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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3955_Библиотеки_им_академика_М_И_Перельмана.pdf
Transjugular Intrahepatic Portosystemic Shunts 335
• Randomized clinical trials comparing TIPS and paracentesis with or without
volume expanders for cirrhotic patients with refractory ascites demonstrated:
b
No significant difference in mortality at 30 days
b
TIPS significantly reduced the re-accumulation of ascites at 3-months
(P < 0.01) and 12 months (P < 0.01).
Key Points
• TIPS is a validated therapeutic alternative for the management of patients
with complications related to portal hypertension.
• Careful patient evaluation before the procedure is critical. A valid indica-
tion for the creation of TIPS should always be established before embarking
on this complex procedure.
• Ideally, the decision to proceed with a TIPS should be a multidisci-
plinary decision, involving a gastroenterologist or hepatologist, a transplant
surgeon, and an interventional radiologist.
• Prognostic models help the interventional radiologist establish an antici-
pated outcome to both referring physician and patient’s family members.
• Use a covered stent for longer patency (Viatorr).
• Target for pressure gradient is less than 12 mmHg.
• Most prospective randomized trials have documented that TIPS is effective
in controlling variceal bleeding and reaccumulation of ascites; however, a
benefit on patient survival has not been established.
Suggested Reading
1. Boyer TD, Haskal ZJ. American Association for the Study of Liver Diseases Practice
Guidelines: The role of Transjugular Intrahepatic Portosystemic Shunt Creation in the
Management of Portal Hypertension. J Vasc Intervent Radiol 2005; 16: 615–629.
2. Ferral H, Gamboa P, Postoak DW, Albernaz VS, Young CR, Speeg KV, McMahan CA. Survival
after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for
end-stage liver disease score. Radiology 2004; 231: 231–236.
3. Pomier-Layrargues G, Villeneuve J-P, Deschênes M, Bui B, Perreault P, Fenyves D, Willems B,
Marleau D, Bilodeau M, Lafortune M, Dufresne M-P. Transjugular intrahepatic portosystemic
shunt (TIPS) versus endoscopic variceal ligation in the prevention of variceal rebleeding in
patients with cirrhosis: a randomised trial Gut 2001; 48: 390–396.
4. Henderson JM, Boyer TD, Kutner MH, Galloway JR, Rikkers LF, Jeffers LJ, Abu-Elmagd
K, Connor J. DIVERT Study Group. Distal splenorenal shunt versus transjugular intrahepatic
portal systematic shunt for variceal bleeding: a randomized trial. Gastroenterology 2006; 130:
1643–1651.
336 G. Behrens and H. Ferral
5. Khan S, Tudur Smith C, Williamson P, Sutton R. Portosystemic shunts versus endoscopic
therapy for variceal rebleeding in patients with cirrhosis. Cochrane Database Syst Rev 2006;
18(4):CD000553.
6. Saab S, Nieto JM, Lewis SK, Runyon BA. TIPS versus paracentesis for cirrhotic patients with
refractory ascites. Cochrane Database Syst Rev 2006; 18(4).
Index
Note: Locators followed by ‘f’ and ‘t’ refer to figures and tables respectively.
A
“Abdominal angina,” 153
Abdominal Aortic Aneurysms (AAA), 225
Access stenosis, cause of, 252f
Acute aortic syndrome (AAS), 207, 221
Acute DVT
complications of, 317
percutaneous options for, 322–323
Acute lower limb ischemia (ALLI), 276
Acute SFA occlusion, 109f
Aggressive distal wire placement, 151
Alexopoulou, Efthymia, 57
Allen test, 36
ALLI, see Acute lower limb ischemia (ALLI)
Anesthesia
EVAR of AAA, 229
intracranial and vertebral artery
angioplasty/stenting, 189
Anesthetic agents, medications, 22
Aneurysm, 174, 220, 225
of descending thoracic aorta, 219f
Angiographic catheters, 3–4
Angiography
aortoiliac angioplasty/stenting, 90
endovascular management of ruptured
abdominal aortic aneurysm,
244–245
endovascular treatment of acute stroke, 296
infrapopliteal angioplasty/stenting, 134
intracranial and vertebral artery
angioplasty/stenting, 190
mesenteric arteries, angioplasty/stenting of,
156–157
renal artery angioplasty/stenting, 146
subclavian and axillary arteries,
angioplasty/stenting of, 201
subintimal angioplasty, 115
superficial femoral artery and popliteal
artery, angioplasty/stenting of, 102
thoracic aorta, stent-grafting of, 216
Angioplasty, 190
alternative therapies to, see Therapies,
alternative
pathophysiology of, 57–59
principles, see Principles of angio-
plasty/stenting
versus stent-assisted angioplasty, 191
tools, see Tools to perform angio-
plasty/stenting
Angioplasty balloons, 6
modified balloons, 8
properties of, 7t
special purpose balloons, 6–8
Angioseal, 77–78
deployment of, 77f
Antecubital fistula, 261f, 263f
Antegrade femoral access, 30
Anticoagulation, medications, 22–23
Antiplatelet medication, 21–22
Aortic arch anatomy, 198f, 199f
reconstructed CT angiogram, 200f
Aortography, 90, 156, 157, 216, 228
Aortoiliac aneurysms, 245
Aortoiliac angioplasty/stenting
complications, 95–96
diagnostic evaluation
clinical, 85–86
imaging, 86–87
laboratory, 86
endovascular treatment of aortoiliac
occlusive disease
alternative therapies, 87–88
contraindications, 87
indications, 87
Techniques in Interventional Radiology, DOI 10.1007/978-1-84800-399-6,
C
Springer-Verlag London Limited 2010
337
R.A. Morgan, E. Walser (eds.), Handbook of Angioplasty and Stenting Procedures,
338 Index
equipment, 89
patient preparation, 88
post-procedure care
follow-up and post-procedure
medications, 94–95
immediate, 94
pre-procedure medications, 89–90
procedure
access, 90
angiography, 90
endovascular procedure, 93–94
intra-procedural medications, 91
lesion characterization and location,
91–93
relevant anatomy
aberrant anatomy, 89
normal anatomy, 88–89
results, 95
Aorto-iliac lesions, TASC classification of, 92f
Aortoiliac occlusive disease, 85
endovascular treatment of
alternative therapies, 87–88
contraindications, 87
indications, 87
Aortouniiliac (AUI) stent-grafts, 232
APACHE II, 329
Arterial access
access sites
axillary artery access, 37
brachial artery access, 35
femoral artery access, 29–33
pedal artery access, 34–35
popliteal artery access, 34
radial artery access, 36–37
EVAR of AAA, 229–230
preparation of access site, 27
principles of arterial puncture, 28
troubleshooting, 28–29
puncture site complications
arterial thrombosis, 38
complications, 38
hemorrhage, 37
pseudoaneurysm, 38
selection of needle type
needle without stylet, 27–28
seldinger needle, 27
subclavian and axillary arteries,
angioplasty/stenting of, 201
superficial femoral artery and popliteal
artery, angioplasty/stenting of, 102
thoracic aorta, stent-grafting of, 215–216
Arterial and venous anastamoses, 257f
Arterial closure devices, 73
active vascular closure devices
angioseal, 77–78
prostar XL10 and perclose A-T, 74–77
StarClose, 78
benefits of VCDS, 82
drawbacks of VCDS, 82
manual compression, 73
outcomes, 81
passive VCD
Boomerang ClosureWire, 78–80
patch technology, 80–81
types of vascular closure device, 74
Arterial pressure measurements
angiographic assessment of peripheral
vascular disease, 13–14
intra-arterial pressure measurements,
14–15
intra-arterial pressure measurements and
therapeutic end points, 15
technical considerations during intra-
arterial pressure measurements,
15–16
Arterial puncture, principles of, 28
troubleshooting, 28–29
Arterial thrombosis, 38
Arterial/venous access
hemodialysis access, 261
mesenteric arteries, 156
Aspirin, management, 20
Atherosclerotic lesions
mechanism of action of balloon angioplasty
in, 58f
Atherosclerotic ostial renal artery stenosis,
146f
Atherosclerotic stenosis in proximal internal
carotid artery, 168f
Axillary arteries, angioplasty/stenting of, see
Subclavian and axillary arteries,
angioplasty/stenting of
Axillary artery access, 37
B
Balloon angioplasty, 61–65
in atherosclerotic lesions, 58f
rupture of outflow vein following, 269f
rupture of renal artery during, of stenotic
lesion, 64f
of venous stenosis, 62f
Behrens, George, 327
Belli, Anna-Maria, 97
Bellmann, Laurent, 129
Bent, Clare L., 41
Beregi, Jean-Paul, 207
Index 339
Bjarnason, Haraldur, 303
Blue finger syndrome, 195
Blue toe syndrome, 85
Boomerang Catalyst wire, 79
Boomerang ClosureWire, 78–80
deployment of, 79f
Boomerang effect, 79
“Bovine arch,” 199
Bovine graft, 256f
Brachial artery access, 35
Brachicephalic elbow fistula, 260f
Brachiocephalic artery, 198
Brachiocephalic occlusion, approach to, 203f
Brountzos, Elias N., 57
C
Calcium channel blockers, 23
Calibrated catheter angiography, 61f
Carotid artery stenting (CAS), 167, 169,
172–173, 175, 183
Carotid atherosclerosis, 168–169
Carotid bifurcation, MRA of, 167, 177f
Carotid endarterectomy (CEA), 167, 169–170
Carotid stenting/angioplasty, 167
alternative therapies, 183
clinical features
angioplasty/stenting, 169
carotid atherosclerosis, 168–169
medical management, 170
complications, 183–184
contraindications, 173–175
diagnostic evaluation
clinical, 170–171
imaging, 171–172
laboratory, 171
follow-up, 182–183
immediate post-procedural issues, 182
indications for carotid artery stenting,
172–173
intra-procedural medications and devices
crossing stenotic lesion, 180–181
embolic protection devices, 179–180
intra-procedural medications, 180
stents, 181–182
patient preparation and selection, 175–177
pre-procedure medications, 178
procedural considerations, 178–179
relevant anatomy – normal and variant, 177
results, 183
Catheter angiography, 113, 226
Catheter-based venography, 306
Catheter-directed pharmacological throm-
bolysis (“infusion-first CDT”),
322–323
Catheters
endovascular treatment of acute stroke, 295
for EVAR, 228–229
guide, 2
and wire compatibility, 5t
Central venous stenosis/occlusion, left
subclavian pacemaker with, 253f
Cephalic vein stenosis, left wrist fistula with
focal juxta-anastomotic, 253f
Cerebral blood flow (CBF) map, 176f
CFA, see Common femoral artery (CFA)
CFV, see Common femoral vein (CFV)
Child-Pugh
classification for liver disease, 328t
TIPS, score, 328
ChitoSeal, 81
Cholesterol embolization (CE), 69, 149
Chronic kidney disease (CKD), 251
Chronic lower limb ischemia, 86t
Chronic mesenteric ischemia (CMI), 153, 154
Claudication, medical treatment of, 19
Cleveland, Trevor John, 195
Clopidogrel, management, 20
Clotted left wrist radiocephalic fistula, 271f
Clotted upper arm graft, 270f
Color duplex sonography (CDS), 154, 163
Common femoral artery (CFA), 39, 44, 90,
92f, 145
Common femoral vein (CFV), 45f, 308, 310
Common iliac vein (CIV), 310–311
Computed tomographic angiography (CTA),
112, 142, 154f, 208–209, 225–226
Computer tomographic venography (CTV),
306
Contralateral retrograde approach, 121
Contralateral retrograde CFA, 30
Contrast-induced nephropathy (CIN),
prevention of, 21
Critical limb ischemia (CLI), 129
CTA, see Computed tomographic angiography
(CTA)
CTV, see Computer tomographic venography
(CTV)
D
Deep vein thrombosis (DVT)
factors that impact decision process for
thrombectomy/thrombolysis of,
321t
major risk factors for developing, 318
Diabetes, managing before medications, 18
Diabetic medication, 20
Diagnostic angiography, 3
340 Index
Digital subtraction angiography (DSA), 115,
130, 143, 171
Distal embolization, 126
Distal SFA and popliteal artery obscured by
total knee replacement, 103f
Drug-eluting stents, 150
Drugs – pre-, peri- and post-intervention
management of pre-existing medications
before intervention
aspirin, 20
clopidogrel, 20
diabetic medication, 20
heparin, 20
warfarin, 19–20
medications during intervention
anticoagulation, 22–23
local anesthetic agents, 22
vasodilators, 23–24
medications post-intervention, 24–25
medications preintervention
managing risk factors before
intervention, 17–19
medical treatment of claudication, 19
medical treatment of ulcers, 19
prescription of medications before
intervention
antiplatelet medication, 21–22
prevention of contrast-induced
nephropathy (CIN), 21
D’Souza, Stephen P., 73
D-Stat, 81
Duplex ultrasound, 98, 112, 130, 197, 319
DVT, see Deep vein thrombosis (DVT)
Dyslipidemia, managing before medications,
18–19
E
Elective endovascular aneurysm repair
(EVAR), 227
Embolic protection devices (EPD), 150
Endografts
technical features of available devices, 214t
valiant, treatment of acute dissection with,
218f
Endoleaks, 221–222, 234
detection of procedural, 246
management of procedural, 246
Endovascular DVT thrombolysis, 319–320
Endovascular management of ruptured
abdominal aortic aneurysm
aftercare, 247
alternative therapies, 248
anatomy, 241
aberrant anatomy, 241
desired normal anatomy, 241
clinical features, 239
complications
early, 248
late, 248
contraindications
absolute, 240
relative, 241
diagnostic evaluation
imaging, 239–240
laboratory, 239
equipment
catheters/balloons, 242–243
emergency access trolley, 241
guidewires, 243
stent grafts, 242
follow-up, 247
indications, 240
procedure
access, 243–244
clinical scenarios, 245
detection of procedural endoleaks, 246
initial angiography, 244–245
management of iliac aneurysms, 245
management of procedural endoleaks,
246
resuscitation/anesthesia, 243
results, 247
Endovascular procedure
aortoiliac angioplasty/stenting, 93–94
crossing lesion, 93
deploying stent/balloon, 93–94
endpoint, 94
Endovascular treatment of acute stroke, 291
aftercare, 300
angiography
access, 296
patient preparation, 296
runs, 296
clinical features, 292
complications, 301
contraindications, 294
relative contraindications, 295
diagnostic evaluation, 292
history, 292
imaging, 293
laboratory, 293
physical exam, 292
equipment
catheters, 295
thrombolytic agents, 295–296
indications, 294
Index 341
performing the procedure
intra-arterial thrombolysis, 297–298
mechanical thrombus disrup-
tion/removal, 298–300
technique, 296
relevant anatomy, 295
results, 300
Endovascular treatment of aortoiliac occlusive
disease
alternative therapies, 87–88
contraindications, 87
indications, 87
EVAR, see Elective Endovascular Aneurysm
Repair (EVAR)
EVAR of AAA
angiogram of AAA before EVAR, 231f
clinical features, 225
complications, 233
endoleaks, 234–235, 235f
management of, 236
contraindications, 227
diagnostic evaluation
catheter angiography, 226
clinical, 225
contrast-enhanced magnetic resonance
angiography (MRA), 226
CT Angiography (CTA), 225–226
information required from imaging
studies, 226–227
ultrasound, 225
equipment required for EVAR
additional tools, 229
catheters, 228–229
guidewires, 229
stent-grafts, 228
follow-up and post-procedure medications,
232
indications for EVAR, 227
patient preparation, 227
relevant anatomy, 228
results, 233
technique of EVAR
anesthesia, 229
arterial access, 229–230
intra-procedural medications, 230
procedure, 230–232
“Eyeball technique,” 61
F
Femoral artery access, 29–33
contralateral retrograde CFA (cross-over),
30
ipsilateral antegrade CFA, 30–32
ipsilateral retrograde CFA access with
reversal of catheter, 32–33
puncture site, 44f
retrograde common femoral artery (CFA),
29–30
Femoral lesions, TASC classification of, 99f
Femoral vein, venous access into, 43
anatomy, 44
complications, 46
contraindications, 43
indications, 43
patient preparation, 43
performing the procedure, 44–45
Ferral, Hector, 327
Fibromuscular dysplasia (FMD), 91, 141, 143
renal angiogram showing “string of beads”
appearance, 145f, 147
Fishwick, Guy, 111
FMD, see Fibromuscular dysplasia (FMD)
Forearm dialysis graft, 252f
French size, 2
G
Glyceryl trinitrate (GTN), 24
Guidewires, 4–6
H
Hemodialysis access, angio-
plasty/stenting/lysis/thrombectomy
of
alternative therapies – surgical intervention,
272
anatomy: grafts and fistulae, 255–257
clinical features, 251
complications and treatment, 272–273
contraindications, 254
diagnostic evaluation
clinical, 251
imaging, 251–252
equipment, 257–259
follow-up and post-procedure medications,
271–272
indications, 253–254
patient preparation, 255
pre-procedure medications, 259
procedure
arterial/venous access, 261
assessing lesion, 264–265
endpoint, 269–270
fistulography, 262
immediate post-procedure care,
270–271
intra-procedural medications, 262–264
342 Index
performing the procedure, 265–269
physical exam, 259–260
results – per K/DOQI guidelines, 272
Heparin, 22–23
management, 20
Hieb, Robert A., 85
Hyperkalemia, 279
Hypertension, 141
managing before medications, 17–18
Hypoplastic aortoiliac syndrome, 85
I
Iliac aneurysms, 245
Iliac venous system, chronic occlusion of left,
312f
Iliofemoral DVT, 317
Inferior vena cava (IVC), 53, 303
venous access into, 53
anatomy, 54
complications, 55
contraindications, 54
patient preparation, 54
performing the procedure, 54
Infrapopliteal angioplasty/stenting
alternative therapies, 139
clinical features, 129
complications, 139–140
contraindications, 131
diagnostic evaluation
clinical, 129
imaging, 130
indications, 130
laboratory, 130
equipment required for infrapopliteal
intervention, 132
follow-up and post-procedure medications,
138
patient preparation, 131
pre-procedure medication, 133
procedure
access, 133
angiography, 134
assessing lesion, 134–135
immediate post-procedure care, 138
intra-procedural medications, 134
performing the procedure, 135–137
relevant anatomy
aberrant anatomy, 132
normal anatomy, 131–132
results, 139–140
Innominate, see Brachial artery access
Internal carotid artery, angioplasty of, 169
Internal jugular vein (IJV), venous access into,
47
anatomy, 48
complications, 51
contraindications, 48
indications, 47–48
patient preparation, 48
performing the procedure, 49–51
using anatomical landmarks, 49
using ultrasound guidance, 49–50
Intimal xanthoma, 168
Intra-arterial pressure measurements, 14–15
technical considerations during, 15–16
and therapeutic end points, 15
Intra-arterial thrombolysis, 296, 297–298
Intracranial and vertebral artery angio-
plasty/stenting, 187
clinical features and patient selection, 187
complications, 193
contraindications, 188–189
diagnostic evaluation
clinical, 188
imaging, 188
laboratory, 188
follow-up evaluation and postprocedure
management, 192–193
patient preparation
anesthesia, 189
pre-procedure and peri-procedure
medications, 189
procedure
angiography, 190
angioplasty, 190
angioplasty versus stent-assisted
angioplasty, 191
guidewire selection, 192
guiding catheter and sheath, 191–192
percutaneous vascular access, 189–190
stent selection, 192
Intracranial hemorrhage, 279, 301
Intracranial vascular occlusion, grading
severity of, 297t
Intravascular ultrasound (IVUS), 306
Ipsilateral antegrade CFA, 30–32
Ipsilateral retrograde CFA
access, 90
with antegrade conversion, 33f
with reversal of catheter, 32–33
Irreversible/profound ischemia, 286
action, 287–288
angiographic findings, 287
clinical/physical findings, 286–287
doppler findings, 287
Ischemic penumbra, 291
Ischemic stroke, 167
Index 343
Isolated Calf DVT, 317
IVC, see Inferior Vena Cava (IVC)
K
Kessel, David O., 1
Kinney, Thomas B., 13
Kissing balloon technique, 63, 65f
Kissing stent technique, 63, 65f, 94
L
Lammer, Johannes, 225
“Leriche Syndrome,” 85
Lesion
assessing
hemodialysis access, 264–265
infrapopliteal angioplasty/stenting,
134–135
renal artery angioplasty/stenting,
146–147
subclavian and axillary arteries,
angioplasty/stenting of, 202–203
subintimal angioplasty, 116
superficial femoral artery and popliteal
artery, angioplasty/stenting of,
103–104
characterization and location, 91–93
crossing
principles of angioplasty/stenting, 60
subintimal angioplasty, 116
mesenteric arteries, angioplasty/stenting of,
157
traversing, 3–4
treating, 6
Levy, Elad I., 187
Lidocaine/lignocaine, 22
Loan, William C., 225
Loop graft, 256f, 257f
Lyse and Wait Technique, 268–269
M
Magnetic resonance angiography (MRA), 86,
113, 130, 142–143, 196, 197, 209
contrast-enhanced, 226
Maldeployment, 221
Matson, Matthew, 41
MCA, 293
occlusion, 299f
McLennan, Gordon, 251
McNamara, Thomas O., 275
Mechanical thrombolysis, results of, 300f
Median arcuate ligament syndrome (MALS),
155
Medications before intervention
antiplatelet medication, 21–22
management of pre-existing
aspirin, 20
clopidogrel, 20
diabetic medication, 20
heparin, 20
warfarin, 19–20
prevention of contrast-induced nephropathy
(CIN), 21
Medications during intervention
anticoagulation, 22–23
local anesthetic agents, 22
vasodilators, 23–24
Medications post-intervention, 24–25
Medications preintervention
managing risk factors before intervention,
17–19
diabetes, 18
dyslipidemia, 18–19
hypertension, 17–18
smoking, 17
medical treatment of claudication, 19
medical treatment of ulcers, 19
Meld score, 329
Merci
R
mechanical thrombolysis, 298
Mesenteric arteries, angioplasty/stenting of
alternative therapies, 162
angiography of celiac trunk, 161f
clinical features, 153
complications
avoiding, 164–165
treating, 163–164
contraindications, 155
diagnostic evaluation
clinical, 153
imaging, 154–155
indications, 155
laboratory, 154
equipment required, 156
follow-up and post-procedure medications,
159
ostial stenosis of celiac trunk and moderate
stenosis of SMA, 160f
patient preparation, 155
pre-procedure medications, 156
procedure
angiography, 156–157
arterial/venous access, 156
assessing the lesion, 157
immediate post-procedure care, 159
intra-procedural medications, 157
performing the procedure, 158–159
relevant anatomy, 155–156
results, 159–162
344 Index
sonography during follow-up after previous
stenting of celiac trunk stenosis,
163f
Midulla, Marco, 207
Misra, Sanjay, 141
Mocco, J., 187
Molsidomine (Corvasol), 24
MRA, see Magnetic resonance angiography
(MRA)
Muir, Susie J., 275
M
¨
uller-H
¨
ulsbeck, Stefan, 153
Multi side-hole catheters, see Pigtails catheters
Murphy, Kieran J., 167
N
Needle type, selection of, arterial access
needle without stylet, 27–28
seldinger needle, 27
Neointimal hyperplasia, 251
Nephrotoxicity, 279
North America Symptomatic Carotid
Endarterectomy Trial (NASCET),
171, 172
O
Occlusion balloon, 244f
Occlusive ulnar artery embolus, 273f
P
Papaverine, 24
Paraplegia, 222
Passive VCD
Boomerang ClosureWire, 78–80
patch technology, 80–81
ChitoSeal, 81
D-Stat, 81
Syvec patch, 80
Patch technology, 80–81
Pedal artery access, 34–35
Pellerin, Olivier, 129
Penumbra stroke system
R
mechanical
thrombolysis, 298
Perclose A-T device, 75–77
deployment of, 76f
Percutaneous intentional extraluminal
recanalization (PIER), see
Subintimal angioplasty
Percutaneous thrombin injection technique,
38f
Percutaneous transluminal angioplasty (PTA),
57, 135
Percutaneous vascular access, 189–190
Peripheral vascular disease (PVD), 82
angiographic assessment of, 13–14
detection of, 13
Pharmacomechanical catheter-directed
thrombolysis (PCDT), 324–325
Pigtails catheters, 89, 201, 217, 228, 242
Popliteal artery
access, 34
angioplasty/stenting of, see Superficial
femoral artery and popliteal artery,
angioplasty/stenting of
approach, 121
Popliteal lesions, TASC classification of, 99f
Popliteal vein, venous access, into
anatomy, 46–47
complications, 47
contraindications, 46
indications, 46
patient preparation, 46
performing the procedure, 47
Post-procedure care, aortoiliac angio-
plasty/stenting
follow-up and post-procedure medications,
94–95
immediate, 94
Post-PTA angiogram, 103f
Post-thrombotic syndrome, 318t
Predeployment, 75
Principles of angioplasty/stenting
complications, 69
cholesterol embolization (CE), 69
puncture site complications, 69
vessel rupture, 69
pathophysiology of angioplasty, 57–59
pre-interventionalwork-up, 59
procedure, 59
balloon angioplasty, 61–65
crossing of lesion, 60
deciding endpoint, 66–68
vascular access, 60
Prostar XL10, 75
Proximal DVT, 317
Pseudoaneurysm, 38, 207
PTA, see Percutaneous transluminal
angioplasty (PTA)
Puncture site complications, arterial access
arterial thrombosis, 38
complications, 38
hemorrhage, 37
pseudoaneurysm, 38
R
Radial artery access, 36–37
Radiocephalic fistula, 255f, 266f
Rapid exchange, 7–8