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Revascularization: Femoropopliteal

Acknowledgment The authors express their gratitude to Dr. Mahmood Razavi for his insight and support in writing this chapter. Femoropopliteal occlusive disease is present in a significant proportion of older patients, with about 20% of men and 17% of women older than 55 living with ankle-brachial indices (ABI) under 0.9. A smaller percentage (3%–7%) present with symptoms of intermittent claudication (IC) between the ages of 60…

Revascularization: Aortoiliac

Epidemiology Aortoiliac occlusive disease (AIOD) refers to stenotic or occlusive disease of the infrarenal aorta and iliac arteries, and is a significant cause of peripheral arterial disease (PAD). Epidemiologic studies reporting on PAD include both AIOD and infrainguinal arterial disease, with most patients having multilevel disease. Although more than half of patients with PAD can have a component of AIOD, femoropopliteal and infrageniculate disease are more…

Revascularization: Upper Extremity

Most of this chapter discusses management of occlusive disease of the subclavian and brachiocephalic arteries. Treatment of various conditions such as thoracic outlet syndrome and more distal lesions is also covered. Subclavian and Brachiocephalic Disease Symptomatic chronic ischemia of the upper extremity is commonly encountered in clinical vascular practice, comprising about 17% of symptomatic extracranial cerebrovascular disease ; 80% occurs in males. In contradistinction to chronic…

Acute Lower Extremity Ischemia

Acute lower extremity ischemia (ALI) is a serious condition with substantial morbidity and mortality. ALI refers to recent onset of lower extremity pain; long-standing lower extremity ischemia is dealt with elsewhere in this book. If ALI is severe and prolonged, the patient may develop progressive paresthesia, motor dysfunction, and eventually tissue infarction in the lower extremity. The rapidity plus severity of the onset of symptoms depend…

Vascular Anatomy of the Upper Extremity

Imaging Modalities of The Upper Extremity Imaging of the arterial and venous systems is an important component of the evaluation in many vascular disorders involving the upper extremity. This chapter provides a brief overview of vascular imaging, including ultrasonography (US), computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography. Real-time grayscale and color Doppler US is used to evaluate both the arterial and…

Closure Devices

After an arteriography or intervention, the access site must be effectively managed. The planning for access site control starts before gaining access. The operator must make sure that (1) the accessed artery is one that can be compressed, (2) the artery is of adequate size to allow manual compression versus the use of closure devices, and (3) the coagulation status has been taken into consideration. In…

Principles of Vascular Access

Invasive vascular imaging is based on the technique described by Sven Ivar Seldinger in 1953 ( Fig. 7.1 ). 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 the radiology department. Virtually all vascular invasive procedures and devices use this technique. Open full size…

Pharmacologic Agents Used in Image-Guided Interventions

As the need for interventional radiologic procedures continues to grow, there is increased interest in better periprocedural pain control. Interventional radiology (IR) plays a significant role in pain management, therapeutically (for chronic pain) and supplementally (for pain caused by intervention). Pain management is essential as IR practice becomes more invasive, readily available, and widely offered to individuals at high risk for both operative procedures and anesthesia.…

Radiation Safety and Protection in the Interventional Fluoroscopy Environment

The x-ray equipment available to perform imaged-guided interventions has accelerated in technical capability, allowing increasingly complex procedures to be performed. Consequently, procedures tend to be longer and the dose to the patient higher. The interventionalist is positioned closest to the anatomy being imaged and receives the majority of their exposure from x-ray radiation scattering from the patient. Typically, measures that reduce the dose to the patient…

Treatment of Medical Emergencies

The interventional suite plays host to a wide variety of patient types and procedures. Some of the patients who arrive in the suite are in good baseline health, others are severely ill. In either case, patients can experience a life-threatening emergency during any interventional procedure. Unlike the operating room, where an anesthesiologist is routinely present to handle any non–procedure-related emergency, the level of support in the…

Clinical Vascular Examination

“It is much more important to know what sort of patient has a disease than what sort of a disease a patient has.” William Osler 1849–1919 Symptoms relating to vascular insufficiency are common complaints among patients presenting to emergency departments in westernized nations. Unfortunately, vascular insufficiency is often misdiagnosed due to variability in presentation and overlap with other diseases. A careful and thorough clinical examination is…

Patient Preparation and Informed Consent

Given the rapid expansion of interventional radiology (IR) and wide adoption of its treatments in medical guidelines, there is increasing patient and clinician expectation for IR teams that can provide high-quality treatments in a safe and effective manner. Delivering this advanced level of care is contingent on safe and reproducible processes and pathways for IR clinicians and other team members. Furthermore, a successful interventional radiologist must…

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A Brief History of Image-Guided Therapy

Acknowledgment The authors would like to thank Shundra Dinkins, Toni Acfalle, and Dana Murphy for their expertise in preparation of this manuscript. The authors also would like to acknowledge Jozef M. Brozyna, Suma Chandra, Hank K. Chen, Gina D. Tran, and Dimitri A. Gagarin for their contributions to this chapter, which were published in previous editions of this book. Historical Highlights of Endovascular Therapy British dentist…

Premature Ovarian Failure

Synonyms/Description Early menopause Ovarian insufficiency Etiology Premature ovarian failure (POF) occurs in women under the age of 40 and is characterized by amenorrhea, hypoestrogenism, and elevated gonadotropins. It affects an estimated 1% of women, including 0.1% under age 30. Most cases of POF are idiopathic. There are theories that POF is the result of follicular depletion, accelerated follicular atresia, or other follicular dysfunction. There are rare…

Polyps, Endometrial

Synonyms/Description None Etiology Endometrial polyps are relatively common intrauterine lesions that are typically benign and often asymptomatic. Hyperplastic/proliferative polyp is the most common type of polyp; it represents overgrowth of endometrial glands and stroma. Clinically they can be associated with postmenopausal and abnormal uterine bleeding as well as infertility. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become…

Polycystic Ovaries

Synonyms/Description Polycystic ovarian syndrome (PCOS) Stein-Leventhal syndrome Etiology Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, occurring in 4% to 6% of the female population. PCOS is a complex of symptoms often associated with obesity, type 2 diabetes, metabolic syndrome, and infertility. Historically there had been a lack of consensus regarding the features that define PCOS. In 2003 a…

Pelvic Kidney

Synonyms/Description Ectopic location of kidney—normal variant Etiology The incidence of pelvic kidney is reported as being between 1 in 2200 and 1 in 3000. The normal human kidney migrates to the renal fossa from a pelvic location early in embryonic development, typically before the 10th week of gestation. The congenital failure of this migration results in a pelvic kidney. Although a pelvic kidney is defined as…

Pelvic Congestion Syndrome

Synonyms/Description Varicose veins of the pelvis Etiology Although the etiology of pelvic congestion syndrome is unclear, it appears that gross dilatation, valve incompetence, and reflux of the ovarian veins may be causal. Anatomic and/or hormonal factors may lead to insufficiency of the ovarian and/or internal iliac veins, resulting in peri-ovarian pelvic varicosities. Such tubo-ovarian varicoceles may be the female equivalent of testicular varicoceles. You’re Reading a…