Kandarpa Handbook of Interventional Radiologic Procedures 6th Edition Sixth Edition

Cover
Title Page
Copyright
Dedication
Contributors
About the Editors
Foreword
Preface
Contents
Abbreviations
SECTION I: VASCULAR ACCESS
	1 Gaining Vascular Access
		Retrograde Common Femoral Artery Access and Initial Catheterization
			Preparation and Puncture
			Catheterization
			Antegrade Common Femoral Artery Puncture
		Postprocedure Management (1)
		Prevention and Management of Complications
		Injection Rates and Image-Acquisition Programs
			Catheter Angiography
			Cone-Beam CT
		Considerations for Preprocedure Preparation Prior to Gaining Arterial or Venous Access
	2 Vascular Closure Devices
		Introduction
		Indications
			Off-Label Uses for Vascular Closure Device
		Contraindications
		Procedure
		Types of Devices
		Selected Device Profiles
		Advanced Techniques
		Complications (Table 2.7)
		Results
		Key Take-Home Points
	3 Management of Vascular Complications
		Introduction
		Pseudoaneurysms
			Indication
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results (2,3)
			Complications (1–3)
			Management of Complications (1,3)
		Other Access Site Complications (1–5)
			Considerations Specific to Radial Access
SECTION II: TRANSARTERIAL PROCEDURES
	4 Endovascular Management of Acute Ischemic Stroke
		Introduction
		Background for EVT
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedural Preparation
			1. Triage, History and Physical Examination
			2. Preprocedural Evaluation
			3. Imaging Evaluation
			Procedure
		Postprocedural Management
		EVT Procedural Steps for M1 MCA LVO with Primary Combined Approach
		Postprocedural Complications
			Access Site Complications (2% to 11%)
			Neurologic
			Cardiac
			Respiratory
	5 Carotid Artery Stenosis
		Introduction
		Indications
		Contraindications
		Preprocedure Workup
		Imaging
		Procedure Preparation
		Intraprocedural Medications
			Blood Thinners
			Management of Intraprocedural Bradycardia
			Intra-Arterial Antihypertensive Medications and Vasospasm Treatment
			Management of Hypotension
		Equipment
		Procedure in Detail
		Postprocedure Management
		Follow-Up
		Complications and Management
		Data from Randomized Controlled Trials
	6 Vascular Emergencies of the Head and Neck
		Introduction
		Neurologic and Neurosurgical Disorders
			Intracranial Subarachnoid Hemorrhage (SAH) (3)
			Clinical Presentation
			Noninvasive Imaging
			Treatment for Ruptured Intracranial Saccular Aneurysm (4,5)
			Treatment of Cerebral Vasospasm (6)
			Nontraumatic Cerebral Parenchymal Hemorrhage (IPH) (7)
		Otorhinolaryngologic (ENT) Emergencies
			Epistaxis (8)
			Traumatic Vascular Injuries (9)
			Malignant Disease of the Head and Neck (10)
	7 Renovascular Hypertension: Endovascular Management
		Introduction (1)
		Renovascular Hypertension
			Indications for Revascularization (4)
		Ischemic Nephropathy
			Indications for Revascularization (3,4)
		Renovascular Hypertension, Ischemic Nephropathy, or Both, with Any of the Following Conditions
			Indications (3–6)
			Contraindications to Renal Revascularization (3–6)
		Renal Artery Balloon Angioplasty
			Equipment Suggestions
			Preprocedure Preparation
			Procedure (Figs. 7.1 and 7.2)
		Renal Artery Stenting
			Indications (3)
			Contraindications (3)
			Equipment Suggestions
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results—Percutaneous Revascularization (3–5,11)
			Complications
		Renal Artery Denervation (2)
		Acknowledgment
	8 Acute Mesenteric Ischemia
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation and Evaluation
		Procedure
		Postprocedure Management
		Results
		Complications
	9 Acute Gastrointestinal Hemorrhage
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	10 Aortoiliac Interventions
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
			Diagnostic Arteriogram
			Techniques General to All Interventions
			Angioplasty Technique
			Stent Placement Technique (Fig. 10.1)
			Available Stents
			Stent Selection
			Special Situations
		Postprocedure Management
		Results
			Intervention, Medical Therapy, and Exercise
			Stenting versus Angioplasty
			Covered Stent Grafts versus Bare-Metal Stents
		Complications and Management
	11 Superficial Femoral Artery Interventions
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	12 Infrapopliteal Arterial Interventions
		Introduction
		Definition of Critical Limb Ischemia
		Differential Diagnosis
			Pain
			Foot Ulceration
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
	13 Acute Limb Ischemia: Pharmacomechanical and Thrombolytic Therapy
		Intraarterial Catheter-Directed Thrombolytic Therapy
		Indications
		Contraindications (1–4)
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications During Lytic Agent Infusion
		Mechanical Thrombectomy in Acute Limb Ischemia
	14 Trauma Management
		Introduction
		Trauma Care in the Interventional Radiology Space
			Hemorrhagic Shock
			Contraindications
			Assessment of the Trauma Patient
			Procedure
			Longitudinal Management
			Indications
			Procedure
			Results
			Complications
			Indications
			Procedure
			Results
			Indications (27,28)
		Contraindications
			Procedure
	15 Thoracic Aortic Aneurysms and Dissections
		Introduction
			Thoracic Aortic Aneurysm (1–4)
			Aortic Dissection (2–4)
			Stent-Grafts
		Goals of Thoracic Endovascular Aortic Repair
			Indications (1–4)
		Contraindications (1–4)
			Absolute
			Relative
		Preprocedure Imaging
			Measurement Techniques and Imaging Assessment
		Selection Criteria for Endograft Repair
			Anatomic Criteria
		Preprocedure Preparation (1–4)
			Device Selection for Descending Thoracic Aortic Aneurysms
			Device Selection for Complicated Acute Type B Aortic Dissections
			Special Considerations
		Procedure
			Vascular Access
			Descending Thoracic Aortic Aneurysms
			Complicated Acute Type B Aortic Dissections
		Postprocedure Management
			Immediate
			Follow-up Imaging Surveillance (1–4)
		Results
			Descending Thoracic Aortic Aneurysms
			Complicated Acute Type B Aortic Dissections (2)
			Uncomplicated Type B Aortic Dissections
		Complications (1–4,10)
			Early
			Late
	16 Pulmonary Vascular Malformations
		Introduction
		Indications
		Contraindications
		Association of PAVM with Hereditary Hemorrhagic Telangiectasia (3,6)
		Pathology of PAVM (4)
		Clinical Manifestations of PAVM and Fistula (2,3)
		Embolotherapy for Pulmonary Arteriovenous Malformation and Fistula
			Preprocedure Evaluation: Diagnostic Evaluation for PAVM
			Periprocedural Considerations
			Procedure (2)
			Posttreatment Care
			Results (2–4)
			Complications and Side Effects
		Alternative Treatments for Pulmonary Arteriovenous Malformation
	17 Stent-Grafts for Abdominal Aortic Aneurysms
		Introduction
		Goals of Stent-Graft Therapy
		Indications
		Contraindications
		Preprocedure Imaging
		Selection Criteria for Endograft Repair
			Anatomic Criteria
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	18 Management of Stent-Graft Endoleaks
		Endovascular Aortic Aneurysm Repair and Endoleaks
		Endoleak Classification (see Table 18.1)
		Post-EVAR Imaging Modalities
		Surveillance and Management Strategies
		Endoleak Treatment
		Special Considerations
	19 Visceral Aneurysms
		Introduction
		Etiology (3)
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			Embolization Strategies
			Organ-Specific Comments
		Postprocedure Management
		Results
		Complications and Their Management
	20 The Management of Extracranial Vascular Malformations
		Introduction
		High-Flow Malformation: AVM
			Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Imaging and Preparation
			Preprocedural Imaging
			Preprocedural Preparation
		Procedure
			General Principles of AVM Embolization
			Arterial Endovascular Approach
			Nidus Direct Puncture
			Retrograde Venous Approach
			How to Choose and Manipulate the Embolic Agent
			Combining Ethanol with Glue or Onyx
			Anatomic Consideration
			Renal AVM
		Postprocedure Management
		Results
		Patient Follow-Up
		Complications
			Management of Complications
		Low-Flow Malformations: Venous (VMs) and Lymphatic Malformations (LMs)
			Introduction
			Indications
		Preprocedure Preparation and Imaging
			Preprocedural Imaging
		Preoperative Preparation
		Procedure
			Venous Malformation
			Lymphatic Malformation
		Sclerosant Agents
			Detergents
			Ethanol
			Bleomycin
			Doxycycline
		Complications
		Management of Complications
	21 Hepatic Metastases: Chemoembolization
		Indications
		Contraindications
		Preprocedure Preparation
			Pretreatment Assessment
			Patient Education
			Patient Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
	22 Hepatocellular Carcinoma: Chemoembolization
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Follow-Up
		Results
		Complications
		Management of Complications
		Summary
	23 Hepatic Malignancies: Radioembolization
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			Postprocedure Management
		Results
		Adverse Events
		Management of Complications
	24 Uterine Fibroid Embolization
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			Uterine Artery Catheterization
			Embolization Technique
		Postprocedure Management
		Results
		Complications
		Management of Complications
	25 Splenic and Renal Embolization
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	26 BPH: Prostatic Artery Embolization
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure (3,4)
		Postprocedure Management
		Results (2,4,8,10)
		Complications and Management (9)
SECTION III: TRANSVENOUS PROCEDURES
	27 Temporary Central Venous Access: Peripherally Inserted Central Catheters and Nontunneled Central Venous Catheters
		Introduction
		Indications (2)
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			General Considerations
		PICC Line Placement
		Central Venous Catheter Placement
		Device Removal
		Postprocedure Management
		Results
		Complications
		Management of Complications
			Malposition
			Pneumothorax
			Air Embolus
			Great Vessel or Cardiac Perforation
	28 Long-Term Central Venous Access: Tunneled Catheters and Subcutaneous Ports
		Introduction
		Indications (2)
		Contraindications
			Absolute (1)
			Relative (1)
		Preprocedure Preparation
		Procedure
			General Considerations
		Tunneled Central Venous Catheters
		Chest Port
		Device Removal
		Exchanging a Nonfunctioning Tunneled Catheter
		Postprocedure Management
		Results
		Complications
		Management of Complications
	29 Central Venous Access Management
		Introduction
		Site Care
		Catheter Evaluation
		Catheter Malfunction
	30 Dialysis Fistulae
		Introduction
		Indications (for Diagnostic Imaging and Intervention)
		Contraindications
			Absolute
			Relative
		Preprocedural Preparation
		Procedure
			Fistulography and Percutaneous Transluminal (Balloon) Angioplasty for Nonmaturing Fistulae
			Fistulography and PTA for Failing AVFs
			Clearing of Thrombus from Occluded AVFs (“Declotting Procedure”)
		Postprocedural Management
		Results
		Complications
			Major
			Minor
		Management of Complications
	31 Dialysis Grafts
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedural Preparation
		Procedure
			Fistulography and Angioplasty for Failing AVGs
			Clearing of Thrombus from Occluded AVGs (Declotting Procedures)
		Postprocedural Management
		Results
		Complications and Management of Complications
	32 Dialysis Catheter Management
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
			Basic Considerations
			Selection of Catheter Insertion Site
			Evaluation of Catheter Insertion Site
			Selection of a Hemodialysis Catheter
		Procedure
			Insertion of Tunneled Hemodialysis Catheter
			Removal of a Tunneled Hemodialysis Catheter
			Exchange of a Tunneled Hemodialysis Catheter
		Postprocedure Management
		Results
		Complications/Management
	33 Venography
		Introduction
		Indications
			Lower Extremity Venography
			Upper Extremity Venography
		Contraindications
			Relative
		Preprocedure Preparation
		Procedure
			Lower Extremity Ascending Venography (4,5)
			Upper Extremity Venography (7)
			CO2 Venography (7,8)
		Postprocedure Management
		Results
		Complications
	34 Pulmonary Embolism: Endovascular Interventions
		Introduction
			Diagnosis of Pulmonary Embolism
			Treatment of Pulmonary Embolism
		Pulmonary Thrombolysis and Thrombectomy
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
			Venous Access
			Selective Catheters
			Measure Right Heart Pressures
			Arteriographic Technique
			Catheter-Directed Thrombolysis
			Catheter Thrombectomy, Aspiration, and Maceration
		Postprocedure Management
			Catheter-Directed Thrombolysis
			Catheter Thrombectomy, Aspiration, and Maceration
		Data and Complications
			Catheter-Directed Thrombolysis
			Catheter Thrombectomy, Aspiration, and Maceration
			Chronic Pulmonary Thromboembolic Disease
		Conclusions
	35 Vena Caval Filters
		Introduction
		Filter Placement
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
			Management of Complications
		Optional Filter Retrieval or Mechanical Conversion
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results (11)
			Complications (11,12)
			Management of Complications (11,12)
	36 Acute Extremity DVT: Thrombectomy and Thrombolysis
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
	37 Endovascular Management of Chronic Deep Venous Obstructive Disease
		Introduction
			Chronic Lower Extremity Deep Venous Disease
			Chronic Upper Extremity Deep Venous Disease/Thoracic Central Venous Obstruction
		Indications
			Postthrombotic Lower Extremity Deep Venous Obstruction
			Nonthrombotic Lower Extremity Deep Venous Obstruction
			Thoracic Central Venous Obstruction
		Contraindications
		Preprocedure Preparation
			Postthrombotic Lower Extremity Deep Venous Obstruction
			Nonthrombotic Lower Extremity Deep Venous Obstruction
			Thoracic Central Venous Obstruction
		Procedure
			Postthrombotic Lower Extremity Deep Venous Obstruction
			Variations to the Procedure for Nonthrombotic Lower Extremity Deep Venous Obstruction
			Variations to the Procedure for TCVO
		Postprocedure Management
		Results
		Complications
	38 Transvenous Biopsy
		Introduction
		Indications
		Contraindications
			Relative
		Preprocedure Preparation
		Procedure
		Transvenous Biopsy of Perivascular/Retroperitoneal Tumors (6)
		Postprocedure Management
		Results
		Complications
		Management of Complications
	39 Preoperative Hepatic Augmentation
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Variations
		Postprocedure Management
		Results
		Complications
	40 Transjugular Intrahepatic Portosystemic Shunts
		Introduction
		Indications (1–5)
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	41 Retrograde Transvenous Obliteration of Varices
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			Balloon-Occluded Retrograde Transvenous Obliteration (Fig. 41.2)
			Plug/Coil-Assisted Retrograde Transvenous Obliteration (PARTO/CARTO) (Fig. 41.3)
		Postprocedure Management
		Results (8–10)
		Complications
	42 Varicocele Embolization
		Introduction (1,2)
			Indications (5,6)
			Contraindications
			Preprocedure Preparation
		Procedure (2,5)
			Postprocedure Management
			Results (2,7)
		Complications
	43 Ovarian and Pelvic Vein Embolization
		Introduction (1–3)
		Indications
		Contraindications
		Preprocedure Preparation
			Pretreatment Assessment (4,5)
			Patient Preparation
			Procedure (6–8)
		Postprocedure Management
		Complications
		Results (9,10)
	44 Thermal and Nonthermal Saphenous Vein Ablation
		Introduction
			Thermal versus Nonthermal Ablation
			Anatomy of Superficial Veins of the Leg
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedural Evaluation
		Preprocedure Preparation
		Procedure
			Thermal Ablation
			VenaSeal Cyanoacrylate Closure
			Mechanicochemical Ablation
			Polidocanol Endovenous Microfoam (Varithena)
		Postprocedure Management
		Results
		Complications
	45 Varicose, Perforator, and Spider Veins: Liquid Ablation and Microphlebectomy
		Introduction (1,2)
		Sclerotherapy
			Indications (1,3)
			Contraindications
			Preprocedure Preparation
			Procedure (2,4)
			Postprocedure Management
			Results
			Complications (7)
			Management of Complications (8)
		Microphlebectomy
			Indications
			Contraindications (9)
			Preprocedure Preparation
			Procedure (9)
			Postprocedure Management
			Results
			Complications (8,10)
			Management of Complications
SECTION IV: NONVASCULAR PROCEDURES
	46 Biopsy Procedures of the Lung, Mediastinum, and Chest Wall
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
			Common
			Infrequent
			Rare
	47 Catheter Drainage of Intrathoracic Collections
		Introduction
		Indications
		Contraindications
		Choice of Drainage Catheter (1–3,5–8)
		Preprocedure Preparation
		Technique
			Malignant Pleural Effusion (1–3,5,8)
			Parapneumonic Effusions and Empyema (2,5–7,9,10)
			Lung Abscess (2,5,6,7,10)
	48 Lymphatic Interventions
		Introduction
		Indications for TDE
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	49 Percutaneous Abdominal Biopsy
		Introduction
		Indications
		Contraindications (1)
		Preprocedure Assessment and Patient Preparation
		Procedure
			Intraprocedure Preparation
			Procedure (1)
		Postprocedure Management
		Pathology Results
		Adverse Events
		Genomics (10)
	50 Drainage of Abdominal Abscesses and Fluid Collections
		Introduction
		Indications
		Contraindications
			Absolute (1,2)
			Relative (1,2)
		Preprocedure Preparation
		Imaging Guidance
		Procedure
		Complications
			Major (1)
			Minor (1)
		Catheter Care
		Catheter Removal
		Results
	51 Percutaneous Gastrostomy, Percutaneous Gastrojejunostomy, Jejunostomy, and Cecostomy
		Percutaneous Enteral Tubes
		Types of Tubes
		Percutaneous Gastrostomy
			Indications (1–5)
			Contraindications (1–5)
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
		Percutaneous Gastrojejunostomy
			Conversion of a Mature PG Tube to PGJ Tube
			Primary Placement of a PGJ Tube
		Percutaneous Jejunostomy
		Percutaneous Cecostomy
	52 Percutaneous Biliary Interventions
		Introduction
		Preprocedural Preparation
		Percutaneous Transhepatic Cholangiography (PTC)
			Indications
			Contraindications
			Procedure
			Postprocedure Management
			Success Rate
			Complications and Their Management
		Percutaneous Transhepatic Biliary Drainage (PTBD)
			Indications
			Contraindications
			Procedure
			Postprocedure Management
			Success Rate
			Complications and Management of Complications
		Percutaneous Transjejunal Cholangiography and Endoscopy
			Indications
			Contraindications
			Procedure
			Postprocedure Management
			Success Rate
			Complications and Management of Complications
		Biopsy
			Brush Biopsy
			Endoscopic
			Percutaneous Fluoroscopic/Ultrasound-Guided Biopsy
		Percutaneous Cholangioplasty
			Indications
			Contraindications
			Procedure
			Postprocedure Management
			Success Rate
			Complications and Management of Complications
		Percutaneous Stent Placement
			Indications
			Contraindications
			Procedure
			Postprocedure Management
			Success Rate
			Complications and Management of Complications
		Pediatric Biliary Interventions
		Combined Procedures
		Percutaneous Cholecystostomy (PC)
			Indications
			Contraindications
			Procedure
			Postprocedure Management
			Success Rate
			Complications and Management of Complications
	53 Percutaneous Nephrostomy and Antegrade Ureteral Stenting
		Introduction
		Indications (1–4)
		Contraindications
			Absolute
			Relative
			Specific to Antegrade Ureteral Stents
		Preprocedure Preparation
		Procedure
			Percutaneous Nephrostomy
			Nephroureterostomy (Nephroureteral Stent) Placement
			Antegrade Ureteral Stent Placement
			Retrograde Nephrostomy
			Removal or Exchange of PCN or Nephroureterostomy
			Exchange of Ureteral Stents
		Postprocedure Management
		Results
		Complications and Management (1–4)
			Major: 4.0%
			Minor: 15%, Usually Without Sequelae
			Complications Specific to Antegrade Ureteral Stent Placement
	54 Lymphocele and Cyst Drainage and Sclerosis
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			Diagnosis
			Aspiration and Drainage
			Sclerotherapy
		Postprocedure Management
		Results
		Complications
			Major
			Minor
	55 Pulmonary Tumor Ablation
		Introduction
		Lung Cancer
		Indications
			Biopsy-Proven Malignancy
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications and Management
	56 Hepatic Tumor Ablation
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
	57 Renal Tumor Ablation
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	58 Musculoskeletal Biopsies, Aspirations, and Injections
		Biopsies
			Introduction
		Indications
		Contraindications
			Absolute
			Relative
			Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
		Joint Injections and Aspirations
			Introduction
			Indications
			Contraindications
		Preprocedure Preparation
		Procedure
			Postprocedure Management
			Results
			Complications
			Management of Complications
		Soft Tissue Aspiration and Sclerosis
			Introduction
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
			Management of Complications
	59 Musculoskeletal (MSK) Ablation
		Introduction
		Radiofrequency Ablation (RFA)
		Microwave Ablation (MWA)
		Cryoablation (CA)
		Combination Procedures
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	60 Osteorestorative Techniques
		Overview
	61 Musculoskeletal Pain and Palliative Procedures
		Spinal Injections
			Introduction
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results (1)
			Complications
		Management of Complications
		Palliative Nerve Blocks, Neurolysis, and Ablations
			Ganglion Blocks/Neurolysis
		Contraindications
		Preprocedure Preparation
		Procedure
			Postprocedure Management
			Results
		Complications
		Management of Complications
		Sympathetic Neurolysis (9)
			Introduction
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
		Management of Complications
		Peripheral Nerve Blocks (PNB) and Neurolysis
			Introduction
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure (Figs. 61.9 to 61.11)
			Postprocedure Management
			Results
			Management of Complications
SECTION V: INTRAPROCEDURAL PATIENT MANAGEMENT
	62 Safety in IR
		Introduction
		Universal Protocol
			Indications
			Exemptions to Universal Protocol
		Preprocedure Verification
		Site Marking
		Time-Out
		Documentation
	63 Sedation, Analgesia, and Anesthesia
		Introduction
		Analgesia and Anesthesia: Options and Indications
		Patient Evaluation
		Recommended Monitoring (Table 63.1)
		Required Resuscitation Equipment
		Medication Prior to Procedure
		Techniques of Sedation, Analgesia, and Anesthesia During the Procedure
			Local Anesthesia
			Local Anesthesia with Sedation/Analgesia
			Neuraxial Anesthesia
			General Anesthesia
		Other Procedural Considerations
		Postprocedure Management
	64 Drug Administration
		Preprocedural Considerations
		Procedural Considerations
		Recovery and Postprocedure Care
		Dosage Calculations
			Units (Table 64.1)
			Calculating Infusion Doses
	65 Contrast Media Reactions: Treatment and Risk Reduction
		General Principles (1,2)
			Know the Patient
			Recognize That There Is a Problem
			Be Prepared to Deliver Treatment Quickly and Call for Help Early
		Treatment of Adverse Reactions (Table 65.1)
		Prophylaxis for Contrast Media Reactions (8)
	66 Contrast-Induced Nephropathy: Prevention and Management
		Introduction
		Pathophysiology
		Diagnosis
		Incidence
		Natural History
		Risk Factors
		Patient Preparation
		Prophylaxis
		The Role of Specific Contrast Agents
		Other Considerations
SECTION VI: NONINVASIVE EVALUATION AND DIAGNOSTIC IMAGING
	67 Noninvasive Physiologic Evaluation: Lower Extremity Arteries
		Segmental Pressure Measurements of the Lower Extremity: Ankle–Brachial Index and Stress Testing
			Indications (1,2)
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
			Limitations and Artifacts
		Pulse Volume Recordings
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Results (6,7)
			Complications
	68 Duplex Ultrasound Imaging of Carotid and Peripheral Arteries
		Carotid Artery Disease
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
		Peripheral Arterial Disease
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
		Lower Extremity Bypass Grafts
			Indications
			Contraindications
			Pre-Procedure Preparation
			Procedure
			Postprocedure Management
			Results
			Complications
	69 Duplex Ultrasound of the Abdominal Vasculature
		Introduction
		Abdominal Aortic Aneurysm
		Transjugular Intrahepatic Portosystemic Shunt
		Liver Transplant Evaluation
		Renal Transplant Evaluation
		Renal Artery Evaluation
		Visceral Artery Evaluation
	70 Color Doppler and Ultrasound Imaging of Peripheral Veins
		Veins of the Lower Extremity
			Indications
			Contraindications
			Preprocedure Preparation
			Detection of Deep Vein Thrombosis
			Saphenous Vein Mapping Prior to Infrainguinal Bypass Procedures (5–7)
			Detection and Segmental Evaluation of Venous Reflux
		Veins of the Upper Extremity
			Indications
			Contraindications
			Preprocedure Preparation
			Procedure
			Postprocedure Management
			Results (10)
			Complications
	71 Magnetic Resonance Angiography
		Introduction
		Preprocedure Preparation
		Procedure
		Standard MRA Examinations (see also Appendix D for Common Protocols)
	72 Computed Tomographic Angiography
		Choice of Appropriate Modality
		Preprocedure Preparation
		Procedure (see Appendix E for Common CTA Protocols)
APPENDICES
	Appendix A: Vascular Anatomy
		Pulmonary Artery Segmental Branches
		Abdominal Aorta
		Common Locations of Abdominal Aortic Branches
		Arteries of the Pelvis
		Collateral Pathways in Aortoiliofemoral Occlusive Disease
		Common Collateral Pathways
		Arteries of the Upper Extremity
		Intracranial Arteries
	Appendix B: Nursing Checklist
		Preprocedure Nursing Evaluation Checklist
	Appendix C: Hemodynamic Monitoring and Cardiovascular Pressures
		Right Heart Catheterization
			Technique
			Complications
		Right Heart and Pulmonary Artery Pressure Waveforms
		Left Heart Catheterization
			Technique
			Complications
		Left Heart and Aortic Pressure Waveforms
		Clinical Significance of Waveforms
			Right Atrial Pressure
			Right Ventricular Pressure
			Pulmonary Arterial Pressure
			Pulmonary Capillary Wedge Pressure/Left Atrial Pressure
			Left Ventricular Pressure
			Aortic Pressure/Systemic Arterial Pressure
		Respiratory Effects
	Appendix D: Common Magnetic Resonance Angiography Protocols
	Appendix E: Computed Tomographic Angiography
		Commonly Used Protocols for Standard Computed Tomographic Angiography Examinations
	Appendix F: Contrast Media Table
	Appendix G: Carotid Stenting Data Tables
INDEX
e-73 Radionuclide Evaluation for Interventional Radiologists
	Ventilation–Perfusion Pulmonary Scintigraphy
		Indications
		Precautions
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results (1)
		Complications
	Gastrointestinal Bleeding Studies
		Indications
		Precautions/Limitations
		Preprocedure Preparation
		Procedure (2)
		Results (2)
	Captopril-Enhanced Renal Scintigraphy for Diagnosis of Renovascular Hypertension
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
	Diuretic Renal Scintigraphy
		Indications (9)
		Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Limitations
e-74 PET/CT for Oncologic Interventions
	Introduction
	PET/CT Imaging with 18F-FDG
		Indications
		Contraindications
	Patient Preparation
	Procedure
	PET/CT Tumor Treatment Assessment
		Hepatocellular Cancer, Intrahepatic Cholangiocarcinoma, and Hepatic Metastases
		Lung Cancer
		Bone Tumors
		Renal Cell Cancer
	Conclusion
e-75 Clinical Evaluation of the Cancer Patient
	Patient Assessment
	Patient Triage
	Patient Follow-Up
e-76 Cancer Imaging for Interventional Radiologists
	Introduction
	Lung Cancer
	Hepatocellular Carcinoma
	Hepatic Metastasis
	Renal Cell Carcinoma
	Adrenal Metastasis
	Pancreatic Cancer
SECTION VII: SPECIAL INTERVENTIONS
	e-77 Pediatric Angiography
		Preprocedure Preparation (1)
		Procedure (1)
		Postprocedure Management
		Complications
		Prevention and Management of Complications (4)
	e-78 Bronchial Artery Embolization
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
	e-79 Tracheobronchial Stents
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation
			Anatomy
			Stent Properties
			Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
		Appendix
			Nature of the Problem
			Recommendations
			Reporting Adverse Events to FDA
	e-80 Esophageal Stents
		Introduction
		Indications
		Contraindications
			Relative
		Preprocedure Preparation
		Procedure
			Stent Placement (Fig. e-80.1A–F)
			Stent Removal (Fig. e-80.2A–F)
		Postprocedure Management
			Postplacement
			Postretrieval
		Results
			Malignant Esophageal Strictures
			Benign Esophageal Strictures
		Management of Complications
	e-81 Gastroduodenal Stent Placement
		Introduction
		Indications
		Contraindications
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
			Technical Success
			Clinical Success
		Complications and Management
	e-82 Colorectal Stent Placement
		Introduction
		Indications (2)
		Contraindications (2,10)
		Preprocedure Preparation
		Procedure (2,10)
		Postprocedure Management (2,10)
		Results
			Technical Success
			Clinical Success
		Complications and Management
	e-83 Retrieval of Intravascular Foreign Bodies
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results
		Complications
		Management of Complications
	e-84 Liver Transplant Management
		Introduction
		Indications (1,2,4–6)
		Contraindications
			Relative
		Preprocedure Preparation
		Procedure
			Hepatic Artery Interventions
			Venous Outflow Interventions
			Portal Venous Interventions
			Portal Hypertension (3,10)
		Postprocedure Management
		Results (1,3,5–8)
		Complications/Management (1,5–8)
	e-85 Selective Salpingography and Fallopian Tube Recanalization
		Indications
			Diagnostic Selective Salpingography (1,2)
			Therapeutic Fallopian Tube Recanalization (3)
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
			Pretreatment Assessment
			Patient Education
			Patient Preparation
		Procedure (2,5)
		Postprocedure Management
		Complications
		Results (6,7)
			Technical Success
			Pregnancy
	e-86 Endovascular Management of Obstetric Hemorrhage
		Introduction
		Indications
		Contraindications
		Preprocedure Preparation
		Procedure
			Postprocedure Management
		Results
		Complications
			Prevention and Management of Complications
	e-87 Peritoneal Dialysis
		Introduction
		Indications
		Contraindications (1,3)
			Absolute
			Relative
		Preprocedure Preparation
		Procedure (5)
		Postprocedure Management
		Results
		Complications (9,10)
			Procedural Complications
			Late Complications
	e-88 Management of Recurrent Ascites
		Indications
			Paracentesis
			Tunneled Peritoneal Catheters
		Contraindications
			Absolute
			Relative for Tunneled Peritoneal Catheters Specifically
		Preprocedure Preparation
		Tunneled Peritoneal Catheter Placement
			Postprocedure Management
			Results
		Complications and Management
			Paracentesis (8)
			Peritoneal Catheter
	e-89 Adrenal Vein Sampling
		Introduction (1–7)
		Indications
		Absolute Contraindications
		Preprocedure Preparation
		Procedure
		Postprocedure Management
		Results (2,8)
		Complications
		Management of Complications
	e-90 Genicular Artery Embolization
		Introduction
		Indications
		Contraindications
			Absolute
			Relative
		Preprocedure Preparation
		Procedure
			Room and Patient Preparation
			Femoral Artery Access
			Catheterization
		Postprocedure Management
		Results
		Complications and Management
SECTION VIII: MATERIALS AND METHODS
	e-91 Intravascular Contrast Media
		Patient Evaluation Prior to Contrast Administration: Areas Requiring Specific Attention (1–4)
		Principles for Intravascular Contrast Agent Administration (1–6)
		Reactions to Intravascular Contrast Agents
		Steps to Prevent Contrast Reactions
		Alternatives to Iodinated Contrast Agents
	e-92 Angiographic Equipment Selection and Configuration
		Imaging Equipment for Angiography
		Generators
		X-Ray Tubes
		Patient Tables
		Gantry Stands
		Displays
		Contrast Injector
		Image Chain
		Image Data Processing
		Acceptance Testing and Quality Control
	e-93 Standard Angiography/Interventional Procedure Tray Contents
		Introduction
		Procedure Tray Content
		Sterile Table Equipment (see Fig. e-93.1)
		Solutions (for Flush/Irrigation)
		Personal Protective Equipment
	e-94 Needles, Guidewires, Catheters, and Stents
		Introduction
		Needles
		Guidewires
		Guidewire Handling
		Vascular Catheters
			Determination of Flow Rate and Bursting Pressure
		Catheters: Technical Facts and Precautions
		Nonvascular Catheters
			Drainage Catheters
			Enteral Drainage Catheters
			Gastrostomy, Gastrojejunostomy, and Jejunostomy Catheters
		Dilatation Balloons
		Stents
		Stent Grafts
	e-95 Embolization: Materials
		Introduction
		Indications for Embolization (1)
		Mechanical Occlusive Devices
		Particulate Embolic Agents
		Liquid Embolic Agents
	e-96 Commonly Used Medications
		Analgesics
			Lidocaine Hydrochloride (Xylocaine)
		Antibiotics
			Background
			Organisms and Suggested Antibiotics
			Common Procedures
		Preprocedural Antibiotics
		Anticoagulants (Tables e-96.2 and e-96.3)
			Low–Molecular-Weight Heparin (LMWH)
			Fondaparinux (Arixtra)
			Heparin
			Warfarin Sodium (Coumadin)
			Direct Thrombin Inhibitor (DTI)
			Direct Oral Anticoagulants (DOACs)
			Reversal Agents
		Antiplatelets
			Abciximab (ReoPro)
			Acetylsalicylic Acid (Aspirin)
			Clopidogrel Bisulfate (Plavix)
			NSAIDs
			Eptifibatide (Integrilin)
		Periprocedural Care (see Tables e-96.2 and e-96.3)
		Antiemetics
			5-HT3 Receptor Antagonists (Ondansetron [Zofran])
			Primary H1 Receptor Antagonist (Promethazine [Phenergan], Hydroxyzine [Atarax], Diphenhydramine [Benadryl], Meclizine [Antivert])
			D2-Receptor Antagonist (Prochlorperazine [Compazine], Metoclopramide [Reglan])
			Primary Muscarinic Receptor Antagonist (Scopolamine Patch [Transderm Scop])
			Antihistamines
		Antiinflammatories
			Ketorolac Tromethamine (Toradol)
			Glucocorticoids (Corticosteroids)
		Contrast Reaction Medications (Tables e-96.5 and e-96.6)
			Antihistamines (Diphenhydramine)
			Beta 2-Adrenergic Receptor (Albuterol)
			Glucocorticoids (Corticosteroids)
		Opioids (see Table e-96.8)
			Fentanyl Citrate (Sublimaze)
			Hydromorphone HCl (Dilaudid)
			Meperidine Hydrochloride (Demerol)
			Morphine Sulfate (MSO4)
		Sedatives
			Benzodiazepines (see Table e-96.9)
		Thrombolytic Agents (Table e-96.10)
			Recombinant Tissue Plasminogen Activator (Alteplase)
			Tenecteplase (TNKase)
			Reteplase (Retavase, Rapilysin)
			Urokinase
		Vasoconstrictors
			Vasopressin (Pitressin)
		Vasodilators
			Nifedipine (Procardia)
			Nitroglycerin (Nitro-Bid IV)
			Tolazoline Hydrochloride (Priscoline)
SECTION IX: RISK MANAGEMENT
	e-97 Obtaining and Documenting Informed Consent
		Introduction
		Foundations of the Doctrine of Informed Consent
		Obtaining Informed Consent
			Essential Elements of Discussion
		Documenting the Informed Consent Conversation
		Emergency Exception
		Practical Tips
		Conclusion
	e-98 Quality Initiatives and Clinical Practice Guidelines: General Principles
		Introduction
		Quality Initiatives
			History of Quality Improvement
			Definition of Quality
			Legislation
		Clinical Practice Guidelines
			History of Clinical Practice Guidelines
			Current Development Standards
		Quality and Guidelines in the Practice of Interventional Radiology
	e-99 Radiation Safety in Interventional Radiology
		Primary Safety Principles
		Radiation Biology and Radiation Effects
		Radiation Dose Measurement
		Protecting the Patient (4,7)
		Patient Radiation Management (4,7)
		Protecting the Operator (1,4,10)
	e-100 Infection Control and Sterile Technique in Interventional Radiology
		Introduction
		Definitions
		Aseptic Technique and Environmental Controls
SECTION X: NURSING MANAGEMENT
	e-101 Periprocedural Care of the Interventional Radiology Patient
		Introduction
		Preprocedure Nursing Phone Interview
		Procedure Day
			Preprocedure Nursing Interview
		Preprocedure Preparation by Advanced Practice Provider
		Preprocedure Laboratory Studies
		Coagulation Testing Guidelines
		Preprocedural Review of Systems and Medical History by Advanced Practice Providers
		Provider Evaluation
		Preprocedure Nurse-to-Nurse Hand-Off
		Intraprocedural Nursing Care
		Intraprocedural Nurse Monitoring/Care
			Continuous Cardiac Monitoring
			Maintaining Fluid Balance
			Continuous Surveillance of Respiratory Status
			Psychosocial Support
			Communication/Hand-Off Report to Receiving Department (Inpatient and Outpatient)
			Postprocedural Nursing Responsibilities
			Discharge Criteria for Outpatient
	e-102 Organization and Operation of the Interventional Radiology Clinic
		Introduction
		Clinical Considerations and Organization of IR Clinic
			Service Lines
			Scheduling
			Clinical Assessment and Coordination of Care
			Patient Education
			Provider Communication
		Operational Considerations
			Staffing Considerations
			Role of the APP
			Infrastructure and Clinic Design
			Documentation
			Billing and Coding
			Building a Referral Network and Practice Promotion
			Telehealth
	e-103 The Management of External Drainage Catheters
		Introduction
		The Components of External Drainage Catheter System
		Skin Care/Wound Dressing
		General Catheter Observations
		Flushing the Catheter
		Catheter-Related Issues and Considerations
		Recording Outputs
		Readying the Patient for Discharge
		Follow-Up Care
		Things Patient Should Bring to Next Appointment