Endovascular Skills-Guidewire and Catheter Skills for Endovascular Surgery, Fourth Edition PDF
Preview Endovascular Skills-Guidewire and Catheter Skills for Endovascular Surgery, Fourth Edition
Endovascular Skills Guidewire and Catheter Skills for Endovascular Surgery Fourth Edition Endovascular Skills Guidewire and Catheter Skills for Endovascular Surgery Fourth Edition Peter A. Schneider Division of Vascular and Endovascular Surgery University of California, San Francisco San Francisco, California, USA CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2020 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper International Standard Book Number-13: 978-1-4822-1737-7 (Hardback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Contents Preface to the Fourth Edition xiii Abbreviations xv PArt I CAtHEtEr AND GUIDEWIrE SKILLS 1 1 Case preparation 3 Endovascular skills in practice 3 Reinvention of vascular care 3 Setting yourself up for success 3 Sizing up the case 4 Prior to the puncture 4 Working environment 4 Equipment 5 Facilities and room setup 5 How pretreatment history and physical examination help to plan therapy 6 Pretreatment imaging 6 2 Safe and strategic vascular access 7 Overview of percutaneous access 7 Choosing your approach 8 Femoral anatomy for arterial access 9 Puncture guidance with ultrasound 10 Micropuncture technique 12 Percutaneous retrograde puncture of the femoral artery 13 Percutaneous antegrade puncture of the femoral artery 17 Percutaneous puncture of a pulseless femoral artery 19 Proximal access 21 Percutaneous puncture of the brachial artery 21 Alternative access to the lower extremity: Superficial femoral, popliteal, tibial, and pedal arteries 23 Percutaneous puncture of bypass grafts 23 Puncture site complications 24 Summary of puncture site options and closure strategy 24 3 Sheath access 27 Introduction 27 Basic access site step-by-step 27 Initial maneuvers to secure the access 28 v vi Contents How do you place a sheath? 28 When is a dilator needed? 30 Basic sizing issues 32 When to use fluoroscopy 32 About access sheaths 33 How do you decide when to place a larger access sheath? 33 When to abandon an access 33 Access in a hostile groin 34 4 Guidewire skills 35 Introduction 35 Mastering guidewires 35 What makes guidewires different from each other 36 Guidewire types in practice 38 When to abandon the chosen guidewire 43 Useful guidewire techniques to start tackling chronic total occlusion 44 Organizing your guidewires 46 5 Small platform guidewires and monorail systems 47 Development of small platform guidewires and monorail systems 47 How do monorail systems differ from coaxial systems? 47 What are the advantages and disadvantages of monorail systems? 49 Principles for the use of rapid exchange systems 49 Which platform is best for each task? 50 Which platform should you start the case with, and when should you switch from one platform to another? 50 Maneuvers you can undertake with 0.14-inch and 0.18-inch guidewires 51 6 Handling catheters 53 Introduction to catheters: Exchange, flush, and selective catheters 53 Which angiographic catheter should you use? 53 Catheter head shape determines function 54 Describing catheter behavior 58 Handling catheters 58 7 Guidewire and catheter passage 63 The goal of the procedure determines the course of the guidewire–catheter apparatus 63 Guidewire and catheter combinations 65 Where does the guidewire naturally want to go? 65 Passing through diseased arteries 66 Negotiating tortuous arteries 67 Remote puncture site 69 How to change the plan if the catheter will not pass and you have tried everything 70 How do you decide if disease encountered on the pathway to treat the target lesion also needs to be treated? 71 8 Imaging: The key to success 77 Imaging and best therapy are intricately linked 77 Image quality 77 Generating an X-ray image 78 Digital subtraction arteriography 79 Imaging technique for best resolution 80 Road mapping: How it works and when to use it 81 Automated power injector 82 Power injection versus contrast administration by hand 83 Contrast agents 84 Contents vii How do you know where you are? 85 Radiation safety and occupational health issues 86 Radiographic equipment 86 Radiographic terms 86 Radiation exposure 87 9 Selective catheterization 89 Many catheter choices but few basic shapes 89 Selective catheterization of the brachiocephalic arteries 91 Selective catheterization of the visceral and renal arteries 98 Selective catheterization of the aortoiliac arteries 100 Selective catheterization of the infrainguinal arteries 105 Selective catheterization of prosthetic bypass grafts 109 Aberrant anatomy to consider 111 10 Principles of arteriography 113 Arteriography is strategic, not diagnostic 113 The future of arteriography 113 Supplies for arteriography 114 Planning for strategic arteriography 114 Questions to consider before arteriography 115 Evaluation before angiography 115 Deciding where to puncture 116 Catheter placement 118 Contrast administration and image acquisition 119 Arteriography sequences 120 11 Arteriography of the vascular beds 123 Arteriography of the brachiocephalic arteries 123 Thoracic aortography 126 Arteriography of the visceral and renal arteries 126 Arteriography of the infrarenal arteries 128 Lesion interrogation: Special views 134 Carbon dioxide arteriography 134 Pressure measurement 136 Arteriography of aneurysms 136 Intravascular ultrasound 137 PArt II ENDOVASCULAr tHErAPY 139 12 Endovascular workshop 141 Where we work determines what we can do 141 Operating room versus special procedures suite versus catheterization laboratory 141 Stationary versus portable imaging systems 142 The ideal vascular workshop 143 13 Medications for endovascular therapy 145 Sedation and analgesia 145 Local anesthetic 145 Prophylaxis with antibiotics 145 Anticoagulation 145 Heparin alternatives: Direct thrombin inhibitors 146 Antiplatelet agents 146 Thrombolysis 147 viii Contents Vasodilators 147 Contrast allergies 147 Practical advice for intraoperative problems 147 14 Access for endovascular therapy 149 Make access as simple as possible 149 Create a platform from which to work 150 Sizing considerations 150 What fits into what? 153 General principles of sheath placement during therapy 153 When to avoid using your initial access site for therapy 155 When do you use a guiding sheath versus a guiding catheter? 155 How do you know if the sheath is following the exchange wire? 158 Uses for upper extremity access 159 Sheath placement in remote branch arteries 159 15 Setting up the therapeutic maneuver: Crossing lesions 163 Introduction 163 Three types of lesions 163 Need for support and directionality 164 Crossing stenoses 164 16 Crossing challenging lesions 171 Arteriography of occluded arteries 171 Crossing occlusions 171 Tools for crossing occlusions 174 Subintimal angioplasty 176 Crossing occlusions in various vascular beds 178 When to approach from the other direction: Retrograde access 184 Crossing calcified lesions 186 Crossing really long lesions 186 What to do after the wire is across 187 Anatomic manipulations can assist in guidewire or device passage 188 17 Balloon angioplasty: Minimally invasive autologous revascularization 191 Balloon dilation causes dissection 191 About balloon catheters 192 The angioplasty procedure 193 Balloon selection 193 When to use a monorail system 195 Supplies for percutaneous balloon angioplasty 195 Sheath selection and placement 196 Balloon preparation and placement 197 Heparin administration during intervention 197 Balloon inflation 198 Balloon removal and completion arteriography 201 18 More about balloon angioplasty: Keeping out of trouble 205 Keeping out of trouble is simpler than getting out of trouble 205 What is the strategy for managing multiple lesions? 205 Which lesions should be predilated? 207 Which lesions are most likely to embolize? 208 What about postangioplasty dissection? 208 When to use kissing balloons 210 Pain during balloon angioplasty 210 What about spasm? 211 Contents ix Preventing puncture site thrombosis 212 Balloon angioplasty troubleshooting 213 Technique: Solving angioplasty problems 215 Management of arterial rupture 217 Management of embolization 218 Management of acute occlusion 219 Technical aspects of balloon angioplasty in different vascular beds 219 Assessing the acute results of balloon angioplasty 221 19 Stents, covered stents, stent–grafts 223 Impact of stents 223 Stent choices 223 Covered stents 225 Indications for stents: Primary or selective stent placement 226 Which lesions should be stented? 227 Residual stenosis after angioplasty 229 Placement technique for balloon-expandable stents 230 Placement technique for self-expanding stents 235 Placement technique for covered stents 237 Which stent for which lesion? 238 How to select the best stent for the job 241 Tricks of the trade 242 Acute complications of stent placement 252 Chronic complications of stent placement 253 20 Other devices and how to use them 255 Microcatheters 255 Re-entry catheters 256 Chronic total occlusion catheters and crossing catheters 257 Atherectomy 258 Laser 260 Drug-coated balloons and drug-eluting stents 261 Cutting, scoring, and cryoplasty balloons 262 Peripheral stent–grafts 265 Thrombectomy and thrombolysis 266 Distal embolic filters 269 PArt III tHErAPY IN SPECIFIC VASCULAr BEDS 273 21 Brachiocephalic interventions 275 Introduction 275 Arch assessment 275 Innominate and common carotid artery 275 Assessment of arch branch lesions 276 Principal techniques 277 Transfemoral approach to the common carotid artery 279 Carotid bifurcation stent placement 281 Open cell, closed cell, and mesh covered carotid stents 286 Distal and proximal protection devices for transfemoral carotid stenting 287 Transcervical approach to carotid stenting 288 Retrograde approach to the common carotid artery 292 The subclavian and axillary arteries 292
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