• Takayasu arteritis
• Infection
• Giant cell arteritis
• Radiation
• Bechet disease
• Connective tissue d/o (RA, AS, Reiters, psoriatic)

Hemoptysis

Pulmonary sequestration

Post lung transplantation

Interrupted pulmonary artery

Preop

In order to fix an AAA by endovascular repair, what are the suitable measurements for:

Infrarenal neck >___mm

AAA neck diameter <___mm

Iliac artery diameter >___mm

Infrarenal neck >15mm

AAA neck diameter <28mm

Iliac artery diameter >7mm

You've done an AAA endovascular repair. What are some predictors of early Type I endoleak?

Hint: has to do with morphology and anatomy.

1. Angulated aneurysm neck
2. Short aneurysm neck
3. Large neck diameter
4. Iliac artery aneurysm

CT, MRI, or US

1 month, 6 month, then annual surveillance.

Fix if >5cm or if increases by 0.5cm in 1 year.

You see a saccular aneurysm at a bifurcation point or other unusual site, or grows rapidly, or has soft tissue stranding on CT.

What's the diagnosis?

MYCOTIC ANEURYSM UNTIL PROVEN OTHERWISE

(to miss this Dx is a disaster)

DDx = inflammatory, chronic pseudoaneurysm, radiation

Due to graft porosity.

Treatment is open repair or re-lining of graft.

Graft defect or separation.

Must call MD. Surveillance is not an option.

Treatment is open repair or re-lining of graft.

Collateral feeders enlarging the aneurysm sac.

• Surveillance q6month (75% shrink and resolve)
• Trans-catheter embolization (IMA supply)
• Trans-lumbar embolization (lumbar supply)

Leakage around the proximal or distal attachment of the graft.

Must call MD.

Open repair or re-lining of graft.

True or false:

If a pt is not an operative candidate, it is ok to use coils to embolize a pseudoaneurysm in a large peripheral vessel such as the iliac artery.

FALSE. The preferred treatment is a stent graft.

True or false:

You should avoid embolizing a uterine fibroid if it is intracavitary, but submucosal fibroids are ok.

TRUE.

Increased complication of infection.

• Abx: Cefazolin 1gm IV
• Pain: Fentanyl PCA
• Anti-inflammatory: Toradol, ibuprofen
• Fever: Tylenol
• Nausea: Zofran

24 hour obs

Pt undergoes UAE but 2 months later the symptoms recur.

Why? Any causes of technical failure?

• Wrong artery embolized
• Ovarian arterial blood supply to fibroid
• Vasospasm, insufficient delivery of particles
• Clumping during delivery of particles

Splenic artery

Short gastric arteries

Any kind of ischemia

Bleeding due to pseudoaneurysms or AVMs

Dose: 0.2-0.4 units/min

Protocol: start at 0.2 u/min, re-angio at 20-30 min; increase to max dose until bleeding controlled, infuse and taper until 24 hours, can pull catheter after no bleeding for 6-12 hours.

Embolic agents:

Microcoils or gelfoam or large particles

Contraindications: unidentified bleeding source, ischemic bowel, inability to super-select bleeding artery.

Left gastric artery.

Gelfoam, large particles, or coils.

GDA or inferior pancreatico-duodenal trunk

Gelfoam, large particles, or coils.

For chronic bleeding with negative endoscopy, tagged RBC, and arteriograms.

Heparin IV 5000u (anticoagulant)

TPA IA (lytic)

NTG 100ug (vasodilator)

Wait 20 min

Perform arteriogram

Vasodilator. Could also use NTG or tolazoline but these have short half-lives.

Vasospasm

Non-occlusive mesenteric ischemia

>25% of spleen devascularized or segmental/hilar vessels involved is Grade IV.

Shattered spleen or pedicle injury is Grade V.

50-60% Grade IV or V need intervention due to immediate and delayed complication.

• Gelfoam or particle embolization of splenic artery.
• Antibiotics.

Must be distal to dorsal pancreatic branches (pancreatitis).

• Small PVA particles
• Cisplatin
• Doxirubicin
• Lipiodol

How long do you hold the following anti-coagulation meds before an interventional procedure?

1. Heparin
2. Lovenox
3. Coumadin
4. Aspirin
5. Plavix

1. Heparin - 4 hrs
2. Lovenox - 12 to 24 hrs
3. Coumadin - 7 days (3 days often ok)
4. Aspirin - 7 days
5. Plavix - 7 days

What labs are generally acceptable at your institution prior to an interventional procedure?

1. Platelets
2. Prothrombin time
3. Partial thromboplastin time
4. INR

1. Platelets <50,000
2. Prothrombin time <15s
3. Partial thromboplastin time <35s
4. INR <1.5

True or False:

When putting in a drain into a splenic abscess, it is better to go through as little normal splenic tissue as possible, unlike the liver.

• Pt's clinical symptoms improved.
• Decreasing or nl WBC
• Drainage <10ml or stopped.

Covered stent

+

Abx

Surgical ligation and bypass.

(not endovascular)

Absolute

• Recent bleed
• Recent CVA
• CNS tumor
• Recent neurosurgery

Relative

• Recent surgery or organ biopsy
• CPR/trauma
• Pregnancy
• Uncontrolled HTN
• Endocarditis
• Organ failure
• Elderly

• tPA: 0.5-1.0 mg/hr
• heparin IV 500 units/hr
• PT/PTT, fibrinogen, H/H, plts q4hrs
• ICU
• Infusion usually 12-24 hrs

True or False:

Stenting may be performed in pts with Paget-Schroeder to improve venous or arterial flow.

Bronchogenic carcinoma (80%)

Catheters and pacemaker leads

Granulomatous disease

Chronic dialysis

1. Underlying hypercoagulable state (majority)
2. Polycythemia vera (10%)
3. Oral contraceptives (10%)

Superficial palmar branch of the ulnar artery in the Guyon space.

(trauma from hook of the hamate)

1. Swan-Ganz catheter
2. TB (Rasmussen's)
3. Bechet disease