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Cerebral Functional Anatomy and Rapid Neurologic Examination

The role of interventional neuroradiology has expanded in the past decades as the safety of cerebral angiogram has improved. Not only is the use of diagnostic angiography increasing, the role of intervention in neurologic injury has increased dramatically as well. Angiography is not solely a means of diagnosis; an increasing number of interventions are now being used to treat injuries such as acute stroke, intracranial stenosis,…

Arterial Anatomy of the Spine and Spinal Cord

Spinal digital subtraction angiography (SpDSA) is the gold standard imaging modality for evaluating vascular anomalies of the spine and spinal cord. Endovascular treatment of spinal vascular lesions was pioneered in the late 1960s shortly after the introduction of selective spinal angiography itself. Performing diagnostic and therapeutic SpDSA requires a solid understanding of the relevant vascular anatomy. This chapter offers an introduction to the arterial anatomy of…

Craniocervical Vascular Anatomy

Craniocervical Arteries Cerebral blood flow is provided by the paired internal carotid arteries (ICAs) and vertebral arteries (VAs). The intradural branches of the ICA supply the anterior cerebral circulation (i.e., cerebral hemispheres, including basal ganglia) and the orbit; these branches include the ophthalmic artery (OA), posterior communicating artery (PComA), anterior choroidal artery (AChoA), and anterior and middle cerebral arteries (ACA, MCA). The vertebrobasilar system, formed by…

Percutaneous Interventions for Acute Pulmonary Embolism

Acute pulmonary embolism (PE) remains a global health problem and represents a life-threatening manifestation along the spectrum of venous thromboembolism (VTE). Although the true incidence of PE is unclear, it is recognized as a significant cause of morbidity and mortality in hospitalized patients. In the United States alone, it is estimated that there are 600,000 cases per year, and more than 300,000 people die every year…

Pulmonary Arteriovenous Malformations: Diagnosis and Management

Pulmonary arteriovenous malformations (PAVMs) consist of varyingly sized dilated vascular channels connecting pulmonary arteries and veins directly with no intervening capillary bed. These are generally congenital and usually found in patients with hereditary hemorrhagic telangiectasia (HHT), although the PAVM is also often applied to acquired arteriovenous fistulae. These shunts are frequently asymptomatic but paradoxical embolization and hemorrhagic rupture can produce sudden severe consequences, problems that can…

Embolization for Hemoptysis

Massive hemoptysis, defined as expectoration of 300 mL of blood or more within a 24-hour period, is a life-threatening condition. The most common mechanism of death from massive hemoptysis is asphyxiation, not exsanguination. Asphyxiation is caused by a reduction of respiratory surface area for oxygen exchange. Over the years, emergency management of massive hemoptysis has changed. Medical treatment consisting of blood replacement, emergency bronchoscopy, and insertion…

Management of Acute Aortic Syndrome

Acute aortic syndrome (AAS) is a modern term used to describe a constellation of potentially life-threatening aortic conditions, generally caused by disruption of or injury to the medial layer of the aortic wall. It can involve the thoracic or the abdominal aorta, or, in some cases, both. AAS is usually characterized by acute onset of severe chest/back/abdominal pain and may be accompanied by symptoms attributable to…

Management of Thoracic Aortic Aneurysm

Thoracic aortic aneurysms (TAAs) are potentially lethal due to rupture or dissection. They represent the 19th most common cause of death in the United States. Only about 5% of patients present with symptoms before an acute event occurs, and for the other 95% the first “symptom” is often death. For this reason, the diagnosis is often only made at the time of aortic dissection or death.…

Vascular Anatomy of the Thorax, Including the Heart

Systemic Arteries The thoracic aorta is conventionally described as consisting of three segments: the ascending aorta , aortic arch , and descending aorta . Conceptually, they may be regarded as the segmental supply to the heart, to the head, neck, and upper limbs, and to the thorax, respectively. Ascending Aorta and Its Branches The ascending aorta arises from the aortic orifice, which in life is closed…

Prostate Artery Embolization

Benign prostatic hypertrophy (BPH) is the most common benign neoplasm in men, affecting more than 50% of men aged 60–69 years and as many as 90% aged 70–89 years. Prostate artery embolization (PAE) has emerged as a promising treatment modality for lower urinary tract symptoms (LUTS) in men secondary to BPH since 2000, when its therapeutic effects were first documented in a case report. Since then,…

Treatment of High-Flow Priapism and Erectile Dysfunction

Superselective embolization of terminal branches of the male internal pudendal artery is a highly successful procedure in the treatment of high-flow arterial priapism. Vascular imaging and treatment in patients with erectile dysfunction (ED) using cavernosography and internal pudendal artery angiography and angioplasty remains a controversial topic. † Deceased Priapism Priapism is a pathologically persisting erection of the penis not associated with sexual stimulation. It is a…

Management of Female Venous Congestion Syndrome

Clinical Relevance Chronic pelvic pain, characterized by noncyclic pelvic pain for longer than 6 months, is a common medical problem among women. The condition is potentially debilitating, and it afflicts millions of women worldwide. It has been reported that up to 39.1% of women have suffered chronic pelvic pain at some period in their lives. Pelvic congestion with pelvic varices has been the focus of clinical…

Management of Male Varicocele

Acknowledgments The authors wish to acknowledge authors Ali Albayati, Emily M. Tanski, and Emily J. Timmreck, who contributed to this chapter in the second edition. Although relatively uncommon, male varicocele often affects otherwise healthy men with symptoms such as pain and infertility. The concept of treating a male varicocele was first developed by Dr. Paré in the 16th century, primarily to treat symptoms such as pain…

Management of Pelvic Hemorrhage in Trauma

In most major trauma centers, angiography and transcatheter embolization have become the standard of care for managing pelvic hemorrhage, either as primary treatment or an as adjunct to open surgery and orthopedic stabilization techniques. Dynamic contrast-enhanced multidetector computed tomography (CT) imaging can rapidly detect the site of hemorrhage, whereas modern endovascular techniques can often allow embolization by selective catheterization in a timely fashion. A wide array…

Management of the High-Risk Obstetric Patient

Acknowledgments The authors wish to acknowledge Kiang Hiong Tay, who contributed to this chapter in the previous edition. Peripartum hemorrhage (PPH) is reported as the most common maternal morbidity in developed countries and a major cause of death worldwide. Globally, postpartum hemorrhage may account for 25% of delivery-associated deaths. The incidence may be up to 20% of pregnancies beyond 18 weeks’ gestation. In the United States,…

Uterine Fibroid Embolization

Uterine fibroid embolization (UFE) was first reported in the United States in 1997 as a minimally invasive alternative to hysterectomy and myomectomy for treatment of fibroids. Since that time, its effectiveness has been confirmed by other investigators, including in major randomized comparative trials, and it has rapidly been incorporated into practice. In 2008, the American College of Obstetricians and Gynecologists acknowledged the effectiveness of UFE, stating…

Vascular Anatomy of the Pelvis

The rich vascular supply of the pelvis not only supports the structures contained within it, including the bladder, rectum, and reproductive organs, but also extends to the lower extremities. For a complete understanding of vascular anatomy as it pertains to the endovascular procedures of interventional radiology, it is useful to discuss the vascular structures in sections, from the bifurcation of the aorta and the inferior vena…

Management of Visceral Aneurysms

The entity of visceral artery aneurysms (VAAs) includes aneurysms of the splanchnic circulation and those of the renal artery. Aneurysms of the splanchnic circulation include aneurysms of the celiac trunk, superior mesenteric artery (SMA), inferior mesenteric artery or their branches. Although rare, their diagnosis remains clinically important because of the high mortality and potential complications associated with them. Splenic artery aneurysms (SAAs) are the most common,…

Splenic Embolization in Nontraumatized Patients

Embolization of the splenic artery has become established practice in the treatment of splenic hemorrhage following abdominal trauma since it was first described by Sclafani in 1981. There has also been a progressive expansion in the use of splenic artery embolization (SAE) in the nontrauma setting. Traditional surgical treatment with splenectomy for many of the nontrauma indications is now being challenged by the less invasive technique…