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S. H. Chandrashekhara
Editor
Textbook of
Interventional
Radiology
123
Textbook of Interventional Radiology
S. H. Chandrashekhara
Editor
Textbook of Interventional
Radiology
Editor
S. H. Chandrashekhara
All India Institute of Medical Sciences
New Delhi, Delhi, India
ISBN 978-981-97-9600-7 ISBN 978-981-97-9601-4 (eBook)
https://doi.org/10.1007/978-981-97-9601-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024
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Preface
Interventional radiology (IR) is a rapidly advancing eld that has revolutionized minimally
invasive medical treatment. Many conventional invasive surgeries are being replaced by minimally invasive IR procedures, thus reducing the complications and decreasing the hospital stay
with equally effective patient outcomes. Interventional radiology procedures encompass a different range of therapeutic interventions performed under image guidance. As IR is a rapidly
evolving branch, it is prudent to stay updated on the latest developments in procedures, hardware, and techniques. The latest digital advances in the form of articial intelligence, robotics,
image fusion, etc. have great potential to revolutionize the eld in the future. Integrating
emerging advances in image-guided therapies is essential for improving healthcare and making it more affordable.
We attempt to cover all the topics of IR comprehensively in a single book, resulting in the
current textbook. This book is intended to serve as a comprehensive textbook, providing an
extensive review of various IR procedures, including current indications, techniques, and their
applications. It is designed for residents, fellows, and practicing clinicians. It will serve as a
guide for various entrance examinations as well as professional examinations related to the
eld.
The various chapters in this book are written by expert authors from the premier institutes
of the country and cover commonly performed vascular and nonvascular interventional procedures. There is updated information on hardware, patient selection, pre-procedure preparation,
and potential complications expected to occur. They provide practical tips and tricks in different IR procedures, which would benet interventional radiologists. The various topics are
made simple to make them even more understandable to beginners. At the same time, the
updated information provides valuable knowledge to experienced practitioners.
As IR often intersects multiple other disciplines such as cardiology, oncology, vascular
surgery, nephrology, gastroenterology, and many more, this book is carefully written keeping
in mind the multidisciplinary approach, tailored to the patient-centric outcomes.
This book will be very helpful for the residents, fellows, and practicing interventional radiologists. It gives a comprehensive list of all the diverse IR procedures. We simplied the
approaches that are followed in IR procedures and made them reader-friendly and easy to
understand. All the chapters have updated guidelines, key points, relevant gures, and welldemonstrated illustrations. This book will prove to be an excellent source for all interventional
radiologists at all levels of training and expertise. We hope this book will serve as a signicant
value addition to existing books on IR.
New Delhi, Delhi, India S.H.Chandrashekhara
v
Acknowledgments
I am obliged to all the contributing authors for sparing their time, their tireless support, and
guidance during this tenure. The insightful feedback and constructive criticism provided by
them have signicantly contributed to the renement of this work. Despite their hectic schedule, they have put in numerous hours contributing valuable chapters. I consider myself honored
and fortunate to have worked with them.
I am deeply overwhelmed by the constant support extended by Dr. Vishnu Prasad Pulappadi
to me throughout my entire period of this book’s preparation. His time-to-time valuable inputs
have helped me tremendously in completing this research work.
I express my profound gratitude to all my teachers for their unwavering support.
I am highly thankful to all my mentors for their continuous support and generous attitudes.
Their unending dynamism, profundity, exceptional interventional skills, and practical approach
to critical analysis of all the issues will always remain as a source of inspiration to me.
I extend my deepest gratitude to all my residents, fellows, and colleagues for their constant
support and guidance. I appreciate all the interventional radiologists for their ever-enthusiastic
attitude in contributing to patient-centric health care.
I cannot thank my family enough for their unconditional support, encouragement, and
affection.
Finally, I appreciate our publisher for bringing this book to life and making my dream come
true.
vii
Contents
Part I General Considerations
1 History of Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
S. H. Chandrashekhara, Prince Das, and Richa Gauba
2 Patient Preparation in Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Vishnu Prasad Pulappadi and S. H. Chandrashekhara
3 Image Guidance in Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Surabhi Vyas and Anjana Rao
4 Contrast and Drugs in Interventional Radiology. . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Sneha Goswami, Smita Manchanda, Ashu Seith Bhalla, and Priyanka Naranje
5 Anesthesia in Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
K. Vishma, Poornachandra Thejeswi, and G. S. Triveni
6 Periprocedural Bleeding and Thrombotic Considerations in Interventional
Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Neha Baijal, Harpinder Singh, and S. H. Chandrashekhara
7 Embolization in Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Ranjan Kumar Patel, Taraprasad Tripathy, M. Maivizhi Shruthi, and Tej Pal
8 Hardware for Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Vishnu Prasad Pulappadi, Abhinav Bansal, and S. H. Chandrashekhara
9 Balloons and Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Deepak Justine Viswanathan, Srinivas Meharwade, and S. H. Chandrashekhara
10 Vascular Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Rupali Jain, Junaid Kazimi, Priyanka Naranje, and Manisha Jana
Part II Vascular Interventions
11 Neurointerventions Including Aneurysm Interventions . . . . . . . . . . . . . . . . . . . . . 105
Leve Joseph Devarajan Sebastian and Nikhila Gunna Reddy
12 Endovascular Treatment of Acute Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Leve Joseph Devarajan Sebastian and Savyasachi Jain
13 Interventions in Intracranial and Spinal Arteriovenous Malformations . . . . . . . . 129
Leve Joseph Devarajan Sebastian, Nikhila Gunna Reddy, and Savyasachi Jain
14 Other Neurointerventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Leve Joseph Devarajan Sebastian, Nikhila Gunna Reddy, and Savyasachi Jain
ix
x
15 Vascular Interventions in Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Shwait Sharma, Ashu Seith Bhalla, Priyanka Naranje,
Anthoni Bala Subashree, and Smita Manchanda
16 Carotid Artery Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Neeraj Kumar, Tej Pal, and S. H. Chandrashekhara
17 Central Venous Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Junaid Kazimi and Priyanka Naranje
18 Interventions of the Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Sanjeev Kumar and Aprateem Mukherjee
19 Vascular Thoracic Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Junaid Kazimi, Ashu Seith Bhalla, Priyanka Naranje, and Iqbal Bashir
20 Interventions of the Pulmonary Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Sanjeev Kumar and Girish Nataraju Komalamma
21 Hepatic Arterial Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Navojit Chatterjee and Yashwant Patidar
22 Interventions of the Hepatic Veins, Inferior Vena Cava, and Portal Vein . . . . . . . 253
Ranjan Kumar Patel and Amar Mukund
23 Interventions of Renal Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Priya Jagia, Resham Singh, and Sravan Nagulkonda
Contents
24 Interventions of the Mesenteric Arterial Circulation . . . . . . . . . . . . . . . . . . . . . . . 293
Naren Hemachandran and Shivanand Gamanagatti
25 Interventions of the Pelvic Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
Vijay Kubihal, S. H. Chandrashekhara, and G. S. Triveni
26 Interventions of the Extremity Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Mansi Verma and Niraj Nirmal Pandey
27 Interventions of the Extremity Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Resham Singh and Vineeta Ojha
28 Endovascular Interventions in Hemodialysis Access Fistulas . . . . . . . . . . . . . . . . . 347
Jinesh Valakkada, Anoop Ayyappan, and Vimal Chacko Mondy
29 IR Management of Vascular Malformations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Amit Gupta, Ankur Goyal, and Abanti Das
30 Vascular Interventions in Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Richa Yadav, Shivanand Gamanagatti, and Atin Kumar
31 Vascular Interventions in Endocrinopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Devasenathipathy Kandasamy and Kavirajan Kabilan
32 Endovascular Interventions for Male Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Surya Pratap Singh, Sreenivasa Narayana Raju, Priya Singh,
and S. H. Chandrashekhara
Part III Non-vascular Interventions
33 Image-Guided Biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
Neha Baijal and S. H. Chandrashekhara
34 Image-Guided Drainage Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Vishnu Prasad Pulappadi and S. H. Chandrashekhara
Contents
xi
35 Ablation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Vishnu Prasad Pulappadi and S. H. Chandrashekhara
36 Nonvascular Interventions of Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Shwait Sharma, Ashu Seith Bhalla, Anthoni Bala Subashree, Priyanka Naranje,
and Smita Manchanda
37 Nonvascular Thoracic Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .459
Abhishek Jayant, Ashu Seith Bhalla, Priyanka Naranje, and Ishan Gupta
38 Interventions of the Biliary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Palak Garg, Vishnu Prasad Pulappadi, and S. H. Chandrashekhara
39 Non-vascular Interventions of the Gastrointestinal Tract . . . . . . . . . . . . . . . . . . . . 483
Rishabh Jain and S. H. Chandrashekhara
40 Non-vascular Interventions of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . 493
Tej Pal, Ranjan Kumar Patel, Neeraj Kumar, and S. H. Chandrashekhara
41 Female Genital Tract and Obstetric Interventions . . . . . . . . . . . . . . . . . . . . . . . . . 503
Vijay Kubihal, S. H. Chandrashekhara, and G. S. Triveni
42 Breast Interventions: Biopsy and Localization Techniques . . . . . . . . . . . . . . . . . . 515
Ekta Dhamija, Palak Bhavesh Popat, and Anjum Syed
43 Spinal Skeletal Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
Stanzin Spalkit and S. H. Chandrashekhara
44 Musculoskeletal Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Richa Arora, Joshua Taylor, Stanzin Spalkit, and S. H. Chandrashekhara
45 Image-Guided Nerve Blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549
Ekta Dhamija and Stuti Chandola
Part IV Miscellaneous
46 Challenges of IR in Deranged Liver and Renal Functions . . . . . . . . . . . . . . . . . . . 563
Richa Gauba, S. H. Chandrashekhara, and Prince Das
47 IR Considerations in Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 569
Dipin Sudhakaran and S. H. Chandrashekhara
48 Chylous Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
Sreenivasa Raju, Surya Pratap Singh, Priya Singh, and S. H. Chandrashekhara
49 Percutaneous Intravascular Foreign Body Retrieval . . . . . . . . . . . . . . . . . . . . . . . . 583
Manish Shaw and S. H. Chandrashekhara
50 Latest Advances in Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589
Arjunlokesh Netaji and Rengarajan Rajagopal
51 Advances in Suction Thrombectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 593
Manish Shaw and Amarinder Singh Malhi
About the Editor
S.H.Chandrashekhara is working as a professor at the All
India Institute of Medical Sciences (AIIMS), Delhi, India. He
had completed his M.D. degree in Radiodiagnosis from
AIIMS, New Delhi. He nished his senior residency from the
same institute, followed by obtaining a D.N.B degree from the
National Board of Examinations. Later, he pursued a D.M.
degree in Cardiovascular Radiology and Endovascular
Interventions at AIIMS, Delhi. He continued his association
with AIIMS Delhi as a faculty member of radiodiagnosis at
IRCH since 2012. Currently, as a professor, Dr.
Chandrashekhara oversees interventional radiology procedures within his department. Apart from teaching undergraduate and postgraduate students, his passion for guiding has also
made him a luminary for numerous Ph.D., D.M., and M.Ch
students and visiting international graduates. Additionally, he
has strategized numerous interdepartmental and intradepartmental research projects at AIIMS Delhi. He has published
over 135 articles and numerous abstracts in reputable national
and international journals and several chapters in various
books. He has served as a reviewer and on the editorial boards
of several international journals. He has organized national
and international medical conferences, conducted multiple
workshops, and delivered over 75 lectures at these conferences. He was a member of various national and international
radiology societies and also served on the selection committees of several prestigious institutions. He has collaborated
with the Indian Institute of Technology (IIT), Delhi, on various research projects related to the development of medical
devices for interventional radiology.
xiii