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Challenging Concepts in Interventional
Radiology and Endovascular Procedures
Published and forthcoming titles in the
Challenging Concepts in series
Anaesthesia (Edited by Dr Phoebe Syme, Dr Robert Jackson, and
Professor Tim Cook)
Cardiovascular Medicine (Edited by Dr Aung Myat, Dr Shouvik
Haldar, and Professor Simon Redwood)
Emergency Medicine (Edited by Dr Sam Thenabadu, Dr Fleur Cantle,
and Dr Chris Lacy)
Infectious Disease and Clinical Microbiology (Edited by Dr Amber
Arnold and Professor George Griffin)
Interventional Radiology and Endovascular Procedures (Edited by
Dr Miltiadis Krokidis, Dr Irfan Ahmed, and Dr Tarun Sabharwal)
Neurology (Edited by Dr Krishna Chinthapalli, Dr Nadia Magdalinou,
and Professor Nicholas Wood)
Neurosurgery (Edited by Mr Robin Bhatia and Mr Ian Sabin)
Obstetrics and Gynaecology (Edited by Dr Natasha Hezelgrave,
Dr Danielle Abbott, and Professor Andrew Shennan)
Oncology (Edited by Dr Madhumita Bhattacharyya, Dr Sarah Payne,
and Professor Iain McNeish)
Oral and Maxillofacial Surgery (Edited by Mr Matthew Idle and
Dr Andrew Monaghan)
Respiratory Medicine (Edited by Dr Lucy Schomberg and
Dr Elizabeth Sage)
Challenging Concepts in
Interventional Radiology
and Endovascular
Procedures
Cases with Expert Commentary
Edited by
Miltiadis Krokidis
Consultant Vascular and Interventional Radiologist,
Department of Radiology, Cambridge University Hospitals
NHS Foundation Trust, Cambridge, UK
Irfan Ahmed
Consultant Vascular and Interventional Radiologist,
Department of Radiology, Guy’s and St Thomas’
NHS Foundation Trust, London, UK
Tarun Sabharwal
Consultant Vascular and Interventional Radiologist,
Department of Radiology, Guy’s and St Thomas’
NHS Foundation Trust, London, UK
1
3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
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© Oxford University Press 2015
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ISBN 978–0 –19 –164150 –3
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FOREWORD
Interventional radiology has come of age, and has an established place in modern
medical care. Its techniques have been shown to be clinically effective, safe, and
less expensive than most equivalent open surgical procedures. There are now
several excellent textbooks of interventional radiology which deal with all aspects
of the discipline. The Cardiovascular and Interventional Radiological Society
of Europe has created a robust examination, which is rapidly setting training
standards in this discipline within Europe and beyond.
This book does not aim to provide systematic instruction in the techniques
of interventional radiology at either a basic or at an advanced level. Instead, the
editors, Miltos Krokidis, Irfan Ahmed, and Tarun Sabharwal, have adopted an
innovative and fresh approach—they have focused on important current issues
in interventional radiology. In each case, instead of an exhaustive review of the
literature and a series of vague statements presenting all views on an individual
topic, they have chosen to deal with each issue with clarity and condence, and
have tried to offer a clear opinion on each subject.
The book contains 31 cases. The emphasis is on endovascular procedures, but
important nonvascular topics, mainly in interventional oncology, are also included.
Each case has been written by either an interventional radiologist in training or
a young staff radiologist. There are clear descriptions of techniques, examples of
challenging cases, learning points, and a focus on these points by experts in the
subject. The layout is clear, colourful, and easy to navigate. This approach has
resulted in a fresh and topical volume, and a ‘no-nonsense’ practical approach.
There is no attempt to cover each subject in a comprehensive fashion, or to present
the latest research on each topic. But the trainee, or the young staff radiologist
seeking guidance on some of the most important issues in this discipline, will
enjoy reading this excellent and refreshing book, and will want to keep a copy
within easy reach.
Andreas Adam CBE, MB, BS(Hons),
PhD, FRCP, FRCR, FRCS, FFRRCSI(Hon),
FRA NZCR(Hon), FACR(Hon), FMedS ci
Professor of Interventional Radiology,
King’s College London
CONTENTS
Experts viii
Contributors xi
Abbreviations xiv
Section 1 Aortic pathology and
peripheral arterial disease
Case 1. Thoracic endoprostheses for type
B aortic dissections 3
Christos Lioupis, Rachel Clough, and Peter Taylor
Case 2. Management of endoleaks after
thoracic endografts 11
Ali Alsafi and Mo Hamady
Case 3. Juxtarenal abdominal aortic aneurysms:
fenestrations versus chimneys 21
Nadeem Shaida and Andrew Winterbottom
Case 4. Management of endoleaks after abdominal
aneurysm endovascular repair 29
Raymond Chung and Robert Morgan
Case 5. Carotid artery stenting: how to
treat restenosis 37
Alessandro Cannavale and Fabrizio Fanelli
Case 6. Iliac artery occlusions: surgical
bypass, covered and uncovered stents 51
Andrew Christie and Iain Robertson
Case 7. SFA endoluminal bypass: the new era
of critical limb ischaemia treatment 61
Aidan Shaw and Irfan Ahmed
Case 8. Below the knee angioplasty: bare
versus drug-eluting stents 69
Stavros Spiliopoulos and Dimitrios Siablis
Case 9. Thrombolysis for acute lower limb ischaemia 79
Athanasios Diamantopoulos and Panos Gkoutzios
Case 10. Renal artery stenosis: angioplasty or stent? 87
Shirish Prabhudesai and Narayan Karunanithy
Case 11. Below the ankle angioplasty:
treatment rationale and access techniques 95
Panagiotis Kitrou and Konstantinos Katsanos
Section 2 Venous procedures
Case 12. Dialysis access at risk: balloons or stent grafts? 105
Stavros Spiliopoulos and Dimitrios Karnabatidis
Case 13. Phlegmasia cerulea dolens:
percutaneous treatment 111
Peter Mezes and Narayan Karunanithy
Case 14. IVC filters and anticoagulation 119
Christopher Burke, Miltiadis Krokidis,
and Hanno Hoppe
Case 15. TIPS and TIPS revision for
Budd–Chiari patients. 129
Vyzantios Pavlidis and Elias Brountzos
Section 3 Embolization
Case 16. Epistaxis: which embolic materials to use? 141
Magdalena Jarząbek, Piotr Trojanowski, and
Małgorzata Szczerbo-Trojanowska
Case 17. Massive haemoptysis: what to embolize? 151
Kendrick Tang and Philip Kwok
Case 18. Gastrointestinal bleeding: which
embolic material to use? 159
Bhaskar Ganai and Michael J Lee
Case 19. Endovascular approach to the
trauma patient 165
Athanasios Diamantopoulos
and Konstantinos Katsanos
Case 20. Uterine fibroid embolization: can fertility
be preserved? 171
Leto Maili, Aneeta Parthipun, and Irfan Ahmed
Case 21. Postpartum haemorrhage: what is
the role of occlusion balloons? 179
Raj Das and Anna-Maria Belli
viiContents
Case 22. Percutaneous varicelectomy: coils or
sclerosant agents? 187
Piero Venetucci, Miltiadis Krokidis, and
Vittorio Iaccarino
Case 23. Prostate artery embolization for
benign prostate hypertrophy 195
Aidan Shaw, Irfan Ahmed, and Tarun Sabharwal
Section 4 Non-vascular procedures
and interventional oncology
Case 24. Lung tumour radiofrequency ablation:
what are the success factors? 203
Victoria St Noble and Nicos Fotiadis
Case 25. Tracheobronchial stenting: covered
versus uncovered 211
Riccardo Inchingolo and Tarun Sabharwal
Case 26. Early-stage hepatocellular carcinoma: the
percutaneous approach 217
Venus Hedayati and Praveen Peddu
Case 27. Small renal tumours: is radiofrequency
ablation better than surgery? 225
Miltiadis Krokidis and Andy Adam
Case 28. Malignant biliary strictures: covered
or uncovered stents? 233
Miltiadis Krokidis and Adam Hatzidakis
Case 29. Vertebroplasty of the cervical spine 239
Georgia Tsoumakidou and Afshin Gangi
Case 30. Percutaneous neurolytic coeliac
plexus block 245
Angie Galea, Richard Guinness,
and Anthony Watkinson
Case 31. Vertebral augmentation techniques and
pain management: is there a role in
metastatic disease? 251
Gianluigi Orgera, Miltiadis Krokidis, and
Michele Rossi
Index 257
EXPERTS
Professor Andreas Adam
Professor of Interventional Radiology
King’s College London
Department of Radiology
Guy’s and St Thomas’ NHS Foundation Trust
London
UK
Dr Irfan Ahmed
Consultant Vascular and Interventional Radiologist
Department of Radiology
Guy’s and St Thomas’ NHS Foundation Trust
London
UK
Professor Anna-Maria Belli
Professor of Interventional Radiology
St Georges Medical School
Department of Radiology
St George’s University Hospitals NHS Foundation
Trust
London
UK
Professor Elias Brountzos
Professor of Interventional Radiology
Athens University Medical School
Second Department of Radiology
Attikon University Hospital
Athens
Greece
Dr Fabrizio Fanelli
Vascular and Interventional Radiologist
Vascular and Interventional Radiology Unit
Department of Radiological Sciences
Sapienza University Hospital
Rome
Italy
Professor Afshin Gangi
Professor of Diagnostic and Interventional
Radiolog y
University of Louis Pasteur
Department of Radiology
University Hospital of Strasbourg
Strasbourg
France
Dr Panos Gkoutzios
Consultant Vascular and Interventional
Radiologist
Department of Radiology
Guy’s and St Thomas’ NHS Foundation Trust,
London
UK
Dr Mo Hamady
Consultant Interventional Radiologist
Honorary Senior Lecturer
Department of Surgery and Cancer
Imperial College
London
UK
Ass. Prof Adam Hatzidakis
Assistant Professor of Radiology
University of Crete Medical School
Department of Medical Imaging
University Hospital of Heraklion
Heraklion
Greece
Dr Hanno Hoppe
Vascular and Interventional Radiologist
Linderhof Hospital
Bern
Switzerland
ixExperts
Professor Vittorio Iaccarino
Professor of Interventional Radiology
University of Naples Medical School
Department of Cardiovascular and Interventional
Radiology
University Hospital Federico II
Naples
Italy
Ass Prof Dimitrios Karnabatidis
Associate Professor of Radiology
University of Patras Medical School
Department of Interventional Radiology
Patras University Hospital
Rio
Greece
Dr Narayan Karunanithy
Consultant Vascular and Interventional Radiologist
Department of Radiology
Guy’s and St Thomas’ NHS Foundation Trust
London
UK
Dr Konstantinos Katsanos
Consultant Vascular and Interventional Radiologist
Department of Radiology
Guy’s and St Thomas’ NHS Foundation Trust
London
UK
Dr Philip Kwok
Consultant Radiologist
Department of Radiology and Imaging
Queen Elizabeth Hospital
Kowloon
Hong Kong
Dr Robert Morgan
Consultant Vascular and Interventional
Radiologist
Department of Radiology
St George’s University Hospitals NHS Foundation
Trust
London
UK
Dr Praveen Peddu
Consultant Interventional Radiologist
Department of Radiology
King’s College Hospital NHS Foundation Trust
London
UK
Dr Iain Robertson
Consultant Interventional Radiologist
Department of Interventional Radiology
Gartnavel General Hospital
Glasgow
UK
Ass Prof Michele Rossi
Associate Professor of Radiology
Department of Radiological, Oncological and
Pathological Sciences
Sapienza University of Rome
Italy
Dr Tarun Sabharwal
Consultant Vascular and Interventional
Radiologist
Department of Radiology
Guy’s and St Thomas’ NHS Foundation Trust
London
UK
Professor Michael J Lee
Consultant Interventional Radiologist
Beaumont Hospital
Professor of Radiology
Royal College of Surgeons in Ireland
Department of Radiology
Beaumont Hospital
Dublin
Ireland
Professor Dimitrios Siablis
Professor of Interventional Radiology
University of Patras Medical School
Department of Interventional Radiology
Patras University Hospital
Rio
Greece
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