Mod 4 - Vascular Interventional (IR)

A set of practice flashcards covering diagnostic and therapeutic vascular interventional radiology procedures, including equipment, techniques, and nursing considerations.

What are the two major categories of vascular IR procedures?

Diagnostic angiography and therapeutic vascular interventions.

What is the MRT primarily responsible for when an angiography nurse is present?

Imaging-related duties such as image acquisition, injector setup, contrast preparation, and post-processing.

What additional responsibilities may the MRT assume if no angiography nurse is present?

Patient monitoring, positioning, dressing changes, and patient education.

What are the three most common MRT duties during angiography?

C-arm operation, image acquisition, and post-processing.

Before an angiographic procedure, what must the MRT verify regarding blood work?

Clotting studies and renal function tests.

What does DSA stand for?

Digital Subtraction Angiography.

What is the purpose of DSA?

To remove superimposed anatomy and improve visualization of contrast-filled vessels.

What is the first image obtained during DSA called?

Mask image.

What does the mask image contain?

Normal anatomy without contrast.

What is the final image produced by DSA called?

Subtracted image.

What anatomy is removed during the subtraction process?

Duplicate bone and soft tissue anatomy.

What remains visible after subtraction?

Contrast-enhanced vasculature.

What is DSA stepping also called?

Bolus Chase.

What body region commonly uses DSA stepping?

Lower extremities.

What is one major advantage of DSA?

Improved contrast resolution.

What is another major advantage of DSA?

Reduced contrast media requirements.

What is one major disadvantage of DSA?

Reduced spatial resolution.

Why can DSA increase patient dose?

Multiple exposures are required.

What is misregistration?

Misalignment between the mask image and subsequent contrast images.

What is the most common cause of misregistration?

Patient movement.

Name one involuntary cause of misregistration.

Peristalsis.

How can MRTs help reduce misregistration?

Proper positioning, immobilization, and breath-hold instructions.

What is the most common indication for angiography?

Evaluation of vascular disease such as stenosis or aneurysm.

What vascular abnormality involves dilation of a vessel wall?

Aneurysm.

Name one trauma-related indication for angiography.

Identification of arterial injury.

What major contrast-related contraindication exists for angiography?

Severe contrast allergy.

Why is renal failure a contraindication for angiography?

Risk of contrast-induced nephrotoxicity.

Why is coagulopathy a contraindication for angiography?

Increased bleeding risk.

Which clotting studies are commonly reviewed before angiography?

Platelets, INR, and PTT.

Which renal function tests are commonly reviewed before angiography?

Creatinine and eGFR.

What two medications are commonly used for conscious sedation in IR?

Fentanyl and Midazolam (Versed).

What three vital signs are continuously monitored during angiography?

Oxygen saturation, ECG, and blood pressure.

Which arterial access site is becoming increasingly popular?

Radial artery.

Why is radial access becoming more popular?

Easier recovery and fewer complications.

What is the most common vascular access technique in IR?

Seldinger technique.

What is the correct sequence of the Seldinger technique?

Needle → Guidewire → Catheter → Sheath.

What access technique is commonly used for vertebroplasty?

Trocar technique.

Following femoral artery access, how long must the patient generally remain supine?

Approximately $4\,\text{hours}$.

What is the purpose of applying compression after catheter removal?

Achieve hemostasis.

What complication should be monitored for at the puncture site after angiography?

Hematoma.

What does PTA stand for?

Percutaneous Transluminal Angioplasty.

What is the purpose of PTA?

To dilate a stenotic vessel.

What device is used to dilate the stenosis during PTA?

Balloon catheter.

What does PTCA stand for?

Percutaneous Transluminal Coronary Angioplasty.

What is a major complication of PTA?

Vessel rupture.

What is the purpose of a vascular stent?

To keep a vessel open and maintain patency.

What metal is most commonly used in self-expanding stents?

Nitinol.

What material covers covered stents?

$$\text{PTFE (Polytetrafluoroethylene)}$$

What does EVAR stand for?

Endovascular Aneurysm Repair.

What condition is EVAR commonly used to treat?

Abdominal aortic aneurysm (AAA).

A DSA image demonstrates vessel outlines but residual bony anatomy remains visible. What likely occurred?

Misregistration.

A patient moves between the mask image and contrast image. What artifact occurs?

Misregistration.

During lower limb angiography, the table automatically follows contrast through the leg. What technique is being used?

DSA stepping (Bolus Chase).

Why can DSA use lower volumes of contrast than standard angiography?

Background anatomy is removed, improving vessel conspicuity.

Which access site generally allows faster discharge: radial or femoral?

Radial.

A patient is taking anticoagulants. What major angiography complication risk increases?

Bleeding.

Which vessel is traditionally used for aortic arch angiography access?

Femoral artery.

Why is heparin used to flush angiography catheters?

To reduce clot formation.

A balloon catheter is inflated across a vessel narrowing. What procedure is occurring?

PTA.

What pressure-related complication can occur if a PTA balloon is overinflated?

Vessel rupture.

What is the major difference between PTA and stent placement?

PTA dilates the vessel; a stent provides ongoing structural support.

Which stent type expands when an outer sheath is withdrawn?

Self-expanding stent.

What property makes nitinol useful for self-expanding stents?

Shape memory.

What therapeutic procedure uses tPA?

Thrombolysis.

What is the primary complication of thrombolysis?

Bleeding.

What procedure physically removes a clot rather than dissolving it?

Mechanical thrombectomy.

What is the most common use of mechanical thrombectomy?

Large-vessel ischemic stroke.

What is the primary purpose of an IVC filter?

Prevent pulmonary embolism.

Does an IVC filter treat DVT?

No, it only prevents embolization to the lungs.

Where should an IVC filter ideally be placed?

Below the lowest renal vein.

What is the preferred access side for IVC filter placement?

Right side.

What is the most common IVC filter shape?

Conical.

What is the most common IVC filter material?

Nitinol.

What condition constitutes an absolute contraindication for IVC filter placement?

Complete IVC thrombosis.

What is the main indication for IVC filter placement?

DVT with contraindication to anticoagulation.

What is another major indication for IVC filter placement?

Recurrent DVT/PE despite anticoagulation.

What is a major complication associated with IVC filter migration?

Pulmonary embolism or cardiopulmonary symptoms.

What happens if excessive clot accumulates around the IVC filter?

IVC thrombosis.

What complication makes filter retrieval difficult over time?

Device adhesion to the vessel wall.

What is a bioconvertible filter?

A filter that biodegrades and converts into an IVC stent.

What is one example of an imaging-related duty the MRT performs regarding equipment?

Injector setup.

What is one example of an additional duty the MRT performs that relates to skin care?

Dressing changes.

In the Seldinger technique, what component is inserted immediately after the needle?

Guidewire.

Which clotting study mentioned in the transcript begins with the letter 'I'?

INR.

Which renal function test mentioned in the transcript is often abbreviated with a lowercase 'e'?

eGFR.

What type of food must usually be avoided before a sedated procedure?

Solid Food

What is the main purpose of fasting before sedation?

To reduce the risk of aspiration.

What is aspiration?

When stomach contents or vomit enter the lungs.

What may happen if a patient does not follow fasting instructions?

The procedure may be postponed or delayed.