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.

ENDOVASCULAR INTERVENTIONS
 
A practical and systematic approach to current endovascular surgical techniques
 
An increasingly popular alternative to open vascular surgery, endovascular intervention offers many advantages, including reduced patient discomfort, smaller incisions, shorter recovery time, and decreased risk of adverse complications. Practitioners and trainees alike require expert guidance on current technologies and up-to-date techniques. Endovascular Interventions provides clinicians with an easy-to-follow guide for minimally invasive treatment of vascular disease. This invaluable resource delivers concise and accurate instructions on a wide range of endovascular interventions, including aorta, renal and mesenteric interventions, lower extremity interventions, venous interventions, and supra-aortic interventions in high-risk patients.
 
Sequential phases of skill development broaden the reader's abilities as they progress through each chapter, supplying step-by-step instructions on when each procedure should be used and how it can be safely and effectively performed. This book offers a complete reference to essential techniques and procedures, suitable for both novice and experienced vascular surgeons, cardiologists, and radiologists. Endovascular Interventions also:
* Reinforces comprehension of each procedure with templated chapters, equipment lists and boxed key learning points
* Provides full-color clinical images and detailed illustrations to demonstrate surgical procedures
* Presents authoritative coverage of modern endovascular technologies and techniques
* Written by a team of respected experts and practicing surgeons from internationally recognized hospitals and universities
 
Suitable for varying skill levels, Endovascular Interventions is a precise, accessible instruction manual for safe and effective endovascular intervention, helping practicing clinicians sharpen their existing abilities and keep pace with the latest surgical technologies while instructing trainees on this innovative approach to vascular surgery.

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 Ma