Endovascular interventions : a step-by-step approach / edited by Jose M. Wiley, Cristina Sanina, George D. Dangas, Prakash Krishnan.

Includes bibliographical references and index.

Table of Contents
List of Contributors xiv

1 Innominate & Carotid Artery Intervention in High- Risk Patients 1
Tyrone J. Collins

Introduction 1

Innominate Interventions in High-Risk Patients 2

Catheter-based Therapy for An Innominate (Brachiocephalic) Stenosis 2

Carotid Artery Intervention in High-Risk Patients 5

Endovascular Treatment of A Carotid Stenosis 5

Catheter-based Therapy for Carotid Stenosis 6

Conclusions 10

References 13

2 Subclavian Artery Intervention: Catheter- Based Therapy 15
Saadat Shariff, Isabella Alviz, Cornelia Rivera, Michelle Cortorreal, and Tyrone J. Collins

Introduction 15

Endovascular Versus Open Surgical Revascularization 16

Endovascular Revascularization Techniques 16

Conclusion 18

References 19

3 Vertebral Artery Intervention: Catheter- Based Therapy 20
Tamunoinemi Bob- Manuel and James S. Jenkins

Introduction 20

Preprocedural Considerations 21

Step 1. Procedural Planning with Diagnostic Angiography 21

Step 2. Vertebral Artery Intervention (Percutaneous Transluminal Angioplasty) 24

Step 3. Vertebral Artery Intervention (Stenting) 25

Management of Potential Complications 27

Postprocedural Care 28

References 29

4 Endovascular Repair of Thoracic Aortic Aneurysms: Catheter-Based Therapy 30
John Denesopolis, Patricia Yau, and Aksim G. Rivera

Introduction 30

Relevant Anatomy 31

Aortic Anatomy 31

Crawford Classification for TAA/TAAA 31

Landing Zones 31

Implication of Aortic Anatomy on Spinal Perfusion 32

Indications/Contraindications to Procedure 33

Indications 33

Asymptomatic TAA/TAAA 33

Blunt Aortic Injury (BAI) 33

Acute Aortic Syndromes 33

Contraindications/Caveats 34

Available Endografts 34

Preoperative Evaluation 40

Positioning and Intraoperative Monitoring Needs 41

Procedural Steps 42

Postoperative Course/Surveillance 46

Monitored Setting 46

Spinal Drain 46

Blood Pressure Control 47

Arm Ischemia Symptoms 47

CTA Surveillance/Endoleak Types 48

References 49

5 Endovascular Abdominal Aortic Aneurysm Repair (EVAR) 50
John Futchko, Katie MacCallum, and Aksim G. Rivera

Introduction 50

Patient Selection 50

Preoperative Imaging and Measurements 51

Graft Selection 52

Graft Sizing 52

Neck Length 53

Neck Diameter 53

Branch Vessels 54

Aortic Length Measurements 54

Step 1. Vascular Access 55

Percutaneous 55

Open 56

Iliac Disease and Conduits 56

Step 2. Imaging 57

Equipment 57

Neck Angulation 58

Renal Arteries 58

Step 3. Wires 58

Step 4. Delivery and Deployment 59

Main Body 59

Graft Orientation 59

Proximal Landing Zone 59

Contralateral Gate Cannulation 60

Limb Deployment 62

Completion Angiogram 62

Step 5. Troubleshooting 63

Endoleaks 63

Inadvertent Coverage of Renal Arteries 65

Iliac Artery Considerations 65

Conclusion 66

References 66

6 Severe Renal Artery Stenosis: How to Intervene 68
Mohammad Hashim Mustehsan, Cristina Sanina, and Jose D. Tafur

Introduction 68

Background and Clinical Significance 69

Epidemiology 69

Clinical Manifestations 69

Patient Selection: Who to Screen for RAS 70

RAS Assessment 70

Noninvasive RAS Assessment 70

Invasive RAS Assessment 72

Indications for Revascularization 72

Intervention 74

References 76

7 Mesenteric Ischemia: Chronic and Acute Management 78
David A. Hirschl

Introduction 78

Chronic Mesenteric Ischemia 78

Step 1. Vascular Access and Sheath Selection 79

Step 2. Diagnostic Angiography 80

Step 3. Vessel Selection 81

Step 4. Selective Angiography 81

Step 5. Placement of a Working Wire 82

Step 6. Stent Placement 82

Step 7. Posttreatment Angiography 83

Step 8. Revision 83

Complications 84

Follow-Up and Outcomes 85

Acute Mesenteric Ischemia 85

Step 1. Arterial Vascular Access and Sheath Selection 87

Step 2. Selection of the SMA 87

Step 3. Aspiration Embolectomy 88

Step 4. Angiogram 89

Step 5. Thrombolysis 89

Step 6. Infusion and Follow-Up 91

Mesenteric Venous Thrombosis 91

Follow-Up and Outcomes 91

References 92

8 Aorto- Iliac Interventions 95
Michael S. Segal, Sameh Elrabie, and Rajesh K. Malik

Introduction 95

Preoperative Workup 95

Noninvasive Studies 96

Computed Tomographic Angiography 96

Ultrasound Duplex 96

Magnetic Resonance Angiography 97

Invasive Imaging 97

Angiography 97

Classification of Lesion and Planning of Intervention 97

TransAtlantic InterSociety Consensus II Classification (TASC II) 97

Planning for the Intervention 97

Step 1. Patient Factors 97

Step 2. Vascular Access 98

Step 3. Crossing the Lesion 99

Step 4. Intervention 100

Step 5. Closure 102

Step 6. Complications 103

Rupture 103

Embolization 103

Access Complications 103

Cases 104

Case 1 104

Case 2 104

References 107

9 Femoropopliteal Arterial Interventions in the Claudicant 108
Sahil A. Parikh, Joseph J. Ingrassia, and Matthew T. Finn

Introduction 108

Patient Evaluation and Indications for Treatment of Femoropopliteal Arterial Pathology 108

Indications for Revascularization Femoropopliteal Claudication 109

Vascular Imaging in Endovascular Treatment 109

Contrast Angiography 109

CO2 Angiography 110

Steps to CO2 Angiography 110

Extravascular and Intravascular Ultrasound 110

Steps to IVUS Use 111

Vascular Access and Lesion Crossing Techniques 113

Steps for Crossover “Up and Over” technique 113

Radial 114

Tibio-Pedal Approach 115

Antegrade Femoral Access 115

Working Wire Size and Changing Between Systems 116

Lesion Preparation 117

Plain Old Balloon Angioplasty 117

Focal Force Balloons for Optimal Lumen Gain 120

Drug-Coated Balloons 120

Atherectomy 121

Laser 121

Excimer Laser Use Steps 122

Rotational Atherectomy 123

Rotational Atherectomy Steps 124

Directional Atherectomy 124

Orbital Atherectomy 126

Embolic Protection 127

Troubleshooting Embolic Protection Devices 130

Troubleshooting a “Full” Filter 130

Distal Embolization or “No Reflow” 130

Stenting for Femoropopliteal Disease 131

Bare-Metal Stents 131

Drug-Eluting Stents (DES) 131

Alternative Stent Technologies 132

Covered Stents 132

Tacks 132

Final Efficacy Assessment 132

Conclusions 132

Acknowledgments 133

References 133

10 Tibial Interventions in Patients with Critical Limb- Threatening Ischemia 138
Raman Sharma, Roberto Cerrud- Rodriguez, and Prakash Krishnan

Introduction 138

Indications and Goals of Endovascular Revascularization 138

Considerations for Access Site 139

Single Versus Multitibial Artery Revascularization 140

Antegrade Tibial Artery Intervention 141

Retrograde Access for Retrograde Lesion Crossing and Wire Externalization with Antegrade Revascularization 143

TAMI Retrograde Revascularization 144

Reentry and Externalization Devices 146

Deep Venous Arterialization (DVA) 146

References 147

11 Acute Limb Ischemia: Endovascular Approach 151
Shunsuke Aoi and Amit M. Kakkar

Introduction 151

Procedure Planning, Equipment, and Considerations 151

References 161

12 Pedal Reconstruction 162
Ehrin Armstrong and Rory Brinker

Introduction 162

Pedal Arch Reconstruction 162

Indications for Pedal Revascularization 166

Technical Considerations 166

Access 166

Lesion Crossing 167

CTO Lesion Subtype 167

Special Considerations of the Pedal Intervention 167

Troubleshooting 169

Summary 169

References 173

13 Endovascular Management of Access Site Complications 175
Manaf Assafin, Robert Pyo, Pedro Cox- Alomar, and Miguel Alvarez- Villela

Introduction 175

Complications Related to Common Femoral Artery Access 176

Access Site Bleeding 176

Crossover Technique 179

Balloon Tamponade, Endovascular Coiling, and Covered Stent Placement 179

Femoral Pseudoaneurysms 180

Ultrasound-Guided Compression Repair 182

Ultrasound-Guided Thrombin Injection 183

Covered Stent Placement 184

Other Techniques 184

Arteriovenous Fistulas 185

Vascular Closure Device Related Complications 186

Radial Artery Related Complications 187

Radial Artery Spasm 188

Radial Artery Occlusion 189

Bleeding Complications 190

References 191

14 Acute Deep Vein Thrombosis 196
Vishal Kapur and Sagar Goyal

Introduction 196

Treatment Strategy 197

Initial and Long-Term Treatment of VTE 200

Oral Anticoagulants 200

Thrombolysis 200

Vena Cava Filters 201

Compression Stockings 202

Cancer-Associated VTE 202

Isolated Distal DVT 202

Extended Treatment 202

Unprovoked VTE 202

Oral Anticoagulants 203

Conclusion 203

References 204

15 Lower- Extremity Venous Stenting 207
Asma Khaliq, Sandrine Labrune, and Cristina Sanina

Introduction 207

Follow-Up 213

References 214

16 Intervention for Pulmonary Embolism 215
Seth I. Sokol, Wissam A. Jaber, and Yosef Golowa

Introduction 215

Pulmonary Angiography 215

Vascular Access 215

Injection and X-Ray Detector Positioning 216

Catheter-Directed Thrombolysis 216

EKOS™ Catheter-Directed Thrombolysis 216

Preparation of System 217

Access 218

Mechanical Disruption 220

Catheter Fragmentation of Clot 220

Large Catheter Aspiration 220

FlowTriever™ 220

Access 221

Penumbra 225

AngioVac 227

Patient Selection and Central Venous Access 227

AngioVac Circuit Setup and Thrombus Aspiration 229

AngioVac for Pulmonary Embolus 231

AngioVac for Clot-in-Transit 232

AngioVac for Right Heart Vegetation 232

Patient Selection and Approach 232

Technique 233

References 234

17 Catheter- Based Therapy for Varicose Veins 236
Juan Terre and Nelson Chavarria

Introduction 236

Thermal Techniques 236

Radiofrequency (RF) Ablation 237

Follow-Up 239

Endovenous Laser Ablation (EVLA) 239

Nonthermal Techniques 240

Mechanico-Chemical Ablation (MOCA) 241

Limitations 242

Summary 243

References 243

Index 245

"An increasingly popular alternative to open vascular surgery, endovascular intervention offers many advantages, including reduced patient discomfort, smaller incisions, shorter recovery time, and decreased risk of adverse complications. Practitioners and trainees alike require expert guidance on current technologies and up-to-date techniques. Endovascular Procedures provides clinicians with an easy-to-follow guide for minimally invasive treatment of vascular disease. This invaluable resource delivers concise and accurate instructions on a wide range of endovascular interventions, including interventions of the aorta, renal and mesenteric interventions, lower extremity interventions, venous interventions, and supra-aortic interventions in high-risk patients. Sequential phases of skill development broaden the reader's abilities as they progress through each chapter, supplying step-by-step instructions on when each procedure should be used and how it can be safely and effectively performed. This book offers a complete reference to essential techniques and procedures, suitable for both novice and experienced vascular surgeons, cardiologists, and radiologists"-- Provided by publisher.

About the Author
Jose M. Wiley, MD, MPH, Sidney W. and Marilyn S. Lassen Chair in Cardiovascular Medicine, Professor of Medicine, Chief, Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.

Cristina Sanina, MD, Interventional Cardiology Fellow, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

George D. Dangas, MD, PhD, Professor of Medicine-Cardiology and Vascular Surgery, Director of Cardiovascular Innovation, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Prakash Krishnan, MD, Professor of Medicine-Cardiology, Director of Endovascular Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA.