Vascular Embolotherapy: A Comprehensive Approach Volume 1 General Principles, Chest, Abdomen, and Great Vessels

300 Pages·2006·8.99 MB·English

by  Melhem J. Sharafuddin MD

Contents I
MEDICAL RADIOLOGY
Diagnostic Imaging
Editors:
A. L. Baert, Leuven
K. Sartor, Heidelberg
Contents III
J. Golzarian · S. Sun · M. J. Sharafuddin (Eds.)
Vascular
Embolotherapy
A Comprehensive Approach
Volume 1
General Principles, Chest, Abdomen,
and Great Vessels
With Contributions by
H. T. Abada · D. M. Coldwell · M. D. Darcy · L. Defreyne · A. Fauconnier · J. Golzarian
D. Hunter · P. Lacombe · A. Laurent · L. Machan · H. Mimura · T. A. Nicholson · J. P. Pelage
J. S. Pollak · M. K. Razavi · J. A. Reekers · A. C. Roberts · G. T. Rosen · M. J. Sharafuddin
G. P. Siskin · S. Sun · K. Takahashi · J. C. van den Berg · D. Valenti · R. I. White, Jr.
J. J. Wong
Foreword by
A. L. Baert
With 171 Figures in 414 Separate Illustrations, 43 in Color and 33 Tables
123
IV Contents
Jafar Golzarian, MD
Professor of Radiology, Department of Radiology
University of Iowa Hospitals and Clinics
Carver College of Medicine
200 Hawkins Drive
Iowa City, IA 52242
USA
Shiliang Sun, MD
Associate Professor of Radiology
University of Iowa Hospitals and Clinics
Carver College of Medicine
200 Hawkins Drive
Iowa City, IA 52242
USA
Melhelm J. Sharafuddin, MD
Departments of Radiology and Surgery
University of Iowa Hospitals and Clinics
Carver College of Medicine
200 Hawkins Drive
Iowa City, IA 52242
USA
Medical Radiology · Diagnostic Imaging and Radiation Oncology
Series Editors: A. L. Baert · L. W. Brady · H.-P. Heilmann · M. Molls · K. Sartor
Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
Library of Congress Control Number: 2004117986
ISBN 3-540-21361-9 Springer Berlin Heidelberg New York
ISBN 978-3-540-21361-1 Springer Berlin Heidelberg New York
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi -
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Medical Editor: Dr. Ute Heilmann, Heidelberg
Desk Editor: Ursula N. Davis, Heidelberg
Production Editor: Kurt Teichmann, Mauer
Cover-Design and Typesetting: Verlagsservice Teichmann, Mauer
Contents V
T
o my parents
a wellspring of love and support without limit.
I owe you everything.
To my wonderful wife, Elham
and my children Sina and Sadra
Dr. Golzarian
To my wife, Shuzhen, and daughter, Yue
for their selfl ess support
Dr. Sun

T
o my wife Lucy, and children Jacob and Evan
Dr. Sharafuddin
T
o all our teachers
Contents VII
Foreword
Percutaneous image-guided treatment is now well recognized as an effective minimally
invasive treatment modality in modern medicine. Its fi eld of application is growing
every year due to the availability of more and more sophisticated materials, tools and
devices, but also because of the technical progress in reduction of the dose of ionizing
irradiation incurred by both patient and radiologist during fl uoroscopy.
Vascular embolotherapy is now one of the main forms of endovascular percutaneous
treatment of diseases of the vascular system.
The editors of the two volumes of “Vascular Embolotherapy: a Comprehensive
Approach”, J. Golzarian, S. Sun and M.J. Sharafuddin, leading experts in the fi eld, were
successful in obtaining the collaboration of many other internationally renowned inter-
ventional radiologists. I am particularly indebted to Professor Golzarian for his origi-
nal concept for these books and his relentless efforts to complete the project in good
time.
I would like to congratulate the editors and authors on producing these well-written,
superbly illustrated and exhaustive volumes covering all aspects of vascular embolo-
therapy. The readers will fi nd comprehensive up-to-date information as a source of
knowledge and as a guideline for their daily clinical work.
These two outstanding books will certainly meet with high interest from interven-
tional radiologists and vascular surgeons. They – and therefore their patients – will
greatly benefi t from its contents. Also referring physicians may fi nd these books very
useful to learn more about the indications, possibilities and limitations of modern vas-
cular embolotherapy
I am confi dent that these two volumes will encounter the same success with readers
as the previous books in this series.
Leuven Albert L. Baert
Contents IX
Preface
Therapeutic embolization has now become a major part of modern interventional prac-
tice, and its applications have become an integral component of the modern multimodal-
ity management paradigms in trauma, gastrointestinal hemorrhage and oncology, and
the endovascular therapy of vascular malformations and aneurysms. The past decade
has also marked the emergence of several new indications for therapeutic embolization,
such as uterine fi broid embolization, and the widespread acceptance of embolization
therapy as an effective non-operative management modality for major hepatic, splenic
and renal injuries that once posed tremendous challenge to the trauma surgeon. Emboli-
zation therapy has also become an integral facet of the modern oncology center, offering
solid-organ chemoembolization, preoperative devascularization, hepatic growth stimu-
lation prior to resection, and direct gene therapy delivery.
Despite this remarkable growth, there are currently few references available to sum-
marize this major fi eld in vascular interventional therapy. The purpose of our two-
volume book was to organize and present the current state of the art of embolotherapy
in a comprehensive yet manageable manner. Our goal was to provide a user-friendly,
well-illustrated, and easy-to-browse resource to enable both experts and novices in
this fi eld to quickly derive high-yield clinically relevant information when needed. In
addition to standard applications of embolotherapy, we have also included a number
of closely related applications that have become intimately associated with the fi eld of
therapeutic embolization, such as stent-graft placement and radiofrequency ablation.
The two volumes constitute the combined experience of many of the leading experts in
the fi eld and have been generously supplemented with helpful tables, illustrations and
detailed imaging material. We have also striven to include insightful discussions and a
“cookbook” segment in each topic to provide a quick outline of procedural preparation
and technique. We have included a chapter on monitoring and resuscitation of the hem-
orrhaging patient that should be a “must-read” for the interventionist who is not well
versed in surgical critical care. Readers will also fi nd important coverage of pathophysi-
ology and of diagnostic clinical as well as imaging workup.
We hope this reference will meet the needs of physicians providing therapeutic embo-
lization, whether they are trainees, recent graduates or even well-established interven-
tionists who wish to refresh their memory or learn the opinion of some of the fi eld’s
renowned experts before embarking on a diffi cult case or trying a new technique or
approach.
Iowa City Jafar Golzarian
Shiliang Sun
Melhem J. Sharafuddin
Contents XI
Contents
General Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 Embolotherapy: Basic Principles and Applications
Melhem J. Sharafuddin, Shiliang Sun, and Jafar Golzarian . . . . . . . . . . . . . . 3
2 Embolization Tools
Jafar Golzarian, Gary P. Siskin, Melhem J. Sharafuddin,
Hidefumi Mimura, and Douglas M. Colswell. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3 Controlled Delivery of Pushable Fibered Coils for Large Vessel Embolotherapy
Robert I. White Jr. and Jeffrey S. Pollak. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
4 Work-up and Follow-up after Embolization
Jim A. Reekers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
GI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5 Upper GI Bleeding
Luc Defreyne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
6 Embolization for Lower GI Bleeding
Michael Darcy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
7 Haemobilia and Bleeding Complications in Pancreatitis
Tony A. Nicholson. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
8 Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices
in Portal Hypertension
Koji Takahashi and Shiliang Sun. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Gynecology and Obstetrics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
9 Interventional Management of Postpartum Hemorrhage
Hicham T. Abada, Jafar Golzarian, and Shilliang Sun . . . . . . . . . . . . . . . . . . . .107
10 Fibroids
Gary P. Siskin, Jeffrey J. Wong, Anne C. Roberts, Jean Pierre Pelage,
Arnaud Fauconnier, Pascal Lacombe, Alexandre Laurent, and
Jafar Golzarian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
10.1 Uterine Fibroid Embolization: Practice Development
Gary P. Siskin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
XII Contents
10.2 Pre-op Work-Up and Post-op Care of Uterine Fibroid Embolization
Jeffrey J. Wong and Anne C. Roberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
10.3 Fibroid Embolization: Anatomy and Technical Considerations
Anne C. Roberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141
10.4 Results and Complications
Jean Pierre Pelage, Arnaud Fauconnier, and Pascal Lacombe. . . . . . . . .157
10.5 How to Minimize Failure after UFE
Jafar Golzarian and Jean Pierre Pelage. . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
10.6 Perspectives
Alexandre Laurent, Jean Pierre Pelage and Jafar Golzarian . . . . . . . .187
11 Pelvic Congestion Syndrome
Lindsay Machan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199
Genitourinary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
12 Varicocele Embolization
David Hunter and Galia T. Rosen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215
13 Embolization Therapy for High-Flow Priapism
Jim A. Reekers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
Aortic-Iliac. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233
14 Endoleak: Defi nition, Diagnosis, and Management
David Valenti and Jafar Golzarian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
15 Internal Iliac Artery Embolization in the Stent-Graft Treatment of
Aortoiliac Aneurysms
Mahmood K. Razavi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .253
Respiratory System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
16 Bronchial Artery Embolization
Jos C. van den Berg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .263
17 Pulmonary Arteriovenous Malformations
Jean Pierre Pelage, Pascal Lacombe, Robert I. White, Jr.,
and Jeffray S. Pollak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
Contents and List of Contributors of Volume 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
Embolotherapy: Basic Principles and Applications 1
General Principles