Endovascular Interventions

Jose M. Wiley, MD, MPH, Sidney W. and Marilyn S. Lassen Chair in Cardiovascular Medicine, Professor of Medicine, Chief, Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.Cristina Sanina, MD, Interventional Cardiology Fellow, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.George D. Dangas, MD, PhD, Professor of Medicine-Cardiology and Vascular Surgery, Director of Cardiovascular Innovation, Icahn School of Medicine at Mount Sinai, New York, NY, USA.Prakash Krishnan, MD, Professor of Medicine-Cardiology, Director of Endovascular Services, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

• List of Contributors xiv1 Innominate & Carotid Artery Intervention in High- Risk Patients 1Tyrone J. CollinsIntroduction 1Innominate Interventions in High-Risk Patients 2Catheter-based Therapy for An Innominate (Brachiocephalic) Stenosis 2Carotid Artery Intervention in High-Risk Patients 5Endovascular Treatment of A Carotid Stenosis 5Catheter-based Therapy for Carotid Stenosis 6Conclusions 10References 132 Subclavian Artery Intervention: Catheter- Based Therapy 15Saadat Shariff, Isabella Alviz, Cornelia Rivera, Michelle Cortorreal, and Tyrone J. CollinsIntroduction 15Endovascular Versus Open Surgical Revascularization 16Endovascular Revascularization Techniques 16Conclusion 18References 193 Vertebral Artery Intervention: Catheter- Based Therapy 20Tamunoinemi Bob- Manuel and James S. JenkinsIntroduction 20Preprocedural Considerations 21Step 1. Procedural Planning with Diagnostic Angiography 21Step 2. Vertebral Artery Intervention (Percutaneous Transluminal Angioplasty) 24Step 3. Vertebral Artery Intervention (Stenting) 25Management of Potential Complications 27Postprocedural Care 28References 294 Endovascular Repair of Thoracic Aortic Aneurysms: Catheter-Based Therapy 30John Denesopolis, Patricia Yau, and Aksim G. RiveraIntroduction 30Relevant Anatomy 31Aortic Anatomy 31Crawford Classification for TAA/TAAA 31Landing Zones 31Implication of Aortic Anatomy on Spinal Perfusion 32Indications/Contraindications to Procedure 33Indications 33Asymptomatic TAA/TAAA 33Blunt Aortic Injury (BAI) 33Acute Aortic Syndromes 33Contraindications/Caveats 34Available Endografts 34Preoperative Evaluation 40Positioning and Intraoperative Monitoring Needs 41Procedural Steps 42Postoperative Course/Surveillance 46Monitored Setting 46Spinal Drain 46Blood Pressure Control 47Arm Ischemia Symptoms 47CTA Surveillance/Endoleak Types 48References 495 Endovascular Abdominal Aortic Aneurysm Repair (EVAR) 50John Futchko, Katie MacCallum, and Aksim G. RiveraIntroduction 50Patient Selection 50Preoperative Imaging and Measurements 51Graft Selection 52Graft Sizing 52Neck Length 53Neck Diameter 53Branch Vessels 54Aortic Length Measurements 54Step 1. Vascular Access 55Percutaneous 55Open 56Iliac Disease and Conduits 56Step 2. Imaging 57Equipment 57Neck Angulation 58Renal Arteries 58Step 3. Wires 58Step 4. Delivery and Deployment 59Main Body 59Graft Orientation 59Proximal Landing Zone 59Contralateral Gate Cannulation 60Limb Deployment 62Completion Angiogram 62Step 5. Troubleshooting 63Endoleaks 63Inadvertent Coverage of Renal Arteries 65Iliac Artery Considerations 65Conclusion 66References 666 Severe Renal Artery Stenosis: How to Intervene 68Mohammad Hashim Mustehsan, Cristina Sanina, and Jose D. TafurIntroduction 68Background and Clinical Significance 69Epidemiology 69Clinical Manifestations 69Patient Selection: Who to Screen for RAS 70RAS Assessment 70Noninvasive RAS Assessment 70Invasive RAS Assessment 72Indications for Revascularization 72Intervention 74References 767 Mesenteric Ischemia: Chronic and Acute Management 78David A. HirschlIntroduction 78Chronic Mesenteric Ischemia 78Step 1. Vascular Access and Sheath Selection 79Step 2. Diagnostic Angiography 80Step 3. Vessel Selection 81Step 4. Selective Angiography 81Step 5. Placement of a Working Wire 82Step 6. Stent Placement 82Step 7. Posttreatment Angiography 83Step 8. Revision 83Complications 84Follow-Up and Outcomes 85Acute Mesenteric Ischemia 85Step 1. Arterial Vascular Access and Sheath Selection 87Step 2. Selection of the SMA 87Step 3. Aspiration Embolectomy 88Step 4. Angiogram 89Step 5. Thrombolysis 89Step 6. Infusion and Follow-Up 91Mesenteric Venous Thrombosis 91Follow-Up and Outcomes 91References 928 Aorto- Iliac Interventions 95Michael S. Segal, Sameh Elrabie, and Rajesh K. MalikIntroduction 95Preoperative Workup 95Noninvasive Studies 96Computed Tomographic Angiography 96Ultrasound Duplex 96Magnetic Resonance Angiography 97Invasive Imaging 97Angiography 97Classification of Lesion and Planning of Intervention 97TransAtlantic InterSociety Consensus II Classification (TASC II) 97Planning for the Intervention 97Step 1. Patient Factors 97Step 2. Vascular Access 98Step 3. Crossing the Lesion 99Step 4. Intervention 100Step 5. Closure 102Step 6. Complications 103Rupture 103Embolization 103Access Complications 103Cases 104Case 1 104Case 2 104References 1079 Femoropopliteal Arterial Interventions in the Claudicant 108Sahil A. Parikh, Joseph J. Ingrassia, and Matthew T. FinnIntroduction 108Patient Evaluation and Indications for Treatment of Femoropopliteal Arterial Pathology 108Indications for Revascularization Femoropopliteal Claudication 109Vascular Imaging in Endovascular Treatment 109Contrast Angiography 109CO2 Angiography 110Steps to CO2 Angiography 110Extravascular and Intravascular Ultrasound 110Steps to IVUS Use 111Vascular Access and Lesion Crossing Techniques 113Steps for Crossover “Up and Over” technique 113Radial 114Tibio-Pedal Approach 115Antegrade Femoral Access 115Working Wire Size and Changing Between Systems 116Lesion Preparation 117Plain Old Balloon Angioplasty 117Focal Force Balloons for Optimal Lumen Gain 120Drug-Coated Balloons 120Atherectomy 121Laser 121Excimer Laser Use Steps 122Rotational Atherectomy 123Rotational Atherectomy Steps 124Directional Atherectomy 124Orbital Atherectomy 126Embolic Protection 127Troubleshooting Embolic Protection Devices 130Troubleshooting a “Full” Filter 130Distal Embolization or “No Reflow” 130Stenting for Femoropopliteal Disease 131Bare-Metal Stents 131Drug-Eluting Stents (DES) 131Alternative Stent Technologies 132Covered Stents 132Tacks 132Final Efficacy Assessment 132Conclusions 132Acknowledgments 133References 13310 Tibial Interventions in Patients with Critical Limb- Threatening Ischemia 138Raman Sharma, Roberto Cerrud- Rodriguez, and Prakash KrishnanIntroduction 138Indications and Goals of Endovascular Revascularization 138Considerations for Access Site 139Single Versus Multitibial Artery Revascularization 140Antegrade Tibial Artery Intervention 141Retrograde Access for Retrograde Lesion Crossing and Wire Externalization with Antegrade Revascularization 143TAMI Retrograde Revascularization 144Reentry and Externalization Devices 146Deep Venous Arterialization (DVA) 146References 14711 Acute Limb Ischemia: Endovascular Approach 151Shunsuke Aoi and Amit M. KakkarIntroduction 151Procedure Planning, Equipment, and Considerations 151References 16112 Pedal Reconstruction 162Ehrin Armstrong and Rory BrinkerIntroduction 162Pedal Arch Reconstruction 162Indications for Pedal Revascularization 166Technical Considerations 166Access 166Lesion Crossing 167CTO Lesion Subtype 167Special Considerations of the Pedal Intervention 167Troubleshooting 169Summary 169References 17313 Endovascular Management of Access Site Complications 175Manaf Assafin, Robert Pyo, Pedro Cox- Alomar, and Miguel Alvarez- VillelaIntroduction 175Complications Related to Common Femoral Artery Access 176Access Site Bleeding 176Crossover Technique 179Balloon Tamponade, Endovascular Coiling, and Covered Stent Placement 179Femoral Pseudoaneurysms 180Ultrasound-Guided Compression Repair 182Ultrasound-Guided Thrombin Injection 183Covered Stent Placement 184Other Techniques 184Arteriovenous Fistulas 185Vascular Closure Device Related Complications 186Radial Artery Related Complications 187Radial Artery Spasm 188Radial Artery Occlusion 189Bleeding Complications 190References 19114 Acute Deep Vein Thrombosis 196Vishal Kapur and Sagar GoyalIntroduction 196Treatment Strategy 197Initial and Long-Term Treatment of VTE 200Oral Anticoagulants 200Thrombolysis 200Vena Cava Filters 201Compression Stockings 202Cancer-Associated VTE 202Isolated Distal DVT 202Extended Treatment 202Unprovoked VTE 202Oral Anticoagulants 203Conclusion 203References 20415 Lower- Extremity Venous Stenting 207Asma Khaliq, Sandrine Labrune, and Cristina SaninaIntroduction 207Follow-Up 213References 21416 Intervention for Pulmonary Embolism 215Seth I. Sokol, Wissam A. Jaber, and Yosef GolowaIntroduction 215Pulmonary Angiography 215Vascular Access 215Injection and X-Ray Detector Positioning 216Catheter-Directed Thrombolysis 216EKOS™ Catheter-Directed Thrombolysis 216Preparation of System 217Access 218Mechanical Disruption 220Catheter Fragmentation of Clot 220Large Catheter Aspiration 220FlowTriever™ 220Access 221Penumbra 225AngioVac 227Patient Selection and Central Venous Access 227AngioVac Circuit Setup and Thrombus Aspiration 229AngioVac for Pulmonary Embolus 231AngioVac for Clot-in-Transit 232AngioVac for Right Heart Vegetation 232Patient Selection and Approach 232Technique 233References 23417 Catheter- Based Therapy for Varicose Veins 236Juan Terre and Nelson ChavarriaIntroduction 236Thermal Techniques 236Radiofrequency (RF) Ablation 237Follow-Up 239Endovenous Laser Ablation (EVLA) 239Nonthermal Techniques 240Mechanico-Chemical Ablation (MOCA) 241Limitations 242Summary 243References 243Index 245