Mastering Endovascular Techniques - Tips and Tricks in Endovascular Surgery (Apr 30, 2024)_(3031427343)_(Springer).pdf

• Publisher: Springer
• Year: 2024
• Tongue: English
• Leaves: 816
• Category: Library

✦ Table of Contents

Foreword
Preface
Contents
List of Contributors
Part I: Introduction in Endovascular Techniques
1: Biological Effects of Ionizing Radiations
Introduction
Direct and Indirect Effects of Ionizing Radiation
Repair Mechanisms
Assessment of Radiation Risks
Deterministic Effects
Stochastic Effects
Risk of Cancer
Hereditary Effects
Other Diseases Caused by Ionizing Radiation
Effects of Ionizing Radiation to the Embryo/Fetus
References
2: Principles and Guidelines for Radiation Protection
Why Is Radiation Protection Essential?
Physics Principles and Image Formation
Biologic Risks Associated to X-Ray Exposure
Deterministic Effects
Stochastic Effects
What are the Key Principles of Radiation Protection?
Focus on Optimization: Tips and Tricks for Daily Practice
Limit the Number of Produced Images
Limit Fluoroscopy Time
Use Pulse Mode
Have the Main Operator Control the Imaging Equipment
Limit the Dose Required to Produce Images
Set Up the Imaging Equipment
Use Low Dose or Half Dose Settings
Use Collimation
Limit C-Arm Angulation
Optimize the Image Chain Geometry
Limit Use of Digital Subtraction Angiography (DSA) (and Other Angiographic Modes)
Avoid Magnification
Impact of Equipment
Individual Protection Measures and Shielding
The Inverse Square Law
Positioning Around the Table
Shielding
Wearable Aprons
Thyroïd Collar
Leg Shields
Eye and Upper Body Protections
Controversial Protections
What You Should Definitely Remember
References
3: Principles of Anaesthesia in Endovascular Procedures
Case Study
Introduction
Pre-operative Assessment
Cardiac Morbidity
Endocrine Morbidity
Renal Morbidity
Frailty
Understanding Risk
Peripheral Limb Revascularisation
Site and Duration
Position
Symptomatology
Endovascular Aneurysm Repair
Surgical Access
Anaesthetic Technique
Local Anaesthesia
Central Neuraxial Blockade
Sedation
General Anaesthesia
Simple Versus Complex EVAR
Aortic Arch Branched Repairs and Thoracic Endovascular Aortic Repair (TEVAR)
Spinal Cord Ischaemia
Prophylactic Versus Therapeutic (Reactive)
Ruptured Aneurysm
Post-operative Care
Analgesia
Position
Level of Care
References
4: The Angiographic Suite: Setup and Ergonomics
Introduction
Layout
Location
Room Set-Up
Booms
Lighting
Monitors
Operating Table
Storage
Control Room
Adjunctive Equipment
Ultrasound
Intravascular Ultrasound
Power Injector
Carbon Dioxide Injector
Suction Thrombectomy Systems
Commonly Used Supplies
Imaging System
Mounting
Image Detection
The Benefits of a Hybrid Operating Room
Examples of Hybrid Room Set-Up
Coordination with Other Specialties
Ergonomics
Effect of Ergonomic Challenges
Radiation Shielding
Room Design
References
5: Basic Tools and Terminology for Endovascular Interventions
Basic Tools
Needles
Dilators
Sheaths
Guidewires
Wire Shapes and Sizes
Wire Types
Wire Problems
Common Wire Examples
Catheters
Guide Catheters
Microcatheter
Common Catheter Examples
Torque Devices
Taps/Hubs/Connectors
Snares
Balloons
Angioplasty Balloons
Compliant Balloons
Inflation Devices
Stents
Re-entry Devices
Embolisation Materials
Closure Devices
Embolic Protection Devices
Central Venous Catheters and Ports
Other Components of the Interventional Radiology Trolley
Personal Protective Equipment
Common Medications Used During Endovascular Procedures
Antiplatelets
Heparin
Antihypertensives
Conscious Sedation
Contrast Media
Anaphylaxis
Imaging Equipment
References
Basic Terminology
6: Principles, Sites and Techniques of Vascular Access
Introduction
Arterial Access
Common Femoral Artery
Technique
Tips and Problem Solving
Radial Artery
Pre-Procedure Assessment
Technique
Tips and Problem Solving
Brachial Artery Access
Technique
Popliteal Access
Tibial/Pedal Access
Technique
Tips and Tricks
Venous Access
Internal Jugular Vein
Technique
Tips and Tricks
Femoral Vein
Subclavian Vein
Technique
Upper Arm Veins
Conclusion
References
7: Coronary Disease for Cardiac Minimally Invasive Techniques
Background
Indications for Intervention
Preoperative Preparation
Timing of Intervention
Imaging
Risk Assessment
Patient
Operator/Center
Other
Endovascular Strategy and Technique
Basic Endovascular Toolkit
Suture-Based Closure Device: Perclose ProGlide and Perclose ProStyle
Suture-Based Closure Device: Prostar XL
Clip-Based Closure Device: StarClose SE
Plug-Based Closure Device: Exoseal
Plug-Based Closure Devices: MynxGrip and Mynx Control Vascular Closure Devices
Manual Assistive Closure Devices: Cardiva Catalyst II and III
Collagen Plug-Based Closure Devices: Vascade Vascular Closure System (VCS) and Vascade MVP Venous Vascular Closure System (VVCS)
Plug-Based Closure Devices: AngioBlock and AngioTen
Plug-Based Closure Device: Manta Vascular Closure Device
Collagen Plug-Based Closure Devices: Angio-Seal Evolution and Angio-Seal VIP Vascular Closure Devices
Plug-Based Closure Device: FemoSeal Vascular Closure Device
Decision-Making Regarding Technique Selection
Anticipated Complications and Management
Perioperative Care and Surveillance
Case Presentation
References
8: Contrast Media, Nephropathy and Prophylaxis
Introduction
Terminology
Incidence and Risk Factors
Prophylaxis
Outcome
References
9: Balloons and Percutaneous Transluminal Balloon Angioplasty
Background
Mechanism of Action
Balloon Technology
The Shaft
The Balloon
Profile
Inflation and Deflation Time
Compliance
Trackability, Pushability, and Crossability
Technique
Vascular Access
Retrograde Femoral Access
Antegrade Femoral Access
Retrograde Popliteal Access
Retrograde Tibial Access
Upper extremity Artery Access
Lesion Crossing
Balloon Angioplasty
Complications
Access Site Complications
Hematoma
Pseudoaneurysm
Arteriovenous Fistula
Access Site Thrombosis
Angioplasty Site Complications
Dissection
Distal Embolization
Arterial Rupture
References
10: The Specificities of the Common Femoral Artery Anatomy, Calcification and Treatment
Introduction
CFA Anatomy
CFA Calcifications
The CFA Treatment
Discussion
Conclusion
References
11: Re-Entry and Recanalisation Techniques in the Endovascular Management of Peripheral Arterial Disease
Background
Conservative Management
Indications for Intervention
Treatment Considerations
Pre-Procedural Assessment
Endovascular Strategy and Technique
Basic Endovascular Toolkit
General Access
Chronic Total Limb Occlusion (CTO)
Subintimal Tracking and Re-entry (STAR) Technique
Sharp Recanalisation
CTO Crossing Devices
Re-entry Devices
Outback ® (Cordis)
BeBack (Bentley)™ Catheter
Pioneer Plus (Philips)
OffRoad™ Re-entry Catheter System
Enteer Re-entry System
SAFARI and CART Techniques
Percutaneous Deep Venous Arterialisation
Possible Complications
Perioperative Care and Surveillance
References
12: Deep Venous Arterialisation
Deep Venous Arterialisation Case at Oxford
Introduction
Indications, Contraindications and Work Up for DVA
Open Surgical Approach to DVA
Endovascular Approach to DVA
Post Procedural Care Aspects for Endovascular DVA
Outcomes and Complications of Endovascular DVA
Conclusion and Future Directions
Equipment Required to Perform a DVA (Table 12.8)
References
13: Robotics and Endovascular Surgery: Current Status
Introduction
Endovascular Surgery
Steerable Catheters
Remote-Controlled Catheter Navigation Systems
Sensei/Magellan Robotic System
Amigo System (Catheter Robotics Inc. NJ, USA)
CorPath (Corindus Vascular Robotics, MA, USA)
Magnetic Robotic Navigation Systems: Niobe (Stereotaxis, St. Louis, MO)
Current Experiences in Robotic Endovascular Surgery
Aortic Arch Cannulation
Visceral Artery Cannulation
Contralateral Gate Cannulation
Embolisation
Developments in Existing Robotic Platforms
Use of Standard Catheters
Force Sensing and Haptic Feedback
Autonomous Catheter Positioning
Master–Slave Interface
Remote Control over Significant Geographical Distance
New Technologies in Robotic Surgeries
Electromagnetic Endovascular Navigation Tracking Systems (EM ENS)
Ultrasound-Based Localisation Tracking Systems (ULS)
3D Rotational Angiography (3DRA)
MR Endovascular Robotic Platform
Microrobots
Advantages and Challenges of Robotic Technologies
Benefits to Patients
Benefits to Surgeon
Technical Challenges
Sustainability
Training
Conclusions
References
Part II: Peripheral Occlusive Disease
14: Embolic Materials and Embolization Techniques
Background
Indications for Intervention
Preoperative Preparation
Timing of Intervention
Anticoagulation
Imaging
Materials and Techniques
Mechanical Embolic Agents
Coils
Plugs
Stents and Flow Diverters
Detachable Balloons
Particulate Embolic Agents
Polyvynil Alcohol (PVA) Particulates
Calibrated Microspheres
Autologous Clots and Tissues
Gelatin Foam
Liquid Embolic Agents
Cyanoacrylates
Copolymers
Anticipated Complications
Perioperative Care and Surveillance
Toolkit
Suggested Toolkit for Embolization with Micro Coils
References
15: Interventions for Aorto-Iliac Disease
Background and Introduction
Pre-Operative Preparation
Anticoagulation and Antithrombotic Medication
Imaging
Endovascular Strategy and Technique
Basic Endovascular Toolkit for TASC C and D Lesion AIOD Endovascular Revascularisation
Decision Making on Technique Selection
Access and Crossing the Lesion
Anticipated Complications
Peri-Operative Care and Surveillance
References
16: Interventions for Femoropopliteal Disease
Introduction
Global Technical Strategy
Arterial Access
Access Materials
Access Sites
The Femoral Access
Upper-Limb Accesses
Retrograde Accesses
Navigation and Stabilization
Lesion Crossing
Support Catheters
Dedicated Crossing Wires
Subintimal Crossing
Dual Access
Extra-Arterial Crossing
Vessel Preparation
Standard Balloon Angioplasty
Cutting and Scoring Balloons
Debulking Devices
Intravascular Lithotripsy
Anti-Restenotic Therapy
Bare-Metal Stents
Drug-Eluting Stents
Covered Stents
Drug-Coated Balloons
Intraoperative Imaging
Access Closure
Conclusion
References
17: Percutaneous Revascularization of the Tibial Arteries
Background
Indications for Treatment
Preoperative Preparation
Timing of Intervention
Baseline Imaging
Patient Work-Up
Best Medical Therapy
Endovascular Strategy and Technique
Basic Toolkit and Access
Lesion Crossing and Guidewires
Retrograde Access and Plantar-Loop Technique
Balloon Angioplasty
Drug-Coated Balloons
Drug-Eluting Stents
Debulking Atherectomy
Deep Venous Arterialization
Perfusion Monitoring
Anticipated Complications
Patient Follow-Up
References
18: Interventions for Pedal Disease
Background
Indications for Intervention [10]
Preoperative Preparation
Timing of Intervention
Laboratory Tests
Drug Therapy
Imaging
Endovascular Strategy and Technique
Basic Endovascular Toolkit
Access and Crossing the Lesion
Results
Anticipated Complications
Perioperative Care and Surveillance
References
19: Atherectomy and Calcium-Modifying Devices
Background
Currently Available Atherectomy Devices and Evidence for Their Efficacy
Rotational Atherectomy
Directional Atherectomy
Orbital Atherectomy
Aspiration Atherothrombectomy
Laser Atherectomy
Indications for Use of Atherectomy or Other Calcium-Modifying Device
Strategy and Endovascular Technique
Complications During Atherectomy and Their Management
Non-atherectomy Calcium-Modifying Devices
References
20: Novel Endovascular Technologies in Femoropopliteal Disease
Background
Basic Endovascular Toolkit
Novel Techniques in Percutaneous Transluminal Angioplasty
Stents
Drug-Eluting Stents and Balloons
Atherectomy
Intravascular Lithotripsy
Re-entry Devices
Tack Endovascular System
Intravascular Ultrasound
Conclusion
References
21: Complications and Their Management in Peripheral Interventions
Background
Puncture Site Complications
Haematoma
Management
Pseudoaneurysm
Management Options
Arteriovenous Fistulae
Management Options
Angioplasty Site Complications
Thrombosis
Management Options
Dissection
Management Options
Arterial Rupture
Management Options
Distal Emboli
Management Options
Systemic Complications
Allergic Reactions
Management
Renal Failure
Management
References
22: Follow-Up and Surveillance After Peripheral Interventions
Clinical Examination
Assessment of Limb Perfusion by Physiologic Testing (Pulse Exam, ABI/TBI/Toe Pressures)
Duplex US Evaluation for Anatomic or Flow Abnormalities
References
23: Endovascular Management of Acute Limb Ischemia
Background
Surgical Approach
Surgical Arterial Thromboembolectomy
Hybrid Treatment
Thrombolysis
Ultrasound-Accelerated Thrombolysis
Endovascular Non-LYTIC Options
Manual Aspiration
Mechanical Fragmentation
Rheolytic Thrombectomy
Aspiration Thrombectomy
Decision Making Algorithm in Acute Limb Ischemia
Conclusion
References
Part III: Cerebrovascular Disease
24: Angioplasty and Stenting of the Arch Branches
Background
Vascular Anatomy of the Aortic Arch
Normal Arch Development
Aortic Arch Morphology
Aortic Arch Anomalies
Pathology
Aortic Arch Aneurysm
Definition
Etiology
Clinical Picture
Imaging
Acute Aortic Syndrome
Non-A–Non-B Aortic Dissection: Type B Dissection Involving the Aortic Arch
Aortic Intramural Hematoma
Penetrating Aortic Ulcer
Atherosclerosis
Approach to Common Lesions
Proximal Occlusive Lesions
Aortic Arch Debranching
Endovascular Repair
Thoracic Endografts
Advanced Devices
Choice of Device
Management of Iatrogenic Injury to Supra-aortic Branches
References
25: Carotid Artery Stenting: Studies, Indications, and Pre-interventional Workup
Background
Key Trials and Indications
Surgical Risk
Asymptomatic Carotid Stenosis
Symptomatic Carotid Stenosis
Future Trial Directions
Transcarotid Artery Revascularization (TCAR)
Current Guidelines
Pre-interventional Workup
Pre-interventional Considerations
Pre-interventional Risk Assessment
Medical Considerations
Incorporating Health Disparities and Health Literacy
Technical Pearls
Technical Considerations in TF-CAS
Technical Considerations in TCAR
Conclusions
References
26: Technique and Complications of Transfemoral Stenting
Introduction
Technique
Complications
Access Site Complications
Selective Catheterization of the CCA
Treatment of the Lesion
Crossing the Carotid Lesion and Deploying the EPD
Stent Deployment
Retrieval of EPD
Other Post-procedural Complications
Adverse Hemodynamic Events (Bradycardia and Hypotension)
Thromboembolic Events
Cerebral Hyperperfusion Syndrome and Intracranial Hemorrhage
Postoperative Care and Surveillance
References
27: Introduction to Transcarotid Artery Revascularization
Background
Pre-operative Considerations
Suitable Patients for TCAR
Medications
Imaging
Anesthetic Technique
Intraoperative Considerations
Patient Positioning and Draping
Endovascular Devices
Open Surgical Instruments
Duplex Ultrasound
TCAR Technique
Incision Choice
Stent and Balloon Selection
Vessel Clamping Choice
Stop Short or Engage External Carotid Artery
Potential Complications Specific to TCAR
Access Site Dissection
Pneumothorax
Incorrect Stent Placement
Nerve Injury
Access Site Hematoma
Perioperative Care
A-Line Monitoring
Discharge Instructions
Surveillance
References
28: Intracranial Atheromatous Stenosis
Background
Indication for Intervention
Preoperative Preparation
Imaging
Timing of Intervention
Medical Treatment
Dual Antiplatelet Therapy (DAPT)
Management of Modifiable Risk Factors
Endovascular Strategy and Technique
Stent Devices
Percutaneous Transluminal Angioplasty with Stenting (PTAS) Procedure
Anesthetic Techniques
Procedural Description: Tips and Tricks
Post-procedural Management
Alternatives Interventional Options
Angioplasty Alone
Surgical Procedure
Follow-Up
Other Situations
ICAS-Related LVO
Asymptomatic ICAS
Forthcoming Improvements in PTAS
Illustrative Case
References
29: Arch Vessel Dissection
Introduction
Clinical Features
Classification of Arterial Dissections
Treatment Options
Endovascular Treatment of Arch Vessel Dissections
Endovascular Technique
References
30: Endovascular Approach for Curative Embolization of Brain AVMs: Insights from Angio-architectonics and Angio-anatomy
Background
Architectonic Organization of the Telencephalon and Location of Brain AVMs
Arterial System: The Neopallial, Leptomeningeal Angio-architecture
The “Deep” Supply to Neopallial AVMs
Venous Drainage of the Neopallium
Nidus
Nidal Subtypes
Historical Aspects of AVM Embolization
Role of Embolization in the Management of AVM
Embolization Agents
Techniques of AVM Embolization
Demonstration of Clinical Cases of Curative Embolization Using NBCA with Technical Pointers
Complications of AVM Embolization
Conclusions
References
Part IV: Splachnic Artery Disease
31: Angioplasty and Stenting of the Mesenteric Arteries
Background
Indications for Treatment
Timing for Operation
Preoperative Assessment
Endovascular Surgery and Technique
Antegrade Access
Retrograde Access
Type of Stent
Other Technical Considerations
Specific Revascularization of the Inferior Mesenteric Artery
Anticipated Complications
Perioperative Care and Follow Up
References
32: Renal Artery Angioplasty and Stent Insertion: An Overview of Modern Practice
Introduction
Overview of Renovascular Disease and Indications for Intervention
Overview of Renovascular Disease
Indications for Intervention
Imaging and Preoperative Preparation
Renal Angioplasty and Stent Insertion Technique
General Technical Considerations
Access, Renal Artery Cannulation and Embolic Protection Devices
Renal Stent Deployment
Technical Considerations for Angioplasty
Closure and Post-procedure Care
Complications
‘Renal’ Complications
Longer-Term Renal Complications
Non-renal Complications
Outcomes
Angioplasty in Fibromuscular Disease
Atherosclerotic Renal Artery Stenosis
Case Outcome
References
33: Visceral Aneurysms
Introduction
Classification
Special Considerations
Workup
Vascular Beds: Renal
Vascular Beds: Splenic
Vascular Beds: Hepatic
Vascular Beds: Celiac
Vascular Beds: Superior Mesenteric Artery
Vascular Beds: Gastric and Gastroepiploic Arteries
Vascular Beds: Pancreatoduodenal and Gastroduodenal Arteries
Vascular Beds: Jejunal, Ileal, and Colic
Technical Considerations
Coil Embolization
Balloon-Assisted Coiling
Stent-Assisted Coiling
Liquid Embolics
Stent Grafts and Flow Diverting Stents
Future Directions
Percutaneous and Surgical Options
Clinical Follow-Up
Conclusion
References
Part V: Peripheral Aneurysm Disease
34: Endovascular Repair of Popliteal Artery Aneurysms
Background
Indications for Intervention
Preoperative Preparation
Imaging
Preoperative Risk Stratification
Endovascular Strategy
Assessing Anatomic Features for Intervention
Patients Presenting with Acute Limb Ischemia and Compromised Run-Off
Selection of an Access Site
Selection of an Endograft
Endovascular Technique
Access
Angiography
Postoperative Care
Post-operative Period
Follow-Up Period
Complications
Access Complications
Graft Complications
References
35: Peripheral Pseudoaneurysms
Introduction
Etiology and Pathophysiology
Iatrogenic
Arterial Access for Endovascular Procedure
Anastomotic Failure
Failure of Closure Device
Non-iatrogenic
Trauma
Infection
Complications
Risk Factors
Physical Examination and Diagnosis
Treatment/Management
Observation
Percutaneous Treatment
Ultrasound-Guided Compression
Ultrasound-Guided Thrombin Injection
With Endovascular Balloon Protection
Percutaneous Coil Embolization
Use of a Closure Device
Endovascular Repair
Stent-Graft Placement
Coil Embolization
Thrombin Injection
Surgical Repair
References
Part VI: Vascular Access
36: Creating a Percutaneous Arteriovenous Fistula: Evidence and Techniques
Device Mechanisms
Access Placement Techniques
Anatomic Applicability
Early Results
Later Results
Comparing Costs
Relative Need for Reintervention and Regional Variation
Status of Use
References
37: Vascular Access
Introduction
Principles of Vascular Access
Image Guidance
Site of Access
Central Access
Peripheral Access
Types of Lines and Ports
Peripheral Lines
Central Lines
Complications
Early Complications
Late Complications
Difficult Situations and Troubleshooting
Recanalisation Methods
Venous Stenosis
Occlusion
Alternative Access Points
Removals
Fistulas
Stenoses
Fistula Thrombosis
Conclusion
References
38: Endovascular Techniques to Manage Vascular Access Failure
Introduction
Failure of Maturation, Stenoses, and Thromboses
Percutaneous Transluminal Angioplasty
Management of Thrombosis
Stenting of the Peripheral Venous Segment
Accessory Vein Obliteration
Aneurysms and Pseudoaneurysms
Central Venous Stenosis
Percutaneous Transluminal Angioplasty
Stenting of the Central Venous System
Conclusion
References
Part VII: Coronary Artery Disease
39: Introduction to Coronary Angioplasty
Background
Indications
Contraindications
Timing of Intervention
Pre-procedural Evaluation/Planning
Monitoring
Periprocedural Antithrombotic Agents Administration
Access
Coronary Artery Engagement and Angiography
Wiring
Lesion Preparation
Stenting
Access Closure
Lesions Functional Assessment and Intravascular Imaging
Complications
References
40: Transcatheter Aortic Valve Implantation
Background
Indications for Intervention
Preoperative Preparation
Transthoracic Echocardiogram (TTE)
Coronary Angiogram
Computed Tomographic (CT) Scan
Deciding for TAVI
Anesthesia
Antithrombotic Therapy
Antibiotic Prophylaxis
Procedural Steps (Transfemoral TAVI)
Self-expanding Evolut R/Pro (Medtronic, Minneapolis, Minnesota) (Fig. 40.3a)
Balloon-Expandable SAPIEN 3 (Edwards Lifesciences, California) (Fig. 40.3b)
Self-expanding Portico (Abbott, Abbott Park, Illinois) (Fig. 40.3c)
Self-expanding ACURATE Neo2 (Boston Scientific, Marlborough, Massachusetts) (Fig. 40.3d)
Alternative Access Sites Transsubclavian Access
Transapical Access
Transaortic Access
Transcarotid Access
Transcaval Access
Procedural Complications
Antithrombotic Management
Durability Data
References
41: Transcatheter Mitral Valve Repair
Background
Indications for Intervention
Preoperative Preparation
Timing of Intervention
Imaging
Transthoracic and Transesophageal Echocardiography
Cardiac MRI
Endovascular Strategy and Technique
Basic Endovascular Toolkit
Transesophageal Echocardiography
Trans-septal Kit
Transcatheter Edge-to-Edge Repair Device
Decision Making on Technique Selection
Pre-procedural Therapeutic Strategy and Number of Clips
Access to the Left Atrium
Anticoagulation
Access to the Mitral Valve
Grasping of the Leaflet
Troubleshooting
Clip Too Deep or Too High in the Left Atrium
Incomplete or Difficult Grasping of One of the Leaflets
Need to Remove the Clip and Delivery System from the LV
Other Devices
Vascular Closure
Anticipated Complications
Vascular Injury
Trans-septal Puncture Complication
Pulmonary Vein or Left Atrium Appendage (LAA) Injury
Intra-cardiac Thrombus
Chordae Coiling Around the Clip
Leaflet Detachment
Reduction in Mitral Valve Area
Perioperative Care and Surveillance
References
42: Atrial Septal Defect: Left Atrial Appendage
Atrial Septal Defect
Left Atrial Appendage Closure
References
Part VIII: Aortic Aneurysm Disease
43: Endovascular Repair of Abdominal Aortic Aneurysms (EVAR): Studies on Long-term Results
References
44: Patient Selection for Endovascular AAA Repair
Introduction
Assessment of Patient’s General Status
Cardiac Disease
Pulmonary Status
Renal Function
Aneurysm Diameter
Patients with Advanced Age
High-risk Patients
Anatomic Considerations for EVAR
Preprocedural Imaging
Proximal Landing Zone
Distal Landing Zone
Vascular Access
Endograft Configurations
References
45: Preprocedural Planning and Measurements for EVAR
Background
Preoperative Clinical Assessment
Assessment of the Computed Tomography Angiography (CTA): Drawing of the Aneurysm
Creating the Centerline: Step-by-Step Measurement
References
46: Introduction to Endografts for Infrarenal AAAs
History
Design and Characteristics of Aortic Endografts
Sheath and Delivery System
Endograft
Principles and Concepts of Endograft Deployment
Choice of Endograft
Preoperative Planning for an EVAR Procedure
Future Perspectives
References
47: Suprarenal vs Infrarenal Fixation
Introduction
Suprarenal Fixation Endografts
Infrarenal Fixation Endograft
Follow-Up Outcomes
Suprarenal Devices
Infrarenal Fixation
Impact of Fixation System on Renal Function
Impact of Fixation System on Neck Adverse Event (Neck Enlargement; Migration; Endoleak)
References
48: The Role of Aorto-Uni-iliac Endografts
Introduction
Use of Aorto-Uni-iliac Device for the Treatment of Ruptured Abdominal Aortic Aneurysms
Durability of the Crossover Femoral-Femoral Bypass Graft
Advantages of Aorto-Uni-Iliac Stent Grafts
Disadvantages of Aorto-Uni-Iliac Stent Grafts
References
49: Hostile Proximal Neck: Angulated, Short, or Conical
Background
The Hostile Neck
Anatomical Features and Associated Outcomes
Short Neck
Wide Neck
Angulation
Conical Neck
Who Does HNA Affect?
Endovascular Strategy and Techniques
Selecting the Right Approach
EVAR
Pre-operative Assessment
Off-the-Shelf Devices
Adjunctive Procedures
Fenestrated EVAR
Chimney EVAR
Open or Hybrid Repair
Conclusion
References
50: Hemodynamic Principles of Endografts
Background
Aneurysm Remodeling: A Multifactorial Issue
The Infrarenal Neck: Modes of Fixation, Central Sealing, and Distribution of Forces
Iliac Limbs: Modes of Fixation, Endoleaks, and the Role of Geometry
The Influence of Geometry on the Hemodynamic Profile of Endografts
The Impact of EVAR on Central Circulation
In-Stent Flow Patterns: An Underappreciated Issue
Discussion
Limitations
Conclusions
References
51: Endovascular Aneurysm Repair Using Fenestrated Endografts
Introduction
Indications and Considerations
Indications
Commercially Available Devices
Cook Zenith Fenestrated
Terumo Fenestrated Anaconda
Design and Planning of Fenestrated Endografts
Advanced Imaging
Volumetric Analysis
Centerline Reconstruction (Curved Planar Reformat or CPR)
Multiplanar Reformat (MPR)
Measurement and Planning Process
Picking a Zero Point
Determining and Confirming Lengths
Inner Vessel Diameter (IVD) Measurements
Fenestration Positioning
Implantation and Technique
Imaging Adjuncts: Fusion and Other Technologies
Fusion Imaging
Cone Beam Imaging
Intravascular Ultrasound (IVUS)
Non-fluoroscopic Imaging Guidance
Access Considerations
Choice of Access
Iliac Artery Size and Disease
Deployment Process
Visceral Artery Cannulation Techniques
Basic Cannulation
Extreme Downgoing Vessels
Misaligned Fenestration
Stenotic Vessels
Bridging Stents
Types of Bridging Stents
Technical Considerations
Bridging Stent-Specific Complications
Physician-Modified Fenestrated Endografts
Regulatory Considerations
Graft Choice
Graft Construction
Consistency and Quality Control
Outcomes
Conclusion
References
52: Branched Endografts
Introduction
Historical Aspects of Evolution of Branched Endografts
Preoperative Planning of Branched Endografts
Sealing Zone
Selection of Fenestration/Branches
Implantation Techniques: Arterial Access
Outcomes of Branched Endografts in TAAA Endovascular Repair
Branched Grafts as Off-the-Shelf Devices
Cook t-Branch®
Gore Excluder TAMBE
E-nside
Branched Grafts for Aortic Arch Repair
Iliac Branched Grafts
Conclusions
References
53: Iliac Bifurcation Devices: Tips and Tricks
Introduction
Iliac Branch Devices: Configurations, Deployment Strategy and Anatomical Constraints
Particular Cases
Isolated Common Iliac Artery Aneurysm
Type 1B Endoleak or Iliac Aneurysm Degeneration in Patients with Prior Bifurcated Aortic Stent Graft
Aneurysmal Degeneration of Iliac Artery After a Previous Open Aneurysm Repair
Internal Iliac Artery Aneurysms (Fig. 53.3)
Conclusion
References
54: Endovascular Approach to the Hypogastric Artery
Background
Bell-Bottom Technique vs. External Iliac Artery Extension
Retrograde Endovascular Bypass
Parallel Grafts: Double Barrel Technique
Parallel Grafts: Crossover Chimney Technique
Catheterization of the Hypogastric Artery
Internal Iliac Artery Occlusion
Using Division Branches of the Internal Iliac Artery as Distal Landing Zones
Conclusions
References
55: Optimizing Imaging and Radiation Exposure During Complex EVAR
Introduction
Optimize Procedure Steps
Optimize Intraoperative Imaging, Radiation Exposure, and Comfort
Basic Set-up
Low-Frequency Pulsed Fluoroscopy
Digital Zoom, Collimation
Reduce C-arm Angulations
Recorded Fluoroscopy, Marker Tool
Alternative Methods of Guidance
Intravascular Ultrasound
FORS Technology
Reduce Contrast Injection
Contrast Medium Dilution
Carbon Dioxide
Optimize Final Check, Intraoperative Cone Beam Computed Tomography
Conclusion
References
56: Rescue of Proximal Failure of Endovascular Abdominal Aortic Aneurysm Repair with Standard and Fenestrated Grafts
Background
Indications for Intervention
Endovascular Treatment Options
Proximal Cuff Extension
Parallel Graft (Chimney Technique)
Embolization
Endostaples
Fenestrated EVAR or Branched EVAR (FBEVAR)
Timing of Intervention
Imaging
Endovascular Strategy and Technique
Proximal Cuff Extension: Basic Endovascular Toolkit
Parallel Graft (Chimney Technique): Basic Endovascular Toolkit
Embolization: Basic Endovascular Toolkit
Endostaples: Basic Endovascular Toolkit
FBEVAR: Basic Endovascular Toolkit
Decision Making on Technique Selection
Patient’s Characteristics
Anatomical Suitability
Endoleak Features
Institution’s Experience
Perioperative Care and Surveillance
Prevention of Type Ia Endoleak after Endovascular Procedures
References
57: In Situ Fenestration of Endovascular Grafts
Introduction
Historical Aspects
Indications
Technical Considerations
In Vivo
Ex Vivo
Outcomes
Conclusions
References
58: Chimneys and Periscopes
Indications and Limitations
Preoperative Imaging Evaluation
Discussion
References
59: Descending Thoracic Aortic Aneurysms
Introduction
Definition, Natural History, and Surgical Indication
Preoperative Workup
General Clinical Evaluation
Preoperative Imaging
Femoral/Iliac Access Evaluation
Proximal and Distal Neck Evaluation
Endograft Sizing
Current Commercially Available Endografts (EU)
Spinal Cord Ischemia Prevention Protocol
Procedure
Standard Step-by-Step Procedure
Management of Challenging Iliac Accesses
Through and Through Technique
Adjunctive Maneuvers to Guarantee the Precise Deployment of Endograft in the Proximal Landing Zone
Complications
Intraoperative Complications
Perioperative Clinical Complications
Follow-up Complications
References
60: Endovascular Management of Aortic Arch Disease
Introduction
Pathologies of the Aortic Arch and Indications for Intervention
Anatomical Considerations
Endograft Characteristics
Fenestrated/Scallop Endograft of the Aortic Arch
Branched Endograft of the Aortic Arch
Parallel Grafts
In-Situ/Physician-Modified Fenestrated Grafts
Future Perspectives
References
61: Endovascular Management of Thoracic Aortic Trauma
Introduction
Limitations
Mechanism of Injury and Diagnosis
Classification
Management of “Minimal Aortic Injury” (Periadventitial Defect or Hematoma)
Timing of Intervention
Endovascular Exclusion
Stent Graft Sizing
Diameter
Length
Stent-Graft Placement
LSA Management
Suitability and the Unmet Needs of Current FDA-Approved Thoracic Endografts
LSA Management
Systemic Heparinization
Choice of Repair in the Young—TEVAR Vs Open
Optimal Follow-Up Strategy
Long-Term Outcomes
Conclusion
References
62: Endovascular Management of Ruptured Aortic Aneurysms
Background
Preoperative Preparation
Endovascular Strategy and Technique
Operation Steps
Special Intraoperative Considerations
Anesthesia
Aortic Occlusion Balloons (AOBs)
Endo-leaks, Endo-anchors
Ancillary Tools
Perioperative Care, Postoperative Complications, and Surveillance
References
63: Endovascular Management of Acute Aortic Dissection
Background
Acute Aortic Syndromes
Classification Systems
Chronicity of AD
Acuity of AD
Uncomplicated AD
High-Risk Features of AD
Complicated AD
Epidemiology
Endovascular Management
Optimalization with Medical Therapy
Complicated Acute Type B Aortic Dissection
High-Risk Acute Type B Aortic Dissection
Uncomplicated Acute Type B Aortic Dissection
Type A Aortic Dissection
Principles and Methods of Intraluminal Stent Graft Treatment
Endovascular Techniques to Obliterate Persistent Retrograde FL Flow
PETTICOAT Technique
STABILISE Technique
Other Endovascular False Lumen Obliteration Techniques
References
64: Endograft Occlusion
Background
Predictive Factors of Endograft Occlusion
Specific Device-related Complications
Prevention
Treatment
Conclusions
References
65: Endoleak Type I
Pathophysiology and Endoleak Types
Endoleak Type I: Clinical Indication, Identification, and Imaging
Endoleak Type I Treatment
Endoleak Type Ia [1]
Endoleak Type Ib
Endoleak Type Ic
Preoperative Preparation
Choice of Treatment
Balloon Dilatation
Large Balloon Expandable Stent Insertion
Endoanchors
Endograft Extension
Fenestration Endograft Extension
Parallel Stent Grafts
Embolic Materials
Type Ic Endoleaks in Aorto-Uni-Iliac (AUI) Stent Grafts
Type Ic Endoleaks in FEVAR and BEVAR
Complications
Balloon Dilatation and Giant Stent (Palmaz) Insertion
Endograft Extension
Fenestration Endograft Extension and Parallel Stent Grafts
Embolisation
References
66: Type 2 Endoleak After EVAR
General Consideration
When to Intervene?
How to Intervene?
Material
Timing
Preemptively
Curatively
Intra Sac Embolization and/or Glue
Trans Caval Embolization
Trans Graft Embolization
Trans Lumbar Embolization
Embolization Through Selective Catheterisms
Clipping the Arteries
In Summary
References
67: Type III–V Endoleaks
Introduction
Classification
Diagnosis
Type III Endoleaks
Primary Type III Endoleak
Secondary Type III Endoleak
Type IV Endoleaks
Type V Endoleaks
Summary
References
68: Endograft Infections
Incidence
Risk Factors
Microorganisms
Diagnosis
Treatment Options
Surgical Treatment
Endograft Explantation
Extra-Anatomic Vs In Situ Reconstruction
Graft Materials
Presence of Aorto-Intestinal Fistula
Antimicrobial Therapy
Conclusions
References
Part IX: Venous Disease
69: Endovenous Ablation Techniques
Introduction
Chronic Venous Disease (CVD)
Endovenous Ablation Techniques
Thermal and Tumescent Techniques and Non-thermal and Non tumescent Techniques
Thermal and Tumescent Techniques
How It Works
Preoperative Evaluation of Patients
Contraindications to Transcatheter Ablation
Preoperative Vein Mapping
General Recommendations
Informed Consent
How to Perform Tumescent Anesthesia for Thermal Techniques
Treating Below Knee Saphenous Veins
Cleaning and Wrapping
Non-thermal and Non Tumescent Techniques
Conclusions and Considerations
References
70: Endovenous Laser Ablation Therapy for Chronic Venous Disease
Introduction
Materials
Positioning the Patient on the Table
How to Perform the Vein Puncture
Decision of the Entry Access Point
Tortuous Vein Axis
Sheath is Hard to Pass
How to Continue if the Sheath or the Fiber is Difficult to Pass
How to Verify the Correct Position of the Fiber at the Junction
How One Guarantees the Safety of the Procedure when one cannot See Anything
How Much Energy Dispence
How to Prevent Nerve Damages
Recommendations Before and After EVLA; How to Avoid EHIT
Conclusion
References
71: Radiofrequency Ablation for Chronic Venous Disease
Introduction
Endovenous Radiofrequency Ablation (EVRFA)
How It Works: Past, Present, and Future
The RFA Technique
Results
Histological Findings After Endovenous Radiofrequency Ablation EVRFA
Conclusions and Considerations
References
72: Endovenous Steam Ablation for Chronic Venous Disease
Introduction
Materials
The Exclusion Criteria
Procedure
Microscopic Examination
Conclusion
References
73: Cyanoacylate Glue Ablation for Chronic Venous Disease
Introduction
The Devices
VenaSeal™
Complications of CAC
VenaBlock™
Veinoff™
VariClose™
Venex™
Indications and Contraindications
Indications
Contraindications
Warnings and Precautions
The Technique
Catheter-Directed Treatment of Saphenous Reflux
Percutaneous Treatment of Tributaries
VenaBlock™, Vennex™, and Veinoff™
Post-Operative Management
Cyanoacrylate in the Treatment of CVD
Cyanoacrylate in the Treatment of Venous Malformations
Complications of CAC
Results and Recommendations
Conclusions
References
74: Mechanochemical Ablation (MOCA) for Chronic Venous Disease
Introduction
Technique
Results
Indications
Contraindications
Complications
Conclusions
References
75: Foam Sclerotherapy for Chronic Venous Disease
Introduction
Technique
Indications
Contraindications
Results
Complications
Major Complications
Thromboembolism
Deep Vein Thrombosis
Superficial Venous Thrombosis
Neurological Events
Transient Events
Stroke
Tissue Necrosis
Nerve Damage
Oedema and Lymphoedema
Cosmetic Complications
Telangiectatic Matting
Pigmentation
Retained Coagulum
Conclusions
References
76: Introduction to Venous Stents and Principles of Stenting
Introduction
Indications
Access Sites
Technique
Stent Selection and Sizing
Complications
Venous Stent Landscape
Medical Management
Follow-up
References
77: Endovascular Treatment of Chronic Venous Disease
Background
Imaging
Duplex Ultrasound (DUS)
Cross-Sectional Imaging
Treatment Strategy
Timing
Assessing Inflow
Endovascular Strategy and Technique
Anaesthesia
Basic Endovascular Toolkit
Access and Other Technical Considerations
Intravascular Ultrasound
Venous Stents
Complications
Perioperative Care and Surveillance
Compression After Treatment
Antithrombotic Treatment
Surveillance
Multidisciplinary Team
Conclusion
References
78: Endovascular Treatment of Pulmonary Embolism
Background
Indications for Intervention
Preoperative Preparation
Anticoagulation
Imaging
Bleeding Risk Assessment
Endovascular Strategy and Technique
Basic Endovascular Toolkit
Timing of Intervention
Access into the Pulmonary Arteries
Inferior Vena Cava Filters
Decision Making on Technique Selection
Type of Anesthesia
Extra-Corporeal Membrane Oxygenation
Thrombolytic and Thrombectomy Catheters/Devices
Catheter-Directed Thrombolysis
Ultrasound-Accelerated Thrombolysis: EKOS Endovascular System
Rheolytic Thrombectomy: ANGIOJET Zelante Catheter
Aspiration Thrombectomy: AngioVac/Alphavac
Aspiration Thrombectomy: Indigo CAT-8/CAT-12 Catheter
Aspiration Thrombectomy: FlowTriever System
Perioperative Care and Surveillance
Anticipated Complications
References
79: Pelvic Congestion Syndrome (PCS)
Introduction
Definition and Demographics
Pathophysiology - Reflux and/or Obstruction
Investigations and Imaging
Treatment
Conclusion
References
80: Primary Subclavian Vein Thrombosis (Paget–Schroetter Syndrome)
Case Presentation
General Considerations
Treatment
Method of Thrombolysis
Conclusion
References
81: Endovascular Treatment of Acute Iliofemoral Deep Venous Thrombosis
Background
Indications for Intervention
Preoperative Preparation
Timing of Intervention
Anticoagulation
Imaging
Deep Venous Thrombosis
Thrombophilia Evaluation
Bleeding Risk Assessment
Endovascular Strategy and Technique
Basic Endovascular Toolkit
Inferior Vena Cava Filters
Intravascular Ultrasound
Decision Making on Technique Selection
Access and Crossing the Lesion
Thrombolytic Techniques
Catheter-Directed Thrombolysis
Ultrasound-Accelerated Thrombolysis: EKOS Endovascular System
Pharmacomechanical Thrombolysis
AngioJet Zelante Catheter (Rheolytic Thrombectomy)
Aspiration Thrombectomy
AngioVac System
Indigo CAT-8/CAT-12 Catheter
JETi™ Hydrodynamic Thrombectomy System
Aspirex System
Mechanical Thrombectomy
ClotTriever System
Other Devices
Venous Stents
Anticipated Complications
Perioperative Care and Surveillance
References
82: Management of Truncular and Extratruncular Venous Malformations
Imaging
Duplex Ultrasound
Treatment
References
Index