Table Of ContentRobert S. Dieter
Raymond A. Dieter, Jr.
Raymond A. Dieter, III
Editors
Endovascular
Interventions
A Case-Based Approach
123
Endovascular Interventions
Robert S. Dieter (cid:129) Raymond A. Dieter Jr.
Raymond A. D ieter III
Editors
Endovascular Interventions
A Case-Based Approach
Editors
Robert S. Dieter , MD, RVT Raymond A. Dieter III , MD
Loyola University Medical Center Cardiothoracic Surgery
Edward Hines, Jr. VA Hospital University of Tennessee Medical Center
Maywood Knoxville
IL TN
USA USA
Raymond A. Dieter Jr. , MD, MS
Thoracic and Cardiovascular Surgery
Northern Illinois Center for Surgery
Naperville
IL
USA
Associate Editor
Aravinda Nanjundappa , MD, RVT, MBA
Interventional Cardiology, Vascular and Endovascular Medicine
Charleston Area Medical Center
Charleston
WV
USA
ISBN 978-1-4614-7311-4 ISBN 978-1-4614-7312-1 (eBook)
DOI 10.1007/978-1-4614-7312-1
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2013946544
© Springer Science+Business Media New York 2014
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally
for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work.
Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the
Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions
for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution
under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of publication, neither
the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may
be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
To my wonderful wife who has been patient and supportive through all my
training and pursuits,
My children who bring a smile to my face every day,
My parents and family who taught me to always strive to do my best,
To God who makes it all possible.
Foreword
Because of improvements in minimally invasive technologies, the endovascular approach is
being increasingly used in the treatment of vascular diseases. By eliminating the need for an
extensive incision, this approach avoids the trauma of conventional surgery, which can result
in postoperative pain, prolonged hospitalization, and a protracted recovery. The mainstays of
endovascular therapy are balloon angioplasty, stent grafting, and coiling. After a catheter
carrying a compressed balloon, stent graft, or coil has been advanced to the diseased site, the
device is expanded to reopen the vessel and keep it open. The current generation of interven-
tional devices is enhanced by new optical fi bers, thromboresistant metals, biomembrane coat-
ings, and other innovative materials. Endovascular therapy also bene fi ts from recent progress
in ultrasonography, radiology, fl uoroscopy, and electronics. Potential disadvantages over con-
ventional techniques include endoleak and device failure or dislocation. Also, the long-term
results of endovascular treatment are not yet known. Nevertheless, this approach offers new
hope for many patients who, because of advanced age or comorbidity, are at high risk for tra-
ditional, open surgery.
These days, the repair of vascular lesions is so much taken for granted, it is easy to forget
that this specialty has a relatively brief history. Until the early 1950s, treatment of aneurysms
was restricted to “indirect” methods, such as introducing wire into the aneurysm to promote
blood clotting or wrapping the exterior of the lesion with cellophane to induce scarring and
reinforce the wall. Although these techniques might keep the aneurysm from rupturing, they
met with only limited success. Early in my surgical career, I was fortunate to participate in
some of the initial direct aneurysm repairs. Until the advent of cardiopulmonary bypass, sur-
geons had only a small window of time in which to make these repairs. Even the idea of
attempting them was at fi rst considered revolutionary. Having retained a special interest in
these lesions throughout my career, I am grati fi ed that minimally invasive technology has
expanded the options for their treatment.
It would be hard to fi nd a better guidebook to endovascular interventions than the present
volume, which is edited by my colleague and friend Ray Dieter, Jr., and his sons. Ray is one of
the pioneers of angiography, endovascular procedures, and hybrid surgical/endovascular pro-
cedures. His sons Ray Dieter III and Robert Dieter are, respectively, a cardiothoracic and
vascular surgeon and an interventional cardiologist with an emphasis on vascular disease. The
book uses a practical, step-by-step approach that shows how the leading experts in endovascu-
lar treatment manage their cases. It covers a wide variety of interventions―ranging from head
to toe and including both arterial and venous lesions. Attractive and highly readable, the book
should be a valuable resource for surgeons, cardiologists, and radiologists.
For several years now, the three Dieters have been steadily producing a series of outstanding
books on vascular disorders. E ndovascular Interventions is a welcome companion to their
earlier works, P eripheral Arterial Disease (2009) and Venous and Lymphatic Diseases (2011),
both published by McGraw-Hill. I am honored to have been asked to write the foreword for
each of these volumes. As one who is well acquainted with the challenges of book publishing,
I applaud the authors for their latest superb contribution to the vascular literature.
Houston, TX, USA Denton A. Cooley, MD
vii
Introduction
This has been a very exciting textbook to put together. The senior-most editor of the textbook,
a cardiothoracic and vascular surgeon, can recall when he did the majority of the angiograms
on his patients. Of course, many of the initial minimally invasive techniques such as embolec-
tomy or “Dottering” of lesions have evolved into fully percutaneous treatment methods. It is
incredible to contemplate this evolution, as aptly pointed out in the foreword by Dr. Denton
Cooley, of vascular care. We are now in an age where percutaneous and hybrid treatments are
thought of fi rst rather than open surgical techniques. Disease states, particularly vascular dis-
eases, have forced the overlap of treatment by different disciplines.
In this textbook, we have asked vascular specialists, regardless of their discipline, to con-
tribute. Our previously published medical textbooks include Peripheral Arterial Disease
(McGraw-Hill), V enous and Lymphatic Diseases (McGraw-Hill), and T horacoscopy for
Surgeons: Diagnostic and Therapeutic (Igaku-Shoin Medical Publishers). The emphasis of the
current textbook is, however, on the endovascular treatment of these diseases. We decided to
take a case-based approach and have asked each contributor to walk us through how they
would actually approach a case. This is of course a monumental task. We have included mul-
tiple disciplines from around the world. We have attempted to maintain a basic format to the
chapters, but of course, there will be variations and we hope that this adds to the quality of the
textbook. In the end, we want you to be able to open this book and learn how to approach an
actual case. There will be overlap and even some gaps. We have intentionally avoided empha-
sis on pathophysiology—our fi rst two books with McGraw-Hill have emphasized that. Herein,
though, is how to treat the patient in an endovascular fashion.
Although we have attempted to maintain a uniform outline and presentation to our chapters,
there are inherent differences from one chapter to the next. Some interventions demand a
lengthier discussion than others. Furthermore, we recognized that no one interventionalist will
be performing all the techniques described. This textbook is designed to be a reference for
practicing clinicians, but it cannot be an exhaustive discussion of all cases and complications
of the various territories involved. Regardless, it does attempt to present a variety of cases
across the vascular system. Hopefully, the reader will be able to assimilate new techniques—
possibly even from other vascular beds—and apply these to treating their patients.
Some topics will be covered by multiple authors and sometimes with different techniques
and discussion. This approach highlights the diversity of treating patients and lesions. It was
never our intent with this textbook to present “the only way” of approaching a situation. Indeed,
it is through the ingenuity of the authors that one can learn how to deal with actual patients.
Once again, we thank you for your support in our endeavor to maintain the current state-of-
the-art reference texts for vascular disease.
Maywood, IL, USA Robert S. Dieter, MD, RVT
Naperville, IL, USA Raymond A. Dieter Jr., MD, MS
Knoxville, TN, USA Raymond A. Dieter III, MD
ix
