Vascular Interventional Radiology: Angioplasty, Stenting, Thrombolysis and Thrombectomy (Medical Radiology Diagnostic Imaging)

175 Pages·2006·4.16 MB·English

by  Mark G. Cowling

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
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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