IR Playbook: A Comprehensive Introduction to Interventional Radiology

Preface
A Message to Students
Acknowledgments
Contents
Contributors
Part I: Radiology Basics
	1: Evolution of IR Training
		References
	2: Radiation Safety
		Introduction
		X-ray Systems for Interventional Radiology
		Basic Medical Radiation Physics Quantities and Units
		Summary of Biological Effects of Ionizing Radiation
			Deterministic Effects
			Stochastic Effects
		Effects of In Utero Irradiation
		Radiation Protection System in Medicine
		Diagnostic Reference Levels in Patient Radiation Protection
		Radiation Protection of Staff (Including Pregnant Women)
		Passive and Active Personnel Radiation Protection
		Patient and Staff Protection as an Integrated Approach
			Importance of Preprocedural Imaging
		Personnel Dose Limits
		Pregnant Personnel
		Particular Consideration for Pediatric Patients and Pregnancy
		Radiation Protection in CT Fluoroscopy (CTF)-Guided Interventions
		Practical Recommendations for a Good Practice Minimizing Radiation Risks
		References
	3: Tools of the Trade
		Needles, Catheters, and Wires
		Vascular Access
			Double Wall
			Single Wall
			Advantages/Disadvantages
		Nonvascular Needles (Table 3.1)
		Guidewires
			Curved
			Straight/Angled
			Stiffness
			Flexibility
			Coating
			Torqueability
			Opacity
			Wire Length and Diameter
		Catheters
			Flush Catheters
			Selective Catheters
			Visceral Catheters
			Multipurpose Catheters
			Cerebral Catheters
			Guiding Catheters
			Microcatheters
		Vascular Sheaths
		Vessel Dilators
		Accessories
			Embolic Agents
			Temporary Agents
			Permanent Agents
		Pushable Coils
		Detachable Coils
		Coiling Techniques (Fig. 3.49)
			Anchor
			Weave
			Scaffolding
		Vascular Plugs
		Particulates
		Liquid Embolics
		Balloons and Stents
			Embolectomy Catheters
			Angioplasty Balloons
			Drug-Coated Balloons
			Vascular Stents
				Balloon-Expandable Stents
			Self-expandable Stents
			Specialty Stents
		References
	4: Patient Care in IR
		Introduction
		Components of Preprocedural Evaluation
		History and Physical Examination
		Informed Consent
		Sedation and Anesthesia
		Patient Selection and Preparation
		Techniques and Pharmacologic Agents
		Recovery
		Periprocedural Optimization
		Periprocedural Emergencies and Acute Patient Care
		Respiratory Failure and Airway Management
		Dysrhythmias
			Narrow Complex Tachycardia
			Wide-Complex Tachycardia
			Bradycardia
		Hypertensive Crises
		Circulatory Shock
		Hemorrhage
		Conclusion
		References
	5: Pharmacology in IR
		Preprocedure Medications
			Antibiotics
			Anticoagulation/Antiplatelets
		Intra- and Postprocedure Medications
			Sedation
			Antiemetics
		Allergy/Contrast Reaction Medications
			Acute Contrast Reaction Management
			Contrast Allergy Premedication
		Summary
		References
	6: The IR Road Map: Vascular Anatomy Overview
	7: Introduction to Cross-Sectional Imaging
		Introduction
		Imaging Modalities
			Ultrasound
			Computed Tomography
			Magnetic Resonance Imaging
		Imaging Planes and Orientation
		Cross-Sectional Anatomy
			Chest
				Segmental Lung Anatomy
				Mediastinum
				Pulmonary Arteries
				Pulmonary Veins
				Bronchial Arteries
			Thyroid and Parathyroid
			Abdomen and Pelvis
			Liver
			Kidneys
			Ureters
			Bladder
			Uterus
		References
Part II: Venous Interventions
	8: Vascular Access Techniques and Closure Devices
		Vascular Access
		Seldinger Technique
		Ultrasound Guidance
		Micropuncture
		Arterial Access
		Single-Wall and Double-Wall Technique
		Common Femoral Artery Access
		Radial Artery Access
		Alternative Arterial Access Sites
		Venous Access
		Central Venous Access
		Advanced Portomesenteric Access
		Hemostasis and Closure Devices
			Manual Compression
			Closure Devices
		Compression Devices
		Topical Agents
		Invasive Devices
		References
	9: Central Venous Access
		Pathophysiology
		Non-tunneled Central Catheters (NTCCs)
		Tunneled Central Catheters (TCCs)
		Implantable Ports
		Peripherally Inserted Central Catheters (PICCs)
		Catheters with Multiple Lumens
		Clinical Indication
		Indications for Different Central Venous Catheters
		Conventional Therapy
			Non-tunneled Central Catheters
			Tunneled Central Catheters
			Ports
			PICCs
		Interventional Therapy
			Tunneled and Non-tunneled Catheters
			Ports
			PICCs
			IR’s Increasing Role in Central Venous Access
			Pre-procedural Prep
				History
				Physical Exam
				Imaging
			Determining a Venous Access Site
			Special Considerations Regarding Venous Access Sites
			Complex Venous Access
			Post-procedural Management
			Complications
				Acute Complications
				Long-Term Complications
			Device Troubleshooting and Complication Management
			Evaluation of the Malfunctioning Catheter
			Treatment of Tip Malposition
			Techniques of Fibrin Sheath Disruption/Stripping
			Device Removal
			PICC and Non-tunneled Catheter Removal
			Tunneled Catheter Removal
			Port Removal
		References
	10: Acute and Chronic Lower Extremity Deep Venous Thrombosis
		Introduction
		Pathophysiology
			Acute Obstructive Venous Disease
			Chronic Obstructive Venous Disease
		Clinical Indications
			Acute Obstructive Venous Disease
			Chronic Obstructive Venous Disease
		Conventional Therapy
		Interventional Therapy
			Preprocedural Planning
			Thrombolysis and Thrombectomy
			Venoplasty and Stent Placement
			IVUS
		Postprocedural Care
		References
	11: Pulmonary Embolism
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Aspiration Thrombectomy
		Catheter-Directed Thrombolysis
		Long-Term Outcomes
		Pulmonary Embolism Response Teams
		References
	12: IVC Filters
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
			Genesis of IR Procedure: Development of IVC Filters
			Indications for IVC Filter Placement
				IVC Filter Placement
		Complications
			IVC Filter Retrieval
		References
	13: Dialysis Interventions
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Surgical AVF
		Percutaneous AVF
		Grafts
		Interventional Therapy
		Dysfunctional Fistulae and Grafts
			The Immature Fistula
			Stenosis
			Thrombosis
			Aneurysmal Dilatation
			Steal Syndrome
			Infection
		Conclusion
		References
	14: Pelvic Venous Disorders
		Introduction
		SVP Classification
		Clinical Indications
		Conventional Treatment
		Interventional Treatment
			Complications
		References
	15: Varicocele
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		References
	16: Varicose Veins
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		References
	17: Vascular Malformations
		Pathophysiology
		Hemangiomas
		Vascular Malformations
		Arteriovenous Malformations (High Flow)
		Venous Malformations (Low Flow)
		Lymphatic Malformations
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		High-Flow AVMs
		Low-Flow Venous Malformations
		Klippel-Trenaunay Syndrome
		Lymphatic Malformations
		Adjunctive Therapy
		References
	18: Adrenal Vein Sampling
		Pathophysiology
			Prevalence
			Clinical Indication
			Radiological Diagnosis
			Conventional Therapy
		Interventional Therapy
			Right Adrenal Vein
			Left Arenal Vein
		Adrenal Vein Sampling Procedure
			Pre-procedural Preparation
			Cosyntropin Stimulation
			Venographic Findings of Adrenal Veins
			Rapid Cortisol Assay
			Sequential vs. Simultaneous AVS
			C-Arm Cone-Beam CT
			Selectivity and Lateralization Indices
		Complications
		Postprocedural Management
		Conclusion
		References
Part III: Aortic Interventions
	19: Thoracic and Thoracoabdominal Aortic Aneurysms
		Pathophysiology
			Thoracoabdominal Aortic Aneurysm (TAAA)
			Clinical Indication
			Conventional Therapy
		Interventional Therapy
			Thoracic Aortic Aneurysm
			Thoracoabdominal Aortic Aneurysm
		Common Complications
			Access
			Endoleaks
			Spinal Cord Ischemia
			Postoperative Monitoring
		References
	20: Abdominal Aortic Aneurysms
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
			Common Complications
			Access
			Endoleaks (Refer to Chap. 22 for More Information)
			Contrast Nephropathy
			Postoperative Monitoring
		References
	21: Aortic Dissection
		Pathophysiology
			Background
			Classification
		Clinical Indication
			Patient Presentation
			Patient Evaluation
		Conventional Therapy
			Medical Management
			Open Surgical Repair
		Interventional Therapy
			Background
			Malperfusion Syndromes
			Type B Aortic Dissection
		References
	22: Endoleaks
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Type I Endoleaks
		Type II Endoleaks
		Type III Endoleaks
		Type IV Endoleaks
		Type V Endoleaks
		References
	23: Traumatic Aortic Injury
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
			Genesis of Thoracic Endograft for Traumatic Injury
		Results and Data
		Pre-Procedural Preparation
		Post-Procedural Management
		Complications (Table 23.6)
		Post-Procedural Imaging
		References
Part IV: Thoracic Interventions
	24: Bronchial Artery Embolization
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		References
	25: Pulmonary Angiography: Arteriovenous Malformation and Pseudoaneurysm
		Pathophysiology
			Pulmonary Arteriovenous Malformation
			Pulmonary Artery Pseudoaneurysm
		Clinical Indications
			Pulmonary Arteriovenous Malformation
			Pulmonary Artery Pseudoaneurysm
		Conventional Therapy
			Pulmonary Arteriovenous Malformation
			Pulmonary Pseudoaneurysm
		Interventional Therapy
			Pulmonary Arteriovenous Malformation
			Pulmonary Artery Pseudoaneurysm
		References
	26: Lymphatic Interventions
		Pathophysiology
		Clinical Indication
		Conventional Therapy
			Dynamic Contrast-Enhanced MR Lymphangiography (DCMRL)
		Interventional Therapy
			Pedal Lymphangiography (PL)
			Intranodal Lymphangiography (IL)
			Thoracic Duct Embolization
			Embolization of Lymphatic Masses
			Plastic Bronchitis
		Conclusion
		References
Part V: Abdominal and Pelvic Interventions
	27: Mesenteric Ischemia
		Pathophysiology
			Acute Mesenteric Ischemia
			Arterial Occlusive Disease
			Portomesenteric Vein Thrombosis
			Nonocclusive Mesenteric Ischemia (NOMI)
			Chronic Mesenteric Ischemia
		Clinical Indication
			Acute Mesenteric Ischemia
			Arterial Occlusive Disease
			Nonocclusive Mesenteric Ischemia (NOMI)
			Portomesenteric Vein Thrombosis
			Chronic Mesenteric Ischemia
		Conventional Therapy
			Acute Mesenteric Ischemia
			Arterial Occlusive Disease
			Portomesenteric Vein Thrombosis
			Nonocclusive Mesenteric Ischemia (NOMI)
			Chronic Mesenteric Ischemia
		Interventional Therapy
			Acute Mesenteric Ischemia
			Arterial Occlusive Disease
			Portomesenteric Vein Thrombosis
			Nonocclusive Mesenteric Ischemia (NOMI)
			Chronic Mesenteric Ischemia
		References
	28: Visceral Aneurysms
		Pathophysiology
			Visceral Artery True Aneurysms (VATAs)
			Visceral Artery Pseudoaneurysm (VAPA)
		Clinical Indication
			VATA
			VAPA
		Conventional Therapy
		Interventional Therapy
		Splenic Artery Aneurysms
		Renal Artery Aneurysms
			Hepatic Artery Aneurysms
			Gastroduodenal Artery (GDA) and Pancreatic and Pancreaticoduodenal Artery (PDA) Aneurysms
			Celiac Artery Aneurysms
			Superior and Inferior Mesenteric Artery Aneurysms (SMA and IMA)
			Complications
				Splenic Aneurysm
					Splenic Infarction
				Pancreatitis
			Renal Aneurysm
			Hepatic Aneurysm
				Hepatic Ischemia, Infarction, or Abscess
				Cholecystitis
			GDA and Mesenteric Aneurysms
				Stomach and Small or Large Bowel Ischemia or Infarction
		References
	29: Renal Artery Stenosis
		Pathophysiology
		Clinical Indications
		Conventional Therapy
		Interventional Therapy
		Post-Procedural Care
		Conclusion
		References
	30: GI Bleeding
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Complications
		References
	31: Uterine Artery Embolization
		Pathophysiology
			Fibroids
			Adenomyosis
			Postpartum Hemorrhage
			Uterine Arteriovenous Fistulae
		Clinical Indication
		Conventional Therapy
			Fibroids
			Adenomyosis
			Postpartum Hemorrhage
		Interventional Therapy
			Fibroids
			Adenomyosis
			Postpartum Hemorrhage
			AV Fistula
		References
	32: Prostate Artery Embolization
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		References
	33: Visceral and Solid Organ Trauma
		Pathophysiology
			Spleen
			Liver
			Kidney
		Clinical Indication
			Spleen
			Liver
			Kidney
		Conventional Therapy
			Spleen
			Liver
			Kidney
		Interventional Therapy
			Spleen
				Pre-Procedure
				Post-Procedure
			Liver
				Pre-Procedure
				Adverse Effects
				Post-Procedure
			Kidney
				Pre-Procedure
				Post-Procedure
		References
Part VI: Lower Extremity Interventions
	34: Aortoiliac Disease
		Pathophysiology
		Blue Toe Syndrome
		Leriche Syndrome
		Fibromuscular Dysplasia
		Iliac Artery Endofibrosis
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Abdominal Aorta
		Aortic Bifurcation
		Common Iliac Artery
		External Iliac Artery
		Internal Iliac Artery
		Blue Toe Syndrome
		References
	35: Infrainguinal Disease
		Pathophysiology
		Asymptomatic Disease (Rutherford Category 0)
		Claudication (Rutherford Categories 1–3)
		Chronic Limb Threatening Ischemia: Rest Pain (Rutherford Category 4)
		Chronic Limb Threatening Ischemia: Skin Lesions (Rutherford Categories 5–6)
		Acute Limb Ischemia
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Percutaneous Transluminal Angioplasty
		Stents
		Recanalization of Chronic Total Occlusions and SAFARI
		Acute Limb Ischemia
		References
	36: Pelvic and Extremity Trauma
		Pathophysiology
		Pelvic Fractures
		Extremity Fractures
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		References
Part VII: Interventional Oncology
	37: Biopsy Techniques
		Introduction
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Biopsy Devices
		Biopsy Techniques
		Molecular Diagnostics in Oncology
		Organ Specifics
		References
	38: Transarterial Chemoembolization
		Pathophysiology
			Liver Cancer
		Clinical Indications
			Imaging Findings
			Treatment Algorithm
		Conventional Therapy
			Medical Management
			Surgical Management
			Resection
			Liver Transplant
		Interventional Therapy
			Background
		Palliative Treatment for those Who are Not Transplant Candidates
			Therapy Regimen
			Pre-Procedure Planning
			Post-Procedure
				Immediate
				Clinic Follow-Up
		References
	39: Transarterial Radioembolization
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Clinical Outcomes with TARE
			Primary Liver Cancers
			Hepatic Metastatic Disease
		References
	40: Liver Ablation
		Pathophysiology
			Liver Cancer
			Liver Metastases
			Liver Cysts and Hemangiomas
			Hemangiomas
		Clinical Indication
		Conventional Therapy
			Liver Cancer
			Liver Transplantation
			Systemic Therapies
			Liver Metastases
			Liver Cysts and Hemangiomas
		Interventional Therapy
		New and Emerging Technologies
			Histotripsy
			High-Intensity Focused Ultrasound
			Irreversible Electroporation
			Pulsed Electric Fields (PEFs)
			Three-Dimensional Ablation Margin Imaging Software
		References
	41: Lung, Kidney, and Bone Ablation
		Pathophysiology
			Lung Cancer
			Renal Cell Carcinoma
			Bone Tumors
		Clinical Indication
			Lung Cancer
			Kidney Cancer
			Bone Lesions
		Conventional Therapy
			Lung Cancer
			Kidney Cancer
			Bone Tumors
		Interventional Therapy
			Radiofrequency Ablation
			Microwave Ablation
			Cryoablation
			Irreversible Electroporation (IRE)
			Lung Cancer
			Kidney Cancer
			Bone Lesions
		References
Part VIII: GI, GU, Hepatobiliary Interventions
	42: Transjugular Intrahepatic Portosystemic Shunt (TIPS) and Portal Hypertension
		Pathophysiology
			Clinical Indication
		Conventional Therapy
			Ascites
			Varices
		Interventional Therapy
		References
	43: Balloon-Occluded Transvenous Obliteration for Gastric Varices
		Pathophysiology
			Etiology
			Epidemiology and Bleeding Risk
			Anatomic Classification
			GV Filling and Drainage
		Clinical Indication
			Physical Exam and Imaging Findings
			Indications for Treatment
		Conventional Therapy
			Medical Management
			Surgical Management
		Interventional Therapy
			BRTO Modifications
			Post-Procedural Management
			Results and Data
			Complications
		References
	44: Biliary Drainage
		Pathophysiology
		Clinical Indications
		Conventional Therapy
		Interventional Therapy
		Pre-Procedure Assessment and Informed Consent
		Post-Procedure Care
		Complications of Percutaneous Transhepatic Biliary Drainage
		References
	45: Ascites and Pleural Effusion
		Pathophysiology
			Ascites
			Pleural Effusion
		Clinical Indication
			Ascites
			Pleural Effusion
		Conventional Therapy
			Ascites
			Pleural Effusion
		Interventional Therapy
			Ascites
			Pleural Effusion
		References
	46: Obstructive Uropathy
		Pathophysiology
		Clinical Indication
		Conventional Therapy
			Urolithiasis
		Infection
			BPH
			Urothelial Carcinoma
			Neurogenic Bladder
		Interventional Therapy
		References
	47: Enteric Access and Feeding Tubes
		Pathophysiology
		Clinical Indications
			Percutaneous Radiologic Gastrostomy (PRG) Tube
			Percutaneous Radiologic Gastrojejunostomy (PRGJ) Tube
			Percutaneous Jejunostomy (PJ) Tube
		Conventional Therapy
		Interventional Therapy
			Percutaneous Radiologic Gastrostomy (PRG)
			Conversion of G to GJ Tubes
			Cecostomy
			Post-Procedure
			Complications
			Special Populations
			Troubleshooting Common Issues
		References
Part IX: NeuroIR and Pain Interventions
	48: Stroke
		Pathophysiology
		Clinical Indication
		Conventional Therapy
		Interventional Therapy
		Complications
		Tandem Lesions
		Post-Procedure Management
		References
	49: Pain Interventions
		Introduction
		Spine Pain
			Malignancy
			Non-oncologic
			Epidural Steroid Injections
			Facet Pain
			Degenerative Disc Disease
			Vertebral Body Fractures
		Non-spine Pain
			Osseous Metastatic Disease
			Knee
			Hip
			Shoulder
			Sacroiliac Joint
		Visceral
			Celiac Plexus Neurolysis
			Superior Hypogastric Nerve Block
		Somatic
			Intercostal Neuralgia
			Post-Mastectomy Pain Syndrome
			Inguinal Neuralgia
			Lateral Femoral Cutaneous Neuralgia (Meralgia Paresthetica)
			Pudendal Neuralgia
			Coccydynia and Deep Pelvic Pain
		Conclusion
		References
Index