Vascular Interventional Radiology: Angioplasty, Stenting, Thrombolysis and Thrombectomy PDF
Preview Vascular Interventional Radiology: Angioplasty, Stenting, Thrombolysis and Thrombectomy
Contents I MEDICAL RADIOLOGY Diagnostic Imaging Editors: A. L. Baert, Leuven M. Knauth, Göttingen K. Sartor, Heidelberg Contents III Mark G. Cowling (Ed.) Vascular Interventional Radiology Angioplasty, Stenting, Thrombolysis and Thrombectomy With Contributions by J. R. Asquith · A.-M. Belli · J. P. Bolduc · G. Canevet · N. Chalmers · M. G. Cowling C. Cron · C. Dambrin · M. R. E. Dean · R. Jackson · F. Joffre · V. Lannareix · B. Marcheix M. Matson · R. G. McWilliams · R. S. Morgan · A. Mugniot · G. Munneke · M. Murphy A. A. Nicholson · P. Otal · V. Prabhudesai · J. A. Reekers · J. Rose · H. Rousseau · G. Tepe S. M. Thomas · D. R. Turner · R. D. Wells · D. J. West Foreword by A. L. Baert With 56 Figures in 145 Separate Illustrations, 11 in Color and 12 Tables 123 IV Contents Mark G. Cowling, MD Radiology Department University Hospital of North Staffordshire Rusell Building, City Central Newcastle Road Stoke-on-Trent Staffordshire, ST4 6QG UK Medical Radiology · Diagnostic Imaging and Radiation Oncology Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Knauth · M. Molls · K. Sartor Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology Library of Congress Control Number: 2005932863 ISBN 3-540-22259-6 Springer Berlin Heidelberg New York ISBN 978-3-540-22259-0 Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi - cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is part of Springer Science+Business Media http//www.springer.com (cid:164) Springer-Verlag Berlin Heidelberg 2007 Printed in Germany The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature. Medical Editor: Dr. Ute Heilmann, Heidelberg Desk Editor: Ursula N. Davis, Heidelberg Production Editor: Kurt Teichmann, Mauer Cover-Design and Typesetting: Verlagsservice Teichmann, Mauer Printed on acid-free paper – 21/3151xq – 5 4 3 2 1 0 Contents V For Lynn, Thomas Oliver and Contents VII Foreword Endovascular therapy is now largely recognized as a major advance in modern medicine. Seldinger’s revolutionary non-invasive percutaneous approach to the vascular system opened up a totally new medical fi eld. Innumerable new technical methods, newly designed catheters, sophisticated new endovascular devices and novel materials have been developed during the past decades. Radiologists have played a major role in laboratory research as well as in the application of endovascular therapy in the clinical environment. Interventional radiology has thus contributed enormously to strength- ening the position of the radiologist as a member of the clinical team responsible for the management of patients in our modern hospitals. A volume presenting the current knowledge in this expanding fi eld was therefore sorely needed in the Medical Radiol- ogy series. The editor, M. G. Cowling, is a leading expert in vascular interventional therapy with long personal experience. He was able to obtain the collaboration of many other internationally renowned vascular radiologists. I would like to thank him for his re- lentless efforts to coordinate the different contributions and to fi nalize this volume on schedule. The editor and the authors are to be congratulated for this well-written and ex- haustive volume offering the latest insights and evidence on vascular interventional therapy. This outstanding volume will certainly meet with keen interest from interventional radiologists and vascular surgeons. They and their patients will greatly benefi t from its contents. Referring physicians may also fi nd this book very useful for learning more about the indications, possibilities and limitations of non-invasive vascular treatment. I am confi dent that it will encounter the same success with readers as the previous volumes published in this series. Leuven Albert L. Baert Contents IX Preface Vascular Interventional Radiology, or endovascular therapy as it is becoming increas- ingly known, continues to develop rapidly. As our patients survive longer because of advances in treatment in other areas, such as coronary artery disease, peripheral vascu- lar disease is becoming an increasingly common problem. In addition, those requiring treatment are increasingly likely to be elderly. They are less able to tolerate open surgical procedures, and will therefore often benefi t immensely from minimally invasive vascu- lar procedures. Although in some countries the prevalence of smoking appears to be reducing in response to public health measures, other risk factors such as hypertension and hyper- lipidaemia remain common. In addition, the incidence of diabetes is actually increasing, probably in association with obesity. Therefore, for the foreseeable future, peripheral vascular disease will remain an important phenomenon. Increasingly it is possible to diagnose peripheral vascular problems non-invasively using Doppler ultrasound, Computerised Tomographic angiography and Magnetic Resonance angiography. These techniques serve to further lower the risk involved in managing these patients, as well as potentially reducing cost. There are also signifi cant advances in management of venous disorders, such as en- dovenous laser therapy for varicose veins, showing that Interventional Radiologists have skills that can be applied ever more widely to assist in the management of important clinical problems. This volume aims to provide up to date evidence on both established and developing techniques. It is only with such information that practitioners can en- courage their more widespread use. I would like to thank all of the authors who have contributed to this volume. In addi- tion, my secretary Mrs Sue Dudley who has provided immense support. Springer-Verlag, and in particular Ms Ursula Davis, have provided all necessary support, and I would also like to thank Prof Baert for entrusting me with this project. Staffordshire Mark G. Cowling Contents XI Contents 1 The Aetiology of Vascular Disease R. David Wells and Mark G. Cowling . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Assessment of Peripheral Vascular Disease Mark G. Cowling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3 Equipment and Environment Vikramaditya Prabhudesai . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 4 Consent Michael R. E. Dean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 5 Sites of Arterial Access and the Role of Closure Devices in Percutaneous Arterial Intervention Nicholas Chalmers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 6 Aortoiliac Intervention Anthony A. Nicholson. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 7 Femoropopliteal Arterial Intervention Gunnar Tepe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 8 Crural Arterial Interventions J. A. Reekers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 9 Thrombolysis, Mechanical Thrombectomy and Percutaneous Aspiration Thrombectomy Graham Munneke, Robert Morgan, and Anna-Maria Belli. . . . . . . . . . . 59 10 Upper Limb Arterial Intervention Douglas R. Turner and Steven M. Thomas . . . . . . . . . . . . . . . . . . . . . . 71 11 Management of Renal and Visceral Arterial Stenoses Mark G. Cowling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 12 Endovascular Abdominal Aortic Aneurysm Repair Richard G. McWilliams and M. Murphy. . . . . . . . . . . . . . . . . . . . . . . . 91 XII Contents 13 Endovascular Repair of Thoracic Aortic Aneurysms H. Rousseau, J. P. Bolduc, C. Dambrin, B. Marcheix, G. Canevet, V. Lannareix, C. Cron, A. Mugniot, P. Otal, and F. Joffre . . . . . . . . . . . . . 101 14 Endovascular Repair of Iliac, Visceral and False Aneurysms Ralph Jackson and John Rose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 15 Dialysis Access Management John R. Asquith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 16 Management of Venous Stenoses John R. Asquith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 17 Inferior Vena Caval Filters Matthew Matson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 18 Management of Venous Insuffi ciency David J. West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 The Aetiology of Vascular Disease 1 1 The Aetiology of Vascular Disease R. David Wells and Mark G. Cowling CONTENTS 1.2 Normal Arterial 1.1 Introduction 1 1.2 Normal Arterial 1 The arterial system consists of three basic types of 1.3 The Aetiology and Pathophysiology of Atherosclerosis 2 vessel: 1.3.1 The Development of the Atherosclerotic Plaque 2 1. The large elastic vessels, in the thoracic, abdomi- 1.3.1.1 The Endothelium and Endothelial Dysfunction 2 nal aorta and the iliac arteries. With their elastic- 1.3.1.2 Inflammatory Response 2 ity they aid the maintenance of the diastolic blood 1.3.1.3 Role of Smooth Muscle Cells 3 pressure. 1.3.1.4 Compensatory Vascular Remodelling 3 1.3.1.5 Unstable Plaques 3 2. Medium sized muscular arteries, including the 1.3.1.6 Thrombosis 3 superfi cial femoral and brachial arteries as well 1.3.1.7 Summary of Stages of Development of the as visceral branches, which distribute blood to the Atherosclerotic Plaque 3 capillary beds. 1.4 The Aetiology of Arterial Aneurysms 3 3. The smaller arterioles that modulate vascular 1.5 Fibromuscular Dysplasia 4 1.5.1 Background 4 tone and themselves have a large role in the regu- 1.5.2 Types 4 lation of systemic blood pressure and the delivery 1.5.3 Aetiology 5 of oxygen and nutrients to the tissues. 1.6 Conclusion 5 References 5 Arterial anatomy is well described and consists of three basic layers; the tunica intima, tunica media and tunica adventitia. The intima is the internal 1.1 layer of the artery and is formed from a single layer Introduction of mesenchymal endothelial cells, basement mem- brane and internal elastic lamina loosely attached to The vast majority of vascular disease that concerns the media by supportive connective tissue. Endothe- interventional radiologists in the western world lial cells have a complex role in the homeostasis of involves atherosclerosis, aneurysmal disease and the vascular tree and adjacent flowing blood secret- fibromuscular dysplasia and as such this chapter ing enzymes, growth factors, immunoglobulins and concentrates mainly on these processes. Before dis- anticoagulants depending on the vascular bed they cussing these pathological processes, the normal serve. arterial structure will be briefly described. Other The media is the thickest layer of the arterial wall vascular disorders such as vasculitis, popliteal and consists mainly of elastic fibres and smooth entrapment, cystic adventitial disease and Raynaud’s muscle cells containing actin and myocin filaments phenomenon are currently not amenable to treat- which contract to varying degrees; hence the ability ment with interventional radiological techniques, to modulate the arterial vascular tone. Pathologi- and are therefore omitted from this chapter. cally the smooth muscle element of the media has a large role to play in the development of the athero- sclerotic plaque. R. D. Wells, MD The adventitia comprises of loose connective Consultant Radiologist, Mid Staffordshire Hospital NHS Trust, tissue, lymphatics and its own nutrient arterial Newcastle Road, Stoke-on-Trent, ST4 6QG, UK M. G. Cowling, MD supply known as the vasa vasorum. University Hospital of North Staffordshire NHS Trust, The arterial system can also be conveniently clas- Newcastle Road, Stoke-on-Trent, ST4 6QG, UK sified into the particular vascular territories they
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