Table Of ContentHandbook of Endovascular
Peripheral Interventions
Christopher D. Owens
Yerem Yeghiazarians
(Editors)
Handbook
of Endovascular
Peripheral
Interventions
Editors
Christopher D. Owens, M.D., M.Sc. Yerem Yeghiazarians, M.D.
Division of Vascular Surgery Division of Interventional
Department of Surgery Cardiology
University of California – Department of Medicine
San Francisco University of California –
San Francisco, CA San Francisco
USA San Francisco, CA
[email protected] USA
[email protected]
ISBN 978-1-4614-0838-3 e-ISBN 978-1-4614-0839-0
DOI 10.1007/978-1-4614-0839-0
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011943616
© Springer Science+Business Media, LLC 2012
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Foreword
Over the last decade, the field of peripheral vascular disease
has seen a dramatic evolution – with an ever-expanding array
of treatment options, and a growing interest among diverse
medical practitioners as well as commercial entities. At the
same time, the global scope of the problem continues to
increase in magnitude. It is estimated that between 8 and 12
Americans harbor symptomatic or occult peripheral artery
disease (PAD). While some risk factors, such as smoking and
hyperlipidemia, have been targeted productively by educa-
tion, public policy, and improved medications, others such as
diabetes, obesity, and physical inactivity appear to be increas-
ing in an ominous fashion. The continued aging of the popula-
tion alone has major implications, as PAD prevalence is
directly related to age and the disease affects as many as one
in five individuals over age 65. The worldwide diabetes epi-
demic – recently estimated to afflict more than 23 million
Americans and roughly 300 million worldwide – portends a
growing burden of PAD on public health. For all vascular
specialists, the treatment of PAD will dominate clinical prac-
tice demands for the foreseeable future.
Yet in no other area of vascular disease do we have such
broad heterogeneity of treatment approaches, limited evi-
dence to support practice guidelines, and lack of standardiza-
tion in virtually all aspects of care – particularly interventional.
The continued evolution of percutaneous revascularization
techniques has allowed for a broader application of treat-
ment to PAD patients with reduced invasiveness, with a con-
comitant explosive increase in the volume of procedures
performed. Unfortunately, a bewildering and continuously
v
vi Foreword
changing array of devices, techniques, and expert opinions
renders the field daunting, if not undecipherable, to the spe-
cialist-in-training or novice interventionalist. We vascular
specialists practice in an era of rapid change, lack of consen-
sus, and diverse sources of information of variable quality.
Hence the need for a book like this.
The current treatment of peripheral vascular disease is
optimized by a collaborative approach among practitioners
with expertise in vascular medicine, vascular imaging, open
surgery, and endovascular intervention. The editors have
assembled a multidisciplinary group of expert authors to pro-
vide practical, focused chapters on the assessment and inter-
ventional management of peripheral vascular diseases. The
goal is to provide the reader with a thoughtful review of the
most current interventional approaches, key considerations
in patient selection and optimization of outcomes, and techni-
cal tips to maximize success and avoid pitfalls. It is organized
in a user-friendly, quick reference format that is ideal for use
“in the trenches.” I anticipate it will be used widely by stu-
dents, residents, and fellows – as well as surgeons and inter-
ventionalists who are expanding their practice in these areas.
I am grateful for their efforts and for the insight of the pub-
lishers in supporting this project, and congratulate them on
producing a high-caliber reference that answers a major need
in our field.
Michael S. Conte , M D
Professor of Surgery
Division of Vascular and Endovascular Surgery
University of California San Francisco
San Francisco , CA
USA
Preface
Why This Book?
Increasingly, peripheral vascular interventions are being
performed by vascular surgeons, interventional cardiologists,
and interventional radiologists. This handbook is meant to be
a guide for the beginner and also for the more advanced inter-
ventionalist covering all aspects of percutaneous peripheral vas-
cular interventions. Each chapter of this highly illustrated book
provides brief background, etiology, clinical presentation, imag-
ing, and percutaneous treatment of different vascular conditions.
Importantly, “Tips of the trade” and “How I do it” sections in
each chapter make this handbook very practical. These invalu-
able pearls are provided by the authors of each chapter who
are experts in the field. This handbook is a collaborative effort
between cardiologists, vascular surgeons, and radiologists as we
strongly believe that each subspecialty brings unique expertise
to the field of percutaneous peripheral vascular interventions.
This handbook was put together as many of our colleagues,
fellows, residents, and medical students have expressed a
need for an easily accessible book which will cover the essen-
tial principles and specific management issues with percuta-
neous peripheral vascular interventions.
How to Use This Book
This book starts with general concepts of vascular imaging,
access sites issues, principles of sheaths/guides, diagnostic
angiography, anti-platelet and anti-coagulation therapies, and
vii
viii Preface
ways to minimize contrast-induced nephropathy that all
practitioners need to be familiar with. The second half of the
book focuses on the different vascular territories and pro-
vides the reader an in-depth but concise review of the prin-
ciples of percutaneous treatments of the specific peripheral
vascular bed.
We envision trainees carrying this handbook in their white
coat pockets so that before they scrub in for a case, they read
the appropriate chapters and enhance their educational
experience during the case. For the more experienced opera-
tor, this handbook provides more details about how the
experts in the field do their cases by mentioning more specific
use of different wires, guides, and techniques that they favor
to overcome the challenges of percutaneous peripheral inter-
ventions. The selected references section located at the end of
each chapter provides additional reading material that the
author feels especially pertinent to the presented material.
Christopher D. Owens
Yerem , Yeghiazarians
Acknowledgments
First and foremost, we would like to deeply thank all the
authors for their contributions. Their tolerance of our con-
stant e-mails and calls and editing is much appreciated. A
special thanks to Kevin Wright at Springer for his superb
efforts in making this book possible.
We would also like to thank our families for their support
while this book was being put together. Leon and Genia,
Vartan, and Suzie Yeghiazarians, Nichole Kendall, and our
children Sofia Yeghiazarians and Luke and Ellen Owens.
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