Card Set Information
IR interventional radiology imaging
Interventional radiology differentials and pearls for the oral radiology boards
Potential aortic abnormalities
(Penetrating, blunt with transection, flap tear, hematoma)
(Takaysu's, infection, Giant cell arteritis)
(Atherosclerotic, infection-syphillis-higher up, CVD-Marfan's-base of aorta)
Most common places to get traumatic aortic injuries
- arch just past left subclavian takeoff
- desc aorta as it goes through the diaphragm
3. Ascending aorta
DDx: Thickening of the aorta
Vasculitis - TIGeR is the main
iant cell (temporal) arteritis
Connective tissue disorders
Sinotubular aneurysm of the aorta
Infections of the aorta
= eggshell calcs, ascending aorta not affecting sinotubular portion like Marfan's
Treatment for aortic dissection
- medical usually, but occ stent grafting
Potential pulmonary artery problems
- Tx prefered medical and IVC filter/ sometimes need catheter-direct thrombolysis if hemo unstable
- Tx coil - Assoc. with OWR/HHT - can result in abscess
TB, Iatrogenic, Behcet's
Indication for bronchial artery embolization
Rarely acutally see a bleeding site
During bronchial artery embolization you see a fine hairpin turn vessel
Anterior spinal artery - injecting particles if this is seen can cause paralysis
Management for type II endoleak
75% will resolve on their own
If not, then need embolized
Management of type I, III or IV endoleak
Cannot use surveilance,
Either reline the graft or open surgical repair
I and III are high pressure and need urgent repair
If you see a AAA repair graft, a leak and the kidneys in the same image?
Most likely a type I endoleak
Odd saccular aneurysm at aortic bifurcation to iliacs is what until proven otherwise?
Indications for stent placement
A.Greater than 30% residual stenosis after angioplasty
B.Flow limiting dissection flap
C.Residual pressure gradient > 5 mm
58 yo male with impotence and bilateral hip and thigh claudication, impotence.
Abd aortagram shows abrupt cutoff of infrarenal aorta with extensive collaterals.
Tx - surgical bypass
Treatment of a pseudoaneurysm of the common iliac?
Covered stent angioplasty
Treatment of pelvic fx bleed
Particles may kill
Do not embolize intracavitary fibroid over what diameter?
One thing that can lead to failure of UAE
Collateral supply from the ovarian artery
Marginal artery of Drummond seen?
Either SMA or IMA is occluded and MAD is the collateral pathway
Opacified vessel seen in anterior abdomen?
Recanalized umbilical vein due to portal HTN
Small or nonvisible splenic vein with gastric wall varices
SVT/occlusion from pancreatic process (i.e. cancer or pancreatitis)
Treatment for bleeding diverticulum
If GI bleed is present and angiodysplasia is seen in the IMA territory, what must also be assessed?
Celic and SMA must also be assessed for involvement
Tx for pseudoaneurysm of splenic or intraabdominal vessel
Diffuse small nodular aneurysms usually in kidneys, but can involve liver and other
corkscrew small artery extending beyond normal SMA blood supply
GI bleed with history of AAA repair
Think of aortoenteric fistula
Where should you coil for GI bleed?
Proximal AND distal to the bleed
Treatment for young post-partum female with NOMI of SMA distribution
Papavarine infusion into SMA
Treatment of splenic vessel bleed
+Acute setting with diffuse injury.–Proximal Occlusion (main splenic artery emb.)
•Acute setting with focal extravasation.–Target Occlusion.
•Delayed setting with focal abnormality.–Target Occlusion.
Treatment for hypersplenism with tortuosity of the splenic vessels
Particle embolization placing catheter distal to dorsal pancreatic artery and pancreatic magna arteries to avoid non-target embolization
50% reduction in flow is goal
Potentional complication later = infection with encapsulated organsims
Tx of choice for splenic artery aneurysm
Coil into aneurysm
Trap the aneurysm
Only trap a pseudoaneurysm
Potential abn if splenic artery seen
Treatment for hepatoma (HCC)
Particles or particles and cytotoxic agent into the target vascular bed
Things to do prior to embolization of liver lesion
Ensure portal vein is patent
Avoid cystic artery
Avoid gastroduodenal artery
Indications for transjugular biopsy status post liver transplant
–Hepatic venous pressures
Which directions to do transjugular biopsy for liver with which vessel?
Right HV Anterior
Middle HV Posterior
"Aunt minnie" spider vessels related to occlusion of hepatic vein seen on angiogram
Indications for TIPS
Contraindications for TIPS
Severe Hepatic Failure
Right Heart Failure
Portal Vein Thrombosis
Goal for TIPS procedure
Get the PV-RA pressure gradient above 4mm Hg and less than 12mm Hg
Interventional management of a pancreatic psuedocyst
Should resolve spontaneously
Only drained if very large or symptomatic
Common ablative therapies
: RF, microwave, laser
–Enhancing renal tumors
Where to target for percutaneous nephrostomy?
Lower pole posterior calyx (less chance of bleeding or PTX)
Ideally at “Brodel’s bloodless line” (junction between medial 1/3 and lateral 2/3)