1. Potential aortic abnormalities
    • •Trauma (Penetrating, blunt with transection, flap tear, hematoma)
    • •Vasculitis (Takaysu's, infection, Giant cell arteritis)
    • •Aneurysm (Atherosclerotic, infection-syphillis-higher up, CVD-Marfan's-base of aorta)
    • •Dissection (Ehlers-Danlos, ASVD)
  2. Most common places to get traumatic aortic injuries
    • 1. Isthmus - arch just past left subclavian takeoff
    • 2. Hiatus - desc aorta as it goes through the diaphragm
    • 3. Ascending aorta
  3. DDx: Thickening of the aorta
    • Vasculitis - TIGeR is the main
    • Takayasu’s arteritis
    • Infection
    • Giant cell (temporal) arteritis
    • Radiation
    • Beçhet’s disease
    • Connective tissue disorders
    • -Rheumatoid arthritis
    • -Ankylosing spondylitis
    • -Reiter’s syndrome
    • -Psoriatic arthritis
  4. Sinotubular aneurysm of the aorta
    Marfan's Syndrome
  5. Infections of the aorta
    • Syphillis = eggshell calcs, ascending aorta not affecting sinotubular portion like Marfan's
    • Salmonella = mycotic
  6. Treatment for aortic dissection
    • Ascending - surgery
    • Descending - medical usually, but occ stent grafting
  7. Potential pulmonary artery problems
    • •Embolism - Tx prefered medical and IVC filter/ sometimes need catheter-direct thrombolysis if hemo unstable
    • •Arteriovenous malformation - Tx coil - Assoc. with OWR/HHT - can result in abscess
    • •Aneurysm - TB, Iatrogenic, Behcet's
    • •Stenosis
  8. Indication for bronchial artery embolization
    • -CF
    • -Lung Cancer
    • -TB

    Rarely acutally see a bleeding site
  9. During bronchial artery embolization you see a fine hairpin turn vessel
    Anterior spinal artery - injecting particles if this is seen can cause paralysis
  10. Endoleak types
    Image Upload 2
  11. Management for type II endoleak
    • Surveilance
    • 75% will resolve on their own
    • If not, then need embolized
  12. 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
  13. If you see a AAA repair graft, a leak and the kidneys in the same image?
    Most likely a type I endoleak
  14. Odd saccular aneurysm at aortic bifurcation to iliacs is what until proven otherwise?

    • DDx:
    • –Inflammatory
    • –Chronic pseudoaneurysm
    • –Radiation therapy
    • –Surgical
  15. Indications for stent placement
    • A.Greater than 30% residual stenosis after angioplasty
    • B.Flow limiting dissection flap
    • C.Residual pressure gradient > 5 mm
    • D.Eccentric lesion
    • E.Calcified lesion
  16. 58 yo male with impotence and bilateral hip and thigh claudication, impotence.
    Abd aortagram shows abrupt cutoff of infrarenal aorta with extensive collaterals.
    • Leriche’s syndrome
    • Tx - surgical bypass
  17. Treatment of a pseudoaneurysm of the common iliac?
    Covered stent angioplasty
  18. Treatment of pelvic fx bleed
    • Coil
    • Particles may kill
  19. Do not embolize intracavitary fibroid over what diameter?
  20. One thing that can lead to failure of UAE
    Collateral supply from the ovarian artery
  21. Marginal artery of Drummond seen?
    Either SMA or IMA is occluded and MAD is the collateral pathway
  22. Opacified vessel seen in anterior abdomen?
    Recanalized umbilical vein due to portal HTN
  23. Small or nonvisible splenic vein with gastric wall varices
    SVT/occlusion from pancreatic process (i.e. cancer or pancreatitis)
  24. Treatment for bleeding diverticulum
    microcatheter embolization
  25. 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
  26. Tx for pseudoaneurysm of splenic or intraabdominal vessel
  27. Diffuse small nodular aneurysms usually in kidneys, but can involve liver and other
    polyarteritis nodosum
  28. corkscrew small artery extending beyond normal SMA blood supply
    Meckel's diverticulum
  29. GI bleed with history of AAA repair
    Think of aortoenteric fistula
  30. Where should you coil for GI bleed?
    Proximal AND distal to the bleed
  31. Treatment for young post-partum female with NOMI of SMA distribution
    Papavarine infusion into SMA
  32. 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.
  33. 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
  34. Tx of choice for splenic artery aneurysm
    • Coil into aneurysm
    • Trap the aneurysm

    Only trap a pseudoaneurysm
  35. Potential abn if splenic artery seen

    • Trauma
    • Hypersplenism
    • Aneurysm
    • Tumor
  36. Treatment for hepatoma (HCC)
    Particles or particles and cytotoxic agent into the target vascular bed
  37. Things to do prior to embolization of liver lesion
    • Ensure portal vein is patent
    • Avoid cystic artery
    • Avoid gastroduodenal artery
    • Analagesia
    • Antiobiotics
  38. Indications for transjugular biopsy status post liver transplant

    • -rejection
    • –Obesity
    • –Ascites
    • –Coagulopathy
    • –Hepatic venous pressures
  39. Which directions to do transjugular biopsy for liver with which vessel?

    • Right HV Anterior
    • Middle HV Posterior
  40. "Aunt minnie" spider vessels related to occlusion of hepatic vein seen on angiogram
  41. Indications for TIPS
    • Refractory ascites
    • Bleeding varices
    • Hepatorenal syndrome
    • Cirrhotic hydrothorax
    • Budd chiari
  42. Contraindications for TIPS
    • Severe Hepatic Failure
    • Right Heart Failure
    • Encephalopathy
    • Portal Vein Thrombosis
    • Hepatic Neoplasm
    • Polycystic Liver
  43. Goal for TIPS procedure
    Get the PV-RA pressure gradient above 4mm Hg and less than 12mm Hg
  44. Interventional management of a pancreatic psuedocyst
    • Should resolve spontaneously
    • Only drained if very large or symptomatic
  45. Common ablative therapies
    • •Heat: RF, microwave, laser
    • –Hepatic tumors
    • –Osteoidosteoma
    • •Cold: Cryoablation
    • –Enhancing renal tumors
  46. 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)
Card Set
Interventional radiology differentials and pearls for the oral radiology boards