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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
v

vi
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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
vii

viii
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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
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