Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3726_Библиотеки_им_академика_М_И_Перельмана.pdf
Скачиваний:
0
Добавлен:
31.08.2026
Размер:
29 Мб
Скачать
Endovascular Treatment of Arterial Emergencies
Stevo Duvnjak
123
Endovascular Treatment of Arterial Emergencies
Endovascular Treatment of Arterial Emergencies
StevoDuvnjak Department of Vascular Surgery Rigshospitalet København Denmark
ISBN 978-3-030-68831-8 ISBN 978-3-030-68832-5 (eBook)
https://doi.org/10.1007/978-3-030-68832-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
To all my teachers in Interventional Radiology and Vascular Surgery in Serbia and Denmark.

Preface

The endovascular treatment of arterial and venous diseases is unavoidable in daily practice. The development of new devices and improvements in cur­rently available devices ensure the steadily increasing usage of endovascular methods. Emergencies are a part of everyday practice, and mastering endo­vascular knowledge and techniques provides a good outcome for our patients. This book presents a practical overview of endovascular treatment in an arte­rial emergency, including the most common clinical scenarios. The cases pre­sented in the book are from my experience during work at the Department of Radiology, Odense University Hospital, Denmark. There are many books available covering endovascular treatment, but few have focused on arterial emergencies alone. Therefore, this book may be valuable for different target groups, including vascular surgery, interventional radiology, cardiology, and emergency surgery. Experienced, resident, and young doctors can use this book for a quick overview and to reference treatment options in acute cases during their clinical work. The book covers the majority of arterial emergen­cies than can be seen in clinical practice. Many quality images of arterial emergencies and treatments and their descriptions can provide readers with the necessary knowledge on and provide insight into endovascular options.
The book describes the treatment of complex and standard thoracic vascu­lar emergency cases, followed by abdominal emergency and peripheral arte­rial emergency cases. At the beginning of each case, a few critical remarks that should be considered during the decision-making process are emphasized.
Copenhagen, Denmark StevoDuvnjak
vii

Contents

1 Endovascular Armamentarium in Vascular Emergencies . . . . . 1
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1.1 Catheters and Microcatheters . . . . . . . . . . . . . . . . . . . . 1
1.1.2 Stent Grafts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1.3 Mechanical Embolization Materials . . . . . . . . . . . . . . 3
1.1.4 Liquid Embolization Materials and Microspheres . . . . 4
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2 Diagnosis of Vascular Emergencies . . . . . . . . . . . . . . . . . . . . . . . . 7
2.1 Diagnosis of Endovascular Emergency . . . . . . . . . . . . . . . . . . 7
2.2 Computed Tomography (CT) Diagnosis of Endovascular
Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.3 Magnetic Resonance Imaging (MRI) Diagnosis
of Endovascular Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.4 Invasive Angiographic Diagnosis of Endovascular
Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Thoracic Vascular Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.1 Thoracic Aortic Dissections . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.1.1 Acute Complicated Aortic Dissection Type B . . . . . . . 14
3.1.2 Subacute Complicated Aortic Dissection Type B . . . . 22
3.1.3 Acute Aortic Dissection Type B Presented
with Rupture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.1.4 Subacute Aortic Dissection Type B Presented
with Rupture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.1.5 Chronic Aortic Dissection with Enlarging
Aneurysm-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
3.1.6 Chronic Aortic Dissection with Enlarging
Aneurysm-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.2 Thoracic Aortic Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
3.2.1 Ruptured Thoracic Descending Aortic Aneurysm . . . . 43
3.2.2 Aortic Arch Aneurysm I . . . . . . . . . . . . . . . . . . . . . . . . 44
3.2.3 Aortic Arch Aneurysm II . . . . . . . . . . . . . . . . . . . . . . . 51
3.2.4 Symptomatic Thoracoabdominal Aneurysm . . . . . . . . 55
3.3 Thoracic Aortic Intramural Haematomas . . . . . . . . . . . . . . . . . 61
3.3.1 Intramural Haematoma Involving the Ascending
and Descending Aorta . . . . . . . . . . . . . . . . . . . . . . . . . 61
ix
x
3.3.2 Intramural Haematoma in the Descending
Aorta-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
3.3.3 Intramural Haematoma in the Descending
Aorta–II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
3.3.4 Intramural Haematoma in the Descending
Aorta-III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
3.4 Penetrating Thoracic Aortic Ulcer . . . . . . . . . . . . . . . . . . . . . . 77
3.4.1 Penetrating Thoracic Ulcer in the Descending
Aorta-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
3.4.2 Penetrating Thoracic Ulcer in the Descending
Aorta-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
3.4.3 Penetrating Thoracic Ulcer in the Descending
Aorta-III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
3.5 Thoracic Aortic Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
3.5.1 Thoracic Aortic Trauma-I . . . . . . . . . . . . . . . . . . . . . . 84
3.5.2 Thoracic aortic trauma-II . . . . . . . . . . . . . . . . . . . . . . . 84
3.5.3 Thoracic Aortic Trauma-III . . . . . . . . . . . . . . . . . . . . . 88
3.6 Thoracic Arterial Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
3.6.1 Pulmonary Artery Bleeding . . . . . . . . . . . . . . . . . . . . . 89
3.7 Intercostal/Bronchial Artery Bleeding . . . . . . . . . . . . . . . . . . . 96
3.7.1 Bleeding from the Intercostal- Bronchial Artery . . . . . 96
3.7.2 Bleeding from the Bronchial Artery . . . . . . . . . . . . . . 104
3.7.3 Bleeding from the Intercostal Artery . . . . . . . . . . . . . . 109
Contents
4 Abdominal Vascular Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . 113
4.1 Abdominal Aortic Emergencies . . . . . . . . . . . . . . . . . . . . . . . . 114
4.1.1 Abdominal Aortic Aneurysm-Symptomatic . . . . . . . . 114
4.1.2 Abdominal Aortic Aneurysm-Ruptured . . . . . . . . . . . . 116
4.1.3 Iliac Artery Aneurysm-Ruptured . . . . . . . . . . . . . . . . . 119
4.1.4 Mycotic Abdominal Aortic Aneurysm . . . . . . . . . . . . . 121
4.1.5 Abdominal Aorto-Iliac Occlusion . . . . . . . . . . . . . . . . 127
4.2 Visceral Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
4.2.1 Splenic Artery-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
4.2.2 Splenic Artery-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
4.2.3 Hepatic Artery–I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
4.2.4 Hepatic Artery-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
4.2.5 Left Gastric Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
4.2.6 Gastroduodenal Artery I . . . . . . . . . . . . . . . . . . . . . . . . 144
4.2.7 Gastroduodenal Artery II . . . . . . . . . . . . . . . . . . . . . . . 145
4.2.8 Superior Mesenteric Artery . . . . . . . . . . . . . . . . . . . . . 150
4.2.9 Inferior Mesenteric Artery . . . . . . . . . . . . . . . . . . . . . . 155
4.2.10 Renal Artery-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
4.2.11 Renal Artery-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
4.3 Visceral Artery Occlusive Diseases . . . . . . . . . . . . . . . . . . . . . 165
4.3.1 Superior Mesenteric Artery-I . . . . . . . . . . . . . . . . . . . . 165
4.3.2 Superior Mesenteric Artery-II . . . . . . . . . . . . . . . . . . . 167
4.3.3 Inferior Mesenteric Artery . . . . . . . . . . . . . . . . . . . . . . 169
4.3.4 Renal Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Contents
xi
4.4 Abdominal Arterial Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . . 180
4.4.1 Coeliac Trunk-Left Gastric Artery . . . . . . . . . . . . . . . . 180
4.4.2 Superior Mesenteric Artery-I . . . . . . . . . . . . . . . . . . . . 181
4.4.3 Superior Mesenteric Artery-II . . . . . . . . . . . . . . . . . . . 185
4.4.4 Inferior Mesenteric Artery . . . . . . . . . . . . . . . . . . . . . . 188
5 Pelvic Vascular Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
5.1 External Iliac Artery Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . 194
5.1.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 194
5.1.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 194
5.1.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 194
5.1.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
5.2 Internal Iliac Artery Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . 197
5.2.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 197
5.2.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 197
5.2.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 197
5.2.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
5.3 Uterine Artery Bleeding-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
5.3.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 201
5.3.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 201
5.3.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 201
5.3.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
5.4 Uterine Artery Bleeding-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
5.4.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 203
5.4.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 203
5.4.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 203
5.4.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
5.5 Uterine Artery Bleeding-III . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
5.5.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 204
5.5.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 208
5.5.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 208
5.5.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
5.6 Arterio-Enteric Fistula Bleeding-I . . . . . . . . . . . . . . . . . . . . . . 208
5.6.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 208
5.6.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 212
5.6.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 212
5.6.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
5.7 Arterio-Enteric Fistula Bleeding–II . . . . . . . . . . . . . . . . . . . . . 213
5.7.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 213
5.7.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 213
5.7.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 213
5.7.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
6 Peripheral Artery Vascular Emergency . . . . . . . . . . . . . . . . . . . . 217
6.1 Carotid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
6.1.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 218
6.1.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 218
6.1.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 218
6.1.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
xii
6.2 Subclavian Artery-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
6.2.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 220
6.2.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 222
6.2.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 222
6.2.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
6.3 Subclavian Artery-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
6.3.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 223
6.3.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 224
6.3.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 224
6.3.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
6.4 Femoral Artery-I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
6.4.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 226
6.4.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 226
6.4.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 226
6.4.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
6.5 Femoral Artery-II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
6.5.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 228
6.5.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 228
6.5.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 229
6.5.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
6.6 Popliteal Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
6.6.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 230
6.6.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 230
6.6.3 Endovascular Intervention . . . . . . . . . . . . . . . . . . . . . . 232
6.6.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
6.7 Crural Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
6.7.1 Aetiology and Clinical Presentation . . . . . . . . . . . . . . 232
6.7.2 Pre-interventional Diagnosis . . . . . . . . . . . . . . . . . . . . 232
6.7.3 Endovascular Treatment . . . . . . . . . . . . . . . . . . . . . . . . 232
6.7.4 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Contents