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Essential
Interventional
Radiology
Review
AQuestion and Answer Guide
RajatChand· AdamE.M.Eltorai·
TerranceHealey·
SunAhnEditors

Essential Interventional Radiology
Review

Rajat Chand • Adam E. M. Eltorai
Terrance Healey • Sun Ahn
Editors
Essential
Interventional
Radiology Review
A Question andAnswer Guide

ISBN 978-3-030-84171-3 ISBN 978-3-030-84172-0 (eBook)
https://doi.org/10.1007/978-3-030-84172-0
© Springer Nature Switzerland AG 2022
This work is subject to copyright. All rights are reserved by the Publisher, whether
the whole or part of the material is concerned, specically the rights of transla-
tion, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on
microlms or in any other physical way, and transmission or information storage
and retrieval, electronic adaptation, computer software, or by similar or dissimi-
lar 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 specic
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 pub-
lication. 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
afliations.
This Springer imprint is published by the registered company Springer
Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Editors
Rajat Chand
The Hospital for Sick Children
Toronto, Ontario
Ontario, Canada
Terrance Healey
Brown University
East Providence, RI, USA
Adam E. M. Eltorai
Radiology
Brigham and Women’s Hospital,
Harvard Medical School
Boston, MA, USA
Sun Ahn
Brown University
Providence, RI, USA

Preface
What Is Interventional Radiology?
One of the newest primary medical specialties, as recognized
by the American Board of Medical Specialties, interventional
radiology (IR) is a field within radiology that offers mini-
mally invasive diagnostic and treatment strategies for a broad
range of illness. IR is proven to provide effective treatment
options, generally associated with lower surgical risk, compli-
cations, and overall morbidity. Often considered to intersect
clinical care, minimally invasive procedures, and radiologic
diagnosis and guidance, IR practitioners have the unique
opportunity to partake in the care of many different disease
processes, as well as partake in cutting-edge and ground-
breaking research. Since the field’s inception, when the radi-
ologists Seldinger and Dotter laid the path for minimally
invasive procedures, IR has today become a primary specialty
of medicine that provides any IR practitioner the opportunity
for a career filled with rich patient interaction experienced
through longitudinal clinical care. The core principles of this
field and its society are to: expand access to the high-quality
care IRs can provide, continuously translate innovation into
better patient outcomes, provide comprehensive and lifelong
education to practitioners at all levels, and always work
alongside other medical specialties to thrive for the best pos-
sible outcomes for patients.
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Using this Book
This review-style book is written in a question-and-answer
format for medical students and residents to utilize during
their interventional radiology rotation. It is designed to be a
quick reference, as well as a tool for independent study, and
covers many general and subspecialty topics in interventional
radiology. As it would be impossible to provide the complete
breadth of education for all disease processes interventional
radiologists treat in this single text, our goal is rather to pro-
vide a resource to help accurately answer many on-the-spot
questions, which are commonly encountered during proce-
dures and clinical management.
Essential Interventional Radiology Review is organized to
first offer some basic knowledge to help acquaint the reader
with important clinical and technical considerations of the IR
workspace, and then focuses on system-based review. The
span of content covers most of the commonly encountered
pathologies in IR, as well as some emerging techniques. We
hope this book serves as a convenient resource and aids in
contributing pearls to all of the rich, educational discussions
taking place in IR training programs across the world.
Toronto, ON, Canada RajatChand
Boston, MA, USA AdamE.M.Eltorai
East Providence, RI, USA TerranceHealey
Providence, RI, USA SunAhn
Preface
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Contents
Part I Daily Workow
1 The Role of a Subintern . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chris Molloy and Junjian Huang
2 Presenting a Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Chris Molloy and Junjian Huang
3 Morning Rounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Chris Molloy and Junjian Huang
4 Afternoon Rounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Chris Molloy and Junjian Huang
5 Taking Call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chris Molloy and Junjian Huang
6 Pre-procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Chris Molloy and Junjian Huang
Part II Vascular Site
7 Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Matthew Czar Taon
8 Running the Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Matthew Czar Taon
9 Choice of Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Matthew Czar Taon
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10 Seldinger Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Matthew Czar Taon
11 Guidewires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Matthew Czar Taon
12 Catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Matthew Czar Taon
13 Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Matthew Czar Taon
14 Balloons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Matthew Czar Taon
15 Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Matthew Czar Taon
16 Embolization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Matthew Czar Taon
Part III Vascular Disease
17 Abdominal Aortic Aneurysms . . . . . . . . . . . . . . . . . . . 81
Dania Daye
18 Thoracic Aortic Aneurysm Chapter . . . . . . . . . . . . . . . 93
Peyton Cramer and Lourdes Alanis
19 Angiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Mertalaine Mulatre
20 Peripheral Arterial Disease . . . . . . . . . . . . . . . . . . . . . . 127
Omowunmi Ajibola and Abeer Mousa
21 Acute Venous Thromboembolic Disease . . . . . . . . . . . 151
Sabeeha Chowdhury and Peyton Cramer
Contents
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22 Mesenteric Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
Akhil Khetarpal
23 Arteriovenous Malformation (AVM) . . . . . . . . . . . . . 193
Charles Hua
24 Central Venous Access . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Gaurav Gadodia
25 Carotid Artery Stenosis . . . . . . . . . . . . . . . . . . . . . . . . .245
Gaurav Gadodia
26 Renovascular Hypertension . . . . . . . . . . . . . . . . . . . . .277
Gaurav Gadodia
27 Varicose Vein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
Anushi Patel
28 Varicocele Embolization . . . . . . . . . . . . . . . . . . . . . . . . 333
Avinash Pillutla
29 Vena Cava Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .349
David Maldow
30 Peripheral and Visceral Artery Aneurysm . . . . . . . . . 361
Jesse Chen and Amit Ramjit
31 Hemodialysis Access Interventions . . . . . . . . . . . . . . . 379
Rana Rabei
32 Hybrid and Complex Aortic Aneurysm
Endovascular Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
Omosalewa Adenikinju, Soa C. D. Vianna, and
Brandon P. Olivieri
Contents
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Part IV Oncology
33 Hepatic Interventional Oncology . . . . . . . . . . . . . . . . . 415
Seth I. Stein
34 Pulmonary Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . .443
John Smirniotopoulos and Maria Mitry
35 Renal Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Shaji Khan and Monica J. Uceda
36 Breast Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .479
Monica J. Uceda and Shaji Khan
Part V Hepatobiliary
37 Percutaneous Biliary Interventions . . . . . . . . . . . . . . . 497
Jacob J. Bundy, Jeffrey Forris Beecham Chick, and
Ravi N. Srinivasa
38 Transjugular Intrahepatic Portosystemic
Shunt (TIPS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Andrew Moore
39 Balloon-Occluded Retrograde Transvenous
Obliteration (BRTO) . . . . . . . . . . . . . . . . . . . . . . . . . . .529
Rupal Parikh
Part VI Genitourinary
40 Percutaneous Nephrostomy . . . . . . . . . . . . . . . . . . . . .551
Marco Ertreo and Ifechi Momah
41 Uterine Artery Embolization . . . . . . . . . . . . . . . . . . . . 567
Ifechi Momah-Ukeh and Marco Ertreo
42 Prostate Artery Embolization . . . . . . . . . . . . . . . . . . . .579
Marco Ertreo, Rakesh Ahuja, and Keith Pereira
Contents
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