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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3860_Библиотеки_им_академика_М_И_Перельмана
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Foreword
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Dr. Bakal has broughttogether contributors with a broad range of experience to create a
text on a current spectrum of inter ventional procedures. As a discipline, we have had
difficulty defining our interests and abilities. Some of the names offered include imageguided surgery, minimally-invasive medicine, and interventional radiology. All of them
have strengths and weaknesses, confuse the public, and sometimes our professional colleagues. This text is the latest in an evolution, as with our discipline, from Arteriography
edited by Herbert Abrams and Interventional Radiology edited by Christos Athanasoulis et al.
Through my 30 years in interventional radiology, I have had several startling experiences. One was the presentation of using arteriography to control bleeding from the
gastrointestinal tract by Stanley Baum. It was this presentation that introduced me to the
concept that a diagnostic method might also be the means to treat. Within a short span
from the presentation patients who had been badly injured and were hemorrhaging to
death from vascular injuries of the pelvis could be treated with embolization. Over the
ensuing years, other momentous experiences and device improvements occurred expanding the usefulness of interventional radiology’s practioners into many diseases and
organ systems. Among these experiences are my being able to work with Andreas
Gruntzig as he was developing balloon catheters for angioplasty of atherosclerotic lesions
that eventually led to treatment for vessels from the head to the lower leg. Another was
an opportunity to collaborate with Charles Dotter, who is the father of many of the
current inter ventions from thrombolysis to TIPS and many catheters and devices.
Although there have been many other colleagues, too numerous to include here, with
whom I have been associated and enjoyed their many contributions and personalities, I
have really most appreciated those who trained in our department, including Dr. Bakal,
and with whom I continue to maintain close friendships. Some of these colleagues are
represented in this text and its wide scope is an example of the ingenuity and skill of the
interventionalist. This text is an attempt to pull the many different therapies together in
a format that allows one to gain the essence and approaches for these therapies without
the overwhelming detail of history and materials.
This is text for where we are and, as I tell our students after introducing them to the
Massachusetts General Hospital’s Ether Dome and the images of medicine in the 19
century, that what we do now will also appear to be primitive in the future which is close.
I look to a future where less invasive medicine is a better way to treat a patient than as
Charles Dotter said “patients deserve to be treated better than a side of beef.”
This text is the beginning and a first step.
Arthur C. Waltman, M.D.
th
xi
Foreword
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Preface
This project grew out of a need for a book, covering the field of vascular and inter ventional radiology, that could be read in a month of evenings by radiology residents on a
typical vascular and interventional radiology rotation. We wanted to give an overview of
the field so that the reader could understand basic principles and approaches that were
technical, clinical, and image-based. We did not want to be too encyclopedic, nor did we
want to be only a list of differential diagnoses or a handbook. As this project moved
forward, we realized that there are others who would benefit from a book of this nature:
general radiologists, radiologic technologists, radiologic nurses, and VIR fellows early in
their training.
To best achieve our goals, I felt that material covering generalized technical and
imaging aspects should be grouped together at the beginning of the book, in Part I,
allowing easy reference to the material. Part II would concentrate on the regional anatomy and the clinical and radiologic problems specific to that anatomy. Many of our
chapters were written by our recent fellows or residents paired with a senior author. We
asked each of them to write about the topic in a manner that would best help them at
this stage of their career. No attempt was made to have all of the chapters conform to a
single writing style or mode of organization. In a sense, the book is a collection of
monographs covering virtually the entire spectrum of a growing and exciting field.
We hope that by reading this book, you will come to a better understanding of how
diagnostic and interventional techniques can be applied to a broad spectrum of clinical
problems.
Curt Bakal
xii
Acknowledgments
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We would like to thank the many colleagues in our departments who contributed ideas
and advice.
Our assistants, Cynthia Caduhada, Cecilia Santos, and Eleanor Murphy, spent hours
organizing, transcribing, and correcting text, references, and figure legends. At Thieme,
Jane Pennington, Kathy Lyons, Diane Sardini, Anne Vinnicombe, and Becky Dille were
crucial to seeing this project from start to publication.
xiii
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To Pam and Matt, my points of light,
https://t.me/med1917
For their love and support.
Curtis W. Bakal
In memory of Mahboobeh Yashar.
James E. Silberzweig
To Aviva and Debora E. with love.
Jacob Cynamon
To Shoshana and Sharon with love.
Seymour Sprayregen
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■
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PART I
■
Basic Principles and
Techniques
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C.W. BakalVascular andInterv entional Radiology: A Brief History
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Vascular and Interventional Radiology
1
■■■
A Brief History
CURTIS W. BAKAL
Within months of Wilheim Roentgen’s discovery of the
x-ray in 1895, Lindenthal produced the first contrast-enhanced radiograph of the veins of the hand.
application of contrast angiography, however, would take
more than two decades. From the 1920s through the
1950s, arteriography was performed infrequently—and by
the translumbar approach. Vascular surgery was in its nascent stage, and diagnoses were made clinically without
much diagnostic testing. For example, in 1923, Leriche
described a group of young men with decreased or absent
femoral pulses, bilateral claudication, and impotence, all
on the basis of clinical findings and history. Leriche called
this entity aortitis terminalis and suggested the possibility of
surgical intervention.
routine clinical tool was years away.
In 1953, Seldinger described a transfemoral arterial
access technique that used a puncture needle and guidewire, which allowed selective catheterization.
tally, the first use of a cloth vascular bypass graft also had
just been reported.
riography of the cardiac and peripheral circulations was
increasingly being used and refined. In the 1960s, radiologists began to develop “interventional” procedures.
Many point to the landmark article that first described
percutaneous transluminal angioplasty (PTA) by Dotter
and Judkins as the birth of interventional radiology.
Dotter and Judkins summarized their article by suggesting that there would be “refinements of technique as well
as further clarification” of the role of this attack on arteriosclerotic obstructions.” The percutaneous transluminal treatment described in this article became a basis for
an emerging class of minimally invasive therapies.
3
Yet the diagnostic arteriogram as a
5
During this decade, diagnostic arte-
1,2
Clinical
4
Coinciden-
6,7
In 1974, the Society of Cardiovascular Radiology was
founded with a membership of about 30 academic angiographers. In addition to diagnostic angiography,
members of this society were beginning to expand their
interventions: in addition to “Dottering” obstructive lesions, they were beginning to treat gastrointestinal
bleeding and pelvic trauma by pharmacologic infusion
or embolization.
tomy and intravascular foreign body attraction soon
were popularized.
Society of Cardiovascular and Inter ventional Radiol-
15
ogy.
Gruentzig and others refined the Dotter angioplasty technique by using an expandable balloon on a
catheter shaft, which allowed smaller punctures to be
made for arterial access and larger vessels to be di-
16,17
lated.
phy scanning allowed nonvascular percutaneous interventions to be developed and refined, notably
intraabdominal abscess drainage.
ized the care of many patients with abdominal infections: Abdominal pus was no longer a surgical disease.
By 1985, small-vessel balloons and steerable guidewires
became commercially available, allowing PTA of the infrapopliteal vessels.
though still large in profile, were being placed by vascular and interventional radiologists as well as by surgical
cut-down.
agents were to be commonly used for peripheral arteriography, increasing safety and patient comfort. Digital
subtraction replaced cut film, and the multiplanar C-arm
became standard in angiography and inter ventional
radiology suites; these two technical advances allowed
8–13
Techniques for nonsurgical splenec-
14
The Society was later renamed the
Real time ultrasound and computed tomogra-
18,19
This revolution-
20–23
Inferior vena cava filters, al-
24
Within a few years, low osmolar contrast
3
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