Vascular, Interventional and Emergency Radiology
Vascular, interventional and emergency radiology tests procedural knowledge, recognition of active bleeding, and safe emergency decision-making.
Core concepts
- The Seldinger technique uses needle, guidewire, catheter and sheath; catheter size is measured in French, wire diameter in inches.
- Embolization agents include coils for focal arterial bleeding, particles for tumour or fibroid devascularization, and glue or plugs for specific lesions.
- Thrombolysis is used in acute stroke, pulmonary embolism and limb ischaemia; absolute contraindications include active bleeding and recent intracranial surgery.
- Abdominal aortic aneurysm is usually repaired above 5.5 cm; rupture shows retroperitoneal haematoma and contrast extravasation.
- Acute limb ischaemia presents with the six Ps: pain, pallor, pulselessness, paraesthesia, paralysis and poikilothermia.
Worked example
A trauma patient with a pelvic fracture and hypotension has a contrast blush on CT. That is active arterial extravasation. If interventional radiology is available, embolization of internal iliac branches is preferred over immediate surgery because it controls bleeding with less physiological insult.
Traps
- Missing a subtle pseudoaneurysm or contrast blush.
- Ignoring cumulative fluoroscopic dose in prolonged procedures.
- Failing to check renal function and coagulation before contrast or intervention.