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J. PETER LANZER • ERIC TOPOL Pan Vascular Medicine Springer-Verlag Berlin Heidelberg GmbH J. PETER LANZER ERIC TOPOL P a nV ascular M e d i c i n e Integrated Clinical Management With 18oo Figures and 291 Tables Springer Editors PETER LANZER, MD Herz-Zentrum Coswig Klinik fiir Kardiologie und Angiologie Lerchenfeld 1 06869 Coswig (Anhalt) Germany J. ERIC TOPOL, MD The Cleveland Clinic Foundation One Clinic Center 9500 Euclid Avenue Cleveland, OH 44195 USA ISBN 978-3-642-62565-7 ISBN 978-3-642-56225-9 (eBook) DOI 10.1007/978-3-642-56225-9 Library of Congress Cataloging-in-Pub1ication Data The use of general descriptive names, registered names, trademarks, Panvascular medicine : integrated clinical management / P. Lanzer, E.J. etc. in this publication does not imply, even in the absence of a specific Topol (eds.) p.; cm. Includes bibliographical references and index. statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. 1. Blood-vesse1s--Diseases. I. Lanzer, P. (Peter), 1950- II. Topo1, Eric J., 1954- [DNLM: 1. Vascular Diseases. WG 500 P957 P2002] RC691.P75 Product liability: The publishers cannot guarantee the accuracy of any 2002 616.1'3--dc21 information about dosage and application contained in this book. In every individual case the user must check such information by consul This work is subject to copyright. AII rights are reserved, whether the ting the relevant literature. whole part of the material is concerned, specifically the rights of trans lation, reprinting, reuse of illustrations, recitation, broadcasting, repro Production editor: w. Bischoff, Heidelberg duction on microfilm or in any other way, and storage in data banks. Layout: W. Bischoff, Heidelberg Duplication of this publication or parts thereof is permitted only under Preparation of Index: Dr. C. Thieme the provision of the German Law of September 9, 1965, in its current Cover design: de'blik Konzept & Gestaltung, Berlin version, and permis sion for use must always be obtained from Sprin Data conversion and page make up: Fotosatzservice K6h1er GmbH, ger-Verlag. Violations are liable for prosecution under the German Wiirzburg Copyright Law. Reproduction of figures: Schneider Repro, Heidelberg; Fotosatzservice K6h1er GmbH, Wiirzburg Printed on acid-free paper SPIN: 10773728 22/3130 - 5 43 2 1 o http://www.springer.de/medicin © Springer-Verlag Berlin Heidelberg 2002 Originally published by Springer-Verlag Berlin Heidelberg New York in 2002. Softcover reprint of the hardcover 1s t edition 2002 Preface Vascular diseases are the leading cause of taken. First, interactive and permeable inter- morbidity and mortality in developed faces have replaced interdisciplinary nations. The numbers presented by the boundaries (Fig. 2). Second, vascular American Heart Association in the teams have supplanted soloist 2002 Heart and Stroke Statistical vascular specialists. The teams Update (www.americanheartorg) have been assembled based on are staggering. In 2000 an esti- the complementary character mated 22.iYo of US citizens of the vascular (vertical inte- suffered from at least one gration) and vascular-related cardiovascular disease (CVD); organ (horizontal integra- for nearly one million, the tion) expertise of individual CVD was deadly. Coronary members, allowing profes- artery disease accounted for sional handling of a compte- the largest share of deaths te spectrum of vascular (55%), with cerebrovascular diseases. Third, vascular- disease contributing an addi- and organ-based disciplines tiona! 17%. With 13 million have been integrated into pan- patients suffering from clinical vascular centers. coronary artery disease and This textbook provides a nearly 5 million patients from comprehensive state-of-the-art cerebrovascular disease, CVD mor- review of current vascular medicine. bidity was also high. Comparable num- Instead of following the traditional hers were reported for other industrial interdisciplinary divides, the vascular nations (www.cdc.gov/nccdphp/vd!international. system is viewed as a functional unity. To pro- htm; www.who.it/dsa/cat98/card8.htm). Figure 1 vide a balanced multidisciplinary perspective, individu- We are in the midst of an epidemic of obesity and dia- al vascular topics are reviewed in successive order by the betes; more than one in four Americans now fulfill the crite- respective organ, interventional, and surgical specialists. ria for obesity. Concurrently, physical activity continues to Due to the early stage of panvascular concept formation, decline markedly. At the outset of the 21st century the world certain redundancies and overlaps in the interdisciplinary is becoming a new place at a fast pace. Technical progress, review of individual topics could not be avoided. Attempts urbanization and improving living standards have become were not made to artificially graft or to implement integra- important perpetrators of vascular disease worldwide. In ted interdisciplinary perspectives if they were not a part of addition, lifestyles that promote vascular disease are now established science or clinical practice at the time of wri- also being spread with an unprecedented efficacy throug- ting. Furthermore, in the course of the production phase of hout the world (and this includes the low-income countries) this textbook, we have gained a better understanding of the by a simple push of an electronic button. If unchecked, the needs and requirements of structuring and directing the costs of vascular treatments will rapidly outpace the slowing multidisciplinary process, yet due to real life constraints and rates of economical growth and exhaust available resources. limitations they could only be implemented in part in this Current vascular medicine and care - fraught with edition. Nevertheless, the principle features of the panva- inconsistency and fragmentation - have failed to meet the scular concept have been maintained throughout the text- dual challenge of increasing vascular risk and mounting economic pressure. The unpromising state of vascular affairs has spurred the search for better forms of vascular Basic Vascular Sciences management. Closer links between organ specialties have been proposed by some, whereas expansion of individual vascular specialties has been practiced by others. However, Neurovascular Laboratory Surgery Neurology Vascular although these new concepts broadened the current appro Sciences ach to vascular medicine and care, in principle, they preser ved and even reinforced the organ-related approach in an OSprgeacnia lties Angiology increasingly unregulated environment. Radiology Panvascular medicine represents a new approach, pro Cardiology viding cohesive and comprehensive quality vascular care. Reflecting the systemic nature of vascular diseases, a vascu Cardiac Vascular lar field that is heterogeneous in character and torn apart by Surgery Surgery turf battles has been integrated into an all-inclusive vascular unity (Fig. 1). To unify the field, three major steps have been Figure 2 VI PREFACE book, providing the reader with a novel multidisciplinary ve and integrated multidisciplinary vascular environment. perspective on a broad range of important and clinically Establishing the first panvascular platforms, it remains the relevant vascular topics. task for the first wave of panvascular scholars, residents, and To provide a systematic review of the immense vascular fellows to successively flesh out this new concept with an field, the textbook has been divided into ten parts. Parts I exciting and stimulating clinical life, and in this way usher and II summarize the principles of vascular sciences and in an era of comprehensive and highly efficient vascular diagnostics. In accordance with their key clinical importan care serving the interest of each individual vascular patient. ce, the diseases of the coronary, cerebrovascular, and peri If this textbook manages to serve as a point of departure pheral vascular beds have been discussed next, being inte toward an integrated, interdisciplinary panvascular culture, grated into Parts III-V. In the subsequent Parts VI-X, it will have served its mission admirably. discussion of the venous, lymphatic, aortic, visceral, end It is a great pleasure and honor to thank to our collea ocrine, and genitourinary vascular disorders completes the gue-authors, many of them trusted friends, who by kindly vascular review. To assist the reader in quickly locating the agreeing to the very first panvascular team memberships topic of his or her interest, selected parts of the textbook worldwide and by devoting their time to expert contribu were further subdivided into sections. Individual chapters tions made this exciting interdisciplinary enterprise possi then provide definitive reviews of vascular diseases of spe ble. We also wish to give thanks to Cornelia Thieme for cific vascular beds. The elaborate index at the back of the superbly indexing the text and to Springer-Verlag for its book facilitates expert multidisciplinary cross-reference to vision in carrying out this demanding project. Without the individual items. continual support and perseverance of Jorg Engelbrecht, It is critical to recognize that the new era of panvascu Neil Solomon, Willi Bischoff, and Gisela Schmitt, this text lar medicine and management is only now beginning. Thus, book would never have become a reality in the budding this textbook represents an early effort toward an interacti- panvascular world. Peter Lanzer Eric J. Topol Co swig Cleveland Contents PART 1: 18 Molecular and Cellular Hemostasis and Fibrinolysis INTEGRATED VASCULAR SYSTEM: GENERAL PRINCIPLES Kathleen E. Brummel, Nancy Swords Jenny, Section 1: Epidemiology of Vascular Diseases . . . . . . . 1 Kenneth G. Mann . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Epidemiology of Atherosclerotic Vascular Disease Section 6: Atherosclerotic Lesions. . . . . . . . . . . . . . . . . 319 Christopher J. O'Donnell, William B. Kannel . . . . 3 19 Atherosclerotic Lesions: Evolution and Regression Section 2: Vascular Embryology. . . . . . . . . . . . . . . . . . . 17 Herbert C. Stary . . . . . . . . . . . . . . . . . . . . . . . . . . . 320 2 Molecular Vascular Embryology 20 Atherosclerotic Lesions: Vulnerability Trine-Line Korsholm, Line Graven Lyngdorf, Steven A. Vokes, Paul A. Krieg ............... . 18 Erling Falk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 3 Genetic Vascular Embryology Jeffrey A. Towbin, John Belmont ............. . 21 Atherosclerotic Lesions: Mechanical Properties Tim Topoleski . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 Section 3: Vascular Anatomy and Pathology ....... . 49 Section 7: Vascular Immunobiology and Heterogeneity 353 4 Integrated Vascular Anatomy Jorg Wilting .............................. . so 22 Vascular Immunobiology and Immunopathology Cora Jean S. Edgell, J. Charles Jennette ......... 354 5 Integrated Vascular Pathology William E. Stehbens ....................... . 76 23 Vascular Heterogeneity Maarten Bergwerff, Marco C. DeRuiter, Robert E. Section 4: Vascular Physiology ................... . 115 Poelmann, Adriana C. Gittenberger-de Groot ... 366 6 Principles of Vascular Physiology Patrick Segers, Pascal Verdonck .............. . 116 7 Hemodynamics PART II: Ajit P. Yoganathan, George P. Chatzimavroudis .. 138 INTEGRATED VASCULAR DIAGNOSTIC EVALUATIONS 8 Arterial Wall Mechanics Section 1: Clinical Examination ................... 377 Alan J. Bank, Daniel R. Kaiser . . . . . . . . . . . . . . . . 151 24 Coronary Artery Disease 9 Microcirculation Function: Coronary Vasculature Kanu Chatterjee . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 Gianmario Sambuceti, Mario Marzilli, Antonio L'Abbate . . . . . . . . . . . . . . . . . . . . . . . . . . 162 25 Cerebrovascular Disease Michael Hennerici, Michael Daffertshofer . . . . . . 382 10 Neurovegetative Regulation of the Vascular System Blair P. Grubb, Daniel J. Kosinski, Yousuf Kanjwal 175 26 Peripheral Vascular Disease Peter Lanzer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388 Section 5: Vascular Biology . . . . . . . . . . . . . . . . . . . . . . . 189 Section 2: Vascular Laboratory. . . . . . . . . . . . . . . . . . . . 397 11 Vascular Endothelium Zhihong Yang, Thomas F. LUscher . . . . . . . . . . . . . 190 27 Peripheral Vascular Diagnostic Methods Todd D. Lovelace, Gregory L. Moneta . . . . . . . . . . 398 12 Vascular Smooth Muscle Cells Gordon R. Campbell, Johnny L. Efendy, 28 Cerebrovascular Ultrasonography Julie H. Campbell . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Stephen Meairs, Michael Hennerici. . . . . . . . . . . . 420 13 Vascular Extracellular Matrix Section 3: Computed Tomography. . . . . . . . . . . . . . . . . 441 Colin M. Fitzsimmons, Catherine M. Shanahan. . 217 29 Technical Principles of CT 14 Principles of Vascular Remodeling Bernd Ohnesorge, Andreas F. Kopp, Seymour Glagov, Clifford Ko, Hisham S. Bassiouny, Christoph R. Becker, Andreas Knez, Stephen Schroder, Christopher K. Zarins. . . . . . . . . . . . . . . . . . . . . . . 232 Thomas Flohr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443 15 Molecular Biology of Vascular Remodeling 30 Coronary Artery Imaging Using CT Philip S. Tsao, Jay Wohlgemuth, Mehrdad Rezaee, Christoph R. Becker . . . . . . . . . . . . . . . . . . . . . . . . 453 Frances L. Johnson, Stephane C. Boutet, 31 Peripheral and Visceral Vascular Imaging Using CT Bahaa M. Fadel, Thomas Quertermous. . . . . . . . . 242 Everett Y. Lam, Robert A. Andrews, 16 Molecular Biology of Collateral Circulation Gregory L. Moneta . . . . . . . . . . . . . . . . . . . . . . . . . 458 Dimitri Scholz, Tibor ZiegelhOffer, 32 Pulmonary Vascular Imaging Using CT Christian Friedrich. . . . . . . . . . . . . . . . . . . . . . . . . 265 Christoph Engelke, Mathias Prokop . . . . . . . . . . . 466 17 Molecular and Cellular Angiogenesis 33 Coronary Artery Imaging Using EBT Peter Carmeliet, Desire Collen, Edward M. Conway 273 Paolo Raggi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496 VIII CONTENTS Section 4: Magnetic Resonance Angiography . . . . . . . 513 51 Coronary Artery Revascularization: Percutaneous Approach 34 Technical Principles of MRA Antonio Colombo, Bernhard Reimers. . . . . . . . . . 820 Rene M. Botnar, Matthias Stuber, Kraig V. Kissinger, Warren J. Manning . . . . . . . . . . . . . . . . . . . . . . . . . 515 52 Coronary Artery Revascularization: Adjunctive Pharmacology in the Percutaneous Approach 35 Coronary Artery Imaging Using MRA Dean J. Kereiakes, Thomas M. Shimshak . . . . . . . 841 Oliver M. Weber, Peter Boesiger. . . . . . . . . . . . . . . 526 53 Coronary Artery Revascularization: 36 Cerebrovascular Artery Imaging Using MRA Surgical Approach - Standard Management Andreas Sommer, Michael Hennerici . . . . . . . . . . 533 Anno Diegeler, Francis G. Duhaylongsod, 37 Peripheral Artery Imaging Using MRA Friedrich Wilhelm Mohr . . . . . . . . . . . . . . . . . . . . 854 Everett Y. Lam, Robert A. Andrews, 54 Coronary Artery Revascularization: Surgical Gregory L. Moneta . . . . . . . . . . . . . . . . . . . . . . . . . 546 Approach - Minimally Invasive Management Section 5: Perfusion Measurements . . . . . . . . . . . . . . . . 553 Valavanur A. Subramanian, Nilesh U. Patel. . . . . . 879 38 Myocardial Blood Flow and Perfusion: 55 Coronary Artery Disease and Endothelial Function Radionuclide Techniques Volker Schachinger, Andreas M. Zeiher . . . . . . . . 887 Heinrich R. Schelbert ...................... . 555 56 Coronary Artery Spasm: Basic Aspects 39 Cerebrovascular Blood Flow and Perfusion Hiroaki Shimokawa, Masahiro Mohri, Peter Horn ............................... . 577 Akira Takeshita . . . . . . . . . . . . . . . . . . . . . . . . . . . . 912 Section 6: X-Ray, Angiography ................... . 591 57 Coronary Artery Spasm: Clinical Aspects Masahiro Mohri, Hiroaki Shimokawa, 40 Technical Principles of X-Ray Angiography Akira Takeshita . . . . . . . . . . . . . . . . . . . . . . . . . . . . 921 Frits Van der Meer ........................ . 593 58 Coronary Artery Syndrome X 41 X-Ray Coronary Angiography Junbo Ge, Juying Qian, Raimund Erbel. . . . . . . . . 930 Stephan Windecker, Bernhard Meier. ......... . 602 59 Inflammatory Diseases of the Coronary Artery 42 X-Ray Peripheral and Visceral Angiography Joseph C. Shanahan, E. William St. Clair. . . . . . . . 935 Peter M. T. Pattynama ...................... . 636 6o Drug-Related Diseases of the Coronary Artery Section 7: Intravascular Ultrasonography ......... . 659 Shereif H. Rezkalla, Robert A. Kloner . . . . . . . . . . 970 43 Technical Principles of Intravascular 61 Hypertrophic Cardiomyopathy and Ultrasonography Coronary Arteries Nicolaas Born, Anton F.W. van der Steen, Nico Barry J. Maron............................. 980 Bruining, Chris L. de Korte, Stephane G. Carlier, Charles T. Lancee ......................... . 661 62 Dilated Cardiomyopathy and Coronary Arteries Kanu Chatterjee . . . . . . . . . . . . . . . . . . . . . . . . . . . 987 44 Coronary Intravascular Ultrasonography Peter Stahr, Yasuhiro Honda, Peter J. Fitzgerald, 63 Vascular Disease in Diabetes Mellitus Michael Poon, Elliot Rayfield. . . . . . . . . . . . . . . . . 995 Paul G. Yock .............................. . 667 64 Coronary Artery Function in Diabetes Mellitus 45 Peripheral Intravascular Ultrasonography Luis Afonso, Marcelo F. Di Carli. . . . . . . . . . . . . . . 1008 Elma J. Gussenhoven, Tjebbe Hagenaars, Jeroen A. van Essen, Trude C. Leertouwer, 65 Systemic Hypertension Nicolaas Born ............................. . 678 Shawn A. Gregory, Suzanne Oparil . . . . . . . . . . . . 1015 Section 8: Special Vascular Examination Techniques. 689 46 Clinical Assessment of Endothelial Function PART IV Joseph A. Vita ............................ . 691 CEREBROVASCULAR DISEASES 47 Functional Coronary Artery Diagnostic Evaluations Section 1: Vascular Diseases of the Central Nervous Stuart T. Higano . . . . . . . . . . . . . . . . . . . . . . . . . . . 701 System: Review and Special Considerations. . . . . . . . . 1065 66 Cerebrovascular Anatomy: Special Considerations Stephan Behrens, Oliver Sedlaczek, PART III Michael Hennerici. . . . . . . . . . . . . . . . . . . . . . . . . . 1067 CORONARY VASCULAR DISEASES 67 Cerebrovascular Pathobiology and Pathophysiology: Special Considerations 48 Integrated Coronary Physiology Michael Hennerici, Stephen Meairs............ 1071 and Pathophysiology Eberhard Bassenge, Michael Schwemmer. . . . . . . 717 68 Cerebrovascular Diseases Michael Daffertshofer. . . . . . . . . . . . . . . . . . . . . . . 1075 49 Coronary Atherosclerosis: Acute Coronary Syndromes Section 2: Vascular Diseases of the Central Nervous Peter Lanzer, Tilman Markert, Axel Frey, System: Percutaneous and Surgical Therapy . . . . . . . . 1113 Rolf Weser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 746 69 Vascular Diseases of the Central Nervous System: 50 Coronary Atherosclerosis: Percutaneous Approach Chronic Coronary Syndromes Peter J. Mitchell, Randall T. Higashida, K. Lance Gould . . . . . . . . . . . . . . . . . . . . . . . . . . . . 779 Christopher F. Dowd, Van V. Halbach . . . . . . . . . . 1115 CoNTENTs IX 70 Intracranial Aneurysms: Surgical and 88 Arterial Disease of the Lower Extremity: Endovascular Approach Surgical Approach Erich Donauer, Hans Henkes, Johannes Reif, Sabine Alexander D. Nicoloff, W. Kent Williamson, Fuhrmann, Klaus Terstegge, Dietmar Kiihne .... 1154 John M. Porter ............................. 1433 71 Intracerebral Hemorrhage: Surgical Approach 89 Peripheral Artery Disease: Aging and Comorbidity Frieder Cortbus, Wolf-Ingo Steudel. ........... 1217 Christian F.A. Kugler ....................... 1449 72 Cerebral Arteriovenous Malformations: 90 Hemodialysis Access Dysfunction Single-Step Combined Approach Dierk Vorwerk ............................. 1470 Ulrich Grzyska, Manfred Westphal ............ 1235 91 Foreign Body Retrieval 73 Aneurysms Associated with Cerebral Arteriovenous Haresh Mehta, Stephan Windecker, Malformations: Therapeutic Options Bernhard Meier ............................ 1480 Manfred Westphal, Ulrich Grzyska ............ 1240 74 Cranial Dural Arteriovenous Fistulas: Therapeutic Options PART VI Eva Neumaier Probst, Ulrich Grzyska, PERIPHERAL VENOUS AND LYMPHATIC DISEASES Manfred Westphal, Herman Zeumer ........... 1245 92 Peripheral Venous Anatomy and Physiology 75 Spinal Vascular Malformations: Sebastian Schellong, Thomas Schwarz ......... 1489 Therapeutic Options 93 Peripheral Venous Pathomorphology and Christoph Koch, Hermann Zeumer, Pathophysiology Manfred Westphal. ......................... 1253 Sebastian Schellong, Thomas Schwarz ......... 1491 76 Intracranial Angiomas: Surgical Approach 94 Peripheral Venous Diseases: Nonsurgical Therapy Erich Donauer, Hans Henkes ................. 1265 Sebastian Schellong, Thomas Schwarz ......... 1497 77 Cerebral and Spinal Cavernomas: 95 Peripheral Venous Diseases: The Surgical Approach Surgical Approach Gerhard Salzmann ......................... 1526 Jiirgen Meixensberger, Klaus Roosen .......... 1282 96 Lymphatic Vascular Diseases 78 Moyamoya Disease: Surgical Approach Jiirgen Meixensberger, Erich Donauer ......... 1292 Etelka Foldi ............................... 1538 79 Neurovascular Cross-Compression Syndromes: Surgical Approach PART VII Abolghassem Sepehrnia ..................... 1297 THORACIC VASCULAR DISEASES So Carotis Artery Disease: Percutaneous Approach Klaus Mathias, Hans Martin Gissler ........... 1302 Section 1: Diseases of the Thoracic Aorta ........... 1547 81 Carotis and Vertebralis Artery Disease: 97 Diseases of the Thoracic Aorta: Percutaneous Approach Surgical Approach Brajesh K. Lal, Robert W. Hobson II ........... 1316 Christoph A. Nienaber ...................... 1549 98 Diseases of the Thoracic Aorta: Surgical Approach Magdi Yacoub ............................. 1561 PARTY PERIPHERAL ARTERIAL DISEASES Section 2: Diseases of the Supra-aortic Great Vessels. 1573 82 Peripheral Artery Physiology and 99 Supra-aortic Great Vessels: Surgical and Percutaneous Approach Pathophysiology: Special Considerations Caroline Schmidt-Lucke, Manju Kalra, Kenneth J. Cherry. .............. 1575 Jan Andre Schmidt-Lucke .................... 1333 Section 3: Vascular Diseases of the Lungs ........... 1597 83 Peripheral Artery Tomographic Imaging: 100 Pulmonary Vasculitides Special Considerations Richard A. DeRemee ........................ 1599 Mathias Goyen, Stefan G. Ruehm, Jorg F. Debatin 1341 101 Hypertensive Pulmonary Vasculopathies: 84 Prevention of Peripheral Artery Atherosclerosis Pathological Findings Knuth Kroger ............................. 1347 Giuseppe G. Pietra, Enrico Dessy .............. 1609 85 Peripheral Arterial Disease: 102 Hypertensive Pulmonary Vasculopathies: Acute Ischemic Syndromes Pathogenesis Gottfried Rudofsky ......................... 1351 Alfred P. Fishman .......................... 1618 86 Peripheral Arterial Disease: 103 Hypertensive Pulmonary Vasculopathies: Chronic Ischemic Syndromes Diagnostic Evaluations Gottfried Rudofsky ......................... 1363 Harold I. Palevsky, Alfred P. Fishman .......... 1632 87 Arterial Disease of the Upper Extremity: 104 Hypertensive Pulmonary Vasculopathies: Special Considerations Clinical Management Edward B. Diethrich ........................ 1423 Tim Higenbottam .......................... 1641