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Index 497
DMSO, 56–57 EVOH, 56–57 lipiodol, 57–58 n-butyl cyanoacrylate, 54–55 sclerosants, 51–52
sodium tetradecyl sulfate, 53–54 Liquid embolics, 387 Liquid–metal coils, 22 Liver
embolization of right lobe of, 410
left lobe of, 412
tumor, 405
tumor, 406 Liver embolization post-percutaneous
biopsy/drainage arteriobiliary fistulae, 317 hematomas, 317 indications for, 318 procedure/steps, 319–320 pseudoaneurysm, 317 vascular anatomy, 318–320
LM, see Lymphatic malformations (LM) Lower extremity arteries, anatomy of, 253 Lower GI hemorrhage
angiography of, 345–346 clinical features of, 341 colonoscopy for, 347 computed tomographic angiogram of, 342 contraindications to, 343 embolization
access approach, 345 catheters for, 343 complications, 347 diverticular bleeding, 345 embolic agents for, 343–344, 346
patient follow-up, 346 indications for, 343 medication for, 344 Tc-99 M RBC study of, 341–342
Lower limb, injuries of, 258–259 Low-flow lesions
anatomy, 140 angiography, 141–142 blood tests, 139–140 clinical examination, 138 clinical features, 137 complications and contraindications, 140 indications for embolization, 139–140 medication, 141 post-embolization, 143 treatment plan and technique, 142–143 ultrasound and MRI of, 138–139
Low-flow priapism, 275
Lumax (Cook) coaxial catheter, 151 Lung embolization post-percutaneous
biopsy/drainage indications for, 324–325 procedure/steps, 325–326
Lymhangioma in neck and chest, 463 Lymphatic malformations (LM), 175, 459
adults, 467 anatomy, 465 children, 466 classification, 460 clinical features, 459 diagnostic evaluation, 461 equipment
bleomycin, 465–466 catheters, 465
doxycycline, 466 follow-up, 468 imaging
CT, 463
cystic lesions, 463–464
MRI, 462–463
ultrasound, 462 laboratory, 462 manifestations, 460–461 medication, 466 occurrence, 459 post-embolization, 468 technique, 467 treatment options
contraindications, 464
evidence for sclerotherapy, 464–465 treatment plan and technique, 466, 467
M
MAA particles, see Macroaggregated albumin
(MAA) particles Macroaggregated albumin (MAA) particles, 36 Macrocystic LN, ultrasound of, 462 Magnetic resonance imaging (MRI)
of HCC, 185 hypervascular mass in proximal humerus,
224
of thoracolumbar region, 473
venous malformation, 137–138 Major hemoptysis, 349 Massive hemoptysis, 90, 364, 369
causes of, 363
definition, 363 Massive intraparenchymal hemorrhage, 324 MCA, see Middle cerebral artery (MCA) MDCT, see Multidetector computed
tomography (MDCT)
498 Index
MDCT trauma protocol, 110 Meningiomas
DSA images, 431, 432 extra-axial brain tumors, 425–433
location and supply, 428 Meningo-hypophyseal arteries, 418 Metallic coils for tract embolization, 306 Metastatic colorectal cancer, 406 Microcatheter, 11, 397
access into thoracic duct, 16
advantages and disadvantages of, 81
use of, 81, 82 Microcoil pushers, 21 Microcoils, 19–20, 257 Microcystic lesions, biopsy of, 462 Microfibrillar collagen, 48–49 Microspheres
acrylamido polyvinyl alcohol, 32
detectable, 37
doxorubicin-eluting, 35
drug-eluting, see Drug-eluting
microspheres ibuprofen-loaded, 34 irinotecan-loaded, 34 radioactive, see Radioactive microspheres
90
Y, 36–37 Midazolam, 410 Middle cerebral artery (MCA), 428 Middle meningeal (MMA), 427 MMA, see Middle meningeal (MMA) MRI, see Magnetic resonance imaging (MRI) Multidetector computed tomography (MDCT),
87, 94 of hepatic artery aneurysm, 99 of pulmonary artery pseudoaneurysm, 89 radiation considerations, 108 of severely injured patient, 108 trauma protocol, 110
Multiloculated LM, with fluid levels in neck,
468
N
Nanoparticles and nanocapsules, 72 Nanotechnology, 72 Nasal endoscopy, 415 Nasal walls, arterial supply of, 419 n-BCA, see n-Butyl Cyanoacrylate (n-BCA) n-Butyl Cyanoacrylate (n-BCA), 54–55 Neo-angiogenesis, 349 Neovascularization, 122 Nephrogram, 315 Nestor coils, array of, 18 Neuroendocrine hepatic metastases
alternative therapies for, 207 clinical features, 205 complications in, 209 contraindications to, 207 diagnostic evaluation, 206 embolization of
arterial access, 208 catheters and embolic agents, 209
indications for, 207 IR evaluation of, 209 medications for, 209 post-embolization syndrome in, 212 post-procedure follow-up, 194 treatment plan and technique, 211–212
Neurological deficits, 351–352 Nickel allergy, 18 Non-bronchial systemic artery supply, 87–88 Non-selective angiography of HCC, 192–193 Non-spherical PVA particles, 31 Non-target embolization
cause of, 123 clinical assessment, 124 risk of, 126 of small vessels, 12–13
Nutcracker phenomenon, 438
O
Occluded deep vein, 448 Occlusion balloons, 82 Octreoscan of metastatic neuroendocrine
tumor, 211 Octreotide, 208, 479 Odontophagia, 352 Ovarian arteries, 482 Ovarian venograms, 440
P
Pain in PES, 130 Pampiniform plexus drains, 438 Pancreatic enzymes, leakage of, 283 Pancreatic hemorrhage
angiography of, 288
flush/selective, 288
pseudoaneurysm, 288 clinical features of, 283 contrast-enhanced CT scan of, 284–285 diagnostic evaluation, 284 embolization
access approach, 288
aftercare, 290
catheters, 287
embolic agents, 287–288
patient follow-up, 290–291
for post-operative bleeding, 290
Index 499
for post-pancreatitis aneurysm and
pseudoaneurysm, 289–290 indications and contraindications for, 285 mortality rate for, 283
Paragangliomas
anatomy
aberrant, 428 normal, 427
strategy, 429 angiographic a ppearance, 432 arterial puncture site, 433 clinical features, 425 diagnostic evaluation
alternative therapies, 427
contraindications, 426–427
imaging, 426
indications, 426
laboratory, 425
specific complications, 427 embolic agents, 429 equipment, 429 follow-up imaging, 433 glomus tumors, 425 location and supply, 428 location of, 431–432 medication
general anesthesia, 429
heparin, 429
lidocaine, 430
sickness control, 430 post-embolization syndrome, 433 procedure
access, 430
angiography, 430 treatment plan and technique, 432–433
Parenchymal phase angiogram, 211 Patient-controlled analgesia (PCA), 117
for PES, 132–133
PAVM s , see Pulmonary arterio-venous
malformations (PAVMs)
PCA, see Patient-controlled analgesia (PCA);
Posterior cerebral artery (PCA) Pedal lymphangiography, 472 Pedal lymphography, 477 Pelvic congestion syndrome, 435 Pelvic fractures
embolization of hemorrhage due to
catheters for, 245, 243–244 embolic agents for, 254
hemorrhage due to, 241
arteriography of, 244–245 complications in, 242–243 contraindications for, 242
imaging of, 242 indications for, 242
laboratory examination of, 242 management of, 246 types of, 241
Pelvic ultrasound (US), 233 Pelvic varicosities, 436 Pelvic venous system, 440 Penis
anatomy, 276–277 cavernosal blush at base of, 280
Percutaneous biopsy, 384 Percutaneous thrombin injection, 389 Percutaneous transhepatic biliary drainage
(PTBD), 317 Perforator, RF SEPS needle, 449 Peripheral vascular malformations
high-flow lesions
alternative therapies, 143 anatomy, 144 angiography, 144–145 blood tests, 139 clinical examination, 143 contraindications, 144 embolic agents for, 144 indications for embolization, 143 medication, 144 patient follow-up, 146 post-embolization, 146 treatment plan and technique, 145–146 ultrasound and MRI of, 143
low-flow lesions
anatomy, 140 angiography, 141–142 blood tests, 139 clinical examination, 138 clinical features, 137 complications and contraindications,
140
indications for embolization, 139–140 medication, 141 post-embolization, 143 treatment plan and technique, 142–143 ultrasound and MRI of, 138–139
Permanent particulate embolization agents
bio-active particles, 34 classification, 29 detectable agents, 37 drug-eluting microspheres, see
Drug-eluting microspheres
hydrogel–polyzene F microspheres, 33 injection of, 39 mechanism of action of, 31
500 Index
physical properties, 30–31 preparation of, 38 PVA, 31–32, 190
tris-acryl microspheres, 29, 33 PES, see Post-embolization syndrome (PES) Pial supply, 430 Pledgets, 47–48 Pleuritic pain in PAVM, 150 Polyvinyl alcohol particles (PVA), 343, 420,
429 for HCC embolization, 190 microspheres, 32–33 non-spherical, 31 recanalization of, 31
Portal vein embolization, 405 Portal venography, 407, 411 Portal venous system, 406 Post-biopsy hemorrhage
around drain site, 311 embolization
AV shunt, 314 complications associated with, 314–315 contraindications to, 314 embolic agents for, 334 indications for, 313 pseudoaneurysm, 314
pre-procedure evaluation
imaging, 313 laboratory tests, 313 patient evaluation, 312–313
risk factors for, 312
Post-embolization syndrome (PES), 124, 387,
389 clinical manifestations of, 129 diagnostic evaluation of
ultrasound and computed tomography,
131
white cells, 130 intraprocedural management of, 132 pathophysiology of, 129 post-procedure management of, 133 pre-procedural care of, 132 prevention of, 131
Posterior cerebral artery (PCA), 428 Post-operative hemorrhage
angiography of, 298 causes of, 293 challenges in post-operative patient, 296 clinical evaluation of, 293–294 coagulopathic patients, 299 contraindications in, 295–296 contrast-enhanced computed tomography
of, 294
embolization of
catheter for, 296–297 complications in, 296 embolic agents for, 297, 299 indications for, 294–295 patient follow-up, 300
procedure of, 297 pseudoaneurysm in, 299 surgical repair of, 295 unstable patients, 299
Post-pancreatico-duodenectomy hemorrhage,
283
Post-pancreatitis aneurysm, embolization for,
289–290
Post-partum hemorrhage (PPH)
clinical features, 481 diagnostic evaluation, 481 intervention/embolization
for acute PPH, 483–484
arterial puncture site, 485–486
contraindications to, 482
embolic agents for, 482–483
equipments for, 482
indications for, 482
patient follow-up, 486
prophylactic, 484–485
Post-procedural pain control, 117 Post-UAE T1 sagittal, 233 Powder, 46–47 PPH, see Post-partum hemorrhage (PPH) Pre-embolization imaging
benefit in patients, 85–86 in clinical scenarios, 87
acute gastrointestinal tract hemorrhage,
92 bone tumor, 223 pulmonary arterio-venous
malformations, 88–92 thoracic embolization, 87–88 trauma, 96–97 true aneurysms of visceral arteries,
98–100 uterine leimyoma, 231
contrast enhancement in, 87 role of, 85 technique, 86–87
Pre-endovascular aneurysm repair
embolization, 377
embolic agents for, 380 goal of, 380 occlusion of internal iliac artery in, 381
Pre-operative portal vein embolization
aftercare, 412
Index 501
angiography
access, 410 clinical features, 405–406 diagnostic evaluation
alternatives include, 410
anatomy, 407
catheters, 408–409
contraindications, 407
embolic agents, 409
equipment, 407
imaging, 406
indications, 406
laboratory, 406
medications, 410
specific complications, 407 follow-up, 412 treatment plan and technique, 411
Pre-procedural CT, 90 Pre-sedation patient assessment, key factors in,
112 Pre-UAE T1 sagittal, 232–233 Priapism
alternative therapies for, 277 classification of, 275 complications of, 277 definition, 275 diagnostic evaluation of, 276 embolization of
aftercare of, 279–280 catheters for, 278 embolic agents for, 278 patient follow-up, 280
indications for
angiography, 276–277
embolization, 277 Proximal embolization, 269 Proximal splenic artery, 393 Pseudoaneurysm
from central line placement, 300 coils, 391–392 embolization for, 289–290 in post-operative hemorrhage, 300 rupture of, 286
PTBD, see Percutaneous transhepatic biliary
drainage (PTBD) Pubic symphaseal artery, 243 Pulmonary angiography, 368 Pulmonary arterial and venous bleeding, 349 Pulmonary arterial hemorrhage
angiography of, 365 causes of, 363–364 CECT scan of, 364–365 contraindications to, 365
embolization
catheterization techniques, 367 catheters for, 366 communication to pulmonary veins,
368 complications, 369–370 embolic agent for, 366 patient follow-up, 369–370
indications for, 365
laboratory assessment, 364 Pulmonary arterial pressures, 368 Pulmonary arterio-venous malformations
(PAVMs) angiography of, 152–153 clinical presentation of
diffuse PAVMs, 148
HHT, 147–148 contraindications and complications, 150 diagnostic evaluation of, 149 embolization therapy
aftercare, 155
catheters and embolic agents for, 151
treatment plan and technique, 152–155 follow-up, 155 indications for, 150 medication for, 151 pre-procedure imaging of, 90–94
Pulmonary artery pseudoaneurysmal disease,
90
Pulmonary fibrosis and massive hemoptysis,
92
Pulmonary vein and artery, communications
with, 358
R
RAA, see Renal artery aneurysms (RAA) Radial and ulnar artery injuries, 258 Radioactive microspheres
considerations relating, 36–37 types of, 36
Radioembolization, 36–37, 191
in hepatic metastases, 201
Radiofrequency (RF)
for occlusion of blood vessels, 62 probes f or, 67
Radionuclide scans of post-operative
hemorrhage, 294 Ranulas, 463 RCC, see Renal cell cancer (RCC) Reflux, prevention of, 123 Renal artery aneurysms (RAA), 395
alternative therapies
autotransplantation, 400
502 Index
ex vivo resection, 400 nephrectomy, 400
in vivo aneurysmectomy, 400 aneurysm, direct coiling of, 401 balloon assisted remodeling, schematic
showing, 401 complications, 400 contraindications, 396 diagnostic evaluation, 395 equipment, 396 FMD, background of, 402 hypertension, 395 imaging, 396 intraparenchymal lesions, 397 results, 399 treatment indications, 396 treatment plan
balloon remodeling, 397–398 covered stents, 397 embolization procedure, 399 immediate post-procedure care, 399 long-term follow-up, 399 primary coiling, 398
stent-assisted coiling, 398 Renal AVF, 164 Renal biopsy/drainage, vascular complications
after
embolization of, see Renal embolization
post-percutaneous biopsy/drainage hematomas, 320–321 prevalence of, 320 pseudoaneurysm in, 320
Renal cell cancer (RCC), 215
See also Renal tumor
Renal embolization post-percutaneous
biopsy/drainage indications for, 320 procedure/steps in
complications, 322–323 native kidneys, 321 transplant kidneys, 321–322
Renal tumor
clinical features, 215 contraindications for, 216 diagnostic evaluation, 215–216 indications for, 216 post-embolization with spongestan, 216 pre-embolization CT, 216
Renal tumor embolization, 215
in AML, 220 arterial puncture site, 220 cathethers in, 218 choice of agent in, 218
follow-up, 221 medication, 218 in patients with inoperable cancer, 220 PES in, 221 pre-operative, 219–220 procedure
access approach, 218 flush aortography, 219
lesion assessment, 219 Renal veins, 438 Retroperitoneal lymph vessels, anatomy of,
475 Reverse curve catheter, 77–78 RF generator, 65 Right portal vein, embolization of, 411 Routine care equipment, 114 Rupture
anemia, 385 hepatic artery, 383 hepatobiliary tract, 385 mortality rate of, 385 non-fatal, 384 pregnancy, 383 risk factor for, 385 splenic artery, 373
S
Sandwich technique, 388 Sapheno-femoral vein junction (SFJ), 447 Sapheno-popliteal vein (SPJ), 447, 449 Scaffold technique, 22 Sclerosants, 11, 51–52 Sclerosis, 61 Sclerotherapy, 464 Sedation
and analgesia, 111 anesthesiology assistance during, 116–117 during embolization procedures, 113–114 following embolization procedures, 117 medications for, 115 for PES, 132
Selective angiography
of left internal iliac artery, 280 of LGA, 289 of right lumbar artery, 315
Selective catheterization
of celiac artery, 79 end hole-only catheter for, 10 guidewires for, 83 hydrophilic-coated nitinol wire for, 84 stable catheter position, 9–10 wedging, 11–12 of youthful, elastic arteries, 78
Index 503
Selective inferior pancreatico-duodenal
arteriography, 285 SFJ, see Sapheno-femoral vein junction (SFJ) Sidewinder catheter, 77 Silk suture, 17 Single-curve catheters, 78 Single end hole catheters, 10 Skin
changes in, 446 sloughing, 418
Slurry
applications, 45 mode of action, 44 physical properties, 43–44 preparation, 44
SMA, see Superior mesenteric arteriogram
(SMA) Small post-biopsy renal AVF, 164 Sodium tetradecyl sulphate (STD), 53–54, 454 Somatastatin, 474–475 SPJ, see Sapheno-popliteal vein (SPJ) Splenic arterial pseudoaneurysm, 391 Splenic artery aneurysms, thrombin injection
of, 389 Splenic embolization
complications of, 269 distal, 269, 272 proximal, 269–270
vs. splenectomy, 268 STD, see Sodium tetradecyl sulphate (STD) Stent-assisted coiling, 398 Stent-grafts, 387–388 Stent-supported embolization technique, 23 Superior mesenteric arteriogram (SMA), 333 Superselective catheterization of bronchial
artery, 30
Support wires, 84
T
TAC E , see Transarterial chemoembolization
(TACE) Takayasu’s arteritis, 385 Target lesion, arterial and venous anatomy of, 5 Tc-99 MAA scan, see Technetium-99
macroaggregated albumin (Tc-99
MAA) scan Technetium-99 macroaggregated albumin
(Tc-99 MAA) scan
of liver tumors, 197 of lower GI hemorrhage, 341–342
Temporary embolic agents
autologous blood clot, see autologous
blood clot
gelatin sponge, 43 indications for using, 39 microfibrillar collagen, 48–49 pledgets, 47–48 powder, 46–47
slurrry, see slurrry Terumo Progreat microcatheter, 80 TESPAL, see Transnasal endoscopic
sphenopalatine artery ligation
(TESPAL) Thoracic duct, anatomy of, 476 Thoracic embolization, pre-procedure imaging
of
hemoptysis, 87–88 pulmonary arterio-venous malformations,
88–92 Thrombus formation, promotion of, 15 Tissue heating, 61–62 Tissue necrosis, 127 TLS, see Tumor lysis syndrome (TLS) Tract embolization
after liver biopsy, 309 autologous clotted blood/blood patch, 308 complications, 308 complications for, 306 gelfoam for, 307 indications for, 305–306 metallic coil for, 307 n-butyl cyanoacrylate for, 307–308 operator preference for, 306 post-procedure management, 308 procedural steps, 307
Transarterial chemoembolization (TACE), 187
in hepatic metastases, 201
Transnasal endoscopic sphenopalatine artery
ligation (TESPAL), 416 Transvaginal ultrasound (TVUS)
of UAE, 234
Trauma
embolization, 190 imaging of
angiography, 107–108 contrast-enhanced CT, 263 contrast-enhanced MDCT, 105–107 conventional radiography, 105 FAST scan, 105, 262 image reconstruction, 106 MDCT, 104–105 pre-procedure, 96–98
rationale for early, 104 importance of blood pressure in, 261–262 trimodal distribution of mortality in,
103–104
504 Index
Traumatic arteriovenous fistulae, 163–164 Tris-acryl microspheres embosphere, 29, 33,
38
True aneurysms of visceral arteries,
pre-procedure imaging of aneurysm neck size, 100 image interpretation, 98–100 indications for, 98
Truncal vein ablation, 454 Tumescent analgesia, 451
ultrasound-guided injection of, 452
Tumor embolization
biological effects of, 179 outcomes, 7
Tumor lysis syndrome (TLS), 181 Tumor, visualization of, 430 TVUS, see Transvaginal ultrasound (TVUS) Tympanic plexus, 425 Tympanicum, see Tympanic plexus
U
UAE, see Uterine artery embolization (UAE) UGIH, see Upper gastrointestinal hemorrhage
(UGIH)
Ulceration, 447 Ultrasound generator, 65 Ultrasound (US), 386
of post-operative hemorrhage, 293 venous malformation, 138–139
Upper extremity arteries, anatomy of, 252–253 Upper gastrointestinal hemorrhage (UGIH)
angiography of, 334–336 catheter-directed vasopressin infusion for,
339 cause of, 329–330 clinical features, 329 CTA of, 331–332, 335 definition, 329 diagnostic evaluation
endoscopy, 331 laboratory examination, 330
embolization
catheters for, 333 contraindications to, 332 embolic agents for, 334 of gastroduodenal artery, 336, 338 indications for, 332 of left gastric artery, 334 patient follow-up, 338–339
technique, 336 medication for, 334 treatment plan, 334
Upper GI arterial anatomy, 332–333
Upper limb, injuries of, 256 US, see Ultrasound (US) Uterine arteries, 482
anatomy of, 235 angiography of, 236–238 re-embolization of, 238
Uterine artery embolization (UAE)
bilateral femoral arterial approach in, 236 catheter for, 78–79, 235 catheterization
of celiac axis and SMA, 79
of ipsilateral internal iliac artery, 78 complications associated with, 239 contraindications for, 234–235 embolic agents for, 236 follow-up, 238 indications for, 234 pain management, 236 PES after, 238 pre-treatment patient information in, 235 recommended particle size for, 38 treatment failures, 238
Uterine leimyoma
diagnostic evaluation
imaging, 232–234
laboratory tests, 231–232 symptoms of, 231
V
VAA, see Visceral arterial aneurysms (VAA) Vag a l e , see Va g a l n e r v e Vagal nerve, 425 Valsalva manoeuvre, 442 Varicose veins
aftercare, 456 alternative therapies
contraindications, 448
foam sclerotherapy, specific
complications of, 449 surgery, 448 thermal ablation, specific complications
of, 449 venous ablation therapy, general
complications of, 448–449
avulsions, 454 clinical features, 445 clinical scenarios, 454–455 definition of, 445 diagnostic evaluation, 446–447 equipment
catheters/introducer sheaths, 450 guidewires, 450
Index 505
imaging, 450
needles, 450 foam sclerotherapy, 453, 455 follow-up, 456–457 imaging, aim of, 447 laser therapy, 452 medication, 451 natural history, 446 normal lower limb venous physiology, 450 normal venous anatomy, 449–450 prominent veins, 455–456 radiofrequency ablation therapy
radiofrequency devices, 453
technique, 453 thermal ablation therapy, 451 treatment, indications for, 447 treatment plan and technique, 451 treatment technique, 452–453 varicosities, 455 venous insufficiency, causes of, 445–446
Varicosities, 455 Vascular anatomy, 225 Vascular embolization, gene therapy for, 71 Vascular malformations, 415 Vascular occlusion, controlling level of, 5 Vascular occlusion device
attributes of, 15 mechanism of action of, 15–16
Vascular sheaths
with hemostatic valve, 82 sizing of, 82–83
Venous anatomy of target lesion, 5 Venous approach, 169 Venous malformation
composite T2-weighted fat-saturated image
of, 176
in KTS, 175–176
Vessel occlusion, heat-induced, 66
by lasers, 62–65 by radiofrequency, 65–66
Visceral arterial aneurysms (VAA), 383
aberrant anatomy, 387 celiac artery, 385 clinical features, 383 complications, reduction methods, 389 conservative, 389 diagnostic evaluation
clinical, 385 contraindications, 386–387 imaging, 386 indications for, 386 laboratory, 386
embolization of
anticoagulation, 388 equipment, 387 procedure, 388 results, 389
sedation and analgesia, 387 hepatic artery, 384–385 natural history, 383 percutaneous thrombin injection, 389 relevant anatomy, 387 ruptures, 383–384 splenic artery, 384 superior mesenteric artery, 381 surgery, 389
W
Waltman loop technique, 78–79 Wires, 387
Y
90
Y microspheres
considerations relating, 36–37 types of, 36
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