Venous pathology is eight times more common in the lower extremities than arterial disease. However, the range of clinically important venous pathology in the lower extremities is relatively narrow, with thrombotic disorders, chronic occlusion, and valvular insufficiency comprising more than 95% of cases. There are an estimated 2,000,000 new cases of deep venous thrombosis (DVT) each year in the United States. Complications of venous thromboembolism are…

The lower-extremity arteries are a common site for vascular diseases. The legs have a relatively large muscle mass and a prominent role in basic daily activities. Lesions in this vascular bed produce troublesome symptoms at an early stage. Advanced disease frequently results in limb loss, although often the underlying systemic disease has the greatest impact on mortality. Interventions in the lower extremities are increasing in frequency…

The inferior vena cava (IVC) and its tributaries are frequent sites of vascular pathology. Diseases of organs that drain into the IVC may first become clinically apparent when the cava becomes involved. IVC imaging and intervention are prominent components of current interventional radiology practice. Normal Anatomy The IVC is formed by the confluence of the common iliac veins at the level of the L5 vertebral body…

The kidneys receive almost 15% of the cardiac output, although they account for less than 5% of the total body mass. Obstructive arterial diseases of the kidney have both functional (e.g., decreased creatinine clearance) and hormonal (angiotensin-mediated hypertension) implications. There are few organs that have such a complex response to vascular disease and potentially rewarding results with intervention. Anatomy Renal Arteries The kidneys are paired organs…

The arterial anatomy of the gastrointestinal tract is the most variable of all vascular beds. In addition, there is great diversity in the types of diseases that involve the gastrointestinal arteries and organs. Many visceral disorders, vascular and otherwise, can be treated effectively with endovascular techniques. As a result, visceral arterial diagnosis and intervention continues to be an important aspect of interventional radiologic practice. Normal Anatomy…

The abdominal aorta and pelvic arteries supply blood to all of the structures below the diaphragm. The pathologic processes that involve these vessels are varied and have major morbidity. This chapter covers aortic-iliac arterial diseases, including the male and female reproductive organs. The renal and mesenteric arteries are discussed in separate chapters. Normal and Variant Anatomy Abdominal Aorta The abdominal aorta begins at the level of…

Thoracic aortic diseases can be among the most challenging vascular problems to manage. The organs that are supplied directly by this segment of aorta (heart, brain, and spine) are intolerant of ischemia for more than a few minutes. Flow disturbances in the aorta impact the entire body. Surgical access requires a thoracotomy or sternotomy, and often cardiopulmonary bypass. The high morbidity of open repair of thoracic…

The lungs receive blood from both ventricles—the entire volume of the right heart and also a small fraction of blood from the left heart (via the bronchial arteries). Functionally, the lungs have two roles: oxygenation of venous blood and filtration of the systemic venous blood. Pulmonary vascular pathology, imaging, and intervention frequently have a clinical impact that extends far beyond the lungs. Anatomy The pulmonary arterial…

The veins of the neck, arms, and chest are visited frequently by interventional radiologists. Placement of long-term central venous access catheters is a common yet essential procedure. The upper extremity veins are of critical importance for dialysis patients, whether they are managed with venous catheters or surgically created access. Upper extremity and central venous occlusions can cause severe symptoms, and are best managed with catheter-based techniques.…

Arterial disease is diagnosed less often in the upper than in the lower extremities, but unusual pathologies such as vasculitis, entrapment syndromes, and trauma are more common. This makes upper extremity arterial diagnosis challenging and intervention interesting. Normal and Variant Anatomy The arterial blood supply of the upper extremities begins with the subclavian artery on the left and the brachiocephalic (also known as the innominate) artery…

Percutaneous vascular interventions can be grouped into those that improve or occlude the lumen and those that implant or remove things. The fundamentals of each of these interventions are the same across most of the vascular system. This chapter describes the basic principles of how to perform vascular interventions. The results of specific interventions are discussed in the appropriate anatomic chapters. The history of percutaneous catheter-based…

The development of modern angiography was enabled by one simple technique: the percutaneous introduction of devices into a blood vessel over a wire guide ( Fig. 2-1 ). Described by Sven Ivan Seldinger in 1953, this elegant innovation (now known by Seldinger’s name) eliminated the need for surgical exposure of a blood vessel before catheterization, thus allowing the transfer of angiography from the operating room to…

Blood vessels are, in the simplest of terms, the plumbing of the body. Problems arise when blood flow is diminished, excessive, in the wrong direction, or when leaks occur ( Table 1-1 ). In reality, blood vessels are complex organs within other complex organs. The degree of vascular disease that can be tolerated before symptoms occur varies with the type of blood vessel, the nature and…