Vascular and Interventional Radiology
Vascular and Interventional Radiology
This domain tests access technique, embolization, vascular interventions, drainage, and complication management. The exam emphasizes indications, anatomy, and periprocedural safety.
Core rules
- Seldinger technique: needle access, wire, catheter exchange; confirm intravascular position before dilation. Coagulation and renal function affect planning.
- Embolic agents: coils for focal arterial bleeding and aneurysms; particles for tumor and uterine fibroid embolization; glue or Onyx for AVMs; gelatin sponge for temporary occlusion.
- TIPS reduces portal pressure in variceal bleeding and refractory ascites; complications include encephalopathy and shunt stenosis. IVC filters are for patients with contraindication to anticoagulation.
- Postembolization syndrome: pain, fever, and nausea after tumor embolization; distinguish it from abscess or nontarget embolization.
Worked example
A patient with massive hemoptysis and cystic fibrosis has a hypertrophied bronchial artery on CTA. Bronchial artery embolization is performed with microcatheters and particles or coils. The artery must be selected beyond spinal branches to avoid nontarget cord ischemia.
Traps
Embolizing without identifying the bleeding artery; using coils too proximally; ignoring spinal artery anatomy; failing to consent for possible conversion to surgery; misreading postembolization fever as infection.