A practical and systematic approach to current endovascular surgical techniques
An increasingly popular alternative to open vascular surgery, endovascular intervention offers many advantages, including reduced patient discomfort, smaller incisions, shorter recovery time, and decreased risk of adverse complications. Practitioners and trainees alike require expert guidance on current technologies and up-to-date techniques. Endovascular Interventions provides clinicians with an easy-to-follow guide for minimally invasive treatment of vascular disease. This invaluable resource delivers concise and accurate instructions on a wide range of endovascular interventions, including aorta, renal and mesenteric interventions, lower extremity interventions, venous interventions, and supra-aortic interventions in high-risk patients.
Sequential phases of skill development broaden the reader’s abilities as they progress through each chapter, supplying step-by-step instructions on when each procedure should be used and how it can be safely and effectively performed. This book offers a complete reference to essential techniques and procedures, suitable for both novice and experienced vascular surgeons, cardiologists, and radiologists. Endovascular Interventions also: - Reinforces comprehension of each procedure with templated chapters, equipment lists and boxed key learning points - Provides full-color clinical images and detailed illustrations to demonstrate surgical procedures - Presents authoritative coverage of modern endovascular technologies and techniques - Written by a team of respected experts and practicing surgeons from internationally recognized hospitals and universities
Suitable for varying skill levels, Endovascular Interventions is a precise, accessible instruction manual for safe and effective endovascular intervention, helping practicing clinicians sharpen their existing abilities and keep pace with the latest surgical technologies while instructing trainees on this innovative approach to vascular surgery.
Table of Contents
List of Contributors xiv
1 Innominate & Carotid Artery Intervention in High- Risk Patients 1
Tyrone J. Collins
Introduction 1
Innominate Interventions in High-Risk Patients 2
Catheter-based Therapy for An Innominate (Brachiocephalic) Stenosis 2
Carotid Artery Intervention in High-Risk Patients 5
Endovascular Treatment of A Carotid Stenosis 5
Catheter-based Therapy for Carotid Stenosis 6
Conclusions 10
References 13
2 Subclavian Artery Intervention: Catheter- Based Therapy 15
Saadat Shariff, Isabella Alviz, Cornelia Rivera, Michelle Cortorreal, and Tyrone J. Collins
Introduction 15
Endovascular Versus Open Surgical Revascularization 16
Endovascular Revascularization Techniques 16
Conclusion 18
References 19
3 Vertebral Artery Intervention: Catheter- Based Therapy 20
Tamunoinemi Bob- Manuel and James S. Jenkins
Introduction 20
Preprocedural Considerations 21
Step 1. Procedural Planning with Diagnostic Angiography 21
Step 2. Vertebral Artery Intervention (Percutaneous Transluminal Angioplasty) 24
Step 3. Vertebral Artery Intervention (Stenting) 25
Management of Potential Complications 27
Postprocedural Care 28
References 29
4 Endovascular Repair of Thoracic Aortic Aneurysms: Catheter-Based Therapy 30
John Denesopolis, Patricia Yau, and Aksim G. Rivera
Introduction 30
Relevant Anatomy 31
Aortic Anatomy 31
Crawford Classification for TAA/TAAA 31
Landing Zones 31
Implication of Aortic Anatomy on Spinal Perfusion 32
Indications/Contraindications to Procedure 33
Indications 33
Asymptomatic TAA/TAAA 33
Blunt Aortic Injury (BAI) 33
Acute Aortic Syndromes 33
Contraindications/Caveats 34
Available Endografts 34
Preoperative Evaluation 40
Positioning and Intraoperative Monitoring Needs 41
Procedural Steps 42
Postoperative Course/Surveillance 46
Monitored Setting 46
Spinal Drain 46
Blood Pressure Control 47
Arm Ischemia Symptoms 47
CTA Surveillance/Endoleak Types 48
References 49
5 Endovascular Abdominal Aortic Aneurysm Repair (EVAR) 50
John Futchko, Katie MacCallum, and Aksim G. Rivera
Introduction 50
Patient Selection 50
Preoperative Imaging and Measurements 51
Graft Selection 52
Graft Sizing 52
Neck Length 53
Neck Diameter 53
Branch Vessels 54
Aortic Length Measurements 54
Step 1. Vascular Access 55
Percutaneous 55
Open 56
Iliac Disease and Conduits 56
Step 2. Imaging 57
Equipment 57
Neck Angulation 58
Renal Arteries 58
Step 3. Wires 58
Step 4. Delivery and Deployment 59
Main Body 59
Graft Orientation 59
Proximal Landing Zone 59
Contralateral Gate Cannulation 60
Limb Deployment 62
Completion Angiogram 62
Step 5. Troubleshooting 63
Endoleaks 63
Inadvertent Coverage of Renal Arteries 65
Iliac Artery Considerations 65
Conclusion 66
References 66
6 Severe Renal Artery Stenosis: How to Intervene 68
Mohammad Hashim Mustehsan, Cristina Sanina, and Jose D. Tafur
Introduction 68
Background and Clinical Significance 69
Epidemiology 69
Clinical Manifestations 69
Patient Selection: Who to Screen for RAS 70
RAS Assessment 70
Noninvasive RAS Assessment 70
Invasive RAS Assessment 72
Indications for Revascularization 72
Intervention 74
References 76
7 Mesenteric Ischemia: Chronic and Acute Management 78
David A. Hirschl
Introduction 78
Chronic Mesenteric Ischemia 78
Step 1. Vascular Access and Sheath Selection 79
Step 2. Diagnostic Angiography 80
Step 3. Vessel Selection 81
Step 4. Selective Angiography 81
Step 5. Placement of a Working Wire 82
Step 6. Stent Placement 82
Step 7. Posttreatment Angiography 83
Step 8. Revision 83
Complications 84
Follow-Up and Outcomes 85
Acute Mesenteric Ischemia 85
Step 1. Arterial Vascular Access and Sheath Selection 87
Step 2. Selection of the SMA 87
Step 3. Aspiration Embolectomy 88
Step 4. Angiogram 89
Step 5. Thrombolysis 89
Step 6. Infusion and Follow-Up 91
Mesenteric Venous Thrombosis 91
Follow-Up and Outcomes 91
References 92
8 Aorto- Iliac Interventions 95
Michael S. Segal, Sameh Elrabie, and Rajesh K. Malik
Introduction 95
Preoperative Workup 95
Noninvasive Studies 96
Computed Tomographic Angiography 96
Ultrasound Duplex 96
Magnetic Resonance Angiography 97
Invasive Imaging 97
Angiography 97
Classification of Lesion and Planning of Intervention 97
TransAtlantic InterSociety Consensus II Classification (TASC II) 97
Planning for the Intervention 97
Step 1. Patient Factors 97
Step 2. Vascular Access 98
Step 3. Crossing the Lesion 99
Step 4. Intervention 100
Step 5. Closure 102
Step 6. Complications 103
Rupture 103
Embolization 103
Access Complications 103
Cases 104
Case 1 104
Case 2 104
References 107
9 Femoropopliteal Arterial Interventions in the Claudicant 108
Sahil A. Parikh, Joseph J. Ingrassia, and Matthew T. Finn
Introduction 108
Patient Evaluation and Indications for Treatment of Femoropopliteal Arterial Pathology 108
Indications for Revascularization Femoropopliteal Claudication 109
Vascular Imaging in Endovascular Treatment 109
Contrast Angiography 109
CO2 Angiography 110
Steps to CO2 Angiography 110
Extravascular and Intravascular Ultrasound 110
Steps to IVUS Use 111
Vascular Access and Lesion Crossing Techniques 113
Steps for Crossover “Up and Over” technique 113
Radial 114
Tibio-Pedal Approach 115
Antegrade Femoral Access 115
Working Wire Size and Changing Between Systems 116
Lesion Preparation 117
Plain Old Balloon Angioplasty 117
Focal Force Balloons for Optimal Lumen Gain 120
Drug-Coated Balloons 120
Atherectomy 121
Laser 121
Excimer Laser Use Steps 122
Rotational Atherectomy 123
Rotational Atherectomy Steps 124
Directional Atherectomy 124
Orbital Atherectomy 126
Embolic Protection 127
Troubleshooting Embolic Protection Devices 130
Troubleshooting a “Full” Filter 130
Distal Embolization or “No Reflow” 130
Stenting for Femoropopliteal Disease 131
Bare-Metal Stents 131
Drug-Eluting Stents (DES) 131
Alternative Stent Technologies 132
Covered Stents 132
Tacks 132
Final Efficacy Assessment 132
Conclusions 132
Acknowledgments 133
References 133
10 Tibial Interventions in Patients with Critical Limb- Threatening Ischemia 138
Raman Sharma, Roberto Cerrud- Rodriguez, and Prakash Krishnan
Introduction 138
Indications and Goals of Endovascular Revascularization 138
Considerations for Access Site 139
Single Versus Multitibial Artery Revascularization 140
Antegrade Tibial Artery Intervention 141
Retrograde Access for Retrograde Lesion Crossing and Wire Externalization with Antegrade Revascularization 143
TAMI Retrograde Revascularization 144
Reentry and Externalization Devices 146
Deep Venous Arterialization (DVA) 146
References 147
11 Acute Limb Ischemia: Endovascular Approach 151
Shunsuke Aoi and Amit M. Kakkar
Introduction 151
Procedure Planning, Equipment, and Considerations 151
References 161
12 Pedal Reconstruction 162
Ehrin Armstrong and Rory Brinker
Introduction 162
Pedal Arch Reconstruction 162
Indications for Pedal Revascularization 166
Technical Considerations 166
Access 166
Lesion Crossing 167
CTO Lesion Subtype 167
Special Considerations of the Pedal Intervention 167
Troubleshooting 169
Summary 169
References 173
13 Endovascular Management of Access Site Complications 175
Manaf Assafin, Robert Pyo, Pedro Cox- Alomar, and Miguel Alvarez- Villela
Introduction 175
Complications Related to Common Femoral Artery Access 176
Access Site Bleeding 176
Crossover Technique 179
Balloon Tamponade, Endovascular Coiling, and Covered Stent Placement 179
Femoral Pseudoaneurysms 180
Ultrasound-Guided Compression Repair 182
Ultrasound-Guided Thrombin Injection 183
Covered Stent Placement 184
Other Techniques 184
Arteriovenous Fistulas 185
Vascular Closure Device Related Complications 186
Radial Artery Related Complications 187
Radial Artery Spasm 188
Radial Artery Occlusion 189
Bleeding Complications 190
References 191
14 Acute Deep Vein Thrombosis 196
Vishal Kapur and Sagar Goyal
Introduction 196
Treatment Strategy 197
Initial and Long-Term Treatment of VTE 200
Oral Anticoagulants 200
Thrombolysis 200
Vena Cava Filters 201
Compression Stockings 202
Cancer-Associated VTE 202
Isolated Distal DVT 202
Extended Treatment 202
Unprovoked VTE 202
Oral Anticoagulants 203
Conclusion 203
References 204
15 Lower- Extremity Venous Stenting 207
Asma Khaliq, Sandrine Labrune, and Cristina Sanina
Introduction 207
Follow-Up 213
References 214
16 Intervention for Pulmonary Embolism 215
Seth I. Sokol, Wissam A. Jaber, and Yosef Golowa
Introduction 215
Pulmonary Angiography 215
Vascular Access 215
Injection and X-Ray Detector Positioning 216
Catheter-Directed Thrombolysis 216
EKOS™ Catheter-Directed Thrombolysis 216
Preparation of System 217
Access 218
Mechanical Disruption 220
Catheter Fragmentation of Clot 220
Large Catheter Aspiration 220
FlowTriever™ 220
Access 221
Penumbra 225
AngioVac 227
Patient Selection and Central Venous Access 227
AngioVac Circuit Setup and Thrombus Aspiration 229
AngioVac for Pulmonary Embolus 231
AngioVac for Clot-in-Transit 232
AngioVac for Right Heart Vegetation 232
Patient Selection and Approach 232
Technique 233
References 234
17 Catheter- Based Therapy for Varicose Veins 236
Juan Terre and Nelson Chavarria
Introduction 236
Thermal Techniques 236
Radiofrequency (RF) Ablation 237
Follow-Up 239
Endovenous Laser Ablation (EVLA) 239
Nonthermal Techniques 240
Mechanico-Chemical Ablation (MOCA) 241
Limitations 242
Summary 243
References 243
Index 245
