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13 Cards in this Set

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1. Uterine artery is a branch of what major vessel?
2. What anatomic arterial variants can contribute to failure of uterine fibroid embolization?
3. What is the most common reason for UFE failure?
1. Uterine artery is a branch of the anterior division of the internal iliac artery.
2. Aberrant uterine arterial anatomy and ovarian arterial supply to the fibroids.
3. The most common reason is when arterial spasm related slow flow in the uterine artery deceives the angiographer into believing that successful embolization has been achieved.
How is MRI helpful in the pre-embolization work-up of uterine fibroid embolization?
1. MRI can help distinguish between fibroids and adenomyosis as cause of uterine enlargement.
2 Accurate, reproducible measurements of uterine fibroids can be made.
3. Accurately classify fibroids as being submucosal, intramural, subserosal, and/or pedunculated.
4. Assess for variant arterial anatomy.
What MRI features are associated with better response to UFE?
Features associated with better treatment response:
- Submucosal fibroid location
- Small fibroid size
- Low T1 SI
- Hypervascularity

NOTE: a high T1 SI of the fibroid is associated with lesser volume reduction after UFE.
1. What is DDX of microaneurysms affecting the visceral arteries?
2. What is polyarteritis nodosa?
1. Polyarteritis nodosa, other vasculitides such as SLE and Wegener's, and speed kidney (amphetamines).
2. Necrotizing vasculitis of small and medium sized vessels.
1.What are the vascular complications of percutaneous biopsy of a renal allograft?
2. What are the most common presenting sxs?
3. What are the doppler findings of AVF?
4. How are symptomatic AVF treated? Why is "back door" embolization not needed?
1. AVF and pseudoaneurysms.
2. Hematuria, HTN, renal insufficiency, and high output CHF.
3.
AVF: Arterial waveforms above and below the baseline, aliasing at the site of communiation, and relative shunting of blood flow away from the normal areas of the kidney transplant.
Pseudoaneurysm: ying-yang sign
4. Symptomatic AVF are treated with coil embolization. Because renal arteries are end-arteries, embolization of the artery at any point proximal to the fistula will result in occlusion. Unlike bowel embolization, it is not necessary to embolize proximal and distal to the point of communication between the artery and vein.
Pseudoaneurysms are treated with coil embolization and/or thrombin injection.
How do you determine the significance of renal artery stenosis in a patient with HTN?
1. Direct arterial pressure measurement across the stenosis to determine if a significant pressure gradient (>10mmHg) exists.
2. Captopril nuclear medicine study.
3. Selective renal vein renin sampling that lateralizes to a kidney with a visualized renal artery stenosis.
1. What is high flow priapism?
2. What normal finding can mimic a true arterial lacunar fistula?
3. How is this treated?
1. Post traumatic abnormality of the perineum and penis that results from lacteration of the cavernous artery (branch of the internal pudendal artery which supplies the penis) resulting in development of an arterial-lacunar fistula with direct, constant entry of arterial blood into the vascular lacuna of the erectile tissue.
2. There is normal minor arterial blush at the base of the corpora cavernosum which can mimic a true arterial-lacunar fistula.
3. Embolization of the distal internal pudendal artery.
1. What is a reason to do adenal vein sampling?
2. What ratio is used for this determination?
3. How are the results managed?
4. What is primary hyperaldosteronism called?
1. To localize an adrenal adenoma producing aldosterone and leading to HTN.
2. Aldosterone/cortisol ratio
3. If there is a unilateral source of excess aldosterone production, then surgery is recommended. If localization is not achieved, the patient may have bilateral adrenal hyperplasia and are treated medically.
4. Conn's sydrome
What is the arterial supply to the adrenal gland?
- Inferior adrenal artery derived from the ipsilateral renal artery.
- Middle adrenal artery derived from the aorta.
- Superior adrenal artery derived from the inferior phrenic artery.
1. What is the purpose of a Whitaker test?
2. What other tests can evaluate the significance of a ureteral stricture?
3. How do you do a Whitaker test?
1. Whitaker test is performed to assess functional significance of ureteral narrowing -- i.e. is it causing obstruction?
2. IVP and nuclear medicine scintigraphy.
3. To a perform a Whitaker test, catheterization of the bladder and needle placement in the renal pelvis is performed. Dilute contrast is injected and pressure difference between the renal pelvis and bladder is measured. If the pressure differential is > 22 cmH20, then obstruction. If < 15cm H2O, then no obstruction.
1. What is the indication for embolization of RCC?
2. What is the embolic agent of choice?
3. What is an expected complication?
1. Done pre-operatively to reduce blood loss or palliatively.
2. Alcohol is the embolic material of choice. Remember to inflate an occlusion balloon to prevent reflux.
3. Post-embolization syndrome occurs in all patients.
1. What is a complication of nephroureteral stent placement?
2. What are the imaging findings of this complication?
3. How is it treated?
1. Ureteral transection
2. Retroperitoneal extravasation of contrast.
3.
- Incomplete transection is treated with ureteral stent placement.
- Complete transection requires surgical intervention.
Indications for nephrostomy/ureterostomy insertion
1. external drainage for obstruction.
2. diversion for leak/fistula
3. tract creation for stone removal or dissolution