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Techniques in Interventional Radiology
Series Editors
Michael J. Lee
Anthony F. Watkinson
For further volumes:
http://www.springer.com/series/8281
Other titles in this Series:
Transcatheter Embolization and Therapy
Interventional Radiology Procedures in Biopsy and Drainage (forthcoming)
Interventional Radiology Techniques in Ablation (forthcoming)
Robert A. Morgan · Eric Walser
Editors
Handbook of Angioplasty
and Stenting Procedures
123
Series Editors
Michael J. Lee, MD
Professor of Interventional Radiology
Beaumont Hospital and Royal College
of Surgeons in Ireland
Dublin
Ireland
Editors
Robert A. Morgan MB ChB, MRCP, FRCR
St George’s Hospital NHS Trust
London
UK
Anthony F. Watkinson, BSc MSc(Oxon)
MBBS FRCS FRCR
Professor of Interventional Radiology
The Royal Devon and Exeter Hospital
and Peninsula Medical School
Exeter
UK
Eric Walser, MD
Mayo Clinic
Jacksonville
Florida
USA
ISBN 978-1-84800-398-9 e-ISBN 978-1-84800-399-6
DOI 10.1007/978-1-84800-399-6
Springer London Dordrecht Heidelberg New York
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2009940403
© Springer-Verlag London Limited 2010
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as
permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced,
stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers,
or in the case of reprographic reproduction in accordance with the terms of licenses issued by the
Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to
the publishers.
The use of registered names, trademarks, etc., in this publication does not imply, even in the absence of a
specific statement, that such names are exempt from the relevant laws and regulations and therefore free
for general use.
Product liability: The publisher can give no guarantee for information about drug dosage and application
thereof contained in this book. In every individual case the respective user must check its accuracy by
consulting other pharmaceutical literature.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Foreword
Despite the fact that Interventional Radiology is steadily moving toward a clini-
cal specialty with the need for broad medical training, daily craftsmanship will
always remain fundamental to what an interventional radiologist does. Without
basic catheter and wire skills IR would not be what it is today. When I watch expe-
rienced colleagues work I am always surprised to see that, concerning the technique
and the materials, we all make the same choices. There is apparently a common IR
skill, which is universal and can be learned with experience. I always see this with
new IR fellows, that it takes time to step away from improvising and letting the pro-
cedure take the lead to logic and standardized control over a procedure. Choosing
the right materials for the right job and building a level of confidence with these
materials is a very important part of any IR fellowship. Why can a supervisor get a
stable catheter position with a new wire in no time, whereas the fellow almost gives
up? The difference is knowing your materials for this specific indication and com-
bining routine and standardized operational procedures. Hands-on workshops are
always very popular at every IR meeting because one can really learn about basic
skills. Lectures with the title “How I do it,” can always count on a full audience.
A handbook that describes the technique of performing the various interventional
radiology procedures is not available and would be very useful as the amount of
IR procedures increases almost everyday. This book will bridge the gap between
books on pathology and more organ-specific IR books. This new series of technique-
specific books will be primarily of benefit to those in training in general radiology
and more specifically for residents and fellows who are training in interventional
radiology. Experienced interventional radiologists can also use a book like this. This
is a book that should be available in every IR cath lab.
Jim A. Reekers
The Netherlands
v
Preface from the Series Editors
Interventional radiology treatments now play a major role in many disease pro-
cesses and continue to mushroom with novel procedures appearing almost on a
yearly basis. Indeed, it is becoming more and more difficult to be an expert in all
facets of interventional radiology. The interventional trainee and practising inter-
ventional radiologist will have to attend meetings and read extensively to keep
up to date. There are many IR textbooks which are disease specific, but incorpo-
rate interventional radiology techniques. These books are important to understand
the natural history, epidemiology, pathophysiology, and diagnosis of disease pro-
cesses. However, a detailed handbook that is technique based is a useful addition
to have in the Cath Lab, the office, or at home where information can be accessed
quickly, before or even during a case. With this in mind we have embarked on a
series of books which will provide technique-specific information on IR procedures.
Initially, technique handbooks on angioplasty and stenting, transcatheter emboliza-
tion, biopsy, and drainage and ablative techniques will comprise the series. In the
future we hope to add books on pediatric and neurointervention.
We have chosen two editors, who are experts in their fields, for each book. One
editor is an European and the other is an American so that the knowledge of detailed
IR techniques is balanced and representative. We have tried to make the information
easy to access using a consistent bullet point format with sections on clinical fea-
tures, anatomy, tools, patient preparation, technique, aftercare, complications, and
key points at the end of each chapter.
These technique-specific books will be of benefit to those residents and fellows
who are training in interventional radiology and who may be taking subspeciality
certificate examinations in interventional radiology. In addition, these books will be
of help to most practicing interventional radiologists in academic or private prac-
tice. We hope that these books will be left in the interventional lab where they
should also be of benefit to ancillary staff, such as radiology technicians, radiogra-
phers, or nurses who are specializing in the care of patients referred to interventional
radiology.
vii
viii Preface from the Series Editors
We hope that you will use these books extensively and that they will be of help
during your working IR career.
Michael J. Lee
Dublin, Ireland
Anthony F. Watkinson
Exeter, UK
Preface from the Editors
In creating this handbook, the first in a new series Techniques in Interventional
Radiology, we compiled a list of relevant topics and distributed them to world-
renowned surgeons and interventional radiologists in Europe and the United States.
Their task was simple – rely on your wealth of experience and the best avail-
able research and create a document outlining the optimal treatment for vascular
disorders. Give us everything you know about, say, venous angioplasty, and then
condense it into a list of what really matters. We fielded authors’ queries as to the
length of the text, the number of pictures, and the reference list with the answers
short, few, and fewer with the objective of providing you with an easily readable,
yet powerful handbook of angioplasty and vascular intervention – a presentation of
topics that can function as a textbook in the hands of a novice or as a reference in
the hands of a seasoned interventionalist.
This work begins with a series of introductory chapters describing the basics of
vascular intervention, such as tools, drugs, hemodynamics, vascular access, and clo-
sure and then proceeds to treat specific topics using a consistent framework. After
reviewing the clinical features and diagnostic evaluation of a particular disorder, the
authors describe the indications, contraindications, and preparations for the proce-
dure; the performance of the procedure itself; and finally the expected outcomes and
complications.
The editors shared a brief, yet intense storm of interventional experiences on
a small island in the ocean many years ago, from which they emerged as lasting
friends and frequent collaborators on medical (and not so medical) projects. While
we remain separated by continents, we hope that we have used this disadvantage to
your benefit by accumulating expert contributors for this handbook from both sides
of the Atlantic.
We wish to thank Professors Michael Lee and Anthony Watkinson for their clear
purpose and valuable guidance. We also deeply appreciate the assistance of the staff
at Springer-Verlag publishing, including Gavin Finney, Melissa Morton, Denise
Roland, and Lauren Stoney. Finally, we thank our wives (Jeannie and Caroline)
ix
x Preface from the Editors
for their patience and support for the time we spent in discussion and in the editing
process, much of it late at night, in the creation of this handbook.
Robert Morgan
London, UK
Eric Walser
Jacksonville, FL, USA