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Venous Interventional Radiology

Laura K. Findeiss, MD, FSIR, FAHA

Professor of Radiology and Surgery Emory University School of Medicine Chief of Service Department of Radiology Grady Health System Atlanta, Georgia

298 illustrations

Thieme New York • Stut tgart • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data

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Names: Findeiss, Laura K., editor. Title: Venous interventional radiology / [edited by] Laura K.

Findeiss.

Description: New York : Thieme, [2020] | Includes bibliographical

references and index. | Summary: "The diagnosis and interventional management of venous disorders is a truly core area in radiology, representing a signiﬁcant percentage of the caseload of an interventional radiologist-up to 75% in some institutions. Covering common disorders such as venous ulceration and varicose veins (affecting half of adults over the age of 50) as well as such serious disorders such as thromboembolic disease, this book will present the state of the art in minimally invasive diagnosis and management of these disorders. Highly practical and authoritative, this book will open with sections on epidemiology, anatomy, and the basics of venous access and then will coverthe wide rangeof these disorders,with practical guidelines and case examples"– Provided by publisher.

Identiﬁers: LCCN 2020001751 (print) | LCCN 2020001752 (ebook)

| ISBN 9781626232730 (hardcover) | ISBN 9781626232747 (ebook)

Subjects: MESH: Vascular Diseases–diagnostic imaging |

Veins–pathology | Vascular Diseases–therapy | Radiology, Interventional–methods | Radiography,Interventional–methods

Classiﬁcation: LCC RD598.67 (print) | LCC RD598.67 (ebook) | NLM

WG 600 | DDC 616.1/307572–dc23 LC record available at https://lccn.loc.gov/2020001751 LC ebook record available at https://lccn.loc.gov/2020001752

Important n ote: Medicine is an ever-changing science undergoing continual development. Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy. Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of

knowledge at the time of production of the book.

Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book. Every user is requested to examine carefully the manufacturers’ leaﬂets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedulesmentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market. Every dosageschedule or every form of application used is entirely atthe user’sown risk andresponsibility. The authorsand publishers request every user to report to the publishers any discrepancies or inaccuracies noticed. If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page.

Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though speciﬁc reference to this fact is not always made in the text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain.

Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, customerservice@thieme.com

Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, customerservice@thieme.de

Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, customerservice@thieme.in

Thieme Publishers Rio de Janeiro, Thieme Publicações Ltda. Edifício Rodolpho de Paoli, 25ºandar Av. Nilo Peçanha, 50 – Sala 2508 Rio de Janeiro 20020-906 Brasil +55 21 3172-2297 / +55 21 3172-1896 www.thiemerevinter.com.br

Cover design: Keith Palumbo and Konzeption Typesetting by Thomson Digital, India

Printed in USA by King Printing Company, Inc. 5 4 3 2 1

ISBN 978-1-62623-273-0

Also available as an e-book: eISBN 978-1-62623-274-7

This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microﬁlms, and electronic data processing and storage

To my parents, who always encouraged me to keep going and let me believe that anything was possible.

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And to my husband, Chuck Ray, who has shown me that everything is possible.

- Laura K. Findeiss

Contents

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Preface ............................................................................................ ix

Acknowledgments ............................................................................... xi

Contributors ...................................................................................... xiii

1 Venous Anatomy and Physiology and Epidemiology of Venous Disorders ................. 1

Kathleen Hamrick and Laura K. Findeiss

2 Venous Thromboembolism ..................................................................... 15

Matthew T. Rondina and Hanadi Farrukh

3 Cerebral Venous Thrombosis ................................................................... 30

Nitish Dhingra and Kieran Murphy

4 Acute Deep Venous Thrombosis: Sporadic and Compressive................................ 35

Kyle Cooper, Minhaj S. Khaja, and Bill S. Majdalany

5 Pulmonary Embolism ............................................................................ 52

Ronald S. Winokur and Akhilesh K. Sista

6 Inferior Vena Cava Filters ........................................................................ 59

Robert L. King and Matthew S. Johnson

7 Chronic Venous Occlusive Disease.............................................................. 67

Deepak Sudheendra

8 Peripheral Venous Insuﬃciency................................................................. 74

Mary Costantino

9 Venous Access .................................................................................... 84

Todd Hoﬀman, Laura K. Findeiss, and Gordon McLennan

10 Pelvic and Gonadal Venous Reflux.............................................................. 99

Douglas A. Murrey, Bill S. Majdalany, and Minhaj S. Khaja

11 Portal and Mesenteric Venous Disorders ...................................................... 114

Maria del Pilar Bayona-Milano and Hector Ferral

12 Venous Anomalies and Syndromes: Classifications, Evaluation, and Treatment........... 141

Christopher R. Bailey, Scott R. Shuldiner, and Cliﬀord R. Weiss

Index .............................................................................................. 152

vii

Preface

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Venous Interventional Radiology was conceived as a comprehensive textbook of image guided intervention in the venous system and is intended to cover a broad range of disease states. It is well recognized that venous disorders are, in many ways,the mainstay of interventional radiology practice and are squarely within the purview of the interventionalradiologist.However,there arefew textbooksthat comprehensively address the broad scope of venous interventional radiology practice beyond lower extremity venous insufﬁciency.

A foundation of this volume is an emphasis on the importance of the clinical management of patients with venous disorders, extending beyond the act of performing image-guided interventions. Using a standardized chapter format and a case-based approach, this text aims to address the nuances of decision-making in clinical encounters, and describes workup, non-interventional management, image guided interventions, and post-procedure care. This richly illustrated textbook begins with an in-depth discussion of anatomy and physiology, followed by a comprehensive review of thrombosis. These chapters are foundational, and the understanding of these topics is critical to excellence in the care of patients with venous disorders. Moving on to a

broad range of topics, from chronic thrombosis and acute thromboembolism to portal venous disease and venous anomalies, the remainder of the text is designed to provide a practical guidance in treating patients with venous disorders and may be read in its entirety, or may serve as a reference in preparing for an individual patient encounter. The authors, recruited from both academics and private practice, are experts with extensive experience in venous disorders or venous interventions, and I am grateful for their generosity in participating in this endeavor.

Venous interventional radiology is a rapidly evolving ﬁeld, and I anticipate that we will continue to increase our understanding of the optimal managementof patients with the disorders described in this text. As this volume goes to press, the devices available for intervention in venous occlusive disease are rapidly increasing in number, such that the options described herein can in no way be considered exhaustive.Such isthe nature ofour dynamicspecialty. It is my goal that the expert clinical guidance provided by the authors will serve as a foundation for outstanding patient care as this area of practice continues to develop.

Laura K. Findeiss, MD, FSIR, FAHA

Acknowledgments

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I would like to express my deepest gratitude to all of the contributing authors for being willing totake this endeavor on in spite of their many other responsibilities. Their excel-

lent contributions haveallowedfor the vision ofthis book to materialize. I also deeply appreciate their patience in getting to the ﬁnish line with me.

Contributors

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Christopher R. Bailey, MD

Russell H. Morgan Department of Radiology and

Radiological Science Johns Hopkins Hospital Baltimore, Maryland

Maria del Pilar Bayona-Milano, MD

Assistant Professor of Interventional Radiology Mallinckrodt Institute of Radiology Washington University St. Louis, Missouri

Kyle Cooper, MD

Department of Radiology Loma Linda University Loma Linda, California

Mary Costantino, MD

Interventional Radiologist Legacy Good Samaritan Medical Center Medical Director CIC-Portland Portland, Oregon

Nitish Dhingra

Candidate, Bachelor of Health Sciences McMaster University Hamilton, Ontario, Canada

Hanadi M. Farrukh, MD

Assistant Professor of Medicine Department of Internal Medicine University of Utah Salt Lake City, Utah

Hector Ferral, MD

Senior Clinician Educator NorthShore University Health System Evanston, Illinois

Laura K. Findeiss, MD, FSIR, FAHA

Professor of Radiolog y and Surgery Emory University School of Medicine Chief of Radiology Grady Health System Atlanta, Georgia

Kathleen Hamrick, MD

Interventional Radiology Fellow Department of Radiology Northwestern University Evanston, Illinois

Todd Hoffman, MD

Quantum Imaging and Therapeutic Associates Lewisberry, Pennsylvania

Matthew S. Johnson, MD

Indiana Radiology Partners Department of Radiology Indiana University Bloomington, Indiana

Minhaj S. Khaja, MD, MBA

Department of Radiology University of Virginia Charlottesville, Virginia

Robert L. King, MD

Assistant Professor of Clinical Radiology University of Illinois College of Medicine-Peoria OSF St. Francis Medical Center Peoria, Illinois

Bill S. Majdalany, MD

Division of Interventional Radiology Department of Radiology Emory University School of Medicine Atlanta, Georgia

Gordon McLennan, MD

Department of Diagnostic Radiology Cleveland Clinic Cleveland, Ohio

Douglas A. Murrey, MD

Inland Imaging Spokane, Washington

Kieran Murphy, MB, FRCPC, FSIR

Professor of Interventional Neuroradiology University of Toronto Toronto Western Hospital Toronto, Ontario, Canada

Matthew T. Rondina, MD

Professor of Internal Medicine and Pathology University of Utah Health Sciences Center George E. Wahlen VAMC Salt Lake City, Utah

Scott R. Shuldiner, BS

Medical Student Johns Hopkins University School of Medicine Baltimore, Maryland

xiii

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