Allen test
- Test done prior to radial artery access to confirm ulnar flow to the hand
- pulse ox placed on middle finger while both ulnar and radial arteries are manually compressed
- releasing ulnar artery should improve desaturation
risks of brachial artery access
- medial brachial fascial compartment syndrome
- vessels spasm
- higher risk of stroke
anticoagulation parameters prior to arterial stick
- stop heparin 2 hrs prior to procedure (PTT 1.2 x control or less; normal 25-35 sec)
- INR of 1.5
- platelets > 50 k
- stop coumadin 5-7 days prior (vit K 25-50 mG IM 4 hours prior or FFP/Cryo)
- stop ASA/plavix 5 days prior
- no antibiotic PPX needed
PICC line: preferred location
- non -dominant arm
- Basilic > brachial > cephalic
National Kidney Foundation- Dialysis Outcome Quality initiative
RIJ > LIJ > REJ> LEJ
- do not place PICCs in dialysis patients
ideal balloon dilation
10-20% over normal artery diameter
Embolization using coils
- varicocele (spermatic veins)
- pulmonary AVM
- segmental renal artery aneurysm
- GI bleed (microcoils)
embolization using autologous blood clot
post-traumatic high flow priapism
embolization using PVA
- uterine fibroid embo (PVA or microspheres 500-1000 microns)
- bronchial artery embo
rate of thrombosis in permanent IVC filters
10% within 5 years
Situations when you would place a suprarenal IVC filter
- pregnancy
- duplicated IVC
- clot in renal or gonadal veins
slow flow in HD graft? in fistula?
for fistula: < 600 cc/min
for graft: < 500 cc/ min
dialysis associated steal syndrome (DASS)
cold, painful fingers/ pale hand during dialysis, relieved by manual compression of the fistula
What is included in MELD score?
- creatinine
- Bilirubin
- INR
What is included in Childs-Pugh score
- ascites
- encephalopathy
- bilirubin
- PT
- albumin
SIR practice guideline for pre-procedure hold for procedures with moderate risk of bleeding (liver or lung biopsy, abscess drain, vertebroplasty, tunneled line placement)
- INR > 1.5
- plt > 50k
- hold plavix for 5 days
- aspirin does NOT need to be held
maximum dose of lidocaine
4-5 mg /kg
-7 mg/kg for lido with epi
branches of the internal iliac
anterior: umbilical (gives off superior vesicular), inferior vesicular, obturator, uterine, middle rectal, internal pudendal, inferior gluteal
posterior: Iliolumbar, lateral sacral, Superior gluteal
Winslow Pathway
- collateral pathway in setting of aorto iliac occlusive disease
- sublcavian artery –> internal thoracic (mammary) arteries –> superior epigastric –> inferior epigastric –> external ilaic
Corona Mortis
vascular connection between obturator and external iliac; vessel courses over superior pubic rim
- can be injured in pelvic trauma or surgery
branches of subclavian artery
- vertebral
- internal thoracic
- thyrocervical trunk
- costocervical turnk
- dorsal scapular
aortic aneurysm repair sizes
> 6 cm in chest
5.5 cm if collagen vascular diseas
5 cm in abdomen
which sinus is most commonly involved by sinus of valsalva aneurysm?
right cusp
Carotid Doppler
- normal PSV in ICA
- normal ICA/CCA ratio
- normal ICA end diastolic velocity
- 50-69% stenosis
- > 70% stenosis
- normal PSV< 125 cm/s
- ratio < 2
- EDV < 40 cm/s
- 50-69% stenosis: 125-230 cm/s, ratio 2-4, EDV 40-100
- > 70% stenosis: > 230 cm/s; ratio> 4, EDV > 100
