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Additional Description
Contents
Forewords xi
Preface xv
Contributing Authors xvii
Abbreviations xxiii
I. DIAGNOSTIC ARTERIOGRAPHY 1
1. Peripheral Arteriography 3
GENERAL PRINCIPLES 3
Krishna Kandarpa and Geoffrey A. Gardiner, Jr.
OUTPATIENT ARTERIOGRAPHY 26
Kathleen Reagan and Stuart J. Singer
2. Cardiac Catheterization and Coronary Arteriography 29
Krishna Kandarpa
3. Pulmonary Arteriography 35
Krishna Kandarpa and Klaus D.. Hag spiel.
II. INTERVENTIONAL PROCEDURES 43
The Head, Neck, and Thorax
VASCULAR PROCEDURES
4. Thrombolysis of Acute Stroke Syndromes 47
David A. Kumpe
5. Carotid Artery Stenting 63
Lee A. Fox and James F. Benenati
6. Brachiocephalic Artery Angioplasty and Stenting 74
Thomas O. McNamara
7. Patient Selection for Stent-Grafts in the Treatment of
Descending Thoracic Aortic Aneurysms 83
John E. Aruny
8. Vascular Emergencies of the Head and Neck 89
Michele H. Johnson
NEUROLOGIC AND NEUROSURGICAL DISORDERS
89
OTOLARYNGOLOGIC(ENT)EMERGENCIES 98
9. Pulmonary Thrombectomy and Thrombolysis109
Klaus D. Hagspiel
THROMBOLYSIS 109
THROMBECTOMY 111
10. Embolization of Pulmonary Vascular Malformations
117
Jeffrey S. Pollak
11. Retrieval of Intravascular Foreign Bodies 125
Mark L. Cockerill
12. Central Venous Access: Tunneled Catheters and
Implantable Ports 129
Adhip Mukerjee
NONVASCULAR PROCEDURES
13. Biopsy Procedures of the Lung, Mediastinum, and Chest
Wall 144
David F. Yankelevitz, Dorith Shoham,
and Orly Goitein
14. Catheter Drainage of Intrathoracic Collections 154
Edward F. Patz, Jr. and Jeremy J. Erasmus
15. TracheobronchialStenting 163
Roy L. Gordon
The Abdomen and Pelvis
ABDOMINAL VASCULAR PROCEDURES
16. Aortoiliac Angioplasty and Stenting 173
Sean R. Sheeran and Timothy P. Murphy
PERCUTANEOUS TRANSLUMINAL ILIAC ARTERY
ANGIOPLASTY 173
ILIAC ARTERY STENT PLACEMENT 175
17. Evaluation of Patients for Endovascular Repair of
Abdominal Aortic Aneurysms 183
Lee A. Fox and Barry T. Katzen
18. Renal Artery Angioplasty and Stenting 194
Renal Artery Balloon Angioplasty and Renal Vein Renin
Sampling 194
David W. Trost, Krishna Kandarpa,
John E. Aruny, and Thomas A. Sos
RENOVASCULAR HYPERTENSION 194
RENAL INSUFFICIENCY 195
RENOVASCULAR HYPERTENSION, OR AZOTEMIA,
OR BOTH, WITH ANY OF THE FOLLOWING
CONDITIONS 195
PLURAL ARTERY BALLOON ANGIOPLASTY 196
RENAL VEIN BENIN SAMPLING 201
Renal Artery Stenting 203
David W. Trost and Moshin Saeed
19. Acute Mesenteric Ischemia 211
Krishna Kandarpa
20. Acute Gastrointestinal Arterial Bleeding 218
Krishna Kandarpa and David W. Trost
21. Chemoembolization of Hepatic Malignancies 227
Michael C. Soulen
22. Transjugular Intrahepatic Portosystemic Shunts (TIPS)
232
Ziv J. Haskal
23. Vena Caval Filters 245
John A. Kaufman
PELVIC VASCULAR PROCEDURES
24. Uterine Artery Embolization for Fibroids 265
Lindsay Machan
25. Testicular Vein Embolization for Varicoceles 269
John E. Aruny
26. Ovarian Vein Embolization 275
Lindsay Machan
NONVASCULAR PROCEDURES
27. Percutaneous Nephrostomy and Antegrade Ureteral
Stent Placement 278
Krishna Kandarpa and John E. Aruny
PERCUTANEOUS NEPHROSTOMY 278
ANTEGRADE URETERAL STENT PLACEMENT 290
28. Transhepatic Cholangiography, Biliary Decompression,
Endobiliary Stenting, and Cholecystostomy 302
Mel Rosenblatt, John E. Aruny,
and Krishna Kandarpa
PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY 302
BILIARY DECOMPRESSION 308
ENDOBILIARY STENTING 318
PERCUTANEOUS CHOLECYSTOSTOMY 323
29. Percutaneous Drainage of Abdominal Abscesses and
Fluid Collections 332
Sanjay Saini and Jose C. Varghese
30. Percutaneous Image-Guided Abdominal Biopsy 342
Stuart G. Silverman
31. Percutaneous Gastrostomy and Gastrojejunostomy Tube
Placement 354
Krishna Kandarpa and Kathleen Reagan
32. Esophageal and Colonic Stenting 364
Michael Maxin,
ESOPHAGEAL STENTING 364
COLON STENTING 367
33. Selective Salpingography and Fallopian Tube
Recanalization 372
Lindsay Machan
34. Lymphocele Drainage and Sclerosis 377
Neil Denbow
The Extremities
35. Extremity Balloon it Angioplasty 385
M. G. Myriam Hunink arid Krishna Kandarpa
36. Peripheral Directional Atherectomy 399
Ducksoo Kim
37. Intra-arterial Thrombolytic Therapy 406
Krishna Kandarpa
38. Venography 418
Krishna Kandarpa and John E. Aruny
LEG ASCENDING VENOGRAPHY 418
LEG DESCENDING VENOGRAPHY 422
ARM VENOGRAPHY 423
RENAL VENOGRAPHY 427
39. Venous Angioplasty and Stenting 434
Michael J. Hallisey
40. Catheter-Directed Thrombolysis of Lower-Extremity
Deep Vein Thrombosis 441
Pamela A. Flick
41. Dialysis Access Maintenance 449
John E. Aruny
DIALYSIS ACCESS SURVEILLANCE 449
DECLOT AND BALLOON ANGIOPLASTY
OF DIALYSIS ACCESS GRAFTS 450
DECLOT AND BALLOON ANGIOPLASTY OF NATIVE
DIALYSIS FISTULAS (AVFS) 458
42. Peripherally Inserted Central Catheters (PICC Lines) and
Arm Ports 465
Adhip Mukerjee
III. NONINVASIVE VASCULAR. EVALUATION
43. Noninvasive Vascular Studies 477
John E. Aruny and Joseph F. Polak
VENOUS ULTRASOUND OF THE LOWER
EXTREMITY 477
SEGMENTAL PRESSURE MEASUREMENTS OF THE
LOWER EXTREMITY: ANKLE-BRACHIAL INDEX
AND STRESS TESTING 483
PULSE VOLUME RECORDING 486
COLOR-ASSISTED DUPLEX VENOUS ULTRASOUND
OF THE UPPER EXTREMITY 488
COLOR-ASSISTED DUPLEX ULTRASOUND OF
LOWER-EXTREMITY VENOUS BYPASS GRAFTS 490
COLOR-ASSISTED DUPLEX IMAGING OF
PERIPHERAL ARTERIAL DISEASE 491
IATROGENIC ARTERIAL INJURIES:
ULTRASOUND-GUIDED COMPRESSION REPAIR 492
44. Magnetic Resonance Angiography 498
Priscilla A. Winchester, Lawrence S. Yu, and Martin
R. Prince
45. Radionuclide Cardiovascular Evaluation 506
Sabah S. Tumeh and John E. Aruny
VENTILATION-PERFUSION PULMONARY
SCINTIGRAPHY 506
GASTROINTESTINAL BLEEDING STUDIES 509
CAPTOPRIL-ENHANCED RENAL SCINTIGRAPHY
FOR DIAGNOSIS OF RENOVASCULAR
HYPERTENSION 510
EXERCISE MYOCARDIAL PERFUSION
SCINTIGRAPHY 515
GATED BLOOD POOL CARDIAC IMAGING 520
IV. MATERIALS, METHODS, AND SAFETY
46. Angiographic Contrast Media 525
Michael A. Bettmann
47. Treatment of Contrast Media Reactions 532
Michael A. Bettmann and John E. Aruny
48. Carbon Dioxide Angiography 536
James G. Caridi, Irvin F. Hawkins Jr.,
Robert F. LeVeen, and Scott A. Klioze
49. Radiocontrast Medium-Induced Nephropathy 542
Albert A. Maniscalco and Susan Grossman
50. Needles, Guidewires, Catheters, and Stents 552
David W. Trost, Krishna Kandarpa,
and Oun J. Kwon
51. Equipment and Techniques for Angiography 573
Basics of Angiographic Equipment 573
Keith J. Strauss, Maria M. Damiano,
and Krishna Kandarpa
Selecting Optimal Radiographic Technique General
Principles 579
Maria M. Damiano, Keith J. Strauss,
and Krishna Kandarpa
Injection Rates and Image-Acquisition Programs 580
Maria M. Damiano
52. Radiation Safety 586
Stuart J. Singer
53. Infection Control 592
Julie M. Sniffen and Krishna Kandarpa
54.-Risk Management 595
Sarah D. Cohn
V. NURSING MANAGEMENT
55. Nursing Management During Angiography and
Interventional Procedures 603
Eileen M. Bozadjian
56. Outpatient Drainage-Catheter Care 618
Catherine M. Burdge
INTRODUCTION TO BILIARY TUBES AND THEIR
CARE 618
INTRODUCTION TO NEPHROSTOMY TUBES AND
THEIR CARE 622
57. Organization and Operation of the Interventional
Radiology Clinic 625
Catherine M. Burdge
V1. DRUGS AND DOSAGES
58. Drug Administration 637
Krishna Kandarpa and Eileen M. Bozadjian
59. Sedation, Analgesia, and Anesthesia 641
Leonard J. Lind, Karen F. Krone,
Prema Venkateswaran, and James C. Phero
60. Commonly Used Medications 653
Krishna Kandarpa
ANALGESICS 653
ANTIBIOTICS 658
ANTICOAGULANTS 658
ANTIEMETICS 663
ANTIINFLAMMATORIES 665
ANTIPLATELET AGENTS 666
SEDATIVES 672
THROMBOLYTIC AGENTS 675
VASOCONSTRICTORS 679
VASODILATORS 681
MISCELLANEOUS 683
Appendices
A. Anatomy 689
Krishna Kandarpa
CORONARY ARTERIES 689
PULMONARY ARTERY SEGMENTAL BRANCHES 693
ABDOMINAL AORTA 697
COMMON LOCATIONS OF ABDOMINAL AORTIC
BRANCHES 699
ARTERIES OF THE PELVIS 702
COLLATERAL PATHWAYS IN AORTOILIOFEMORAL
OCCLUSIVE DISEASE 704
COMMON COLLATERAL PATHWAYS 705
ARTERIES OF THE EXTREMITIES 706
B. Hemodynamic Monitoring and Cardiovascular
Pressures 711
Michael G. Flater
C. Normal Laboratory Values 734
Krishna Kandarpa
D. Standard Angiography/Interventional Procedure
Tray Contents 736
Eileen M. Bozadjian
E. The Whitaker Test 738
John E. Aruny
Subject Index 743
Contributing Authors
John E. Aruny, M.D. Assistant Professor, Yale University
School of Medicine, Department of Diagnostic
Imaging, Section of Vascular and Interventional
Radiology, Yale-New Haven Hospital, New Haven,
Connecticut
James F. Benenati, M.D. Voluntary Associate Professor,
Department of Radiology, University of Miami
School of Medicine, Miami, Florida; Medical
Director, Peripheral Vascular Laboratory, Miami
Cardiac and Vascular Institute, Miami, Florida
Michael A. Bettmann, M.D. Professor of Radiology,
Department of Radiology, Dartmouth Medical
School, Hanover, New Hampshire; Cardiovascular
and Interventional Radiologist, Department of
Radiology, Dartmouth-Hitchcock Medical Center,
Lebanon, New Hampshire
Eileen M. Bozadjian, R.N., B.S.N. Nurse Manager,
Department of Radiology, Brigham and Women's
Hospital, Boston, Massachusetts
Catherine M. Burdge, A.P.R.N. Clinical Nurse Coordinator,
Department of Diagnostic Radiology, Yale-New
Haven Hospital, New Haven, Connecticut
James G. Caridi, M.D. Associate Professor, Department of
Radiology, University of Florida, Gainesville,
Florida; Chief, Department of Vascular and
Interventional Radiology, Shands Hospital,
Gainesville, Florida
Mark L. Cockerill, M.D. Section Head, Vascular .and
Interventional Radiology, Department of Radiology,
Virginia Beach General Hospital, Virginia Beach,
Virginia
Sarah D. Cohn, J.D. Director, Legal Affairs /Risk
Management, Yale-New Haven Hospital, New
Haven, Connecticut
Maria M. Damiano, R.T. (R)(CV) Department of
Information Systems, Brigham and Women's
Hospital, Boston, Massachusetts
Neil Denbow, M.D. Assistant Professor, Department of
Radiology, Yale University, New Haven,
Connecticut; Interventional Radiologist, Department
of Radiology, Yale-New Haven Hospital, New
Haven, Connecticut
Jeremy J. Erasmus, M.D. Department of Radiology, Duke
University Medical Center, Durham, North Carolina
Michael G. Flater, R.N. Clinical Application Specialist,
Department of Cardiology/ Vascular Access, Daig
Division, St. Jude Medical, Minnetonka, Minnesota
Pamela A. Flick, M.D. Associate Professor, Department of
VascularInterventional Radiology, Georgetown
University, Washington, D.C.; Chief, Department of
Interventional Radiology, Georgetown University
Medical Center, Washington, D.C.
Lee A. Fox, M.D., MAL Interventional Radiologist,
Department of Radiology, JFK Medical Center,
Atlantis, Florida
Geoffrey A. Gardiner, Jr., M.D. Associate Professor
Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pennsylvania
Orly Goitein, M.D. Department of Radiology, Hadassah
Medical Center, Jerusalem, Israel
Roy L. Gordon, M.D. Professor, Department of Radiology,
University of California, San Francisco, San
Francisco, California; Chief of Interventional
Radiology, Department of Radiology, Moffitt
Hospital, San Francisco, California
Susan Grossman, M.D. Associate Professor of Clinical
Medicine, Department of Internal Medicine, New
York Medical College, Valhalla, New York; Chief of
Nephrology Section, Department of Internal
Medicine, St. Vincent's Catholic Medical Centers of
New York, Staten Island Region, Staten Island, New
York
Klaus D. Hagspiel, M.D. Associate Professor of Radiology,
Department of Radiology, University of Virginia
Medical School, Charlottesville, Virginia; Attending
Interventional and Cardiovascular Radiologist,
Department of Radiology, University of Virginia
Health System, Charlottesville, Virginia
Michael J. Hallisey, M.D. Associate Clinical Professor,
Department of Radiology, University of Connecticut
School of Medacine, Farmington, Connecticut;
Medical Director, Connecticut Vascular Institute,
Hartford Hospital, Hartford, Connecticut
Ziv J. Haskal, M.D., F.S.C.V.I.R. Professor of Radiology,
and Surgery, Columbia University College of
Physicians and Surgeons, New York, New York;
Director, Vascular and Interventional Radiology, and
Director, Interventional Radiology Research
Laboratory, The New York Presbyterian Hospital/
Columbia, New York, New York
Irvin F. Hawkins Jr., M.D. Professor, Department of
Radiology, University of Florida College of
Medicine, Gainesville, Florida
M. G. Myriam Hunink, M.D., Ph.D. Professor, Department
of Epidemiology and Biostatistics; Professor,
Department of Radiology, Erasmus University
Medical Center Rotterdam, Rotterdam, The
Netherlands
Michele H. Johnson, M.D. Director, Interventional
Neuroradiology, Yale-New Haven Hospital, Yale
University School of Medicine, New Haven,
Connecticut
Krishna Kandarpa, M.D., Ph.D. Professor of Radiology,
Weill Medical College, Cornell University; Professor
of Radiology (Adjunct), College of Physicians and
Surgeons, Columbia University; Chief, Division of
Cardiovascular and Interventional Radiology,
Department of Radiology, The New York
Presbyterian Hospital Weill Cornell Center, New
York, New York
Barry T. Katzen, M.D., F.A.C.R., F.A.C.C. Voluntary
Professor of Radiology ,Department of Radiology,
University of Miami, Miami, Florida; Medical
Director and Founder, Miami Cardiac and Vascular
Institute, Baptist Hospital, Miami, Florida
John A. Kaufman, M.D. Professor of Interventional
Radiology, Dotter Interventional Institute, Oregon
Health and Science University, Portland, Oregon
Ducksoo Kim, M.D. Professor of Radiology and Surgery,
Department of Radiology, University of
Massachusetts Medical School, Worcester,
Massachusetts; Director of Cardiovascular and
Interventional Radiology Department of Radiology,
University of Massachusetts Medical Center,
Worcester, Massachusetts
Scott A. Klioze, M.D. Assistant Professor, Department of
Radiology, University of Florida College of
Medicine, Gainesville, Florida
Karen F. Krone, M.D. Adjunct Associate Professor of
Clinical Anesthesia, Department of Anesthesia,
University of Cincinnati, Cincinnati, Ohio; Interim
Director, Acute Pain Service and University of
Cincinnati Physicians Pain Center, Department of
Anesthesia, University Hospital, Incorporated,
Cincinnati, Ohio
David A. Kumpe, M.D. Professor of Radiology, Surgery,
and Neurosurgery, Department of Radiology,
University of Colorado Health Sciences Center,
Denver, Colorado; Director, Interventional
Radiology and Interventional Neuroradiology,
Department of Radiology, University of Colorado
Hospital, Denver, Colorado
Oun J. Kwon, M.D. Division of Vascular and Interventional
Radiology, Department of Radiology, SUNY Upstate
Medical University, Syracuse, New York
Robert F. LeVeen, M.D. Associate Professor, Department of
Radiology, University of Florida College of
Medicine, Gainesville, Florida
Leonard J. Lind, M.D., F.C.C.M. Professor of Clinical
Anesthesia, Department of Anesthesia, University of
Cincinnati, Cincinnati, Ohio; Director of PACUand
Same Day Surgery, Department of Anesthesia,
University Hospital, Incorporated, Cincinnati, Ohio
Lindsay Machan, M.D., F.R.C.P.(C) Associate Professor,
Department of Radiology University of British
Columbia, Vancouver, British Columbia, Canada;
Head, Department of Angiography and
Interventional Radiology, University of British
Columbia Hospital, Vancouver, British Columbia,
Canada
Albert A. Maniscalco, M.D. Attending in Medicine,
Department of Medicine, Staten Island University
Hospital, Staten Island, New York
Michael Maxin, M.D. Chief of Cardiovascular and
Interventional Radiology, Group Health Cooperative,
Seattle, Washington
Thomas O. McNamara, M.D. Professor, Interventional
Radiology Section Department of Radiological
Sciences, UCLA Medical Center, Los Angeles,
California
Adhip Mukerjee, M.D. Instructor in Radiology, Department
of Radiology, Brigham and Women's Hospital,
Boston, Massachusetts
Timothy P. Murphy, M.D. Associate Professor, Department
of Diagnostic Imaging; Director, Section of Vascular
and Interventional Radiology, Brown University
School of Medicine, Providence, Rhode Island
Edward F. Patz, Jr., M.D. Professor, Department of
Radiology, Duke University Medical Center,
Durham, North Carolina
James C. Phero, D.M.D. Professor of Clinical Anesthesia
Clinical Surgery and Clinical Pediatrics, Department
of Anesthesia, University of Cincinnati Cincinnati
Ohio; Attending Anesthesiologist, Department of
Anesthesia, University Hospital, Incorporated,
Cincinnati, Ohio
Joseph F. Polak, M.D., M.P.H. Director, Noninvasive
Vascular Imaging, Associate Professor, Department
of Radiology, Harvard University Medical School,
Brigham and Women's Hospital, Boston,
Massachusetts
Jeffrey S. Pollak, M.D. Associate Professor, Department of
Radiology, Yale University School of Medicine;
Co-Section Chief, Vascular and Interventional
Radiology, Yale-New Haven Hospital, New Haven,
Connecticut
Martin R. Prince, M.D., Ph.D. Professor, Department of
Radiology, Cornell University, New York, New
York; Chief of Mrl, Department of Radiology, The
New York Presbyterian Hospital, New York, New
York
Kathleen Reagan, M.D. Associate Professor of Clinical
Radiology, Columbia University College of
Physicians and Surgeons; Co-Director of Cardiac
Radiology, Columbia-Presbyterian Medical Center,
New York, New York
Mel Rosenblatt, M.D. Associate Professor, Department of
Diagnostic Radiology, Yale University School of
Medicine, New Haven Connecticut; Clinical Section
Chief, Department ofDiagnostic Radiology,
Yale-New Haven Hospital, New Haven, Connecticut
Sanjay Saini, M.D. Department of Abdominal Imaging and
Interventional Radiology, Massachusetts General
Hospital, Boston, Massachusetts
Moshin Saeed, M.D. Clinical Professor of Radiology,
University of California, San Diego, School of
Medicine, San Diego; Vice-Chairman, Department
of Radiology, Scripps Clinic and Research Center,
La Jolla, California
Dorith Shaham, M.D. Department of Radiology, Hadassah
Medical Center, Jerusalem, Israel
Sean R. Sheeran, M.D. Staff Radiologist, Department of
Radiology, Brockton Hospital, Brockton,
Massachusetts
Stuart G. Silverman, M.D. Associate Professor, Department
of Radiology, Harvard Medical School, Boston,
Massachusetts; Director, Abdominal Imaging and
Intervention, Department of Radiology, Brigham and
Women's Hospital, Boston, Massachusetts
Stuart J. Singer, M.D. Clinical Assistant Professor,
Department of Radiology Upstate Medical
University, Syracuse, New York; Attending
Radiologist, Department of Medical Imaging, Crouse
Hospital, Syracuse, New York
Julie M. Sniffen, M.A.* Infection Control Practitioner,
Brigham and Women's Hospital, Boston,
Massachusetts
Thomas A. Sos, M.D. Professor of Radiology, Weill
Medical College, Cornell University;
Vice-Chairman, Department of Radiology, The New
York Presbyterian Hospital Weill-Cornell Center,
New York, New York
Michael C. Soulen, M.D. Associate Professor, Departments
of Radiology and Surgery, University of
Pennsylvania, Philadelphia, Pennsylvania;
Interventional Radiologist, Hospital of the University
of Pennsylvania, Philadelphia, Pennsylvania
Keith J. Strauss, M.Sc. Associate in Radiology Department
of Radiology Harvard Medical School, Boston,
Massachusetts; Director of Radiology Physics and
Engineering, Department of Radiology, Children's
Hospital, Boston, Massachusetts
David W. Trost, M.D. Associate Professor of Clinical
Radiology Department of Radiology, Weill Medical
College of Cornell University, New York, New
York; Associate Attending Radiologist, Department
of Radiology, The New York Presbyterian Hospital,
New York, New York
Sabah S. Tumeh, M.D., F.A.C.R. Director Department of
Nuclear Medicine, Piedmont Hospital, Atlanta,
Georgia
Jose C. Varghese, M.D. Clinical Fellow, Department of
Abdominal Imaging and Interventional Radiology,
Massachusetts General Hospital, Boston
Massachusetts
Prema Venkateswaran, M.D. Associate Professor of Clinical
Anesthesia, Department of Anesthesia, University of
Cincinnati, Cincinnati, Ohio; Attending
Anesthesiologist, Department of Anesthesia,
University Hospital, Incorporated, Cincinnati, Ohio
Priscilla A. Winchester, M.D. Assistant Professor,
Department of Radiology, Cornell University, New
York, New York ;Attending Radiologist, Department
of Radiology, The New York Presbyterian Hospital,
New York, New York
David F. Yankelevitz, M.D. Professor, Department of
Radiology, Weill Medical College of Cornell
University, New York, New York; Attending,
Department of Radiology, The New York
Presbyterian Hospital, New York, New York
Lawrence S. Yu, M.D. Attending Radiologist, Department
of Radiology, St. Clare's Hospital, Denville, New
Jersey
* Deceased
