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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3892_Библиотеки_им_академика_М_И_Перельмана
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26
What were the findings
of the “Heart Outcomes
Prevention Evaluation”
(HOPE) trial?
9541 patients at least 55years old
with history of vascular disease
or diabetes and at least one other
risk factor randomized in a double-
blind manner to ACE inhibitor
(ramipril) or placebo for 4–6years
with primary outcome of combined
rate of cardiovascular death, MI, or
ischemic stroke:
At the end of 4years, primary
endpoint was 22% lower in
ramipril group than placebo
group
C. Molloy and J. Huang
https://t.me/med1917
27© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_5
The “call” experience will vary and is based on the institution
and the attending physician. In most institutions, “call” means
covering the service after-hours and on weekends. The subin-
tern may hold the call pager and answer any immediate ques-
tions or see consults. It helps to understand what is a
medically emergent case, because in many institutions the
rest of the call team (nurse, scrub tech, etc.) will not be acti-
vated and the procedure will not be performed unless the
case is a medical emergency. The individual taking call should
be comfortable with routine postoperative care, management
of pain and complications, as well as handling emergent con-
sults in the fields of trauma, emergent ischemia and hemor-
rhage, thromboembolic disease, as well as infection.
Chapter 5
Taking Call
ChrisMolloy andJunjianHuang
C. Molloy (*)
Department of Vascular and Interventional Radiology, Kaiser
Permanente Los Angeles Medical Center, Los Angeles, CA, USA
J. Huang
Department of Vascular and Interventional Surgery, Kaiser
Permanente Los Angeles Medical Center, Los Angeles, CA, USA
https://t.me/med1917
28
Describe how
to obtain and
calculate ankle-
brachial index
(ABI)?
Position the patient in the supine position.
Measure the bilateral brachial blood
pressures and measure the bilateral ankle
blood pressures. Calculate the highest
brachial pressure divided by the ankle blood
pressure to determine the ABI
How is the ABI
interpreted and
what ranges are
abnormal?
ABI range
0.9 – 1.2: Normal range
0.8 – < 0.9: Mild arterial disease
0.5 – < 0.8: Moderate arterial disease
< 0.5: Severe arterial disease
How do you
explain normal or
elevated ABIs in
a diabetic patient
with vascular
claudication?
In diabetics, the ABI may be spuriously
elevated due to medial calcific sclerosis
(Mönckeberg sclerosis). In this scenario, toe-
brachial index (TBI) and toe pressures are
more reliable measures of arterial perfusion.
What is the
National Institutes
of Health Stroke
Scale (NIHSS)?
C. Molloy and J. Huang
https://t.me/med1917
29
What diagnosis
should be
considered if you
see the “floating
viscera sign”?
Acute aortic dissection
What are the acute
aortic syndromes?
1. Acute aortic dissection
2. Intramural hematoma
3. Penetrating atherosclerotic ulcer
What are the
predictors of
mortality in
patients with
aortic intramural
hematoma?
Ascending aorta diameter > 5cm
Hematoma diameter > 2cm
Pericardial effusion
What types of
trauma cases may
be IR-related
emergencies?
Acute hemorrhage (often visceral bleed
or pelvic trauma). Bilateral selective
arteriograms in the internal iliac arteries
with multiple obliquities are necessary to
clear the pelvis.
What kidney cases
are considered
IR emergencies
requiring urgent
intervention?
Pyonephrosis, acute urinary obstruction,
Page kidney
What are the
indications for
percutaneous
nephrostomy?
To relieve obstruction, create urinary
diversion, pyonephrosis, to establish access
for other genitourinary procedures
What lung/
pulmonary cases
are considered
IR emergencies
requiring urgent
intervention?
Massive or submassive PE, massive
hemoptysis
(continued)
5
Taking Call
https://t.me/med1917
30
What Rutherford
classifications
of acute limb
require immediate
intervention?
Class IIb requires immediate intervention
for limb salvage. Classes I and IIa are
salvageable with urgent intervention.
What are the
sonographic
findings of arterial
pseudoaneurysm?
“Yin-yang” sign on color Doppler
To-and-fro flow within the pseudoaneurysm
neck on Doppler waveform
What are the
sonographic
findings of
acute deep vein
thrombosis?
Non-compressible veins
Echogenic thrombus visualized within the
deep vein lumen
Absence of color flow within the vein lumen
Absence of respiratory phasicity suggests
a more central venous obstruction, and
further evaluation with CT venogram or MR
venogram is warranted
What IR
procedure is
usually performed
for massive
hemoptysis?
Bronchial artery embolization
Where do the
bronchial arteries
usually originate
from? Where can
the bronchial
artery originate
from in normal
anatomic variants?
The left bronchial arteries (typically
two) usually originate directly from the
descending aorta. The right bronchial artery
(typically one) arises from a right posterior
intercostal or left bronchial artery. They can
also originate from internal mammary and
subclavian arteries.
What is the corona
mortis?
Named the “crown of death,” an anatomic
variant artery, which connects the obturator
artery via the external iliac artery. It may be
injured during pelvic trauma and surgery or
may cause type 2 endoleak.
C. Molloy and J. Huang
https://t.me/med1917
31© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_6
According to SIR
guidelines, how
is procedural
bleeding risk
stratified?
The below 2019 updates to periprocedural
bleeding risk and recommendations should be
reviewed prior to the IR rotation:
Society of Interventional Radiology
Consensus Guidelines for the Periprocedural
Management of Thrombotic and Bleeding
Risk in Patients Undergoing Percutaneous
Image- Guided Interventions—Part I: Review
of Anticoagulation Agents and Clinical
Considerations
Society of Interventional Radiology
Consensus Guidelines for the Periprocedural
Management of Thrombotic and Bleeding
Risk in Patients Undergoing Percutaneous
Image-Guided Interventions—Part II:
Recommendations
Chapter 6
Pre-procedure
ChrisMolloy andJunjianHuang
C. Molloy (*)
Department of Vascular and Interventional Radiology, Kaiser
Permanente Los Angeles Medical Center, Los Angeles, CA, USA
J. Huang
Department of Vascular and Interventional Surgery, Kaiser
Permanente Los Angeles Medical Center, Los Angeles, CA, USA
(continued)
https://t.me/med1917
32
What value
should a patient’s
INR be prior to a
high bleeding risk
procedure?
INR ≤1.5 prior to a high-risk procedure
What value should
the patient’s
platelets be prior
to a high bleeding
risk procedure?
Platelets ≥50,000/μL: if platelets ≤50,000/μL,
transfuse prior to a high-risk procedure
Some patients
refuse transfusion
of blood products
due to religious
preferences.
What adjunctive
medications may
be considered
to improve
hemoglobin levels
and decrease
bleeding in
patients who
refuse blood
transfusions?
Erythropoietin and desmopressin
What agent can
be administered
to improve
platelet function
in patients with
uremic platelet
dysfunction? At
what dose?
Desmopressin. Dose 0.3μg/kg is given
intravenously
What lab is used
to monitor low
molecular weight
heparin therapy?
Anti-factor Xa activity
C. Molloy and J. Huang
https://t.me/med1917
33
How long
should LMWH
be held prior
to a procedure
considered high
bleeding risk?
Hold LMWH for 24h or usually 2 doses prior
to high-
risk procedures
What is the
minimum number
of unique patient
identifiers that
should be used
during the pre-
procedural
timeout?
Though variable between institutions, generally
two unique identifiers should be used during
the pre-
procedural timeout, for example, the
MRN and date of birth
6 Pre-procedure
https://t.me/med1917
Part II
Vascular Site
https://t.me/med1917
37© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_7
In patients undergoing
procedures with a
high risk of bleeding,
how long should
clopidogrel and
aspirin be withheld
prior to procedure?
According to the 2019 Society of
Interventional Radiology Consensus
Guidelines for the Periprocedural
Management of Thrombotic and
Bleeding Risk in Patients Undergoing
Percutaneous Image-Guided
Interventions, in procedures associated
with a low risk of bleeding, clopidogrel
does not need to be withheld. In
procedures associated with a high risk of
bleeding, clopidogrel should be withheld
for 5days.
In procedures associated with a low risk
of bleeding, aspirin does not need to be
withheld. In procedures associated with
a high risk of bleeding, aspirin should be
withheld for 3–5days.
Chapter 7
Patient Preparation
MatthewCzarTaon
M. C. Taon (*)
Kaiser Permanente Los Angeles Medical Center,
Los Angeles, CA, USA
(continued)
https://t.me/med1917
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