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90 Cards in this Set

  • Front
  • Back
What are the findings of a thoracic aortic aneurysm or rupture on plain film
displacement of NGT or trachea
depression of the left main stem bronchus
apical cap
indirect signs such as fx
Is an intimal flaps seen sometimes in pseudoaneurysms
no
Where is the catheter from when performing an aortic angiogram
right subclavian artery
What are the angiographic findings of a traumatic pseudoaneursym
indistinct borders
delayed wash out of contrast
intimal tear
What is the differential diagnosis of a traumatic pseudoaneuryms
ductus diverticulum
What does a ductus diverticulum look like
a smooth anteromedial outpouching
Where do pseudoaneurysms most commonly occur
at the aortic isthmus (distal to the left subclavian)
Why do pseudoaneurysms occur at the aortic isthmus
the ascending aorta is fixed and decelerates more rapidly that the descending aorta
What are the 2 options for treatment of surgical and endovascular repair of traumatic aortic injury
surgical repair
endovascular repair
What is the ddx of a aortic aneurysm
post-traumatic
atherosclerotic
mycotic
congenital
syphylittic
idiopathic
Do thoracic aortic aneurysms have a higher rate of rupture than an abdominal aortic aneurysm
yes
What tends to happen to the true lumen in a dissection
they tend to become compressed by the false lumen
Is there usually delayed filling of the false lumen
yes
What is the debakey classification of thoracic aortic aneurysms
-1=ascend and descend
-2=ascending only
-3=descending only
What is the Stanford classificaion
A=Ascending involved
B=Ascending not involved
What is the main option if a dissection involves the ascending aorta
surgery
What is the treatment of a descending aortic dissection
medical treatment
If there is involvement of branch vessels what is the treatment
surgery
When is the best time to look for a graft leak
delayed images
What type of endoleak is the result of retrograde filling
type 2
What is the treatment of a type 2 endoleak
to coil the branch vessel
What is the treatment of an acute SMA embolus
operative embolectomy
What are 2 causes of acute visceral ischemia
embolic
thrombotic (hypercoaguable)
What are the causes of chronic visceral ischemia
4
stenosis at orgin of celiac or SMA
atherosclerosis
median arcuate ligament syndrome
FMD
vessels of the internal iliac artery
Where are the middle colic , right colic arteries and ileocolic artery
middle colic -6
right colic- 4
ileocolic- 10
Where is the marginal artery
#9
What is the marginal artery
also known as the marginal artery of Drummond and artery of Drummond (named after Sir David Drummond (1852-1932) an English physician),[1] is a blood vessel that anastomoses (connects) the inferior mesenteric artery (IMA) with the superior mesenteric artery (SMA). It is sometimes absent, as an anatomical variant.
Where are the left colic, and hemorrhoidal arteries
Is it important to obtain a lateral when viewing the abdominal aorta
yes, it makes it easier to see the celiac, sma and ima
What vessel is involved in collateralization of the abdomen in chronic mesenteric ischemia
the marginal arteries run between the ima and sma
What is the collateral vessels of the celiac and sma
pancreatico doudenal arteries
What are the arteries of the celiac axis
Where are the pancreaticodoudenal arteries located
Can vessels from the internal iliac vessel sometimes feed the IMA via retrograde flow
yes
Can FMD go into the branch vessels of the renal arteries
yes
What percent of renovascular htn are caused by FMD
only 1/3rd
What percent of FMD are bilateral
2/3rds
What is the more common side if FMD is unilateral
the right side
What are the 3 types of fibrodysplasia
medial fibrodysplasia (85%)
perimedial fibroplasia (10%)
intimal fibroplasia (5%)
What is the tx of fmd
balloon angioplasty
What type fibrodysplasia causses web like stenosis
intimal fibroplasia
what is the ddx of web-like stenosis of the renal artery in a young person
intimal fibroplasia
connective tissue disease
vasculitis
dissection mimmicking an aneurysm
What is typically seen distal to the web-like stenosis in a pt with intimal fibrodysplasia
post stenotic dilation
What is the treatment for a GI bleed
microcatherization
coil embolization
What is the treatment of bilateral renal artery stenosis
bilateral renal stents
What percent of pts improve there htn with stents in renal artery stenosis
>60%
What are the arteries of the leg
NOTE COMMON FEMORAL IS FROM THE EXTERNAL ILIAC
What is thoracic outlet syndrome
compression of brachial plexus, subclavian artery, or subclavian veins by bones or muscles of the thoracic outlet (scalene, pectoralis, clavicle, first rib)
What are the SS of thoracic outlet syndrome
unilateral upper extremity pain, swelling or ischema
What are 2 complications of thoracic outlet syndrome
post-stenotic aneurysm or distal emboli
What is the anatomy of TOS
What is the treatment of arterial TOS
surgical decompression by first rib resection
What is another name for venous thoracic outlet obstruction
paget schroetter syndrome
What is seen in paget schroetter syndrome
extensive venous collateralization
What is the treament of venous TOS
angioplasty, thombolysis, 1st rib resection
What is subclavian steal syndrome
Retrograde vetebral artery flow with transient neurologic symptoms related to cerebral ischemia
What are the findings in late angiographic images
reconsititution of flow in the left subclavian secondary to flow from the vetebral artery
What is the treatment for subclavian steal
angioplasty Vs stent (controversial)

complete occlusion is treated with bypass
What is the anatomy of portosystemic shunts
Where do paraesophageal varices come frome
Where are sappeys veins
Does the umbilical vein get canulated via the left portal vein
yes
What feeds the esophageal varices
What are the 2 shunts off the left renal vein
What is the coronary vein also known as
the left gastric vein
What is the clinical triad of budd-chiari syndrome
RUQ pain
ascites
hepatomegaly
What are the findings of budd chiari syndrome
hepatic outflow obstruction (spider web appearance of collateral vessels)
What is a secondary finding of cudd chiari
spider web appearance of intrahepatic collaterals
How is budd chiari tx
pta or stent
Is budd chiari an indication for TIPS
yes
What is may thurner syndrome
left iliac vein stenosis (due to crossing of right iliac artery)
What is the treatment for May Thurner Syndrome
thrombolysis and then stenting
What is the criteria for eligibility of liver transplant
. To be eligible for a transplant, a patient must have fewer than four tumors, with no single tumor greater than three centimeters in diameter, and must have had no cancer outside the liver in the last six years.
What are the factors associated with poor prognosis of survival with liver cancer
Factors associated with poor prognosis for overall patient survival include Child-Pugh class B or C, tumor size ≥4 cm, 5 or more tumors, portal vein invasion, and an alpha fetoprotein (AFP) level >83 ng/mL
Is portal vein thrombosis a relative contraindication to chemoembolization
yes
Does chemoembolization and radiofrequency ablation increase the life expectancy in pts with liver cancer
yes, up to 3 times longer
When should radiofrequency ablation be used
should be used in patients with early-stage HCC with up to 3 lesions with a tumor diameter of ≤ 3 cm and for patients with nonresectable liver metastasi
When is a follow up scan of chemoembolization obtained
10-14 days after the procedure
When is polyvinyl alcohol embolization commonly used
carcinoid syndrome
How and why is a preprocedure angiogram performed prior to chemoembolization
Angiography is usually performed by placing a 5F to 6F catheter through a sheath via the right or left femoral artery. The catheter should be able to accept the insertion of a 3F coaxial microcatheter. A celiac-axis and superior mesenteric angiogram is first obtained to identify common variations in the blood supply to the liver and to check for patency of the portal vein.
Why is the chemotherapy used in chemoembolization so effective
there are very high levels of chemo
What are the 2 parts of chemoembolization
chemo
embolization
How are the candidates for chemoembolization
pt with primary or metastatic liver tumors that are not resectable (to prolong life)
Pt on transplant list who need to have a tumor reduced in size
What is the most common type of metastatic liver tumor treated with chemoembolization
carcinoid
What are the side effects of chemoembolization
pain
fatigue
decreased appetite
fever
bleeding
infection
hairloss
bonemarrow suppression
What are the 2 common agents used for chemoembolization
cisplatin
doxorubicin
What is the embolic agent
iodiodal
Are patients typically admitted overnight following chemoembolization
yes