Endovascular skills : guidewire and catheter skills for endovascular surgery / Peter Schneider.

Format:

Book

Author/Creator:

Schneider, Peter A., author.

Contributor:

Taylor & Francis eBooks.

Louis B. Flexner Medical Book Fund.

Language:

English

Subjects (All):

Blood-vessels--Endoscopic surgery.

Blood-vessels.

Blood-vessels--Interventional radiology.

Peripheral vascular diseases--Endoscopic surgery.

Peripheral vascular diseases.

Peripheral vascular diseases--Interventional radiology.

Interventional radiology.

Endoscopic surgery.

Physical Description:

1 online resource (1 volume) : illustrations (black and white)

polychrome

Edition:

Fourth edition.

Place of Publication:

Boca Raton : CRC Press, 2020.

System Details:

text file

Biography/History:

Division of Vascular Therapy, Kaiser Foundation Hospital, Honolulu, Hawaii, USA

Contents:

Part I Catheter and Guidewire Skills p. 1

1 Case preparation p. 3

Endovascular skills in practice p. 3

Reinvention of vascular care p. 3

Setting yourself up for success p. 3

Sizing up the case p. 4

Prior to the puncture p. 4

Working environment p. 4

Facilities and room setup p. 5

How pretreatment history and physical examination help to plan therapy p. 6

Pretreatment imaging p. 6

2 Safe and strategic vascular access p. 7

Overview of percutaneous access p. 7

Choosing your approach p. 8

Femoral anatomy for arterial access p. 9

Puncture guidance with ultrasound p. 10

Micropuncture technique p. 12

Percutaneous retrograde puncture of the femoral artery p. 13

Percutaneous antegrade puncture of the femoral artery p. 17

Percutaneous puncture of a pulseless femoral artery p. 19

Proximal access p. 21

Percutaneous puncture of the brachial artery p. 21

Alternative access to the lower extremity: Superficial femoral, popliteal, tibial, and pedal arteries p. 23

Percutaneous puncture of bypass grafts p. 23

Puncture site complications p. 24

Summary of puncture site options and closure strategy p. 24

3 Sheath access p. 27

Basic access site step-by-step p. 27

Initial maneuvers to secure the access p. 28

How do you place a sheath? p. 28

When is a dilator needed? p. 30

Basic sizing issues p. 32

When to use fluoroscopy p. 32

About access sheaths p. 33

How do you decide when to place a larger access sheath? p. 33

When to abandon an access p. 33

Access in a hostile groin p. 34

4 Guidewire skills p. 35

Mastering guidewires p. 35

What makes guidewires different from each other p. 36

Guidewire types in practice p. 38

When to abandon the chosen guidewire p. 43

Useful guidewire techniques to start tackling chronic total occlusion p. 44

Organizing your guidewires p. 46

Small platform guidewires and monorail systems p. 47

Development of small platform guidewires and monorail systems p. 47

How do monorail systems differ from coaxial systems? p. 47

What are the advantages and disadvantages of monorail systems? p. 49

Principles for the use of rapid exchange systems p. 49

Which platform is best for each task? p. 50

Which platform should you start the case with, and when should you switch from one platform to another? p. 50

Maneuvers you can undertake with 0.14-inch and 0.18-inch guidewires p. 51

6 Handling catheters p. 53

Introduction to catheters: Exchange, flush, and selective catheters p. 53

Which angiographic catheter should you use? p. 53

Catheter head shape determines function p. 54

Describing catheter behavior p. 58

Handling catheters p. 58

7 Guidewire and catheter passage p. 63

The goal of the procedure determines the course of the guidewire-catheter apparatus p. 63

Guidewire and catheter combinations p. 65

Where does the guidewire naturally want to go? p. 65

Passing through diseased arteries p. 66

Negotiating tortuous arteries p. 67

Remote puncture site p. 69

How to change the plan if the catheter will not pass and you have tried everything p. 70

How do you decide if disease encountered on the pathway to treat the target lesion also needs to be treated? p. 71

8 Imaging: The key to success p. 77

Imaging and best therapy are intricately linked p. 77

Image quality p. 77

Generating an X-ray image p. 78

Digital subtraction arteriography p. 79

Imaging technique for best resolution p. 80

Road mapping: How it works and when to use it p. 81

Automated power injector p. 82

Power injection versus contrast administration by hand p. 83

Contrast agents p. 84

How do you know where you are? p. 85

Radiation safety and occupational health issues p. 86

Radiographic equipment p. 86

Radiographic terms p. 86

Radiation exposure p. 87

9 Selective catheterization p. 89

Many catheter choices but few basic shapes p. 89

Selective catheterization of the brachiocephalic arteries p. 91

Selective catheterization of the visceral and renal arteries p. 98

Selective catheterization of the aortoiliac arteries p. 100

Selective catheterization of the infrainguinal arteries p. 105

Selective catheterization of prosthetic bypass grafts p. 109

Aberrant anatomy to consider p. 111

10 Principles of arteriography p. 113

Arteriography is strategic, not diagnostic p. 113

The future of arteriography p. 113

Supplies for arteriography p. 114

Planning for strategic arteriography p. 114

Questions to consider before arteriography p. 115

Evaluation before angiography p. 115

Deciding where to puncture p. 116

Catheter placement p. 118

Contrast administration and image acquisition p. 119

Arteriography sequences p. 120

11 Arteriography of the vascular beds p. 123

Arteriography of the brachiocephalic arteries p. 123

Thoracic aortography p. 126

Arteriography of the visceral and renal arteries p. 126

Arteriography of the infrarenal arteries p. 128

Lesion interrogation: Special views p. 134

Carbon dioxide arteriography p. 134

Pressure measurement p. 136

Arteriography of aneurysms p. 136

Intravascular ultrasound p. 137

Part II Endovascular Therapy p. 139

12 Endovascular workshop p. 141

Where we work determines what we can do p. 141

Operating room versus special procedures suite versus catheterization laboratory p. 141

Stationary versus portable imaging systems p. 142

The ideal vascular workshop p. 143

13 Medications for endovascular therapy p. 145

Sedation and analgesia p. 145

Local anesthetic p. 145

Prophylaxis with antibiotics p. 145

Anticoagulation p. 145

Heparin alternatives: Direct thrombin inhibitors p. 146

Antiplatelet agents p. 146

Thrombolysis p. 147

Vasodilators p. 147

Contrast allergies p. 147

Practical advice for intraoperative problems p. 147

14 Access for endovascular therapy p. 149

Make access as simple as possible p. 149

Create a platform from which to work p. 150

Sizing considerations p. 150

What fits into what? p. 153

General principles of sheath placement during therapy p. 153

When to avoid using your initial access site for therapy p. 155

When do you use a guiding sheath versus a guiding catheter? p. 155

How do you know if the sheath is following the exchange wire? p. 158

Uses for upper extremity access p. 159

Sheath placement in remote branch arteries p. 159

15 Setting up the therapeutic maneuver: Crossing lesions p. 163

Three types of lesions p. 163

Need for support and directionality p. 164

Crossing stenoses p. 164

16 Crossing challenging lesions p. 171

Arteriography of occluded arteries p. 171

Crossing occlusions p. 171

Tools for crossing occlusions p. 174

Subintimal angioplasty p. 176

Crossing occlusions in various vascular beds p. 178

When to approach from the other direction: Retrograde access p. 184

Crossing calcified lesions p. 186

Crossing really long lesions p. 186

What to do after the wire is across p. 187

Anatomic manipulations can assist in guidewire or device passage p. 188

17 Balloon angioplasty: Minimally invasive autologous revascularization p. 191

Balloon dilation causes dissection p. 191

About balloon catheters p. 192

The angioplasty procedure p. 193

Balloon selection p. 193

When to use a monorail system p. 195

Supplies for percutaneous balloon angioplasty p. 195

Sheath selection and placement p. 196

Balloon preparation and placement p. 197

Heparin administration during intervention p. 197

Balloon inflation p. 198

Balloon removal and completion arteriography p. 201

18 More about balloon angioplasty: Keeping out of trouble p. 205

Keeping out of trouble is simpler than getting out of trouble p. 205

What is the strategy for managing multiple lesions? p. 205

Which lesions should be predilated? p. 207

Which lesions are most likely to embolize? p. 208

What about postangioplasty dissection? p. 208

When to use kissing balloons p. 210

Pain during balloon angioplasty p. 210

What about spasm? p. 211

Preventing puncture site thrombosis p. 212

Balloon angioplasty troubleshooting p. 213

Technique: Solving angioplasty problems p. 215

Management of arterial rupture p. 217

Management of embolization p. 218

Management of acute occlusion p. 219

Technical aspects of balloon angioplasty in different vascular beds p. 219

Assessing the acute results of balloon angioplasty p. 221

19 Stents, covered stents, stent-grafts p. 223

Impact of stents p. 223

Stent choices p. 223

Covered stents p. 225

Indications for stents: Primary or selective stent placement p. 226

Which lesions should be stented? p. 227

Residual stenosis after angioplasty p. 229

Placement technique for balloon-expandable stents p. 230

Placement technique for self-expanding stents p. 235

Placement technique for covered stents p. 237

Which stent for which lesion? p. 238

How to select the best stent for the job p. 241

Tricks of the trade p. 242

Acute complications of stent placement p. 252

Chronic complications of stent placement p. 253

20 Other devices and how to use them p. 255

Microcatheters p. 255

Re-entry catheters p. 256

Chronic total occlusion catheters and crossing catheters p. 257

Atherectomy p. 258

Laser p. 260

Drug-coated balloons and drug-eluting stents p. 261

Cutting, scoring, and cryoplasty balloons p. 262

Peripheral stent-grafts p. 265

Thrombectomy and thrombolysis p. 266

Distal embolic filters p. 269

Part III Therapy in Specific Vascular Beds p. 273

21 Brachiocephalic interventions p. 275

Arch assessment p. 275

Innominate and common carotid artery p. 275

Assessment of arch branch lesions p. 276

Principal techniques p. 277

Transfemoral approach to the common carotid artery p. 279

Carotid bifurcation stent placement p. 281

Open cell, closed cell, and mesh covered carotid stents p. 286

Distal and proximal protection devices for transfemoral carotid stenting p. 287

Transcervical approach to carotid stenting p. 288

Retrograde approach to the common carotid artery p. 292

The subclavian and axillary arteries p. 292

22 Visceral and renal artery interventions p. 297

Approach to the visceral arteries p. 297

Celiac and superior mesenteric artery angioplasty and stenting p. 297

Renal angioplasty and stenting p. 302

23 The infrarenal aorta, aortic bifurcation, and iliac arteries: Advice about balloon angioplasty and stent placement p. 311

Aorta p. 311

Aortic bifurcation p. 318

Iliac artery p. 321

Ipsilateral retrograde approach to the iliac artery p. 321

Contralateral approach to the iliac artery p. 323

Self-expanding versus balloon-expandable stents for the aortoiliac segment p. 326

Use of covered stents p. 326

Access related issues p. 327

24 The infrainguinal arteries: Advice about balloon angioplasty and stent placement p. 329

Superficial femoral and popliteal arteries p. 329

Ipsilateral antegrade approach to the superficial femoral and popliteal arteries p. 330

Up-and-over approach to the superficial femoral and popliteal arteries p. 334

Access related issues: Difficult up-and-over approach to the superficial femoral and popliteal arteries p. 337

Tibial artery occlusive disease: Angioplasty and stenting p. 341

25 Complex lower extremity revascularization p. 345

Aortoiliac occlusive disease p. 345

Femoral-popliteal occlusive disease p. 353

Tibial artery occlusive disease p. 365

Angiosomes of the lower leg and foot p. 367

26 Salvage of previous reconstructions p. 373

Previous endovascular reconstruction p. 373

Managing occluded stents p. 374

Infrainguinal bypass graft p. 375

Extra-anatomic bypasses: Axillofemoral and femoral-femoral p. 378

Reconstructions for aortoiliac disease: Aortofemoral, iliofemoral, and aortoiliac bypasses p. 378

27 Hybrid procedures p. 381

Principles of hybrid procedures p. 381

Technical points for performing hybrid procedures p. 381

Iliac stent and femoral endarterectomy p. 387

Femoral endarterectomy plus distal intervention p. 389

28 Technical aspects of treating aortic aneurysms p. 391

Imaging p. 391

Open access or percutaneous access of femoral arteries p. 392

Percutaneous large bore access using the pre-close technique p. 392

Closure of large bore access p. 394

Managing bad iliac arteries p. 394

Conduits p. 398

Endograft placement p. 401

Cannulation of the contralateral gate p. 403

Balloon angioplasty after endograft placement p. 405

Postplacement stenting of iliac arteries p. 406

Management of a difficult aortic neck p. 407

Endovascular graft treatment of a ruptured abdominal aortic aneurysm p. 411

Hybrid procedures associated with aortic disease: Arch debranching p. 413

Management of endoleaks after endovascular abdominal aortic aneurysm repair p. 414

29 Coiling of peripheral aneurysms p. 419

Coils p. 419

Vessel occluders p. 423

Endovascular management of a popliteal aneurysm p. 424

30 Puncture site management p. 427

Obtaining hemostasis p. 427

Holding pressure p. 427

Timing the sheath removal p. 429

Closure devices p. 429

Managing puncture site complications p. 432.

Notes:

Electronic reproduction. London Available via World Wide Web.

Description based on online resource; title from digital title page (viewed on October 03, 2019).

Local Notes:

Acquired for the Penn Libraries with assistance from the Louis B. Flexner Medical Book Fund.

Other Format:

Print version: Schneider, Peter A. Endovascular skills.

ISBN:

9780429156304

0429156308

9781498717090

1498717098

9781482217384

1482217384

9780429580994

0429580991

Publisher Number:

99982032987

Access Restriction:

Restricted for use by site license.