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Vascular and Interventional Radiology
Principles and Practice
Vascular and Interventional Radiology
Principles and Practice
Curtis W. Bakal, M.D., M.P.H.
Director, Vascular and Interventional Radiology Beth Israel Medical Center St. Luke’s-Roosevelt Hospital Center Long Island College Hospital New York, New York and Professor of Radiology Albert Einstein College of Medicine New York, New York
James E. Silberzweig, M.D.
Associate Professor of Clinical Radiology Albert Einstein College of Medicine St. Luke’s-Roosevelt Hospital Center New York, New York
Jacob Cynamon, M.D.
Professor of Clinical Radiology Albert Einstein College of Medicine Montefiore Medical Center New York, New York
Seymour Sprayregen, M.D.
Professor Department of Radiology Albert Einstein College of Medicine Montefiore Medical Center New York, New York
Thieme
New York
.
Stuttgart
Thieme Medical Publishers, Inc.
https://t.me/med1917
333 Seventh Ave. New York, NY 10001
Editor: Kathleen P. Lyons Editorial Assistant: Diane Sardini Director, Production and Manufacturing: Anne Vinnicombe Production Editor: Becky Dille Marketing Director: Phyllis Gold Sales Manager: Ross Lumpkin Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Northeastern Graphic Services, Inc. Printer: Maple-Vail Book Manufacturing Group
Library of Congress Cataloging-in-Publication Data
Vascular and interventional radiology : principles and practices / Curtis W. Bakal …[et al.].
p.; cm. Includes bibliographical references and index. ISBN 0-86577-678-4 (alk. paper) – ISBN 3131079118 (alk. paper)
1. Blood-vessels—Imaging. 2. Interventional radiology. I. Bakal, Curtis W. [DNLM: 1. Vascular Diseases—radiography. 2. Radiology, Interventional—methods.
WG 500 V33115 2002] RC691.6.A53 V373 2002
616.1⬘30757—dc21 2001058205
Copyright ©2002 by Thieme Medical Publishers, Inc. 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 liableto prosecution. This applies in particular to Photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage.
Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accepted at the time of publication. However, in the view of the possibility of human error by the authors, editors, or publisher, of the work herein, or changes in medical knowledge, neither the authors, editors, or publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
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.
Printed in the United States of America 54321 TMP ISBN 0-86577-678-4 GTV ISBN 3 13 107911 8
Contents
Contents
https://t.me/med1917
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
PART I. BASIC PRINCIPLES AND TECHNIQUES
1. Vascular and Interventional Radiology: A Brief History . . . . . . . . . . . . . 3
2. Catheters and Guidewires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3. Filming and Injection Techniques . . . . . . . . . . . . . . . . . . . . . . . . . 17
4. An Approach to Sedation and Monitoring . . . . . . . . . . . . . . . . . . . . 25
5. Magnetic Resonance and Computed Tomographic Angiography . . . . . . . 29
6. Clinical and Noninvasive Evaluation of Peripheral Vascular Disease . . . . . . 55
7. Vascular Recanalization Techniques . . . . . . . . . . . . . . . . . . . . . . . . 71
8. General Principles of Embolization and Chemoembolization . . . . . . . . . 89
9. Organ Access Techniques: General Principles for Localization, Drainage,
and Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
10. Percutaneous Needle Biopsy and Drainage . . . . . . . . . . . . . . . . . . . 109
11. Radiologic Gastrostomy and Gastrojejunostomy . . . . . . . . . . . . . . . . 123
12. Radiation Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
13. Physician Health and Safety in the Angiography Suite . . . . . . . . . . . . . 137
PART II. A SYSTEMS APPROACH TO DIAGNOSIS AND MANAGEMENT
14. Vascular Anatomy above the Diaphragm . . . . . . . . . . . . . . . . . . . . 147
15. Pulmonary and Bronchial Arteries . . . . . . . . . . . . . . . . . . . . . . . . 153
16. Diseases of the Thoracic Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . 163
17. Thoracic Outlet and Upper Extremities . . . . . . . . . . . . . . . . . . . . . 179
18. Carotid, Vertebral, and Spinal Arteriography . . . . . . . . . . . . . . . . . . 189
19. Vascular Anatomy below the Diaphragm . . . . . . . . . . . . . . . . . . . . 203
20. Atherosclerotic Disease of the Aorta, Pelvis, and Lower Extremities . . . . . . 211
21. Venous Thromboembolic and Vena Cava Filters . . . . . . . . . . . . . . . . 233
22. Anatomy of the Kidneys and Genitourinary Tract . . . . . . . . . . . . . . . 255
23. Vascular Manifestations of Renal Disease . . . . . . . . . . . . . . . . . . . . 267
24. Obstructive Uropathy and Renal Calculus Disease . . . . . . . . . . . . . . . 287
25. Pelvic and Obstetric Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . 297
26. Pudendal Arteriography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
27. Varicocele and Female Infertility . . . . . . . . . . . . . . . . . . . . . . . . . 317
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Contents
28. Anatomy of the Gastrointestinal Tract, Liver, and Biliary System . . . . . . . 339
29. Interventional Management of Gastrointestinal Strictures . . . . . . . . . . 353
30. Nonvariceal Upper GI Bleeding . . . . . . . . . . . . . . . . . . . . . . . . . 359
31. Liver and Spleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
32. The Biliary Tree and Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . 391
33. Vascular Diseases of the Lower Gastrointestinal Tract . . . . . . . . . . . . . 411
34. Arteriography and Venous Sampling of the Parathyroid Glands, Pancreas,
and Adrenal Glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425
35. Central Venous Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
36. Hemodialysis Access Management . . . . . . . . . . . . . . . . . . . . . . . . 459
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
ContributorsContributors
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Contributors
Ramsey Abadir, M.D.
Horton Medical Center Middletown, New York
Jacqueline Bello, M.D.
Director Neuroradiololgy and Professor of Clinical Radiology Albert Einstein College of Medicine Montefiore Medical Center New York, New York
Bruce Berkowitz, M.D.
Fort Collins Radiologic Associates Fort Collins, Colorado
Steven E. Black, M.D.
Diagnostic Radiology Consultants Chattanooga, Tennessee
Steven L. Dawson, M.D.
Head, GI Inter ventional Radiology Department of Radiology Massachusetts General Hospital Boston, Massachusetts
Kevin W. Dickey, M.D.
Assistant Clinical Professor Diagnostic Radiology Yale University School of Medicine and Staff Interventional Radiologist Hospital of St. Raphael New Haven, Connecticut
Bernard G. Fish, M.D.
Associate Clinical Professor of Pediatric Cardiology Section of Pediatric Cardiology New York Medical College Valhalla, New York
Andrei Frost, M.D.
Associate Professor of Clinical Radiology Weiler Hospital Albert Einstein College of Medicine Montefiore Medical Center New York, New York
Jeffrey D. Georgia, M.D.
Assistant Professor of Radiology Uniformed Services University of Health Sciences Department of Radiology National Naval Medical Center Bethesda, Maryland
Thomas J. DiBartholomeo, M.D.
Stamford Radiological Associates Stamford, CT
Mark A. Greenberg, M.D.
Division of Cardiology Montefiore Medical Center New York, New York
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Contributors
Michael J. Hallisey, M.D.
Associate Professor of Medicine University of Connecticut, Hartford Hospital Connecticut Surgical Group Hartford, Connecticut
Margaret E. Hansen, M.D.
CPO Radiology Associate Dallas, Texas
Brad Hoppenfield, M.D.
Associated Radiologists of Singer Lake Elmira Heights, New York
John A. Kaufman, M.D.
Professor Dotter Interventional Institute Oregon Health and Science University Portland, Oregon
Andrew S. Kerr, M.D.
Department of Radiology Metropolitan Hospital New York, New York
Philip S. Lakritz, M.D.
Holmdel, New Jersey
Timothy P. Murphy, M.D.
Associate Professor of Diagnostic Imaging Rhode Island Hospital and Brown University School of Medicine Providence, Rhode Island
Irene Osborn, M.D.
Department of Anesthesiology Mount Sinai Hospital New York, New York
Marlene Rackson, M.D.
Residency Program Director Attending Radiologist Beth Israel Medical Center and Assistant Professor of Radiology Albert Einstein College of Medicine Department of Radiology New York, New York
Charles E. Ray, Jr., M.D.
Chief, Interventional Radiology Denver Health Medical Center and Associate Professor of Radiology University of Colorado Health Sciences Center Denver, Colorado
Matthew A. Mauro, M.D.
Professor of Radiology and Surgery Vice-Chairman, Department of Radiology University of North Carolina School of Medicine and University of North Carolina Hospitals Dept. of Radioloby Chapel Hill, North Carolina
Steven G. Meranze, M.D.
Section Chief Interventional Radiology Vanderbilt University Medical Center Nashville, Tennessee
Donald L. Miller, M.D.
Professor of Radiology Uniformed Ser vices University of Health Sciences National Naval Medical Center Department of Radiology Bethesda, Maryland
Kenneth S. Rholl, M.D.
Chief, Interventional Radiology INOVA Alexandria Hospital Alexandria, Virginia and Associate Clinical Professor of Radiology Department of Radiology George Washington University
Anne C. Roberts, M.D.
Professor and Interim Chair Department of Radiology University of California at San Diego Medical Center/ Thomton Hospital La Jolla, California
Melvin Rosenblatt, M.D.
New Rochelle, New York and Associate Professor Yale University School of Medicine Section of Vascular and Interventional Radiology New Haven, Connecticut
Contributors ix
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Alla Rozenblit, M.D.
Associate Professor of Radiology Department of Radiology Albert Einstein College of Medicine Montefiore Medical Center New York, New York
Michael B. Rubin, M.D.
Department of Radiology Sound Shore Medical Center New Rochelle, New York and New Rochelle Radiology & MRI New Rochelle, New York
J. Mark Ryan, M.D.
Duke University Medical Center Department of Radiology Durham, North Carolina
Alan H. Schoenfeld, M.S.
Department of Radiology Montefiore Medical Center New York, New York
Scott Segal, M.D.
Berkshire Medical Center Pittsfield, MA
Randall W. Snyder III, M.D., M.A.
South Jersey Radiology Associates Voorhees, New Jersey
Hugo Spindola-Franco, M.D.
Montefiore Medical Center Albert Einstein College of Medicine New York, New York
Keith M. Sterling, M.D.
Department of Radiology Inova Alexandria Hospital Alexandria, Virginia
Jonathan J. Trambert, M.D.
Clinical Director Vascular and Interventional Radiology Department of Radiology Montefiore Medical Center Weiler Hospital and Associate Professor of Radiology Albert Einstein College of Medicine Weiler Hospital New York, New York
Samuel I. Wahl, M.D.
Irvington, New York
Arthur C. Waltman, M.D.
Director, Division of Vascular Radiology Massachusetts General Hospital Harvard Medical School Boston, Massachusetts
Kenneth M. Zinn, M.D.
Radiology, Division of Interventional Radiology Bridgeport Hospital/Advanced Radiology Consultants Bridgeport, Connecticut