Vascular Interventional Radiology
Angiographic drugs - ANS-
\Angiography complications - ANS-1. Puncture site complications - groin hematoma, AVF,
pseudoaneurysm, vessel thrombosis, neuritis, infection
2. Contrast reaction - anaphylaxis, renal failure, cardiac failure, phlebitis
3. Catheter related complications -dissection, cholesterol emboli, thromboembolism,
cerebrovascular accident, arterial dissection
4. Therapy related complications (CNS bleed during thrombolysis)
\Aortic stenosis - ANS-Congential:
Coarctation
Pseudocoarctation
Williams syndrome
Rubella syndrome
Takayasu's (most common arteritis to cause stenosis)
NF
Radiation
\Arc of Buehler - ANS-Embryonic ventral communication of celiac artery to SMA
\Arc of Riolan; Marginal artery of Drummond - ANS-SMA - IMA connection
\Arm veins - ANS-
\Arterial embolism - ANS-Clinical 5 Ps: pain, pallor, pulselessness, paresthesias, paralysis
Multiple lesions at bifurcations. Lack of collaterals. Severe vasospasm. Menisci filling
defects.
Treatment: Surgical embolectomy (*** must differentiate from in situ thrombosis due to
different therapy)
Etiology:
Cardiac - mural thrombus, Ventricular aneurysm, MI, Afib
Aneurysm
Iatrogenic
Paradoxical embolus (DVT and L --> R shunt)
\Assymetric pulmonary artery enlargement - ANS-Pulmonary valve stenosis
Pulmonary artery aneurysm
\AV fistula types - ANS-Brescia - Cimino fistula - side to side anastomosis of radial artery and
cephalic vein at the wrist
Brachial artery and cephalic vein
Brachial artery and basilic vein
Femoral artery and saphenous vein
\axillary artery anatomy - ANS-
\Axillary artery approach - ANS-Preferred - easier to access descending aorta
-left side approach crosses fewer CNS arteries (when going down aorta
-3J wire preferred
Disadvantages:
, -difficult to compress
- high incidence of complications
-brachial plexus injury
\Buerger's disease - ANS-Pan arteritis of unknown etiology
thromboangiitis obliterans
venous involvement in 25%
Nearly all are smokers, 98% male
-Calf and foot vessels most common
-ulnar and radial arteries
-palmar and digital arteries
Abrupt segmental arterial occlusions
intervening normal appearing arteries
corkscrew collaterals
sparing of larger inflow arteries
\Causes of thoracic aortic aneurysm - ANS-Atherosclerosis (most common)
Connective tissue disease (Marfans, Ehlers Danlos)
Syphillis
Post traumatic pseudoaneurysm
Mycotic
Aortitis (Takayasus Giant Cell, Rheumatoid arthritis, Ank Spond)
\Celiac axis vessels - ANS-
\Cholesterol emboli - ANS-Microemboli to ischemic digits
Livedo reticularis
Blue toe syndrome
\Collateral pathways around occluded distal aorta - ANS-
\Collaterals in occlusive iliac disease - ANS-Internal mammary --> inferior epigastric --> CFA
Lumbar / iliolumbar --> circumflex iliac --> CFA
Lumbar / illiolumbar --> lateral circumflex --> PFA
Gluteal / Obturator --> lateral and medial circumflex --> PFA
Geniculate branches
\Complications of central venous catheter placement - ANS-Pneumothorax
Arterial puncture
Hemorrhage
Occlusion
Mechanical problems
Air embolism
\Complications of embolization - ANS-Post embolization syndrome (fever, inc WBC) 40%
Infection of embolized area
Reflux of embolic material (nontarget embolization)
Alcohol infarction in the periphery
\Contraindications to PA cath - ANS-No absolute, all relative
Severe pulmonary HTn
LBBB (catheter irritant may induce RBBB --> complete heart block) --> place transvenous
pacer
CHF
\Contraindications to TIPS - ANS-Absolute
Severe right sided heart failure with elevated CVP
Angiographic drugs - ANS-
\Angiography complications - ANS-1. Puncture site complications - groin hematoma, AVF,
pseudoaneurysm, vessel thrombosis, neuritis, infection
2. Contrast reaction - anaphylaxis, renal failure, cardiac failure, phlebitis
3. Catheter related complications -dissection, cholesterol emboli, thromboembolism,
cerebrovascular accident, arterial dissection
4. Therapy related complications (CNS bleed during thrombolysis)
\Aortic stenosis - ANS-Congential:
Coarctation
Pseudocoarctation
Williams syndrome
Rubella syndrome
Takayasu's (most common arteritis to cause stenosis)
NF
Radiation
\Arc of Buehler - ANS-Embryonic ventral communication of celiac artery to SMA
\Arc of Riolan; Marginal artery of Drummond - ANS-SMA - IMA connection
\Arm veins - ANS-
\Arterial embolism - ANS-Clinical 5 Ps: pain, pallor, pulselessness, paresthesias, paralysis
Multiple lesions at bifurcations. Lack of collaterals. Severe vasospasm. Menisci filling
defects.
Treatment: Surgical embolectomy (*** must differentiate from in situ thrombosis due to
different therapy)
Etiology:
Cardiac - mural thrombus, Ventricular aneurysm, MI, Afib
Aneurysm
Iatrogenic
Paradoxical embolus (DVT and L --> R shunt)
\Assymetric pulmonary artery enlargement - ANS-Pulmonary valve stenosis
Pulmonary artery aneurysm
\AV fistula types - ANS-Brescia - Cimino fistula - side to side anastomosis of radial artery and
cephalic vein at the wrist
Brachial artery and cephalic vein
Brachial artery and basilic vein
Femoral artery and saphenous vein
\axillary artery anatomy - ANS-
\Axillary artery approach - ANS-Preferred - easier to access descending aorta
-left side approach crosses fewer CNS arteries (when going down aorta
-3J wire preferred
Disadvantages:
, -difficult to compress
- high incidence of complications
-brachial plexus injury
\Buerger's disease - ANS-Pan arteritis of unknown etiology
thromboangiitis obliterans
venous involvement in 25%
Nearly all are smokers, 98% male
-Calf and foot vessels most common
-ulnar and radial arteries
-palmar and digital arteries
Abrupt segmental arterial occlusions
intervening normal appearing arteries
corkscrew collaterals
sparing of larger inflow arteries
\Causes of thoracic aortic aneurysm - ANS-Atherosclerosis (most common)
Connective tissue disease (Marfans, Ehlers Danlos)
Syphillis
Post traumatic pseudoaneurysm
Mycotic
Aortitis (Takayasus Giant Cell, Rheumatoid arthritis, Ank Spond)
\Celiac axis vessels - ANS-
\Cholesterol emboli - ANS-Microemboli to ischemic digits
Livedo reticularis
Blue toe syndrome
\Collateral pathways around occluded distal aorta - ANS-
\Collaterals in occlusive iliac disease - ANS-Internal mammary --> inferior epigastric --> CFA
Lumbar / iliolumbar --> circumflex iliac --> CFA
Lumbar / illiolumbar --> lateral circumflex --> PFA
Gluteal / Obturator --> lateral and medial circumflex --> PFA
Geniculate branches
\Complications of central venous catheter placement - ANS-Pneumothorax
Arterial puncture
Hemorrhage
Occlusion
Mechanical problems
Air embolism
\Complications of embolization - ANS-Post embolization syndrome (fever, inc WBC) 40%
Infection of embolized area
Reflux of embolic material (nontarget embolization)
Alcohol infarction in the periphery
\Contraindications to PA cath - ANS-No absolute, all relative
Severe pulmonary HTn
LBBB (catheter irritant may induce RBBB --> complete heart block) --> place transvenous
pacer
CHF
\Contraindications to TIPS - ANS-Absolute
Severe right sided heart failure with elevated CVP
