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254 Interventional radiology and endovascular procedures
(a) (b)
Figure 31.3 (a) Control scan obtained immediately after the procedure shows a very good result, with a
homogeneous filling of PMMA within the vertebral body without local complications. (b) PET–CT shows
a consistent reduction of metabolic activity (SUV
Discussion
= 3.00) at one month.
max
Learning point Types of
approach for percutaneous
vertebral augmentation
procedures
A transpedicular approach is
often used in the lumbar territory
because of the broad-based
pedicles. Costopedicular or
paravertebral approaches are
usually employed in the thoracic
region as the pedicles have a
narrow needle entry point. These
approaches are also used in
situations where there is significant
tumour destruction of the pedicles.
Percutaneous vertebral augmentation procedures were introduced 25 years ago by
Harrington [10] in an intra-operative setting where 14 patients with metastatic spinal
instability were treated with methylmethacrylate for anterior stabilization of the
spine. Galibert et al. [11] wwre the rst to describe the use of percutaneous acrylic
cement injection for the treatment of an aggressive vertebral body haemangioma.
Currently, three vertebral augmentation procedures are licensed for clinical use:
vertebroplasty, kyphoplasty, and skyphoplasty. Each of these requires a similar
pre-procedural workup. Kyphoplasty provides restoration of vertebral body height
with similar rates of analgesia to vertebroplasty, reducing the rate of cement leakage. However, it costs ve to ten times times as much as vertebroplasty because
of the equipment used and the requirement for general anaesthesia [7]. These two
procedures provide similar pain control, so it is difcult to recommend kyphoplasty over vertebroplasty as the procedure of choice even if signicant kyphosis is
present. Skyphoplasty is the newest tool in the armamentarium of percutaneous
vertebral augmentation procedures. It uses a stiff plastic tube that is deployed
through a cannula and squashed into a popcorn-like shape to create the vertebral
body cavity which is then lled with cement. The skyphoplasty device creates
more pressure in a more predictable way than kyphoplasty. Another innovation
is stentoplasty which uses a metallic stent as a scaffold that remains in situ after
balloon deployment.
Thermal ablation (RFA, microwave ablation, etc.) of spinal metastases can be
carried out at the same time as percutaneous vertebral augmentation, with the two
procedures acting synergistically to provide signicant analgesia and increased vertebral stabilization within 24 hours of the procedure. There is also some evidence
demonstrating that if RFA is carried out before percutaneous vertebral augmentation, the risk of cement extravasation is reduced [12]. Theories of its mechanism
of action include destruction of sensory nerve bres, reduction of the lesion size,
and destruction of tumour cells producing nerve-stimulating factors. These combined procedures can give a patient stable and painless vertebra within 24 hours
of admission with an unstable vertebra [13]. Cumulative analyses of literature data
demonstrate that these patients have a signicant reduction in pain, with minimal
procedure-related morbidity, thus improving mobility, response to physiotherapy,
and quality of life with minimal interference with adjuvant therapies and a reduction in analgesic-related side effects [14,15].
Evidence base Results and complications of percutaneous vertebroplasty from a multicentre
trial—the European VErtebroplasty RESearch Team (EVEREST) [16]
●
4547 patients (3211 females and 1336 males, mean age 70.2 years).
●
Percutaneous vertebroplasty (PV).
●
13,437 treated vertebrae.
●
Procedures were performed using fluoroscopic guidance or combined CT–fluoroscopic guidance.
●
4004 out of 4547 (88.0%) patients reported significant pain relief within 48 hours.
●
An average score of 8.3 ± 0.4 on the 11-point VAS dropped to 2.4 ± 0.4 in patients with metastatic
disease.
●
430 osteoporotic patients (13%) were re-treated for a subsequent fracture.
●
In 302 out of 430 patients (70.2%) a new fracture occurred in the contiguous vertebra.
●
No major neurological complications were reported and the most frequent minor complication
was venous leakage (20.5%).
255Case 31 Vertebral augmentation techniques and pain management
A final word from the expert
Vertebral metastatic disease has a huge negative impact on patient quality of life and
survival. Palliative treatments (medical or radiotherapeutic and/or radiometabolic) are
first-line treatments in diffuse disease. In vertebral metastases from thyroid cancer, a radical
therapeutic attitude should be considered if clinically and technically indicated because of
the good life expectancy of these patients.
Radiotherapy needs time to provide pain control and structural stabilization. In the specific
case of thyroid metastases, radiometabolic therapy with iodine-131 in uptaking masses
has good control of tumour growth. Moreover, samarium-153 has selective indications in
bone methastases as it induces a peripheral osteoblastic reaction. Therefore it is effective
at the edge of the mass and, potentially, controls pain. Both radiometabolic treatments
can be combined with local thermal ablation as it induces an immediate tumour necrosis
peripherally directed from the central site of the energy source. Thus, in theory, in this
modality of action thermal ablation should favourably combine with and potentiate
radiometabolic therapy with samarium-153.
The key to vertebral augmentation in these cases is cementoplasty. Techniques such as
kyphoplasty, skyphoplasty, or even stentoplasty may have applications in metastatic disease,
but their actual efficacy compared with standard vertebroplasty is unclear because of
increased invasiveness, more pain, bilateral access, and higher costs. Moreover, cement
diffusion within the osteolytic lesion after thermal ablation is usually is wide and quite
homogeneous. Extravasation in the vertebral canal, root recesses, or root foramen can
occur, but it can be carefully monitored by imaging and limited to an asymptomatic level.
Therefore complications are rare. The low invasiveness of the procedure, which is always
256 Interventional radiology and endovascular procedures
performed under local anaesthesia and mild sedation, often makes it possible to discharge
the patient from hospital on the same day or the following day (‘daycase surgery’).
The ability of this combined procedure to provide rapid pain relief with little interference
with other adjuvant therapies and minimal comorbidities should make it the first-line
treatment in selected patients in centres that can offer it.
References
1. Gokaslan ZL, York JE, Walsh GL, et al. Transthoracic vertebrectomy for metastatic spinal
tumors. J Neurosurg 1998; 89(4): 599–609.
2. Jacobs WB, Perrin RG. Evaluation and treatment of spinal metastases: an overview.
Neurosurg Focus 2 001; 11(6): e10.
3. Benbassat CA, Mechlis-Frish S, Hirsch D. Clinicopathological characteristics and long-
term outcome in patients with distant metastases from differentiated thyroid cancer.
World J Surg 2006; 30:1088–95.
4. Hirabayashi H, Ebara S, Kinoshita T, et al. Clinical outcome and survival after palliative
surgery for spinal metastases. Cancer 2003; 97: 476–84.
5. Georgy BA. Metastatic spinal lesions: state-of-the-art treatment options and future trends.
AJNR Am J Neuroradiol 20 08; 29(9): 16 05 –11.
6. Hamady M, Sheard S. Role of cementoplasty in the management of compression vertebral
body fractures. Postgrad Med J 2009; 85(1004): 293–8.
7. Denaro L, Longo UG, Denaro V. Vertebroplasty and kyphoplasty: reasons for concern?
Orthop Clin North Am 2009; 40 (4): 465–71.
8. Ouoglu O. Minimally invasive management of spinal metastases. Orthop Clin North Am
2009; 40(1): 155–68.
9. Gangi A, Sabharwal T, Irani FG, et al. Quality assurance guidelines for percutaneous
vertebroplasty. Cardiovasc Intervent Radiol 2006; 29(2): 173–8.
10. Harrington KD. The use of methylmethacrylate for vertebral-body replacement and
anterior stabilization of pathological fracture-dislocations of the spine due to metastatic
malignant disease. J Bone Joint Surg Am 1981; 63(1): 36–46.
11. Galibert P, Deramond H, Rosat P, Le Gars D. [Preliminary note on the treatment of verte-
bral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie 1987; 33(2): 166–8
(in French).
12. Chi JH, Gokaslan ZL. Vertebroplasty and kyphoplasty for spinal metastases. Curr Opin
Support Palliat Care 2008; 2(1): 9–13.
13. Georgy BA. Percutaneous image-guided augmentation for spinal metastatic tumors. Tech
Vasc Interv Radiol 2009; 12(1): 71–7.
14. Evans AJ, Jensen ME, Kip KE, et al. Vertebral compression fractures: pain reduction and
improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 2003; 226(2): 366–72.
15. Barragan-Campos HM, Vallee JN, Lo D, et al. Percutaneous vertebroplasty for spinal
metastases: complications. Radiology 2006; 238(1): 354–62.
16. Anselmetti GC, Marcia S, Saba L, et al. Percutaneous vertebroplasty: multi-centric results
from EVEREST experience in large cohort of patients. Eur J Radiol 2012; 81(12): 4083–6.
INDEX
A
abdominal aortic aneurysm, juxtarenal 21–7
branched EVAR 26
chimney graft 27
fenestrated endovascular aortic repair
(FEVAR) 23, 25–6
hybrid repairs 27
ACHILLES trial 75, 76
acute decompensated heart failure 87
acute limb ischaemia
catheter-directed thrombolysis 79–85
causes 79
commercially available thrombectomy
catheters 85
contraindications to catheter-directed
thrombolysis 81
denition 79
mechanical thrombectomy 84–5
pharmaco-mechanical thrombolysis 85
risks of thrombolysis 83
ROCHESTER trial 83
STILE trial 83
thrombolytic agent infusion
techniques 83–4
thrombolytic agents 81, 84
thrombus aspiration 84
TOPAS trial 83
treatment options 80
airway stents
kissing stents 212, 214
self-expanding metallic stents 212, 213, 214
silicone stents 213, 214
aneurysmal bone cysts, percutaneous
vertebroplasty 239–43
angiosome concept 96, 100
ankle–brachial pressure index
(ABPI/ABI) 61, 69
anterior spinal artery 249
anticoagulants
carotid restenosis prevention 43
contraindications to oral
administration 120
deep vein thrombosis 112, 113, 115
antiplatelets
carotid restenosis prevention 43
peripheral arterial interventions 64,
70, 71
aortic dissection
bare stents 6, 7
branched EVAR 26
classication 11
connective tissue disease 6, 7, 16
CT angiography 7
endovascular aneurysm repair (EVAR) 25
EUROSTAR trial 6
fenestrated endovascular aortic repair
(FEVAR) 23, 25–6
hybrid repairs 27
juxtarenal abdominal aortic
aneurysm 21–7
malperfusion syndrome 7
post-endovascular repair pain 6, 7
STABLE trial 8
stent-graft size 6
surgical repair 16, 17, 27
TEVAR, see thoracic endovascular
aortic repair
type B 3–9, 16
aortic trauma 16, 169
aortogram, bronchial artery
embolization 153, 155
arterial ulcers 61
artery of Adamkiewicz 249
articial pneumothorax 205, 206
ASTRAL trial 90, 91
ATTRACT trial 115
B
Barcelona Clinic Liver Cancer (BCLC)
staging 221, 222
Barthel Index 38–9
BASIL trial 66
Bead Block 155
below the knee angioplasty 69–76, 95–101
ACHILLES trial 75, 76
angiosome concept 96, 100
antiplatelets 70, 71
Destiny trial 75
drug-eluting stents 71, 74, 75, 76
pedal-plantar loop 97
pre-procedural imaging 70
retrograde access 95, 97
SAFARI technique 95, 96–7
YUKON-BTX trial 75
258 Index
benign prostatic hyperplasia, prostate artery
embolization 195–9
evidence base 198
pre-procedure CT angiography 196, 197
PVA use 196, 197
surgical alternatives 199
biliary stents 233–7
bare versus covered 236–7
covering materials 236
migration problems 237
plastic versus metal 234
staged approach 234
brachytherapy, carotid restenosis 46
branched EVAR 26
bronchial artery
branching patterns 152, 153
embolization 153, 155–6
bronchoscopy 152
Budd–Chiari syndrome 129–37
alternative TIPS techniques 135
contraindications to TIPS 131
CT ndings 129–30
direct intrahepatic portocaval shunt 135
evidence base for TIPS 135
interventional complications 132
outcome prediction after TIPS 131
post-interventional management 132
post-TIPS ultrasound 133
pre-interventional ascites evacuation 131
pre-interventional preparation 131
ultrasound ndings 129
C
caesarean hysterectomy 182
carotid artery stenting
compared to endarterectomy 42
imaging 37, 38, 43
carotid in-stent restenosis 37–47
antiplatelet and anticoagulant therapy 43
brachytherapy 46
carotid artery stenting versus
endarterectomy 42
CREST trial 42
cutting balloon angioplasty 45, 46
drug-eluting stents 47
endovascular interventions 45, 46
imaging assessment 37, 38, 43
management guidelines 44
neurological assessment 38–9, 43
rates of 42
risk factors 42, 44–5
surgical treatment 45, 47
treatment options 45, 46
carotid sinus dysfunction 43
cavagram 123
CaVenT trial 113
Celect IVC lter 121
cervical percutaneous vertebroplasty 239–43
complications 243
efcacy 243
needle placement 242
Child–Pugh score 131
chimney graft 27
cholangiocarcinoma, biliary stents 237
clopidogrel resistance 109
coeliac plexus 248
coeliac plexus neurolysis 245–9
complications 249
duration of pain relief 249
efcacy 248
endoscopic ultrasound guidance 249
pain during alcohol injection 245, 247
pneumothorax prevention 246
post-procedure pain 248
coil embolization
bronchial artery 156
gastrointestinal bleeding 161, 162, 163
pelvic artery 184
trauma settings 168, 169
varicocele 190
computed tomography (CT)
Budd–Chiari syndrome 129–30
coeliac plexus neurolysis guidance 245–9
gastrointestinal bleeding 161
hepatocellular carcinoma 219, 220–1
massive haemoptysis 152
pancreatic adenocarcinoma 234
PET-CT for lung ablation follow-up 207
pre-tracheobronchial stenting 212
renal cell carcinoma 225
trauma patients 165
connective tissue disease, endovascular repair
of aortic disease 6, 7, 16
contrast-enhanced CT
Budd–Chiari syndrome 129–30
pancreatic adenocarcinoma 234
contrast-enhanced multidetector CT
gastrointestinal bleeding 161
hepatocellular carcinoma 219
trauma patients 165
contrast-enhanced ultrasound, hepatocellular
carcinoma 219
Cook Celect lter 121
Cool-Tip RFA system 226
CORAL trial 91
Crawford classication 22
259Index
CREST trial 42
critical limb ischaemia
ankle–brachial pressure index
(ABPI/ABI) 61, 69
balloon angioplasty 74
BASIL trial 66
below the knee angioplasty 69–76,
95–101
prognosis 64–5
supercial femoral artery endoluminal
bypass 61–6
CT angiography (CTA)
aortic dissection evaluation 7
bronchial artery embolization 153
endoleaks 17, 31–2
prostate artery embolization 196, 197
cutting balloon angioplasty, carotid
restenosis 45, 46
D
De Bakey classication 11
deep vein thrombosis (DVT)
anticoagulants 112, 113, 115
ATTRACT trial 115
catheter-directed thrombolysis versus
anticoagulation 113
CaVenT trial 113
economic burden 114–15
Egypt trial 113
incidence 114
inferior vena cava lters 115–16
intravascular ultrasound 116
mechanical thrombectomy 115
PEARL 115
pharmaco-mechanical
thrombectomy 114, 115
phlegmasia cerulea dolens 111–16
stenting tips 116
superior vena cava lters 124
surgical thrombectomy 115
delayed-phase imaging, endoleaks 17, 32
Destiny trial 75
dialysis access graft failure 105–9
clinical signs of 105
stulogram 108, 109
graft monitoring 105, 108
graft surveillance 105, 108
stent-graft versus balloon
angioplasty 108–9
digital subtraction angiography
(DSA)
carotid restenosis 38
endoleaks 17, 32
direct intrahepatic portocaval shunt
(DIPS) 135
disseminated intravascular coagulopathy
(DIC) 184
Doppler ultrasound
carotid restenosis 37, 38
dialysis access monitoring and
surveillance 108
varicocele 188
drug-eluting balloons 65
drug-eluting stents 47, 66, 71, 74, 75, 76
dual antiplatelet therapy
carotid restenosis prevention 43
peripheral arterial interventions 64,
70, 71
Dutch Iliac Stent Trial 54, 56
E
echocardiography, transoesophageal (TOE),
endoleaks 17
Egypt trial 113
Embosphere 155
Embozene 155
EMMY trial 172
endoleaks 11–18, 29–34
classication 12, 31
EUROSTAR trial 32, 33
EVAR 1 trial 33
GORE TAG trial 16
imaging 17, 31–2
management options 18, 33
natural history 32–3
Onyx embolization 12, 13, 15, 29, 30
rates in TEVAR trials 16–17
VALOR trial 16
endoscopy, gastrointestinal bleeding 159
endotension 12, 31, 33
endovascular aortic repair (EVAR)
branched 26
limitations 25
epidural anaesthesia 4
epistaxis embolization 141–7
anterior bleeding 141
common causes of epistaxis 143
complications 146
embolic materials 146
nasal vascular anatomy 143
persistent epistaxis 147
posterior bleeding 141
essential thrombocytopenia 129
ethanol injections
hepatocellular carcinoma 221–2
renal cell carcinoma 230
260 Index
EUROSTAR trial 6, 32, 33
EVAR 1 trial 33
EVEREST trial 255
everolimus-eluting stents 66, 75
external iliac artery occlusion 51–8
Dutch Iliac Stent Trial 54, 56
hybrid repair 57
primary stenting 53–4, 55, 56
surgical treatment 55, 57
TASC guidelines 52, 55
F
FAST 165
FemPac trial 65
fenestrated endovascular aortic repair
(FEVAR) 23, 25–6
fetal radiation exposure 184–5
broid embolization, see uterine broid
embolization
bromuscular dysplasia 89
stulogram 108, 109
ash pulmonary oedema 87
focused abdominal ultrasonography
(FAST) 165
Fontaine classication 62
foot, angiosome concept 96, 100
G
gastrointestinal bleeding 159–63
coil embolization 161, 162, 163
contrast-enhanced multidetector CT 161
embolic agents 162
embolization of upper versus lower
GI tract 162
endoscopy 159
NBCA embolization 161
Gelfoam 155, 168, 169, 184
GORE TAG trial 16
graft monitoring and surveillance 105, 108
H
haemoptysis, see massive haemoptysis
heat sink effect 208
hepatic encephalopathy 130
hepatocellular carcinoma 217–23
Barcelona Clinic Liver Cancer (BCLC)
staging 221, 222
bridge to liver transplantation 220
contrast-enhanced ultrasound 219
CT 219, 220–1
enhancement pattern variation 219
liver biopsy 217, 219
liver resection/transplantation 221
MRI 221
percutaneous ethanol injection 221–2
percutaneous techniques 221–3
radiofrequency ablation 217, 220, 221–3
selective internal radiation treatment
(SIRT) 223
sorafenib therapy 223
surgical treatment 221
transarterial chemoembolization
(TACE) 217, 220, 223
HOPEFUL trial 172
I
inferior vena cava (IVC) lters
Cochrane Database Review 125–6
Cook Celect lter 121
ileofemoral deep vein thrombosis 115–16
indications 124
PRECIP study 124–5
pre-placement cavagram 123
pulmonary embolism 119–26
retrievable designs 123, 124
types 124
internal iliac artery occlusion 179–81, 183,
184, 185
internal spermatic vein 187
International Prostate Symptom Score
(IPSS) 195
intravascular ultrasound 116
J
juxtarenal abdominal aortic aneurysm 21–7
branched EVAR 26
chimney graft 27
fenestrated endovascular aortic repair
(FEVAR) 23, 25–6
hybrid repairs 27
K
kidney trauma 169
kyphoplasty 252, 254
L
Le Fort classication 142
left subclavian artery revascularization 7–8
leiomyoma embolization, see uterine broid
embolization
Levant 1 trial 65
liver
biopsy 217, 219
resection 221
transplantation 221
trauma 169
261Index
lung cancer, tracheobronchial stenting 211–15
lung tumour radiofrequency ablation 203–9
anaesthetic considerations 204
articial pneumothorax 205, 206
complications 206
follow-up imaging 207
microwave ablation versus 208
patient selection 204
PET-CT 207
RAPTURE trial 208
recurrence 207, 209
M
magnetic resonance angiography (MRA)
carotid stents 43
endoleaks 32
lower limb vascular disease 57
magnetic resonance imaging (MRI)
carotid restenosis 43
endoleaks 17, 32
hepatocellular carcinoma 221
stent-graft artefacts 32
uterine broids 171
malperfusion syndrome 7
massive haemoptysis 151–6
bronchial artery anatomy 152, 153
bronchial artery embolization 153, 155–6
bronchial source 154
bronchoscopy 152
complication of embolization 156
CT 152
denition 151
diagnostic work-up 151–2
embolic agents 155–6
failure of embolization 156
non-bronchial source 154–5
maxillofacial injuries, Le Fort
classication 142
mechanical thrombectomy 84–5, 115
Meld score 131
microwave ablation
hepatocellular carcinoma 221
lung tumours 208
spinal metastases 254–5
morbidly adherent placenta 181–2
N
n-butyl cyanoacrylate (NBCA) glue 154,
156, 161
nasal vascular anatomy 143
National Institute of Health Stroke Scale
(NIHSS) 38
neurological assessment scales 38–9, 43
O
obstetric haemorrhage, see post-partum
haemorrhage
Onyx 16
endoleak embolization 12, 13, 15, 29, 30
gastrointestinal embolization 162
ovarian arteries 174
ovarian-uterine anastomoses 174
P
Pacier trial 65
paclitaxel-coated balloons 65
paclitaxel-coated stents 66
pain management
coeliac plexus neurolysis 245–9
percutaneous vertebral
augmentation 251–6
pancreatic cancer
biliary stents 233–7
coeliac plexus neurolysis for pain
relief 245–9
CT protocol 234
PEARL trial 115
pedal-plantar loop 97
pelvic arterial embolization 183–4
pelvic haemorrhage 169
peptic ulcer bleeding 161
percutaneous vertebral augmentation 251–6
approaches 254
EVEREST trial 255
indications and contraindications 252
kyphoplasty 252, 254
skyphoplasty 252, 254
stentoplasty 254
vertebroplasty 252, 253, 254
percutaneous vertebroplasty 239–43
complications 243
efcacy 243
needle placement 242
periscope graft 27
PET-CT, lung ablation follow-up 207
pharmaco-mechanical thrombectomy 85,
114, 115
phlegmasia alba dolens 111
phlegmasia cerulea dolens 111–16
placenta accreta 181, 182
placenta increta 181–2
placenta percreta 179–81, 182, 183
pneumothorax
articial 205, 206
post-lung RFA 206
polyvinyl alcohol (PVA) particles 145, 155,
196, 197
262 Index
popliteal artery stenting 64
post-embolization syndrome 172
post-partum haemorrhage 179–85
caesarean hysterectomy 182
fetal complications 184
internal iliac artery occlusion 179–81, 183,
184, 185
pelvic arterial embolization 183–4
Triple-P technique 181, 183
PRECIP trial 124–5
premature ovarian failure 172
prostate artery angiography 196, 197
prostate artery embolization 195–9
evidence base 198
pre-procedure CT angiography 196, 197
PVA use 196, 197
prostate-specic antigen 195
pulmonary embolism
inferior vena cava lters for 119–26
post-uterine broid embolization 172
pulmonary haemorrhage, post-lung RFA 206
PVA particles 145, 155, 196, 197
R
radiofrequency ablation
Cool-Tip system 226
heat sink effect 208
hepatocellular carcinoma 217, 220, 221–3
lung tumours 203–9
renal cell carcinoma 225–31
spinal metastases 253, 254–5
Rankin scale 38, 39
RAPTUREtrial 208
recombinant tissue plasminogen
activator (r-tPA) 81
re-entry catheters 64, 65
renal artery stenosis 87–92
ASTRAL trial 90, 91
atherosclerotic 89, 92
CORAL trial 91
bromuscular dysplasia 89
incidence 89
indications for percutaneous
revascularization 91–2
medical therapy versus stenting 89–91
predictor of other vascular morbidity 89
pre-procedure imaging 88
STAR trial 90, 91
renal cell carcinoma, radiofrequency
ablation 225–31
classication of tumours 226
compared to partial nephrectomy 226,
229, 230–1
CT characteristics 225
ethanol injections and 230
oncological outcomes 228, 229
recurrence detection 228
residual tumour detection 228
REST trial 172
ROCHESTER trial 83
Rutherford classication 62
S
SAFARI technique 95, 96–7
sandwich graft technique 27
sclerotherapy, varicocele 189, 190, 191
scrotal temperature 188
selective internal radiation treatment
(SIRT) 223
SIROCCO trial 66
sirolimus-eluting stents 66, 71, 75
skyphoplasty 252, 254
sorafenib 223
spinal metastases
percutaneous vertebral
augmentation 251–6
radiofrequency ablation 253, 254–5
splenic artery embolization 165–6, 167,
168, 169
STABLE trial 8
Stanford classication 11
STAR trial 90, 91
stentoplasty 254
STILE trial 83
streptokinase 81
STRIDES trial 66
subintimal arterial ossing with
antegrade–retrograde intervention
(SAFARI) 95, 96–7
supercial femoral artery endoluminal
bypass 61–6
drug-eluting balloons 65
drug-eluting stents 66
FemPac trial 65
Levant 1 trial 65
Pacier trial 65
SIROCCO trial 66
STRIDES trial 66
surgery versus (BASIL trial) 66
Thunder trial 65
Zilver PTX trial 66
superior vena cava lters 124
T
TACE 217, 220, 223
telethermography 188
263Index
thoracic aortic aneurysm
bare stents 6, 7
classication 11
connective tissue disease 6, 7, 16
CT angiography 7
incidence 16
malperfusion syndrome 7
post-endovascular repair pain 6, 7
stent-graft size 6
surgical repair 16, 17
TEVAR, see thoracic endovascular
aortic repair
thoracic aortogram, bronchial artery
embolization 153, 155
thoracic endovascular aortic repair
(TEVAR) 3–9
aortic imaging 16
bare stents 6, 7
complications 17
connective tissue disease 7, 16
endoleak rates 16–17
follow-up 12, 18
left subclavian artery
revascularization 7–8
post-procedure pain 6, 7
stent-graft size 6
survival 16
thoraco-abdominal aneurysms 21, 22
thrombolytic agents 81, 84
thrombus aspiration 84
Thunder trial 65
tissue plasminogen activator (tPA) 81, 84
TOPAS trial 83
tracheobronchial stenting 211–15
complications 215
kissing stents 212, 214
pre-procedure CT 212
removal 215
self-expanding metallic stents 212,
213, 214
silicone stents 213, 214
transarterial chemoembolization (TACE) 217,
220, 223
Transatlantic Inter-Society Consensus (TASC)
guidelines 52, 55, 62, 65
transjugular intrahepatic portosystemic shunt
(TIPS) 129–37
alternative techniques 135
complications 132
contraindications 131
evidence base for use in Budd–Chiari
syndrome 135
outcome prediction 131
post-interventional management 132
pre-interventional ascites evacuation 131
pre-interventional preparation 131
ultrasound after 133
transoesophageal echocardiography (TOE),
endoleaks 17
transurethral resection of the prostate
(TURP) 199
trauma patients 165–9
aortic injury 16, 169
CT 165
focused abdominal ultrasonography
(FAST) 165
kidney injury 169
liver injury 169
pelvic haemorrhage 169
splenic artery embolization 165–6, 167,
168, 169
trials
ACHILLES 75, 76
ASTRAL 90, 91
ATTRACT 115
BASIL 66
CaVenT 113
CORAL 91
CREST 42
Destiny 75
Dutch Iliac Stent Trial 54, 56
Egypt 113
EMMY 172
EUROSTAR 6, 32, 33
EVAR 1: 33
EVEREST 255
FemPac 65
GORE TAG 16
HOPEFUL 172
Levant 1: 65
Pacier 65
PEARL 115
PRECIP 124–5
RAPTURE 208
REST 172
ROCHESTER 83
SIROCCO 66
STABLE 8
STAR 90, 91
STILE 83
STRIDES 66
Thunder 65
TOPAS 83
VALOR 16
YUKON-BTX 75
Zilver PTX 66
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