Interventional Radiology and Vascular Procedures
Interventional Radiology and Vascular Procedures tests access technique, embolisation, vascular intervention and complication management.
Basics
Seldinger technique: needle access, guidewire, catheter exchange, haemostasis. Ultrasound guidance reduces complications. Check coagulation and renal function, and stop anticoagulants according to local protocol. Consent must include bleeding, infection, vessel injury and contrast reaction.
Procedures
Embolisation controls haemorrhage and treats tumours; use coils, particles or glue depending on the target. Angioplasty and stenting treat stenotic arteries; measure pressure gradients. TIPS decompresses portal hypertension; target portosystemic gradient is below 12 mmHg. IVC filters are for patients with pulmonary embolism and contraindication to anticoagulation. Thrombolysis requires monitoring for bleeding.
Worked example
A cirrhotic patient has refractory ascites despite diuretics. TIPS is considered; a portosystemic gradient of 18 mmHg is measured and reduced to 8 mmHg after shunt creation. Reasoning: a gradient above 12 mmHg drives ascites and variceal bleeding; the target is below 12 mmHg.
Traps
Ignoring a raised INR without assessing bleeding risk; forgetting to reverse anticoagulation; not recognising post-embolisation syndrome; placing an IVC filter without a retrieval plan; using TIPS in severe encephalopathy or heart failure.