Peripheral Vascular Interventions

Description

This comprehensive clinical reference describes the full range of endovascular interventions currently used for peripheral vascular problems. The first section provides essential information on peripheral vascular diseases, including etiology, clinical and laboratory evaluation, and imaging before performing a procedure. The second section explains the physics, techniques, and clinical uses of all vascular imaging modalities. The major portion of the book covers specific arterial and venous interventions for each anatomic region. These chapters address clinical issues, indications, patient selection, procedural and technical considerations, results, and post-procedural management, and discuss available devices and pharmaceuticals. More than 1,100 illustrations complement the text. Cover 1 Peripheral Arterial Diseases Anne Hamik Mark A. Creager PATHOBIOLOGY OF PERIPHERAL ARTERIAL DISEASES Atheroscl erosis Arterial Thrombosis Fibromuscular Dysplasia LOWER EXTREMITY ATHEROSCLEROTIC PERIPHERAL ARTERIAL DISEASE Etiology Epidemiology Clinical Presentation and Evaluation TABLE 1 - 1 INDIVIDUALS AT RISK FOR LOWER EXTREMITY PERIPHERAL ARTERIAL DISEASE TABLE 1 - 2 RUTHERFORD - BAKER SCALE OF SEVERITY OF PERIPHERAL ARTERIAL DISEASE Noninvasive Vascular Testing TABLE 1 - 3 CLINICAL CATEGORIES OF ACUTE LIMB ISCHEMIA Differential Diagnosis Management TABLE 1 - 4 DIFFERENTIAL DIAGNOSIS OF EXERTIONAL LEG PAIN ABDOMINAL AORTIC ANEURYSMS Etiology Epidemiology Clinical Presentation and Evaluation Management Iliac, Femoral, and Popliteal Artery Aneurysms RENAL ARTERY DISEASE Etiology Epidemiology/Prognos is Clinical Presentation and Evaluation Management Renal Artery Aneurysms MESENTERIC ARTERY DISEASE Etiology Epidemiology Clinical Presentation and Evaluation Management EXTRACRANIAL CAROTID ARTERY STENOSIS Etiology Epidemiology Clinical Presentation and Evaluation Prognosis Mana gement Medical Revascularization References Jae Hyung Park 2 Vasculitides: Inflammatory Diseases of Aorta and Arteries TAKAYASU ARTERITIS Epidemiology and Etiology Clinical Findings TABLE 2 - 1 SELECTED VASCULITIDES OF LARGE - AND MEDIUM - SIZED PERIPHERAL VESSELS Laboratory Findings Diagnosis Pathology Gross Findings Microscopic Findings Imaging Findings Conventional Management GIANT CELL ARTERITIS Epidemiology and Etiology Clinical Findings Laboratory Findings Diagnosis Pathologic Findings Imaging Findings Conventional Management BEHÇET DISEASE Epidemiology and Etiology Clinical Findings Laboratory Findings Diagnosis Pathologic Findings Imaging Findings POLYARTERITIS NODOSA Epidemiology and Etiology Clinical Findings Laboratory Findings Diagnosis Pathologic Findings Imaging Findings CHURG - STRAUSS SYNDROME AND POLYARTERITIS NODOSA KAWASAKI DISEASE Epidemiology and Etiology Clinical Findings Laboratory Findings Diagnosis Pathologic Findings Imaging Findings Conventional Management THROMBOANGIITIS OBLITERANS (BUERGER DISEASE) Epidemiology and Etiology Clinical Findings Laboratory Findings Diagnosis Pathologic Findings Imaging Findings Conventional Management Michael R. Jaff Steven D eitelzweig 3 Venous Thromboembolic Diseases PATHOGENESIS HISTORY AND PHYSICAL EXAMINATION RISK FACTORS TABLE 3 - 1 RISK FACTORS FOR VENOUS THROMBOEMBOLISM DIAGNOSIS OF DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM Acute Pulmonary Embolism Chest Radiography Electrocardiography Arterial Blood Gas Analysis D - Dimer Testing Cardiac Troponin Brain Natriuretic Peptide Ventilation/Perfusion Scanning and Pulmonary Arteriography Spiral (Helical) Compute d Tomographic Scanning Magnetic Resonance Imaging Echocardiography Acute Deep Venous Thrombosis Compression Duplex Ultrasonography Contrast Venography Magnetic Resonance and Computed Tomographic Venographic Imaging TREATMENT OF VENOUS THROMBOEMBOLIC DISEASE Acute Venous Thromboembolic Disease Management Antithrombotic Agents Unfractionated Heparin (UFH). Low Molecular Weight Heparins. Factor Xa Inhibitors (Pentasaccharides). Thrombolytic Therapy Inferior Vena Cava Interruption CHRONIC VENOUS INSUFFICIENCY TABLE 3 - 2 THE CEAP CLASSIFICATION F OR CHRONIC VENOUS INSUFFICIENCY References Michael A. Bettmann 4 Angiography IMAGING EQUIPMENT TECHNIQUES AND TOOLS OF THE TRADE: NEEDLES, GUIDE WIRES, SHEATHS, CATHETERS, ANCILLARY MEDICATIONS TABLE 4 - 1 ASA CLASSIFICATION OF PATIENTS PRIOR TO SURGERY CONTRAST AGENTS References 5 Doppler Ultrasound in Abdominal Vascular Interventions Ajay K. Singh KIDNEY AORTA AND INFERIOR VENA CAVA TABLE 5 - 1 SPECTRAL DOPPLER TRACINGS TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT EVALUATION TABLE 5 - 2 DOPPLER CHANGES IN RENAL ARTERY ST ENOSIS TABLE 5 - 3 DOPPLER CRITERIA FOR COMPROMISED TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) AND/OR HEPATIC VEIN LUMEN LIVER TRANSPLANT FEMORAL ARTERY PSEUDOANEURYSM References Joshua L. Rosebrook Martin J. Lipton Frank J. Rybicki 6 Computed Tomographic Angiography IMAGING TECHNOLOGY Computed Tomography Fundamentals Gantry Rotation Times Multiple Source Te chnologies Electrocardiographic Gating Radiation Exposure Image Pro cessing Reconstruction Intervals Multiplanar Reformations Maximum - Intensity Projections Volume Reconstructions Intravenous Contrast Administration and Timing CLINICAL APPLICATIONS Introduction Aorta Head and Neck Computed Tomographic Angiography Pulmonary Art e rial Imaging Computed Tomographic Pulmonary Venography Abdominal and Pelvic Vasculature Mesenteric Computed Tomographic Angiography Renal Computed Tomographic Angiography Oncologic Computed Tomographic Angiography Peripheral Arterial Imaging Cardiac Imaging References 7 Magnetic Resonance Angiography Hale Ersoy Frank J. Rybicki Martin R. Prince MAGNETIC RESONANCE SYSTEM REQUIREMENTS TABLE 7 - 1 PULSE SEQUENCES PATIENT EVALUATION AND PREPARATION UNENHANCED MAGNETIC RESONANCE ANGIOGRAPHY TECHNIQUES Time - of - Flight MRA Phase Contrast Magnetic Resonance Angiography Steady - State Free Precession Imaging DIMENSIONAL CONTRAST - ENHANCED MRA Pulse Sequence Parameters I mage Features and k - Space Ordering Gadolinium Dose and Injection Rate for Three - Dimensional Contrast - Enhance Bolus Timing Thr ee - Dimensional Time - Resolved Imaging of Contrast Kinetics Magnetic Re MAGNETIC RESONANCE ANGIOGRAPHY OF THE ABDOMINAL AORTA AND ITS BRANCHES MAGNETIC RESONANCE ANGIOGRAPHY Time - Resolved Contrast - Enhanced Magnetic Resonance Angiography of the Foo Three - Dimensional Contrast - Enhanced Magnetic Resonance Angriography of t DATA PROCESSING AND PRESENTATION Digital Subtractio n Zero - Filling Reconstruction Techniques COMMON PITFALLS AND ARTIFACTS Metal Artifacts Pseudo - occlusion Ringing Artifact and Venous Contamination Aliasing (Wraparound) Artifact Magnetic Resonance Angiography Applications and Interpretation for Selected C Atheroscl erotic Disease of the Abdominal Aorta and Lower Extremity Arteries Abdominal Aorta Aneurysm Aortic Dissection Renal Artery Stenosis, Fibromuscular Dysplasia, and Renal Artery Aneurysm Accessory Renal Arteries Endovascular Stent Grafts: Pre - and Postintervention Evaluation Revascularization Procedures: Pre - and Postintervention Evaluation Presurgical Abdominal Vascular Roadmapping for Organ Transplantation Renal Transplant Evaluation Upper Extremity Magnetic Resonance Angiography and Surveillance of Dialysis G SUMMARY Appendix: Glossary of Terms GLOSSARY OF TERMS Aliasing artifact: This artifact occurs when the FOV is narrower than the body part that is bei the phase encode direction. Blooming artifact: Mild stenosis causes an acceleration of the laminar flow that results in brigh intensity with blooming artifact, causing one to overlook th e stenosis. Calibration scan: As one example, motion of the patient and/or the coil array between the sensit reference scan and the accelerated acquisition can lead to calibration errors reconstruction artifacts. k - Space (Fourier space): This is an array of data containing the digitized raw MR signals in a coded f temporary storage space for the real spatial information. When acquiring a 2D matrix (no. of phase encoding steps × no. of frequency encoding steps) determi size of the k - space, and a line of data corresponds to the digitized MR sign phase encoding step. By applying a second phase encoding axis to the k - space acquisition can be achieved. The 3D imaging is usually implemented with grad i pulse sequences. The advantages of 3D acquisition over 2D acquisition are the acquire thinner slices and the higher SNR. The disadvantages of 3D are longer ringing artifact, and aliasing. While the data at the center of the k - spac information, the peripheral k - space data contain the resolution information, the edge details. These signal data are transformed to an MR image by mathemat conversion, so - called Fourier transformation. Linear ( sequential) k - space acquisition: Conventional acquisition scheme, in which the central k - space data (low spat frequencies) are acquired in the middle of the scan. The slice encoding ( kz ) in a regular linear fashion along the phase encode direction ( ky ). Phase e from one end of the k - space and proceeds toward the other end. Centric k - space acquisition: Central k - space data are acquired at the beginning of the scan. The slice en accomplished in an alternating lin ear fashion along the phase encode directio encoding begins from the center of the k - space and proceeds toward the perip k - space above and below the ky = 0 line that is located in the center of Elliptical centric k - spac e acquisition: Central k - space data are acquired at the beginning of the scan. The k - spac encoded in a radial fashion along both the phase encode ( ky ) and the slice e directions beginning from the center of the k - space. This acquisition tech more compact central k - space data at the beginning of the scan during the ar plateau of the paramagnetic contrast agent. Magnetic susceptibility artifact: Bright buildup of a signal on one side of the signal void. Parallel im aging: Parallel imaging techniques require the use of multiple rf channels to transmi receive the MR signals. The entire image is reconstructed from an undersampled the phase encoding direction and thus the acquisition time decreases. By usi imaging techniques, the acquisition speed can be increased up to a maximum a factor equal to the number of coil array elements. With a typical acceleration every other line in the k - space is skipped, therefore the sc an time is decr 5 0%. This reduced acquisition time can also be traded for a higher spatial re expense of the SNR, which is inversely proportional to the square root of the factor times a geometry factor that is dete rmined by the coil design. where g is the geometry factor, which depends on the coil geometry, and R acceleration factor. Each receiver coil element in an array provides informati distinct portion of the imaging FOV based on the spatial distribution of its signal. Undersampling, i.e., the acquisition of a reduced number of serial pha steps, results in significant scan acceleration. Then multiple sets of undersa are used to form a single fully sa mpled data set that is required to acquire Partial Fourier acquisition: Number of excitation (NEX) is