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- •Foreword
- •Preface
- •Disclaimer
- •Contents
- •Contributors
- •1: Uterine Artery Embolization
- •Introduction
- •Anatomy
- •Pelvic Arterial Anatomy
- •Imaging
- •Differential Diagnosis on MR Imaging
- •Adenomyosis
- •Solid Adnexal Mass
- •Focal Myometrial Contraction
- •Uterine Leiomyosarcoma
- •Patient Encounter
- •Indications
- •Pathophysiology
- •Clinical Manifestations
- •Contraindications
- •Consult, Consent, and Preparation
- •Patient Preparation
- •Technique
- •Equipment and Materials
- •Contrast Media
- •Catheters and Wires
- •Embolic Agents
- •Vascular Closure Devices
- •Procedure Start
- •Step by Step
- •Technical Points, Pitfalls, and Pearls
- •Postoperative Care, Discharge Instructions, and Follow-Up
- •Pain Management
- •Assessing the Need for Hospital Admission
- •Inpatient Care
- •Care After Discharge
- •Repeat Treatment
- •Outcomes
- •Complications
- •Summary and Conclusions
- •References
- •2: Pelvic Varices Embolization
- •Introduction
- •Pathophysiology
- •Clinical Manifestations
- •Anatomy
- •Veins of the Pelvis
- •Imaging
- •Patient Encounter
- •Indications and Contraindications
- •Consult, Consent, and Preparation
- •Technique
- •Materials
- •Catheters and Wires
- •Embolic Agents
- •Coils
- •Occlusion Balloons
- •Contrast Agents
- •Procedure Start
- •Step by Step
- •Hints, Technical Pitfalls, and Pearls
- •Post-Operative Care, Discharge Instructions, and Follow-up
- •Outcomes
- •Complications
- •Summary and Conclusions
- •References
- •3: Fallopian Tube Recanalization
- •Introduction
- •Pathophysiology
- •Clinical Manifestations
- •Anatomy
- •The Female Reproductive Organs
- •Imaging
- •The Hysterosalpingogram (HSG)
- •Patient Encounter
- •Indications and Contraindications
- •Consult, Consent, and Preparation
- •Technique
- •Materials
- •Vaginal Speculum
- •Transcervical Catheters
- •Catheters and Wires
- •Contrast Agents
- •Cervical Os Finder, Cervical Dilator, Uterine Sound
- •Procedure Start
- •Step by Step
- •Hints, Technical Pitfalls, and Pearls
- •Postoperative Care, Discharge Instructions, and Follow-Up
- •Outcomes
- •Complications
- •Summary and Conclusions
- •References
- •4: Fallopian Tube Occlusion
- •Introduction
- •Consult, Consent, and Preparation
- •Patient Preparation
- •Technique
- •Equipment and Materials
- •Vaginal Speculum
- •Guide Sheath
- •Essure ® Occlusion Device
- •Catheter
- •Procedure Start
- •Step by Step
- •Hints, Technical Pitfalls, and Pearls
- •Postoperative Care, Discharge Instructions, and Follow-Up
- •Anatomy
- •Female Reproductive Anatomy
- •Imaging
- •Patient Encounter
- •Indications and Contraindications
- •Alternative Imaging for Confirmation
- •Outcomes
- •Complications
- •Summary and Conclusions
- •References
- •5: Kyphoplasty and Vertebroplasty
- •Introduction
- •Pathophysiology
- •Anatomy
- •Anatomy of the Spine
- •Imaging
- •Patient Encounter
- •Indications and Contraindications
- •Consult, Consent, and Preparation
- •Technique
- •Equipment and Materials
- •Radiopaque Bone Cement
- •Cement Infusion Systems
- •Balloon Tamp: Kyphoplasty
- •Bone Biopsy Devices and Drills
- •Vertebroplasty or Kyphoplasty Kits
- •Contrast
- •Procedure Start
- •Step by Step
- •Balloon Kyphoplasty
- •Vertebroplasty
- •Radiofrequency Kyphoplasty: Overview and Technique
- •Hints, Technical Points, Pitfalls, and Pearls
- •Postoperative Care, Discharge Instructions, and Follow-Up
- •Outcomes
- •Vertebroplasty
- •Kyphoplasty
- •Controversy over Outcomes
- •Cost
- •Complications
- •Summary and Conclusions
- •References
- •6: Spine Pain Management
- •Introduction
- •Pathophysiology
- •Clinical Manifestations
- •Anatomy
- •Anatomy of the Spine
- •Imaging
- •Patient Encounter
- •Indications and Contraindications
- •Consult, Consent, and Preparation
- •Technique
- •Equipment and Materials
- •Needles
- •Contrast
- •Local Anesthesia
- •Steroids
- •Procedure Start
- •Step by Step
- •Lumbar Nerve Block
- •Thoracic Nerve Block
- •Cervical Nerve Block
- •Sacral Nerve Block
- •Epidural Spine Injection
- •Hints, Technical Pitfalls, and Pearls
- •Postoperative Care, Discharge Instructions, and Follow-up
- •Outcomes
- •Complications
- •Summary and Conclusions
- •References
- •Introduction
- •Pathophysiology
- •Clinical Manifestations
- •Anatomy
- •Lower Extremity Venous Anatomy
- •Imaging
- •Patient Encounter
- •Indications and Contraindications
- •Consult and Consent
- •Review of Benefits and Risks of Various Procedures
- •Sclerotherapy
- •Radiofrequency Ablation
- •Endovenous Laser Therapy
- •Bilateral Procedures
- •Patient Preparation
- •Technique
- •Equipment and Materials
- •Sclerotherapy Materials
- •RFA and Laser Materials
- •Procedure Start
- •Step by Step
- •Sclerotherapy
- •RFA and EVLT
- •Hints, Technical Pitfalls, and Pearls
- •Postoperative, Discharge, and Follow-Up
- •Outcomes
- •Sclerotherapy
- •EVLT
- •Complications
- •Summary and Conclusions
- •References
- •Index


Women’s Health in Interventional Radiology


Elizabeth Ann Ignacio • Anthony C. Venbrux
(Editors)
Women’s Health in
Interventional Radiology

Editors
Elizabeth Ann Ignacio
The George Washington University
Medical Center
Department of Radiology
Division of Interventional Radiology
900 23rd St NW
Washington, DC 20037
USA
Anthony C. Venbrux
The George Washington University
Medical Center
Department of Radiology
Division of Interventional Radiology
900 23rd St NW
Washington, DC 20037
USA
ISBN 978-1-4419-5875-4 e-ISBN 978-1-4419-5876-1
DOI 10.1007/978-1-4419-5876-1
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011939211
© Springer Science+Business Media, LLC 2012
All rights reserved. This work may not be translated or copied in whole or in part without the written
permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY
10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connec-
tion with any form of information storage and retrieval, electronic adaptation, computer software, or by
similar or dissimilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are
not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject
to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going to
press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any
errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect
to the material contained herein
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)

For my family, my lovely husband, Charles,
and especially my mother, Eleodora – thank
you so much for your endless love
and support.
EAI
To Michael Heinl, who believes in me.
To all those whom I have had the privilege
of teaching.
To our patients, who have taught
us so much about life.
ACV


vii
Foreword
I am honored to have been asked to contribute a few words regarding this fi rst edition of
Women’s Health in Interventional Radiology . Having spent much of my professional
energy for the past decade in interventional practice in Women’s Health, I am pleased that
a comprehensive guide to the fi eld is now available, and reviewing it has been a pleasure.
What struck me fi rst about this text is the breadth of topics that are addressed. It focuses
not just on interventions in the female reproductive tract, but on all the major interventions
that have a major impact on Women’s Health. The inclusion of lower extremity venous
insuffi ciency and osteoporotic spinal compression fractures is in recognition of the dispro-
portionate impact that these pathologies have on women and their quality of life. In turn,
women are the primary benefi ciaries of recent advances in interventional therapies for
those conditions. As a result, this book provides the means for those already practicing in
women’s intervention to increase their knowledge in those procedures in which they are
already active and the opportunity to broaden their scope of care to new procedures. This
book is ideal for those who would like to dedicate themselves to high quality of Women’s
Health at all stages of life.
Dr. Venbrux and Dr. Ignacio have long been active in the fi eld of women’s interven-
tions, and they have assembled a similarly dedicated group of authors. Their commitment
to excellence comes through on every page. I congratulate them on an outstanding new
contribution to our fi eld, one that I hope will advance our knowledge but also our commit-
ment to ensuring the best case outcome for those we are privileged to treat.
Washington , DC , USA James B. Spies , M.D., MPH


ix
In the last 20 years, national and international interest has become increasingly focused on
Women’s Health. Throughout the world, this important health care discipline has tradition-
ally been underserved and specifi c conditions undertreated. The National Women Health
Network (1975), the Women’s Health Initiative of the National Institutes of Health (1991),
and the Global Alliance for Women’s Health of the United Nations (1994) are a few exam-
ples of the many comprehensive efforts to increase education, advocacy, research, and
resources for Women’s Health issues.
Interventional Radiology, a medical fi eld known for its creativity and innovation in
procedural patient care, continues to deliver inventive and resourceful methods for caring
for women in all stages of life. In the average Interventional Radiology practice, Women’s
Health may represent a signifi cant component branch of the practice. Furthermore, the
contemporary Interventional Radiologist, assuming more clinical responsibility than his or
her predecessors, now has offi ce hours, admissions, and follow-up management protocols
that are standard and an integral part of daily patient care operations. As we face a chal-
lenging and demanding fi eld with a rapidly expanding body of scientifi c knowledge, par-
ticularly in the area of Women’s Health, it is important to provide texts that present a clear,
concise, and timely overview of the subject matter.
This book will highlight those Interventional Radiology procedures most pertinent to
Women’s Health. The authors have labored to cover the sections completely, providing a
detailed discussion of pathophysiology, techniques, clinical notes, and a broad review of
the literature. Additionally, the authors have distilled information into a concise format so
that the actual book has portability.
We hope this book can be a working text, on hand for the Interventional Radiologist in
the offi ce or as he or she makes rounds in the hospital. We trust that our readers will fi nd
this manual of practical assistance in the work-up, procedural treatment, and management
of patients. If this book meets the educational goals of the reader, then the time, energy, and
effort expended in its preparation will be justifi ed.
We wish to express our gratitude to our talented and experienced colleagues who con-
tributed to this book. They are a constant source of inspiration and motivation, and we are
appreciative of their dedication and concerted efforts.
Elizabeth Ann Ignacio , M.D.
Anthony C. Venbrux , M.D.
Preface
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