What are the common indications for transcatheter embolotherapy?
a. Exercise intolerance
b. Prevention of neurologic complications
c. Prevention of lung hemorrhage (hemoptysis)
In PAVM patients, at what diameter is embolization of the feeding artery usually indicated?
When the feeding artery is at least 3 mm in size.
What is the most common indication for bronchial arteriography?
In general, a normal ABI should be greater than what value?
An ABI between _____ and _____ signifies intermittent to severe claudication.
0.95 and 0.5
In acute peripheral thrombosis or embolism, what clinical findings steer toward an endovascular approach versus open surgery?
a. In general, patients with pain and pallor are embolic candidates.
b. Sensory and motor deficits are treated surgically.
Exclusive of Takayasu arteritis, what two main vasculitides occur in the peripheral arterial system?
a. Giant cell arteritis
b. Buerger disease
Giant cell arteritis typically involves the medium to large blood vessels in which general locations? Which patient population is generally affected?
a. Those vessels supplying:
- head (Temporal arteries),
- neck (Carotid arteries), and
- arms (Axillary and brachial arteries).
b. Most common in women greater than 60 years.
c. Smooth, long segment narrowing.
What is Buerger disease?
a. AKA (thromboangiitis obliterans)
b. Acute inflammation and thrombosis of arteries and veins
c. Primarily affects hands and feet
d. Typically young heavily smoking males
What is the hypothenar hammer?
a. The result of palmar trauma
b. Leads to injury of ulnar artery adjacent to hook of hamate
c. Ulnar artery can be aneurysmal, thrombosed, or can send emboli to digital arteries
Which peripheral arteries can be sacrificed (embolized) without consequence?
a. Branches of internal iliac
b. Branches of profunda femoris
c. Geniculate branches
d. Subclavian/axillary/brachial artery branches (except vertebrals)
e. Lower extremity:
- Iliac artery
- Femoral artery
- Popliteal artery
At what diameter of an asymptomatic AAA is elective repair considered?
When the diameter exceeds 5.0 cm.
Describe the four (4) main types of endoleaks.
Type 1: Leak at superior or inferior attachment site
Type 2: Patent side branch filling grafted aneurysm sac (Lumbar or Inferior mesenteric artery)
Type 3: Loss of stent graft integrity
Type 4: Leak through porous graft material
What is Leriche syndrome? How can it be treated?
a. Classic Triad:
- Bilateral buttock claudication
- absent femoral pulses secondary to aortoiliac occlusion, typically secondary to atherosclerosis
b. Treatment options
- Kissing balloon angioplasty +/- stent
- Aortoiliac bypass graft
- Axillofemoral and femoral-femoral bypass
Differential diagnosis of microaneurysms? (5)
a. Polyarteritis nodosa (PAN)
b. Wegener granulomatosis
c. Systemic lupus erythematosus
d. Rheumatoid vasculitis
e. Drug abuse
Which hepatic neoplasms (mets included) are most responsive to embolization? (5)
a. Hepatocellular carcinoma
b. Neuroendocrine tumors
e. Colorectal metastases
Tumor replacement of greater than _____% of normal liver is a contraindication to embolization.
50% to 75%.
What are some causes of acute mesenteric ischemia? (3)
a. Arterial embolism and thrombosis
b. Nonocclusive ischemia
c. Mesenteric venous thrombosis
What are the contraindications for peripheral thrombolysis? (7)
a. Internal bleeding
b. Stroke within past 6 months
c. Cranial or spinal surgery within past 2 months
d. Intracranial neoplasm
e. Bleeding diathesis
f. Uncontrolled hypertension
g. Contraindication to anticoagulation
What are some potential complications of venous thrombolysis?
a. Pulmonary embolus
b. Bleeding: At access site
c. Hemorrhagic stroke
d. GI bleeding
e. Retroperitoneal hematoma
What is phlegmasia cerulea dolens? How might it present?
Limb arterial compromise caused by massive acute venous thrombosis. Thrombosis involves both main and collateral venous drainage. Causes swelling and severe elevations in vascular resistance resulting in ischemia.
What is Paget-von Schrötter syndrome? How does it present?
Compression of subclavian vein by a cervical rib, soft tissue anomaly, or scar tissue after clavicle fracture. Results in thrombosis and arm swelling.
What are the general contraindications to TIPS?
a. Hepatic failure
b. Severe right heart failure