Interventional Radiology
What the exam tests
IR questions cover image-guided procedures, vascular access, embolization, ablation, drainage, periprocedural medications, and complications. Expect patient selection, technique, and complication management.
Core rules
- Before procedures, review coagulation, renal function, allergies, medications, and pregnancy status.
- Embolization can be temporary (gelatin sponge) or permanent (coils, particles, glue); choose based on vessel size and goal.
- Ablation success depends on adequate margin; follow-up imaging assesses residual or recurrent disease.
- Conscious sedation requires monitoring and airway readiness; general anesthesia may be needed for high-risk patients.
Worked example
A 68-year-old with massive hemoptysis is stabilized and has CTA showing hypertrophied bronchial arteries. Reasoning: after airway control, bronchial artery embolization is appropriate. The interventionalist selectively catheterizes the bleeding artery and embolizes with particles or coils while avoiding the artery of Adamkiewicz and spinal branches. Nontarget embolization can cause spinal cord ischemia.
Traps
Proceeding without securing the airway in massive hemoptysis; ignoring renal function before contrast; embolizing without identifying the bleeding vessel; and forgetting antibiotic prophylaxis when required.
Key points
- Airway stabilization precedes embolization in massive hemoptysis.
- Bronchial artery embolization must avoid spinal arteries.
- Coils are permanent; gelatin sponge is temporary.
- Preprocedure labs and medications affect complication risk.