Vascular & Interventional Radiology
Core Concepts
Vascular and interventional radiology (VIR) questions focus on indications, contraindications, techniques, and complications of minimally invasive procedures. You must know the difference between diagnostic angiography and interventional procedures, the role of embolization (e.g., for GI bleeding, trauma, tumors), and the principles of thrombolysis and thrombectomy. Familiarity with catheter types, embolic agents (coils, particles, glue), and imaging guidance (fluoroscopy, CT, ultrasound) is essential. Also understand pre- and post-procedure care, including anticoagulation management and radiation safety.
Common Traps
A common trap is confusing the indication for a procedure with its contraindication. For example, transarterial chemoembolization (TACE) is indicated for unresectable hepatocellular carcinoma but is contraindicated in portal vein thrombosis. Another trap is the timing of intervention: for acute limb ischemia, revascularization should occur within 6 hours; for stable patients with chronic mesenteric ischemia, elective stenting is preferred. Questions may also test your knowledge of complications such as post-embolization syndrome (fever, pain, nausea) which is self-limited and should not be mistaken for infection.
Worked Example
A 60-year-old man with cirrhosis and a 4 cm HCC not amenable to resection. The question asks for the best treatment. TACE is appropriate if the portal vein is patent. If portal vein thrombosis is present, TACE is contraindicated, and systemic therapy or radioembolization may be considered. Rule of thumb: always assess portal vein patency before TACE.
Key Points
- TACE is contraindicated in portal vein thrombosis.
- Post-embolization syndrome is common and self-limited.
- Acute limb ischemia requires revascularization within 6 hours.
- Coils are used for embolization of bleeding vessels and aneurysms.
- Radiation safety: use ALARA principles.