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130 Cards in this Set
- Front
- Back
What are the 2 major locations of atheroscleoric disease that requires angioplasty
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aorto-iliac
fem popiteal |
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What is the inflow location of atherosclerotic disease
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aorto-iliac
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What is the outflow location of atherosclerotic disease
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fem-pop
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What other locations have atherosclerotic disease that may require angioplasty
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tibial-pedal and renal
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What types of lesions typical respond well to angioplasty
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short stensosis that are non-calcified
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When refering to tibial pta what is really being referred to
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posterior tibial
anterior tibial peroneal artery |
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What is the anatomy of the lower extremity arteries
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What is the anatomy of the iliac arteries
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internal iliac goes posteriorly
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What direction does the internal iliac artery go
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posteriorly
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Why are IR docs more hesitant to do tibial (meaning anterior, posterior or peroneal) artery PTA
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the risk are greater
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What are the indications for PTA of the tibial arteries and peroneal artery
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limb salvage
rest pain gangrene or ulcers graft salvage |
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Do you typically experience rest pain with an ABI less than 0.4
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yes
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What is considered hemodynamically significant
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greater than 50% stenosis
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What does 50% stenosis correspond to in cross-sectional area
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75% reduction
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What amount change in blood pressure across a stenotic area is considered significant at rest
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10mmhg
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What are indirect signs of hemodynamic significant stensosi
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collaterals
decrease kidney size |
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When do you measure pressure of a stensois
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if u are unsure if the pressure gradient is hemodynamically significant
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What two measurements are important in PTA
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length and diameter
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What is the optimal balloon diameter
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10% larger than the normal unaffected vessel
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What is the optimal balloon length
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spans the lesion and does not extend more than 1 cm on either side
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What is the size of the guide wire for standard balloons
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0.035 inches
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What is the size of the guide wire for small vessel balloons
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0.018 inch
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Where are smaller vessel balloons typically used
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coronary arteries
tibial vessels |
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What is the size of a ballon for the renal artery
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6mm
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What is the size of a ballon for the common iliac artery
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10mm
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What is the size of a ballon for the external iliac artery
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8mm
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What is the size of a ballon for the SFA
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6mm
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popitieal vessel
tibial vessels |
5mm
3-4mm |
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What should occur prior to performing PTA
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heparinized to prevent thrombosis
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What should you do if a thrombosis occurs
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give TPA
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Do infrarenal aortic and Iliac vessels have good prognosis
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yes, 70-80% typically stay patent in 3-5 years
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Do femorpopiteal and infrapopiteal have good long term patency
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not as good 20-80%
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What is the treatment of choice of FMD
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PTA without stent placement
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What is the success of doing angioplasty for renal vascular disease
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85% (atherosclerosis is less at 64%)
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What are the complications of PTA
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puncture site (hematoma, psuedoaneurysm)
PTA site (acute thrombosis,rupture) Distal (thromboembolism, cholesterolembolism) |
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What are the complications at the puncture site
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puncture site (hematoma, psuedoaneurysm)
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What are the complications at the PTA site
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PTA site (acute thrombosis,rupture)
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What are the complications at the distal site
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Distal (thromboembolism, cholesterolembolism)
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What are the 2 MC complications
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hematoma at the puncture site and acute thrombosis at the PTA site
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What also commonly occurs following PTA
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intimal dissection (technically not a complication unless it obstructs flow)
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What happens to the intima when the balloon is blown up
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it cracks and will cause a focal dissection
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Where are stents used most commonly
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iliac arteries
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What is the rationale for using a stent
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better immediate result and better long term patency
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What are 2 ways a stent can be deployed
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primary or secondarily
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What is meant by deploying a stent primarily
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?
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What does it mean to deploy a stent secondarily
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this means if the results of the PTA are suboptimal a stent can be used as a secondary option. Primarly just means starting out with a stent
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Besides the iliac vessels where else are stents uses
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renal arteries and heart
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What are 2 types of stents that are available
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the balloon expandable
self expanding |
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What is the prototype of the balloon expandable stent
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palmaz stent (genesis is another type of balloon expandable stent)
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What is needed to deploy the palmaz stent
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a balloon
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What is an example of a self expanding stent
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wallstent
Nitinol stent |
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What is an advantage of the nitinol family of stents
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less shortening
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Why is a palmaz stent not commonly used for the SFA
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because people cross there legs and it may crush the stent
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What is a stent graft
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a metallic stent covered with fabric (dacron, gortex)
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What is the MC indication for a stent graft
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infra-renal abdominal aortic disease
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What is the MC stent graft used in the US
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Zenith stent graft
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What does a zenith stent graft look like
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deploys with suprarenal fixation which increases stability
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What is a type 1 endoleak
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leak at proximal and distal attachments
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What must be done to treat common iliac artery aneurysm
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use covered stent that extends into the external iliac artery
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Why is important to embolized the internal iliac artery if you are treating a common iliac artery aneurysm with a graft stent
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if you dont you will get a type 2 endoleak
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What is a mneuomic for the branches of the internal iliac artery
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I Love Going Places In My Very Own Underwear:
Ileolumbar Lateral sacral Gluteal (superior and inferior) Pudendal (internal) Inferior vesicle (uterine in females) Middle rectal Vaginal Obturator Umbilical |
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What is fibrinolysis
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another name for thrombolytic therapy
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What is used for fibrinolysis
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tissue plasminogen activator
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What is plasmin
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this is a byproduct of plasminogen and spits fibrin into fibrin split products
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What is fibrinolysis used for
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acute or subacute thrombus in native vessels or grafts
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What is a loose cutoff for the use of fibrinolysis
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less than 2 wks
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What is a very common indication for fibrinolysis
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clottted grafts
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What are the contraindications of fibrinolysis
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recent surgery
GI bleeding recent stroke brain mets threatened limb (do embolectomy) |
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What should be done in the case of motor or sensory deficit in a limb
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embolectomy
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What are some fibrinolytic agents
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TPA
Urokinase Tenecteplase reteplase (recombinant TPA) |
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Do pts undergoing fibrinolytic therapy often undergo adjunctive heparin therapy
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yes
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What is the normal dosage of TPA
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1mg/hr
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How is TPA administered
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through a side hole catheter lodged in the thrombus
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What labs should be followed on a patient on TPA
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H/H
PTT (bc on heparin) Fibrinogen (important) |
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What is the lowest fibrinogen can go
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150
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When does lysis most commonly occur
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with in 24-48 hours
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What are the complications of fibrinolysis
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bleeding (puncture site or systemic)
Embolization |
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How long do you typically allow fibrinolytic therapy to occur
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48 hrs then discontinue
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What is the most feared complication of fibronlysis
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bleeding into the brain
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What percent of pts undergoing fibrinolysis have bleeding in the brain
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0.4%
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What are some indication of therapeutic embolization
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control of GI bleeding
treatment of fibroids palliate malignancy traumatic injury (organ bleeding) |
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What are 4 embolic agents that are commonly used
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liquids
particulates coils balloons |
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What are 2 types of liquids that are used for embolization
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alcohol and glue
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What are 2 types of particulates that are used as embolic agents
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gelfoam and ivalon
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What 2 tpes of embolic agents are not commonly used
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liquids (very specialized indications)
balloons |
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What are the 2 most commonly used embolization agents
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particulates
coils |
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What are the exmples of particulates
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gelfoam
polyvinyl alcohol (Ivalon) collagen embospheres |
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How is Ivalon specified
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by size (150-200 microns etc)
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Are collagen and embospheres also specified by size
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yes
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Are gelfoams considered a temporary agents
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yes usually will embolize for 2-3 wks
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Is collagen commonly used as an embolization agent
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no
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What are the common sizes of coils
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0.018 ir 0.035 inches
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What are the shapes that coils are seen
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striaght, looped and shaped
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Why is GI bleeding embolization not as common
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medical treatment has improved and cauterization with an UGI is now commonly done
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What is the treatment if cauterization and medical treatement of an upper GI bleed fails
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gelfoams or coils
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What must you be sure to do if you are treating a GI bleed with coils or gelfoams
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embolize the collaterals
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What is the treatment of lower GI bleeding
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microcoils, gelfoam, Ivalon
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What is the risk of infarction with lower GI bleeding embolizaton
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5-20%
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What is the more common indication upper or lower GI embolization
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lower
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What major abdominal arterial vessel supplies the stomach and doudenum
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celiac
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What are the vessels of the celiac
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left gastric
hepatic, GDA splenic |
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What are the vessels of the celiiac axis
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What supplies the midgut
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the superior messenteric artery
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What are the vessels of the SMA
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What are the vessels of the inferior mesenteric artery
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Does the SMA supply the descending colon
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not normaly
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What supplys the left colon, sigmoid and superior rectum
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IMA
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Where is the MC location of the origin of the IMA
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left pedicle of L3
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Where is the MC location of the origin of SMA
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right pedicle of L1
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What is the success of treating a mallory weiss and gastric tear
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80 %
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What is the success rate of doudenal
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50-70 % (lower because of the collaterals between the celiac and SMA)
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Can vasopressin be used to treat lower gi bleeds
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yes
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What must you follow if vasopressin (ADH) is used
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sodium levels
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When is uterine artery embolization performed
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post partum bleeding
ectopic bleeding post surgical bleeding fibroids |
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What is uterine artery embolizaton MC used for
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the treatment of fibroids
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What is the embolic agent that is most common
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embospheres (plastic micropspheres)
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Why do the fibroids die and the normal myometrium stay intact following uterine artery embolization
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there are collaterals to the uterus and the normal myometrium does not require as much blood as the the fibroids
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What liver malignancy are treated with embolization
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HCC
metastatic carcinoid metastatic islet cell tumors metastatic sarcomas |
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Besides liver malignacies what else is commonly treated with palliative embolization
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kidney lesion
osseous mets |
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What is embolization for palliation of malignancy done with
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mixture of lipiodol, chemotherapy and particulate agents
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What does TIPS stand fro
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transjugular intrahepatic portosystemic shunt
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What are the vessels that get distended with portal htn
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umbilical
gastro-esophageal IMV-mesenteric rectal spontaneous splenorenal shunts |
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What are the indications for TIPS
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variceal bleeding
ascites (refractive to medical tx) |
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What is hepatohydrothorax
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ascites that goes into chest because of holes in the diaphragm
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How is the TIPS placed
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through the jugular vein into the hepatic vien through the hepatic parenchyma into the portal vein
(right hepatic vein to right portal vein) |
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What is the goal portosytemic gradient
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less than 12mmhg (portal pressure - right atrial pressure)
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What is the diameter of TIPS
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8mm to 12mm
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What type of stents are typically used
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uncovered (wallstent) and covered (Viatorr)
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What are the immediate complications of TIPS
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bleeding
liver failure renal failure stent migration |
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What is the MELD score used for regarding TIPS
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determines who will survive TIPS procedure
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