Peripheral Vascular Interventions: An Illustrated Manual

242 Pages·2013·6.44 MB·English

by  Juergen Schroeder

Peripheral Vascular Interventions:
An Illustrated Manual
Juergen Schroeder, MD
Associate Professor
Department of Diagnostic and Interventional Radiology
Diaconess Medical Center
Flensburg, Germany
Thieme
New York • Stuttgart
Library of Congress Cataloging-in-Publication Data Important note: Medicine is an ever-changing science
undergoing continual development. Research and clini-
Schröder, Jürgen, 1938- cal experience are continually expanding our knowledge,
[Trainer vaskuläre Interventionen. English] in particular our knowledge of proper treatment and
Peripheral vascular interventions : an illustrated manual / drug therapy. Insofar as this book mentions any dosage
Jörgen Schröder. or application, readers may rest assured that the authors,
p. ; cm. editors, and publishers have made every eff ort to ensure
Includes bibliographical references and index. that such references are in accordance with the state of
ISBN 978-3-13-169751-6 knowledge at the time of production of the book.
I. Title. Nevertheless, this does not involve, imply, or express
[DNLM: 1. Peripheral Vascular Diseases--surgery. any guarantee or responsibility on the part of the pub-
2. Radiography, Interventional--methods. WG 500] lishers in respect to any dosage instructions and forms of
applications stated in the book. Every user is requested
616.1'31--dc23 to examine carefully the manufacturers’ leafl ets accom-
2012046150 panying each drug and to check, if necessary in consul-
tation with a physician or specialist, whether the dosage
schedules mentioned therein or the contraindications
stated by the manufacturers diff er from the statements
made in the present book. Such examination is particu-
larly important with drugs that are either rarely used or
have been newly released on the market. Every dosage
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the user’s own risk and responsibility. The authors and
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This book is an authorized translation and update of the www.thieme.com on the product description page.
1st German edition published and copyrighted 2011 by
Georg Thieme Verlag, Stuttgart, Germany. Title of the
German edition: Trainer Vaskuläre Interventionen.
Translator: John Grossman, Schrepkow, Germany
llustrator: Jürgen Schröder, Fockbek and Malgorzata &
Piotr Gusta, Paris, France
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Preface
It has been a mere 48 years since the fi rst intervention omitted detailed descriptions of certain complex, high-
in a pelvic artery - an incidental observation yet one that risk interventions such as endovascular aortic prostheses
Charles Dotter pursued systematically and enthusiasti- or carotid artery stents. Whoever intends to attempt such
cally. This has since given rise to a major specialty that procedures should no longer need this book.
now boasts its own congresses, journals, and thousand- There are some fi rm rules in interventional radiology
page textbooks. Scholars in this fi eld will naturally be that one may not disregard without endangering the pa-
more interested in the broad and rapid increase in new tient. Yet many other precepts that are also accepted as
scientifi c knowledge than in the description of the fun- rules are actually better described as conventions. Some
damentals, which have changed little since Dotter’s time. originate from such simple considerations as the lim-
Vascular interventions have evolved from the tech- ited time available for performing the intervention. This
nique of angiography. As recently as 20 years ago, every does not mean that such rules should not become es-
beginner in diagnostic angiography had ample opportu- tablished. On the contrary, only the observance of rules
nity to learn how to work with guidewire and catheter. generally accepted as binding can provide a basis for
Many of today’s diagnostic studies require contrast but optimizing procedures according to empirical criteria.
dispense with the catheter. At the same time, shrinking From this it also follows that such rules must continu-
budgets for medical staff have made it far less common to ally be reexamined in the interest of further developing
fi nd an experienced practitioner side by side with a be- the methods.
ginner at the angiography table. Many of the details that You will occasionally fi nd an instruction in this book
were once conveyed in such a teacher-student relation- that deviates from the customary recommendations. A
ship are diffi cult to present clearly in text alone, nor can review of the current literature will reveal that this is
they be demonstrated on standard angiographic images. hardly unusual. Yet every such deviation must be based on
Abstract description will always be a roundabout way logical reasoning and supported by one’s own experience.
for imparting practical instructions for procedures per- The allurement of interventional radiology is that it
formed primarily under visual control. The emphasis can often achieve maximum successes with minimal pro-
must be on visual representation. Since there is an ob- cedures. Its actual therapeutic tools are almost always
vious shortage in this respect, I have combined concise simple. Interventional radiology is not magic. Its suc-
texts with numerous schematic diagrams in an attempt to cesses are largely the result of meticulous planning. And
illustrate what one needs to perform vascular interven- the fast interventionalist is one who understands how to
tions successfully. reach their goal directly.
This little book is hardly intended to replace one of
the customary textbooks. Moreover, I have purposely Winter 2012 Jürgen Schröder
V
Acknowledgments
I feel very grateful for many people. Above all to my wife Mittmann, Burckhard Terwey, Jens Allenberg, Christos
Elisabeth and our children Hannah, Robert, and Ruth. Papachrysanthou, Bernd Glücklich, Issifi Djibey, Walter
Walter Frommhold, Charles Dotter, and Josef Rösch Müller, Ulrich Schroeder, Stefan Müller-Hülsbeck, Lo-
were important teachers. Since the beginnings of in- thar Wöstenberg, Hedwig Horn, Klaus Graeber, Gudrun
terventional radiology, many have accompanied me Petersen, Mathias Ehmke, Van Khiem Tran, and Karsten
in Tübingen, Heidelberg, Rendsburg, and Flensburg. I Schmidt.
have learned from them and with them, and have ac- I owe so very much to my mother Josefi ne Gieshoff
quired and evaluated experience together with them. I who died at a young age. One gift of hers was the joy of
would expressly like to mention Gernot Bürkle, Ulrich drawing.
Glossary
“Glide” wire Nitinol wire with hydrophilic coating
Ipsilateral On the same side as the vascular access
Contralateral On the opposite side
Overlay Fluoroscopic image over an angiographic image
Primary patency rate Percentage of patent vessels after one treatment
Roadmapping Digital subtraction fl uoroscopy
Secondary patency rate Patency rate after the second or third intervention
Y prosthesis Aortobifemoral or aortobiiliac bypass
VI
Abbreviations
A. Artery IM Intramuscular
Aa. Arteries
ABI Ankle brachial index LAO Left anterior oblique
ACC Acetylcysteine
ACE Angiotensin converting enzyme M Muscle
A DP Adenosine diphosphate MRA Magnetic resonance angiography
A TA Anterior tibial artery MRI Magnetic resonance imaging
AV fi stula Arteriovenous fi stula
NaCl Sodium chloride
C-arm C-arm fl uoroscopic image intensifi er NFS Nephrogenic systemic fi brosis
C FA Common femoral artery
CFV Common femoral vein OTW Over the wire (balloon catheter)
C IA Common iliac artery
CLI Critical limb ischemia PA Posteroanterior (projection)
CO Carbon dioxide P A Plasminogen activator
2
C T Computed tomography PD Plantodorsal
CTA CT angiography P TA Percutaneous transluminal angioplasty
PTA Posterior tibial artery
DES Drug-eluting stent PTFE Polytetrafl uoroethylene
DSA Digital subtraction angiography PTT Partial thromboplastin time
P VA Polyvinyl alcohol
E IA External iliac artery
RA Renal artery
F MD Fibromuscular dysplasia R AO Right anterior oblique
R AS Renal arterial stenosis
GFR Glomerular fi ltration rate R DC Renal double curve
RH Rösch Hepatica
HIT Heparin-induced thrombocytopenia r-tPA Recombinant tissue plasminogen activator
RX Rapid exchange
IA Intra-arterial
IIA Internal iliac artery S FA Superfi cial femoral artery
I JV Internal jugular vein SVC Superior vena cava
I V Intravenous
IVC Inferior vena cava T IPS Transjugular intrahepatic portosystemic shunt
IU International units T OS Thoracic outlet syndrome
VII
Contents
Preface ......................................................................................................................................................................................................... V
Acknowledgments ............................................................................................................................................................................. VI
Glossary ....................................................................................................................................................................................................... VI
Abbreviations ......................................................................................................................................................................................... VII
1
General ........................................................................................................................................................................................ 1
Clinical Presentation of Peripheral Preparing the Patient ........................................... 5
Arterial Occlusive Disease ................................... 1
Radiation Protection ............................................. 6
Consultation with the Patient ............................ 4
2
Material ...................................................................................................................................................................................... 7
Size Specifi cations for Cannulas, Angiography Catheters ........................................ 16
Guidewires, Catheters, and Sheaths ................ 7
Balloon Catheters ................................................... 27
Cannulas ................................................................... 7
Stents ......................................................................... 30
Guidewires ............................................................... 8
Contrast Agents ...................................................... 35
Sheaths ...................................................................... 13
Medications ............................................................. 39
3
Methods ..................................................................................................................................................................................... 42
Retrograde Catheterization of the Common Stent Placement .....................................................  93
Femoral Artery ........................................................ 42
Local Thrombolysis ................................................  97
Antegrade Catheterization of the Common
Aspiration of Thrombus ....................................... 105
Femoral Artery ........................................................ 51
Subintimal Recanalization ................................... 109
Crossover Catheterization ................................... 60
Atherectomy ............................................................ 111
Access via the Brachial Artery ............................ 65
Excimer Laser .......................................................... 112
Venous Access ......................................................... 78
Embolization ............................................................ 112
Angiography ............................................................ 80
Extracting Foreign Bodies and
Measuring Vessel Diameter ................................ 91
Pull-Through Technique ....................................... 117
Percutaneous Transluminal
Angioplasty .............................................................. 92
VIII