected UAE results:Reduction of 20-40% in size of fibroids and uterus typically seen at 3 months
52
Gastrostomy contraindications?
Contraindications: uncorrectable bleeding diathesis, lack of safe access window into stomach, massive ascites, anterior gastric wall neoplasm, presence of VP shunt
53
What should occur before remove of cholecystostomy tube?
-Before removal, tube cholangiogram performed to ensure that cystic duct and CBD are patent – Catheter should not be removed if retained stones are demonstrated within gallbladder
54
Indications for vertebroplasty?
– Acute (high T2/STIR) painful osteoporotic compression fractures – Painful vertebral body osteolytic mets/myeloma – Symptomatic vertebral hemangioma
55
Injection rate for carotid artery?
6 cc/s Thoracic and Abdominal Aorta, pulmonary arteries- 20 CC/sec Celiac-SMA 5 cc/s Renal- 4 cc/sec
56
What are common vasodilators and their doses?
Nitroglycerin: 100 ug doses Papaverine: 30-60 mg/h IA
57
Dose of vasopressin for vasoconstriction?
Vasopressin: 0.1-0.4 U/min
58
Doses for antagonists (opioid and benzo)?
-Naloxone (opioid antagonist): 1 mg IV – Flumazenil (benzodiazepine antagonist): 0.2 mg IV
59
How long is common anticoagulation stopped?
– Antiplatelet agents (ASA, Plavix): 5-7 d – Lovenox: 12-24 h – Heparin: < 6 h – Coumadin: 7 d
60
What does protamine reverse?
Protamine: 50 mg slow IV push dose will reverse common intraprocedural doses of heparin (3,000-5,000 IU)
61
Contraindications to thrombolysis?
Absolute: active internal bleeding, irreversible limb ischemia, recent stroke, brain tumor, left heart thrombus Relative: h/o GI bleeding, major surgery within 10 d, diabetic hemorrhagic retinopathy, coagulopathy, embolus of cardiac source
62
What is given during adrenal vein sampling?
Cosyntropin (synthetic ACTH) stimulates cortisol production to assure catheter is in right place
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