Endovascular Interventions

List of Contributors xiv 1 Innominate & Carotid Artery Intervention in High- Risk Patients 1 Tyrone J. Collins Introduction 1 Innominate Interventions in High-Risk Patients 2 Catheter-based Therapy for An Innominate (Brachiocephalic) Stenosis 2 Carotid Artery Intervention in High-Risk Patients 5 Endovascular Treatment of A Carotid Stenosis 5 Catheter-based Therapy for Carotid Stenosis 6 Conclusions 10 References 13 2 Subclavian Artery Intervention: Catheter- Based Therapy 15 Saadat Shariff, Isabella Alviz, Cornelia Rivera, Michelle Cortorreal, and Tyrone J. Collins Introduction 15 Endovascular Versus Open Surgical Revascularization 16 Endovascular Revascularization Techniques 16 Conclusion 18 References 19 3 Vertebral Artery Intervention: Catheter- Based Therapy 20 Tamunoinemi Bob- Manuel and James S. Jenkins Introduction 20 Preprocedural Considerations 21 Step 1. Procedural Planning with Diagnostic Angiography 21 Step 2. Vertebral Artery Intervention (Percutaneous Transluminal Angioplasty) 24 Step 3. Vertebral Artery Intervention (Stenting) 25 Management of Potential Complications 27 Postprocedural Care 28 References 29 4 Endovascular Repair of Thoracic Aortic Aneurysms: Catheter-Based Therapy 30 John Denesopolis, Patricia Yau, and Aksim G. Rivera Introduction 30 Relevant Anatomy 31 Aortic Anatomy 31 Crawford Classification for TAA/TAAA 31 Landing Zones 31 Implication of Aortic Anatomy on Spinal Perfusion 32 Indications/Contraindications to Procedure 33 Indications 33 Asymptomatic TAA/TAAA 33 Blunt Aortic Injury (BAI) 33 Acute Aortic Syndromes 33 Contraindications/Caveats 34 Available Endografts 34 Preoperative Evaluation 40 Positioning and Intraoperative Monitoring Needs 41 Procedural Steps 42 Postoperative Course/Surveillance 46 Monitored Setting 46 Spinal Drain 46 Blood Pressure Control 47 Arm Ischemia Symptoms 47 CTA Surveillance/Endoleak Types 48 References 49 5 Endovascular Abdominal Aortic Aneurysm Repair (EVAR) 50 John Futchko, Katie MacCallum, and Aksim G. Rivera Introduction 50 Patient Selection 50 Preoperative Imaging and Measurements 51 Graft Selection 52 Graft Sizing 52 Neck Length 53 Neck Diameter 53 Branch Vessels 54 Aortic Length Measurements 54 Step 1. Vascular Access 55 Percutaneous 55 Open 56 Iliac Disease and Conduits 56 Step 2. Imaging 57 Equipment 57 Neck Angulation 58 Renal Arteries 58 Step 3. Wires 58 Step 4. Delivery and Deployment 59 Main Body 59 Graft Orientation 59 Proximal Landing Zone 59 Contralateral Gate Cannulation 60 Limb Deployment 62 Completion Angiogram 62 Step 5. Troubleshooting 63 Endoleaks 63 Inadvertent Coverage of Renal Arteries 65 Iliac Artery Considerations 65 Conclusion 66 References 66 6 Severe Renal Artery Stenosis: How to Intervene 68 Mohammad Hashim Mustehsan, Cristina Sanina, and Jose D. Tafur Introduction 68 Background and Clinical Significance 69 Epidemiology 69 Clinical Manifestations 69 Patient Selection: Who to Screen for RAS 70 RAS Assessment 70 Noninvasive RAS Assessment 70 Invasive RAS Assessment 72 Indications for Revascularization 72 Intervention 74 References 76 7 Mesenteric Ischemia: Chronic and Acute Management 78 David A. Hirschl Introduction 78 Chronic Mesenteric Ischemia 78 Step 1. Vascular Access and Sheath Selection 79 Step 2. Diagnostic Angiography 80 Step 3. Vessel Selection 81 Step 4. Selective Angiography 81 Step 5. Placement of a Working Wire 82 Step 6. Stent Placement 82 Step 7. Posttreatment Angiography 83 Step 8. Revision 83 Complications 84 Follow-Up and Outcomes 85 Acute Mesenteric Ischemia 85 Step 1. Arterial Vascular Access and Sheath Selection 87 Step 2. Selection of the SMA 87 Step 3. Aspiration Embolectomy 88 Step 4. Angiogram 89 Step 5. Thrombolysis 89 Step 6. Infusion and Follow-Up 91 Mesenteric Venous Thrombosis 91 Follow-Up and Outcomes 91 References 92 8 Aorto- Iliac Interventions 95 Michael S. Segal, Sameh Elrabie, and Rajesh K. Malik Introduction 95 Preoperative Workup 95 Noninvasive Studies 96 Computed Tomographic Angiography 96 Ultrasound Duplex 96 Magnetic Resonance Angiography 97 Invasive Imaging 97 Angiography 97 Classification of Lesion and Planning of Intervention 97 TransAtlantic InterSociety Consensus II Classification (TASC II) 97 Planning for the Intervention 97 Step 1. Patient Factors 97 Step 2. Vascular Access 98 Step 3. Crossing the Lesion 99 Step 4. Intervention 100 Step 5. Closure 102 Step 6. Complications 103 Rupture 103 Embolization 103 Access Complications 103 Cases 104 Case 1 104 Case 2 104 References 107 9 Femoropopliteal Arterial Interventions in the Claudicant 108 Sahil A. Parikh, Joseph J. Ingrassia, and Matthew T. Finn Introduction 108 Patient Evaluation and Indications for Treatment of Femoropopliteal Arterial Pathology 108 Indications for Revascularization Femoropopliteal Claudication 109 Vascular Imaging in Endovascular Treatment 109 Contrast Angiography 109 CO2 Angiography 110 Steps to CO2 Angiography 110 Extravascular and Intravascular Ultrasound 110 Steps to IVUS Use 111 Vascular Access and Lesion Crossing Techniques 113 Steps for Crossover “Up and Over” technique 113 Radial 114 Tibio-Pedal Approach 115 Antegrade Femoral Access 115 Working Wire Size and Changing Between Systems 116 Lesion Preparation 117 Plain Old Balloon Angioplasty 117 Focal Force Balloons for Optimal Lumen Gain 120 Drug-Coated Balloons 120 Atherectomy 121 Laser 121 Excimer Laser Use Steps 122 Rotational Atherectomy 123 Rotational Atherectomy Steps 124 Directional Atherectomy 124 Orbital Atherectomy 126 Embolic Protection 127 Troubleshooting Embolic Protection Devices 130 Troubleshooting a “Full” Filter 130 Distal Embolization or “No Reflow” 130 Stenting for Femoropopliteal Disease 131 Bare-Metal Stents 131 Drug-Eluting Stents (DES) 131 Alternative Stent Technologies 132 Covered Stents 132 Tacks 132 Final Efficacy Assessment 132 Conclusions 132 Acknowledgments 133 References 133 10 Tibial Interventions in Patients with Critical Limb- Threatening Ischemia 138 Raman Sharma, Roberto Cerrud- Rodriguez, and Prakash Krishnan Introduction 138 Indications and Goals of Endovascular Revascularization 138 Considerations for Access Site 139 Single Versus Multitibial Artery Revascularization 140 Antegrade Tibial Artery Intervention 141 Retrograde Access for Retrograde Lesion Crossing and Wire Externalization with Antegrade Revascularization 143 TAMI Retrograde Revascularization 144 Reentry and Externalization Devices 146 Deep Venous Arterialization (DVA) 146 References 147 11 Acute Limb Ischemia: Endovascular Approach 151 Shunsuke Aoi and Amit M. Kakkar Introduction 151 Procedure Planning, Equipment, and Considerations 151 References 161 12 Pedal Reconstruction 162 Ehrin Armstrong and Rory Brinker Introduction 162 Pedal Arch Reconstruction 162 Indications for Pedal Revascularization 166 Technical Considerations 166 Access 166 Lesion Crossing 167 CTO Lesion Subtype 167 Special Considerations of the Pedal Intervention 167 Troubleshooting 169 Summary 169 References 173 13 Endovascular Management of Access Site Complications 175 Manaf Assafin, Robert Pyo, Pedro Cox- Alomar, and Miguel Alvarez- Villela Introduction 175 Complications Related to Common Femoral Artery Access 176 Access Site Bleeding 176 Crossover Technique 179 Balloon Tamponade, Endovascular Coiling, and Covered Stent Placement 179 Femoral Pseudoaneurysms 180 Ultrasound-Guided Compression Repair 182 Ultrasound-Guided Thrombin Injection 183 Covered Stent Placement 184 Other Techniques 184 Arteriovenous Fistulas 185 Vascular Closure Device Related Complications 186 Radial Artery Related Complications 187 Radial Artery Spasm 188 Radial Artery Occlusion 189 Bleeding Complications 190 References 191 14 Acute Deep Vein Thrombosis 196 Vishal Kapur and Sagar Goyal Introduction 196 Treatment Strategy 197 Initial and Long-Term Treatment of VTE 200 Oral Anticoagulants 200 Thrombolysis 200 Vena Cava Filters 201 Compression Stockings 202 Cancer-Associated VTE 202 Isolated Distal DVT 202 Extended Treatment 202 Unprovoked VTE 202 Oral Anticoagulants 203 Conclusion 203 References 204 15 Lower- Extremity Venous Stenting 207 Asma Khaliq, Sandrine Labrune, and Cristina Sanina Introduction 207 Follow-Up 213 References 214 16 Intervention for Pulmonary Embolism 215 Seth I. Sokol, Wissam A. Jaber, and Yosef Golowa Introduction 215 Pulmonary Angiography 215 Vascular Access 215 Injection and X-Ray Detector Positioning 216 Catheter-Directed Thrombolysis 216 EKOS™ Catheter-Directed Thrombolysis 216 Preparation of System 217 Access 218 Mechanical Disruption 220 Catheter Fragmentation of Clot 220 Large Catheter Aspiration 220 FlowTriever™ 220 Access 221 Penumbra 225 AngioVac 227 Patient Selection and Central Venous Access 227 AngioVac Circuit Setup and Thrombus Aspiration 229 AngioVac for Pulmonary Embolus 231 AngioVac for Clot-in-Transit 232 AngioVac for Right Heart Vegetation 232 Patient Selection and Approach 232 Technique 233 References 234 17 Catheter- Based Therapy for Varicose Veins 236 Juan Terre and Nelson Chavarria Introduction 236 Thermal Techniques 236 Radiofrequency (RF) Ablation 237 Follow-Up 239 Endovenous Laser Ablation (EVLA) 239 Nonthermal Techniques 240 Mechanico-Chemical Ablation (MOCA) 241 Limitations 242 Summary 243 References 243 Index 245