Procedures
Core concepts
Know the major vascular and interventional procedures and their indications, access sites, and complications. Common categories: diagnostic angiography (arterial/venous), angioplasty and stenting, embolization (e.g., for bleeding or tumors), thrombolysis/thrombectomy, IVC filter placement, TIPS, central venous access, and biopsy/drainage. Access is usually femoral (common femoral artery), with radial or brachial alternatives. Seldinger technique: needle → wire → catheter/sheath.
Traps to watch
Questions test complication recognition: hematoma, pseudoaneurysm, arteriovenous fistula, dissection, distal embolization, contrast-induced nephropathy, and infection. Know that post-embolization syndrome (pain, fever, nausea) is expected and distinct from infection. For IVC filters, know indications (contraindication to anticoagulation, recurrent PE despite anticoagulation). For thrombolysis, monitor for bleeding and fibrinogen levels. Distinguish diagnostic from therapeutic goals. Know catheter sizes and typical guidewire use (e.g., hydrophilic wires for tortuous vessels).
Rule of thumb
If a question asks the most likely complication after femoral access, think access-site hematoma or pseudoaneurysm - not systemic reaction.
Worked example
A patient develops a pulsatile groin mass with a bruit 2 days after angiography. This suggests a pseudoaneurysm; ultrasound with compression or thrombin injection may be used. This is a classic post-procedure complication question.