Interventional Radiology Practice Questions

Q: What is an early complication of TIPS procedures?

Capsule rupture and bleeding. **Explanation:** **Transjugular Intrahepatic Portosystemic Shunt (TIPS)** is a procedure used to manage complications of portal hypertension by creating a low-resistance channel between the portal vein and the hepatic vein. **Why Option B is Correct:** **Capsule rupture and intraperitoneal hemorrhage** is a dreaded **early/acute complication** that occurs during the procedure. It happens if the needle used to puncture the portal vein from the hepatic vein passes through the liver parenchyma and inadvertently pierces the liver capsule (Glisson’s capsule). This leads to immediate hemoperitoneum and can be life-threatening. **Analysis of Incorrect Options:** * **A. Hepatic Encephalopathy:** While a common complication (occurring in ~25-30% of patients), it is typically considered a **subacute to chronic** complication. It occurs because the shunt allows unfiltered nitrogenous waste (like ammonia) to bypass the liver and enter the systemic circulation. * **C. Stenosis of the Shunt:** This is a **late complication**, usually occurring months after the procedure due to pseudointimal hyperplasia within the stent. * **D. Thrombosis of the Shunt:** This can occur early or late, but it is less common than bleeding complications during the initial periprocedural period. **High-Yield Clinical Pearls for NEET-PG:** * **Indications:** Refractory ascites and variceal bleeding unresponsive to endoscopic therapy. * **Absolute Contraindications:** Severe congestive heart failure (due to sudden increase in venous return), polycystic liver disease, and severe uncontrolled systemic infection. * **Monitoring:** Doppler Ultrasound is the primary modality used to monitor shunt patency. * **Goal:** To reduce the Portosystemic Pressure Gradient (PPG) to **<12 mmHg**.

Q: Which of the following is NOT a material used for therapeutic embolisation?

Omentum. **Explanation:** Therapeutic embolization involves the intentional occlusion of a blood vessel using various agents to control hemorrhage, devascularize tumors, or treat vascular malformations. **Why Omentum is the correct answer:** The **Omentum** is a large, fatty fold of peritoneal tissue. While it is highly vascular and used in "omental transposition" surgeries to promote healing or provide a blood supply to ischemic areas, it is **not** an embolic agent. It cannot be injected or delivered through a catheter into a vessel to cause occlusion. **Analysis of incorrect options:** * **Blood Clot:** This is a **temporary** embolic agent. Autologous blood clots were among the first materials used for embolization. They are eventually lysed by the body’s fibrinolytic system, making them useful when only short-term occlusion is required. * **Ethyl Alcohol (Absolute Alcohol):** This is a **permanent** liquid sclerosing agent. It causes rapid protein denaturation and endothelial destruction, leading to total and permanent vascular occlusion. It is commonly used for arteriovenous malformations (AVMs) and renal ablation. * **Wool:** While less common today, wool (specifically **Dacron or cotton fibers** attached to stainless steel coils) is used to increase the thrombogenicity of the device. The fibers induce rapid local thrombosis to ensure complete vessel occlusion. **High-Yield Clinical Pearls for NEET-PG:** * **Classification of Embolic Agents:** * **Temporary:** Gelfoam (absorbable gelatin sponge), Autologous blood clot. * **Permanent:** Coils (Stainless steel/Platinum), PVA (Polyvinyl Alcohol) particles, Cyanoacrylate (Glue), and Absolute Alcohol. * **Gelfoam** is the most commonly used temporary agent (lasts 2–6 weeks). * **Absolute Alcohol** is the most potent and carries a higher risk of tissue necrosis if it refluxes into non-target vessels.

Q: What is the most commonly employed treatment for carotid-cavernous fistula nowadays?

Ballon embolization. **Explanation:** **Carotid-Cavernous Fistula (CCF)** is an abnormal communication between the carotid arterial system and the cavernous sinus. It is categorized into Direct (high-flow, usually traumatic) and Indirect (low-flow, spontaneous). **Why Option A is Correct:** **Endovascular embolization** is the current gold standard and most commonly employed treatment. Specifically, **detachable balloon embolization** is the preferred technique for direct CCFs. The goal is to navigate a balloon into the cavernous sinus via the internal carotid artery (ICA) and inflate it to seal the fistula while maintaining the patency of the ICA. If balloons are unavailable or technically difficult, **platinum coils** or liquid embolic agents (like Onyx) are used. **Why Other Options are Incorrect:** * **Option B (Ligation of ICA):** This was a historical surgical approach. It is rarely performed now because it carries a high risk of ischemic stroke and does not always close the fistula due to collateral flow. * **Option C (No treatment available):** This is incorrect. Untreated CCFs can lead to progressive vision loss, intracranial hemorrhage, and debilitating proptosis. * **Option D (Fistulectomy):** Direct surgical excision (fistulectomy) of a CCF is technically extremely difficult and hazardous due to the complex anatomy of the cavernous sinus and the risk of massive hemorrhage. **Clinical Pearls for NEET-PG:** * **Classic Triad:** Pulsatile exophthalmos (proptosis), conjunctival chemosis, and an orbital bruit. * **Gold Standard Investigation:** Digital Subtraction Angiography (DSA) is the definitive diagnostic tool to characterize the fistula. * **Classification:** The **Barrow Classification** divides CCFs into Types A (Direct), and B, C, D (Indirect/Dural). * **Treatment Goal:** To occlude the fistula while preserving the parent artery (ICA).

Q: The Seldinger needle is primarily used for which of the following procedures?

Arteriography. **Explanation:** The **Seldinger technique**, described by Sven-Ivar Seldinger in 1953, is the gold standard method for obtaining percutaneous access to hollow organs or blood vessels. The **Seldinger needle** is a hollow, large-bore needle used as the initial step to puncture a vessel (most commonly the femoral artery). Once blood flashback is observed, a guide wire is inserted through the needle, the needle is withdrawn, and a catheter is advanced over the wire. This makes it the fundamental tool for **Arteriography** and other endovascular procedures. **Analysis of Options:** * **B. Arteriography (Correct):** It is the primary application. The technique allows for safe, large-bore catheterization of arteries for diagnostic imaging or therapeutic interventions (like stenting). * **A. Suturing muscles:** Seldinger needles are rigid and hollow, designed for vascular access, not for passing suture material through muscular tissue. * **C. Pulmonary biopsy:** While some percutaneous biopsies use coaxial systems, a standard Seldinger needle is specifically designed for vascular entry, not for harvesting tissue cores from the lung. * **D. Lymphangiography:** This procedure typically requires direct surgical cut-down and cannulation of a lymphatic vessel using a very fine-gauge needle or cannula, as lymphatics are too small and low-pressure for the standard Seldinger technique. **High-Yield Clinical Pearls for NEET-PG:** * **Steps of Seldinger Technique:** Puncture → Guidewire insertion → Needle removal → Dilatation (optional) → Catheter insertion over the wire. * **Modified Seldinger Technique:** Uses a needle with a stylet (to prevent tissue plugging) or a "single-wall" puncture to reduce hematoma risk. * **Common Sites:** Common Femoral Artery (most common), Radial Artery, and Internal Jugular Vein (for Central Venous Lines). * **Complications:** Hematoma, pseudoaneurysm, and arterial dissection.

Q: TIPS refers to the creation of an anastomosis between which of the following?

Portal vein and hepatic vein. **Explanation:** **TIPS (Transjugular Intrahepatic Portosystemic Shunt)** is a high-yield interventional radiology procedure used primarily to treat complications of portal hypertension, such as refractory ascites and variceal bleeding. **Why Option C is Correct:** The procedure involves creating an artificial channel within the liver parenchyma that connects the **Portal Vein** (high-pressure system) to the **Hepatic Vein** (low-pressure system). By bypassing the congested liver sinusoidal bed, the portal venous pressure is effectively decompressed as blood flows directly into the systemic circulation via the Inferior Vena Cava (IVC). **Analysis of Incorrect Options:** * **Option A & D:** The **Hepatic Artery** supplies oxygenated blood to the liver. Connecting it to the portal or hepatic veins would create an arteriovenous fistula, which does not address portal hypertension and could lead to high-output heart failure. * **Option B:** While the goal is to reach the systemic circulation, the shunt is anatomically created between the portal vein and the hepatic vein (usually the right hepatic vein). A direct portal vein to **IVC** shunt is a surgical procedure (Portacaval shunt), not the standard radiologic TIPS. **NEET-PG High-Yield Pearls:** * **Access Route:** Internal Jugular Vein (usually the right side) → Superior Vena Cava → Right Atrium → IVC → Hepatic Vein. * **Indications:** Refractory variceal bleeding (most common), refractory ascites, and Budd-Chiari syndrome. * **Contraindications:** Severe congestive heart failure (due to sudden increase in venous return), severe pulmonary hypertension, and multiple hepatic cysts. * **Major Complication:** **Hepatic Encephalopathy** (due to nitrogenous wastes bypassing liver detoxification) and shunt stenosis.

Q: All of the following are absolute contraindications to uterine artery embolization except?

Age of patient >= 50 years. **Explanation:** Uterine Artery Embolization (UAE) is a minimally invasive procedure primarily used for the management of symptomatic uterine fibroids and adenomyosis. Understanding the contraindications is high-yield for NEET-PG. **Why Option D is the Correct Answer:** **Age ≥ 50 years** is **not** a contraindication. While UAE is often preferred by women wishing to preserve their uterus or avoid major surgery in their 30s and 40s, there is no upper age limit for the procedure. In perimenopausal women (around age 50), UAE can effectively bridge the gap to natural menopause by resolving symptoms like menorrhagia. **Analysis of Incorrect Options (Absolute Contraindications):** * **A. Pregnancy:** UAE is strictly contraindicated as it can lead to placental insufficiency, fetal growth restriction, or fetal demise due to compromised uterine blood flow. * **B. Uterine Infection:** Active pelvic inflammatory disease (PID) or uterine sepsis is an absolute contraindication. Embolizing an infected organ can lead to abscess formation, necrosis, and septic shock. * **C. Endometrial Cancer:** UAE is contraindicated in the presence of suspected or confirmed gynecological malignancy (endometrial, cervical, or uterine sarcoma). These conditions require definitive surgical staging and oncological management; embolization may delay diagnosis or mask symptoms. **Clinical Pearls for NEET-PG:** * **Most common indication:** Symptomatic uterine fibroids (Leiomyomas). * **Agent of choice:** Polyvinyl Alcohol (PVA) particles or Tris-acryl gelatin microspheres. * **Post-Embolization Syndrome:** The most common complication, characterized by pain, low-grade fever, nausea, and leukocytosis (managed conservatively). * **Relative Contraindications:** Renal insufficiency (due to contrast), uncorrected coagulopathy, and prior pelvic radiation.

Q: Which of the following is an embolization agent?

All of the above. **Explanation:** Embolization is an interventional radiology procedure where substances are introduced into the circulatory system to deliberately occlude a blood vessel. This is used to stop hemorrhage, devascularize tumors, or treat aneurysms and arteriovenous malformations (AVMs). The correct answer is **D (All of the above)** because embolization agents are classified based on their duration of action, and all three options represent different categories: 1. **Gelfoam (Absorbable Gelatin Sponge):** A **temporary** particulate agent. It provides occlusion for roughly 2 to 6 weeks before being resorbed. It is commonly used in trauma or preoperative embolization where permanent occlusion is not required. 2. **Polyvinyl Alcohol (PVA):** A **permanent** particulate agent. These non-absorbable particles cause inflammatory endarteritis leading to permanent vascular occlusion. They are frequently used for uterine artery embolization (fibroids) and bronchial artery embolization. 3. **Autologous Blood Clot:** A **temporary** agent (the shortest acting). While rarely used today due to rapid lysis (within hours), it was historically the first embolic agent used. **High-Yield Facts for NEET-PG:** * **Classification by Duration:** * *Temporary:* Gelfoam, Autologous blood clot, Oxidized cellulose. * *Permanent:* PVA, Coils (mechanical), Glue (Cyanoacrylate), Onyx (Ethylene vinyl alcohol copolymer), Absolute Alcohol (Sclerosant). * **Absolute Alcohol:** Considered the most potent and permanent embolic agent; it causes immediate protein denaturation and capillary bed destruction. * **Coils:** Best for high-flow vessels (e.g., aneurysms) to induce mechanical thrombosis. * **Onyx:** A liquid embolic agent often used in the treatment of brain AVMs because it solidifies slowly, allowing for controlled delivery.

Q: Percutaneous vertebroplasty is indicated in all except:

Tuberculosis. **Explanation:** Percutaneous Vertebroplasty (PVP) is a minimally invasive procedure involving the injection of bone cement (Polymethylmethacrylate - PMMA) into a vertebral body to provide structural stability and pain relief. **Why Tuberculosis is the Correct Answer (Contraindication):** Active infection, such as **Tuberculous spondylitis (Pott’s spine)** or pyogenic osteomyelitis, is an **absolute contraindication** for vertebroplasty. Injecting foreign material like PMMA into an infected site can exacerbate the infection, prevent effective antibiotic penetration, and lead to the formation of a persistent nidus for bacteria/mycobacteria. Surgical debridement and antitubercular therapy (ATT) are the mainstays of treatment for TB. **Analysis of Incorrect Options (Indications):** * **Osteoporosis:** The most common indication. It is used for painful osteoporotic vertebral compression fractures (VCFs) that do not respond to conservative management. * **Metastasis:** Indicated for painful osteolytic lesions or multiple myeloma to prevent pathological fractures and provide rapid pain relief. * **Hemangioma:** Specifically indicated for symptomatic aggressive vertebral hemangiomas that cause debilitating pain or risk of collapse. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindications:** Active systemic or local infection, uncorrected coagulopathy, and asymptomatic fractures. * **Relative Contraindication:** Retropulsion of a bone fragment into the spinal canal (risk of cord compression). * **Kyphoplasty vs. Vertebroplasty:** Kyphoplasty involves inflating a balloon first to restore vertebral height before injecting cement, whereas vertebroplasty is a high-pressure injection without height restoration. * **Most common complication:** Cement leakage (usually asymptomatic, but can cause pulmonary embolism or nerve root compression).

Q: In cerebral angiography, through which artery is the dye typically injected?

Femoral artery. **Explanation:** In modern interventional radiology, the **Femoral artery** (specifically the Common Femoral Artery) is the gold-standard access point for cerebral angiography via the **Seldinger technique**. This is because the femoral artery is a large-caliber, superficial vessel that is easily compressible against the femoral head for hemostasis. It provides a relatively straight and wide anatomical pathway through the aorta to the carotid and vertebral arteries, allowing for the easy manipulation of large catheters and neuro-interventional devices. **Analysis of Incorrect Options:** * **Brachial and Axillary Arteries:** These were used historically but are now largely avoided due to a higher risk of complications, including hematomas that can cause permanent nerve damage (brachial plexus injury) and a higher incidence of vasospasm. * **Radial Artery:** While the "Transradial Approach" (TRA) is rapidly gaining popularity for both cardiac and cerebral angiograms due to lower bleeding risks and earlier patient mobilization, the **Femoral artery** remains the "typical" or conventional answer for examinations unless "radial" is specified as the preferred modern alternative. **High-Yield Clinical Pearls for NEET-PG:** * **The Seldinger Technique:** The universal method for vascular access (Needle → Guide wire → Dilator/Sheath → Catheter). * **Puncture Site:** The femoral artery should be punctured below the inguinal ligament to prevent **retroperitoneal hemorrhage**, a life-threatening complication where bleeding occurs into the pelvic cavity. * **Gold Standard:** Digital Subtraction Angiography (DSA) via femoral access remains the gold standard for diagnosing intracranial aneurysms and Arteriovenous Malformations (AVMs).

Question 1

What is an early complication of TIPS procedures?

Accepted Answer

Capsule rupture and bleeding

Answer

Hepatic encephalopathy

Answer

Stenosis of the shunt

Answer

Thrombosis of the shunt

Question 2

Which of the following is NOT a material used for therapeutic embolisation?

Accepted Answer

Omentum

Answer

Blood clot

Answer

Ethyl alcohol

Answer

Wool

Question 3

What is the most commonly employed treatment for carotid-cavernous fistula nowadays?

Accepted Answer

Ballon embolization

Answer

Ligation of internal artery

Answer

No treatment available

Answer

Fistulectomy

Question 4

The Seldinger needle is primarily used for which of the following procedures?

Accepted Answer

Arteriography

Answer

Suturing muscles

Answer

Pulmonary biopsy

Answer

Lymphangiography

Question 5

TIPS refers to the creation of an anastomosis between which of the following?

Accepted Answer

Portal vein and hepatic vein

Answer

Portal vein and hepatic artery

Answer

Portal vein and IVC

Answer

Hepatic vein and hepatic artery

Question 6

All of the following are absolute contraindications to uterine artery embolization except?

Accepted Answer

Age of patient >= 50 years

Answer

Pregnancy

Answer

Uterine infection

Answer

Endometrial cancer

Question 7

Which of the following is an embolization agent?

Accepted Answer

All of the above

Answer

Gelfoam

Answer

Polyvinyl alcohol (PVA)

Answer

Autologous blood clot

Question 8

Which artery is dissected most frequently following arteriography by the femoral route?

Accepted Answer

Inferior mesenteric artery

Answer

Celiac trunk

Answer

Superior mesenteric artery

Answer

Gastroduodenal artery

Question 9

Percutaneous vertebroplasty is indicated in all except:

Accepted Answer

Tuberculosis

Answer

Metastasis

Answer

Osteoporosis

Answer

Hemangioma

Question 10

In cerebral angiography, through which artery is the dye typically injected?

Accepted Answer

Femoral artery

Answer

Brachial artery

Answer

Axillary artery

Answer

Radial artery

Interventional Radiology — MCQs

Interventional Radiology — MCQs

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