ANSWERS

Abdominal Aorta Anatomy ANSWERS

1. SMA Superior Mesenteric Artery

2. Hepatic Artery from the Celiac Trunk

3. Splenic Artery from the Celiac Trunk

4. Renal Arteries

Place the pigtail catheter at L1-L2 for renal artery angiogram. (REMEMBER that T12 the last rib!)

Pelvic Artery Angiogram ANSWERS

Top Image:
1. IMA Inferior Mesenteric Artery
2. Common Iliac Artery
3. External Iliac Artery
4. Internal Iliac Artery

Bottom Image:
1. Internal Iliac Artery
2. External Iliac Artery

Questions:

To separate the internal and external iliac arteries you need to do a contralateral oblique. So to view the left internal iliac you need to do an RAO view.

Typically people with iliac occlusions experience claudication in the thighs and lower legs, pain in the buttocks, and impotence.

Typical settings for a MedRad would be 20ml/sec for 2 sec for a total of 40ml. Visipaque is less irritating than Omnipaque in the periphery.

When access is obtained at the level of the upper portion of the femoral head and above the inferior epigastric artery, there is a higher risk of retroperitoneal bleed occurring because if you cause injury that involves extravasation of contrast, the bleed will flow into the retroperitoneal space. 

Femoral Artery ANSWERS

1. Common Femoral Artery
2. Superficial Femoral Artery
3. Profunda (Deep Femoral Artery)

The inguinal ligament marks the distinction between the external iliac and the common femoral. The inguinal ligament is found at what is known as Hesselbach's Triangle: the inferior border being the ligament, the superolateral border being the inferior epigastric vessels, the medial border being the lateral margin of the rectus sheath

The bifurcation of the Profunda femoris or Deep femoral artery from the common femoral marks the start of the superficial femoral artery.

Fem-fem bypass grafts are typically constructed from artificial material like Dacron or PTFE (Gore-Tex) and they actually can be accessed with a percutaneous needle and sheath system. Post sheath removal care must be taken when holding pressure as to not entirely occlude the graft and cause it to shut down. The artificial grafts are easily palpated and feel like a giant bendable straw.
Autogenous grafts may be used in the presence of suspect infection of the surgical site.

The profunda artery oftentimes is the provider of collateral flow in the setting of SFA occlusion or disease. It rarely ever becomes diseased (like LIMAS and EXTERNAL CAROTIDS) for reasons mostly unknown but thought to be because of flow velocities and physics. When treating lesions around the bifurcation of the profunda, you risk embolizing and shutting down collateral flow to the distal limb.