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59Vertebroplasty and KyphoplastyMartin G. Radvany and Kieran Murphy60Spinal Injections for Pain ControlManraj K.S. Heran and Mohammed T. AlshammariSECTION V: INTRAPROCEDURAL PATIENT MANAGEMENT61Universal Protocol in Interventional RadiologyRathachai Kaewlai and Hani H. Abujudeh62Sedation, Analgesia, and AnesthesiaMarcus A. Lehman and Leonard J. Lind63Drug AdministrationEllen McKeon-Levine and Petra Clark64Treatment of Contrast Media ReactionsMichael A. Bettmann65Contrast-Induced Nephropathy: Prevention and ManagementMichael A. BettmannThe following chapters can be accessed online.SECTION VI: NONINVASIVE EVALUATION AND DIAGNOSTIC IMAGINGe-66Noninvasive Evaluation: Lower Extremity ArteriesJoseph F. Polak and James F. Benenatie-67Color Doppler and Duplex Ultrasound Imaging of Peripheral ArteriesJoseph F. Polake-68Doppler Ultrasound of Abdominal VasculatureAjay K. Singh and Rathachai Kaewlaie-69Color Doppler and Ultrasound Imaging of Peripheral VeinsJoseph F. Polake-70Magnetic Resonance AngiographyNanda Deepa Thimmappa and Martin R. Princee-71Computed Tomographic AngiographyMichael L. Martine-72Radionuclide Evaluation for Interventional RadiologistsDon C. Yoo and Sabah S. Tumehe-73PET/CT for Oncologic InterventionsDon C. Yooe-74Clinical Evaluation of the Cancer PatientKaren Marshall and Robert J. Lewandowski15

e-75Cancer Imaging for Interventional RadiologistsAjay K. Singh and Rathachai KaewlaiSECTION VII: SPECIAL INTERVENTIONSe-76Pediatric AngiographyManraj K.S. Heran and Mohammed T. Alshammarie-77Bronchial Artery EmbolizationMohammed T. Alshammari and Manraj K.S. Herane-78Tracheobronchial StentsK. Pallav Kolli and Roy L. Gordone-79Esophageal StentsHo-Young Song, Ji Hoon Shin, and Chang Jin Yoone-80Gastroduodenal Stent PlacementJin Hyoung Kim, Ho-Young Song, and Chang Jin Yoone-81Colorectal Stent PlacementJin Hyoung Kim, Ho-Young Song, and Ji Hoon Shine-82Retrieval of Intravascular Foreign BodiesAneeta Parthipun and Tarun Sabharwale-83Liver Transplant ManagementWael E.A. Saade-84Selective Salpingography and Fallopian Tube RecanalizationLindsay Machane-85Abnormal Placentation: Minimizing Surgical Blood LossSusan Kiernan O’Horoe-86Peritoneal DialysisPeter B. Hathawaye-87Management of Recurrent AscitesMaye M. Chan and David A. Rosenthale-88The Whitaker TestDavid W. HunterSECTION VIII: MATERIALS AND METHODSe-89Angiographic Contrast MediaMichael A. Bettmanne-90Angiographic Equipment Selection and ConfigurationKeith J. Strauss and J. Anthony Seiberte-91Standard Angiography/Interventional Procedure Tray Contents16

Petra Clarke-92Needles, Guidewires, Catheters, and StentsDavid W. Troste-93Embolization MaterialsSiobhan M. Flanagan, Olga Duran-Castro, and Jafar Golzariane-94Commonly Used MedicationsMikhail C.S.S. Higgins, Krishna Kandarpa, and Michael A. BettmannSECTION IX: RISK MANAGEMENTe-95Risk ManagementSarah D. Cohne-96QA/QI General PrinciplesMichael A. Bruno and Hani H. Abujudehe-97Quality Improvement Strategies in Interventional RadiologyGloria M. Salazar and Hani H. Abujudehe-98PQI ProjectsMohammad Mansouri and Hani H. Abujudehe-99Radiation Safety in Interventional RadiologyDonald L. Millere-100Infection Control and Sterile Techniquein Interventional RadiologyDaniel ChanSECTION X: NURSING MANAGEMENTe-101Nursing Management during Angiography and Interventional ProceduresEvelyn P. Wempe, DéAnn O. McNamara, and Krishna Kandarpae-102Organization and Operation of the Interventional Radiology ClinicEvelyn P. Wempe, Richard Foley, and DéAnn O. McNamarae-103Outpatient Drainage—Catheter CareSusan Benveniste, Maye M. Chan, and DéAnn O. McNamaraAPPENDICESAppendix A: Vascular AnatomyKrishna KandarpaAppendix B: Nursing ChecklistEvelyn P. Wempe, DéAnn O. McNamara, and Krishna KandarpaAppendix C: Hemodynamic Monitoring and Cardiovascular PressuresMichael G. Flater17

Appendix D: Magnetic Resonance Angiography ProtocolsNanda Deepa Thimmappa and Martin R. PrinceAppendix E: Computed Tomographic Angiography ProtocolsMichael L. MartinAppendix F: Contrast Media TableMichael A. Bettmann18

FOREWORDThe field of interventional radiology continues to grow and to change. The scope of care provided by thiscritical medical discipline has advanced rapidly over the quarter of a century since the very first edition of thisHandbook in 1989. There are few other disciplines that have changed so much in this brief amount of time.The scope of this change is represented by the table of contents that has expanded to over 100 chapters, andmore important, the Handbook continues to emphasize not only procedures that have been described inprevious editions but also the important expanding roles of endovascular and nonvascular interventionaltherapies for a multitude of disease states. Reflecting changes in the health care system, important chapters onquality assurance and improvement, risk management, as well as safety—including radiation and infectioncontrol—have been included.More important, discussions on the clinical practice of interventional radiology are addressed, includingorganizational and operational issues, nursing management, and the practical use and management ofpharmacologic therapies.It is hard to imagine how the Handbook of Interventional Radiologic Procedures could possibly improveover prior editions. Since its initial publication, this Handbook has become an essential reference forinterventionalists at all levels of experience. It will undoubtedly be essential for residents and fellows duringtheir training and should remain an important reference for practitioners who will benefit from the valuablepractical information contained in this volume.The field of interventional radiology continues to evolve as both a clinical and a procedural discipline.The challenges of creating a comprehensive handbook of practical information in a volume that can actuallybe carried around has become more difficult. Yet the editors and authors have amassed a volume that is briskand focused in style, extremely well organized and catalogued to make it easy for the reader to get criticalinformation when necessary in the treatment of specific patients. This handbook is a tool in the hands ofinterventionalists which is as helpful as any of the devices that may be used in specific procedures. In keepingwith the times, an updated electronic version for handheld devices is once again provided.I’m certain that the fifth edition of the Handbook of Interventional Radiologic Procedures will become anindispensable tool and resource in the lab coat of all interventional radiologists and staff performing theseprocedures. I know it will for me.Barry T. Katzen, MD19

PREFACEFrom inability to let well alone; from too much zeal for the new and contempt for what is old; from puttingknowledge before wisdom, science before art, and cleverness before common sense, from treating patients ascases, and from making the cure of the disease more grievous than the endurance of the same, Good Lord,deliver us.Sir Robert HutchinsonCorrespondence regarding modern treatment in the British Medical Journal, March 12, 1953, p. 671.Interventional radiology remains a vibrant field with evolving and rapidly growing applications due in large part of the ingenuity andcreativity of its practitioners. Although it is true that medical necessity may have mothered many inventions, scientific advances andcompetitive pressures have also done much to motivate this innovational spirit. Future success will depend not only on a continued proactive“innovational” attitude but, more importantly, also on embracing the clinical management of patients, and staying ahead of unrelentingcompetition. Fortunately, the pace of innovations and the specialty’s acquisition of clinical management skills have necessitated a fifth editionof Handbook of Interventional Radiologic Procedures.This book should be useful not only for practicing interventional radiologists but also for fellows and residents in training, and for thoseseasoned general radiologists who are several years out from formal training but have retained the skills required for performing interventionalprocedures. This book will also help interventional nurses and special procedure technologists in performing their own vital tasks moreefficiently by enhancing medical knowledge specific to each procedure.We realize that there is no single way to perform a procedure and do not mean to imply that the descriptions here are the only appropriateones. The intent is to provide a framework that the interventionalist can use and build on as more experience is gained. As in prior editions, eachchapter on procedures has been organized in a consistent outline format to facilitate easy access to specific sections on indications andcontraindications, preprocedure preparation, procedural protocol, postprocedure care, and expected outcomes—all toward improving patientsafety by preventing complications or managing them appropriately when they do occur. This latter information is especially useful while theprocedure is being discussed with the patient before obtaining informed consent. We have—to the best of our ability—corrected mistakes andoversights from prior editions.We are eternally grateful to the contributors worldwide for their painstaking efforts in creating what we hope will be another successfulhandbook. We thank Dr. Barry Katzen for kindly writing the foreword. We thank Ryan Shaw and Rebeca Barroso of Wolters Kluwer forguiding us through the process, and most of all for their patience.K. K.L. M.J. D.20

CONTRIBUTING AUTHORSHani H. Abujudeh, MD, MBAAssociate Professor of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBoston, MassachusettsSun Ho Ahn, MD, FSIRAssistant Professor of RadiologyAlpert Medical School of Brown UniversityProvidence, Rhode IslandMohammed T. Alshammari, MDConsultant Interventional RadiologistSecurity Forces Hospital ProgramRiyadh, Saudi ArabiaParag Amin, MDAssistant Professor of RadiologyLoyola University Medical CenterMaywood, IllinoisRonald S. Arellano, MD, FSIRAssociate Professor of RadiologyMassachusetts General Hospital/Harvard Medical SchoolBoston, MassachusettsJamie B. Arton, MHS, PA-CInstructor of RadiologyUniversity of Colorado School of MedicineAurora, ColoradoJames F. Benenati, MDClinical Professor of RadiologyMiami Cardiac and Vascular InstituteFlorida International University HerbertWertheim College of MedicineMiami, FloridaSusan Benveniste, BSN, RN, CRNDivision of Interventional RadiologyBrigham and Woman’s HospitalBoston, MassachusettsMichael A. Bettmann, MD, FACR, FSIRProfessor of Radiology EmeritusWake Forest University School ofMedicineWinston-Salem, North Carolina21

Allison Borowski, MDRadiologistLenox Hill HospitalNew York, New YorkUgur Bozlar, MDAssociate Professor of RadiologyGulhane Military Medical AcademyAnkara, TurkeyDaniel B. Brown, MD, FSIRProfessor of RadiologyVanderbilt University School of MedicineNashville, TennesseeMichael A. Bruno, MS, MD, FACRProfessor of Radiology and MedicinePenn State College of MedicineHershey, PennsylvaniaFrancisco Cesar Carnevale, MD, PhDProfessor of RadiologyUniversity of São Paulo Medical SchoolSão Paulo, BrazilMatthew D. Cham, MDAssociate Professor of RadiologyIcahn School of Medicine at Mount SinaiNew York, New YorkDaniel Chan, MDPrecision Vascular and InterventionalDallas, TexasMaye M. Chan, PA-CDivision of Abdominal Imaging and InterventionBrigham and Women’s HospitalBoston, MassachusettsDanny Cheng, MDAssistant Clinical Professor of RadiologyUC Davis Medical CenterSacramento, CaliforniaJared D. Christensen, MDAssistant Professor of RadiologyDuke University Medical CenterDurham, North CarolinaJohn Chung, MD, FRCPCClinical Instructor of RadiologyUniversity of British ColumbiaVancouver, British Columbia, CanadaPetra Clark, MS, CNS-AG, RN, CRN22

Division of Interventional RadiologyBrigham and Women’s HospitalBoston, MassachusettsTimothy W.I. Clark, MD, FSIRAssociate Professor of Clinical Radiology and SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphia, PennsylvaniaSarah D. Cohn, RN, JD, FACNMGeneral CounselMedical College of WisconsinMilwaukee, WisconsinAnne M. Covey, MD, FSIRAssociate Professor of RadiologyMemorial Sloan-Kettering Cancer Center/Weill Cornell Medical CenterNew York, New YorkLaura Crocetti, MD, PhD, EBIRAssistant Professor of RadiologyCisanello Hospital/Pisa University School of MedicinePisa, ItalyMichael D. Dake, MDThelma and Henry Doelger ProfessorDepartment of Cardiothoracic SurgeryStanford University School of MedicineStanford, CaliforniaMichael D. Darcy, MDProfessor of RadiologyWashington University School of MedicineSt. Louis, MissouriAndré Moreira de Assis, MDInterventional RadiologyUniversity of São Paulo Medical SchoolSão Paulo, BrazilOlga Duran-Castro, MDProfessor of RadiologyDivision of Interventional Radiology and Vascular MedicineUniversity of MinnesotaMinneapolis, MinnesotaJeremy J. Erasmus, MDProfessor of Diagnostic RadiologyMD Anderson Cancer CenterHouston, TexasJoseph P. Erinjeri, MD, PhDAssociate MemberMemorial Sloan Kettering Cancer Center/Weill Cornell Medical CenterNew York, New York23

Khashayar Farsad, MD, PhDAssistant ProfessorDotter Interventional InstituteOregon Health and Science UniversityPortland, OregonSiobhan M. Flanagan, MDAssistant Professor of RadiologyDivision of Interventional Radiology and Vascular MedicineUniversity of MinnesotaMinneapolis, MinnesotaMichael G. Flater, RNTerritory ManagerZOLL LifeVestPittsburgh, PennsylvaniaRichard Foley, MS, RNRadiology and IV TherapyBrigham and Women’s HospitalBoston, MassachusettsBrian Funaki, MDProfessor of RadiologyUniversity of ChicagoChicago, IllinoisRipal T. Gandhi, MD, FSVMAssociate Clinical ProfessorMiami Cardiac and Vascular InstituteFlorida International University Herbert Wertheim College of MedicineMiami, FloridaChristos S. Georgiades, MD, PhD, FSIR, FCIRSEAssociate Professor of Radiology and SurgeryJohns Hopkins UniversityBaltimore, MarylandJean-Francois H. Geschwind, MDProfessor of Radiology and OncologyYale University School of MedicineNew Haven, ConnecticutMatthew G. Gipson, MDAssistant Professor of RadiologyUniversity of Colorado School of MedicineAurora, ColoradoJafar Golzarian, MD, FSIRProfessor of Radiology and SurgeryUniversity of MinnesotaMinneapolis, MinnesotaRoy L. Gordon, MDProfessor Emeritus of Radiology24

University of CaliforniaSan Francisco, CaliforniaRajan K. Gupta, MDAssistant Professor of RadiologyUniversity of Colorado School of MedicineAurora, ColoradoKlaus D. Hagspiel, MDProfessor of Radiology, Medicine (Cardiology) and PediatricsUniversity of VirginiaCharlottesville, VirginiaMichael J. Hallisey, MDDepartment of RadiologyHartford HospitalHartford, ConnecticutRulon L. Hardman, MD, PhDAssistant Professor of RadiologyUniversity of UtahSalt Lake City, UtahZiv J. Haskal, MD, FSIR, FAHA, FACR, FCIRSEProfessor of RadiologyUniversity of Virginia School of MedicineCharlottesville, VirginiaPeter B. Hathaway, MDUtah Imaging AssociatesUtah Vascular ClinicSalt Lake City, UtahNicholas J. Hendricks, MDInterventional RadiologyVirginia Hospital CenterArlington, VirginiaClaudia I. Henschke, PhD, MDProfessor of RadiologyIcahn School of Medicine at Mount SinaiNew York, New YorkManraj K.S. Heran, MD, FRCPCAssociate Professor of RadiologyUniversity of British ColumbiaVancouver, British Columbia, CanadaMikhail C.S.S. Higgins, MD, MPHFellow, Division of Interventional RadiologyHospital of the University of PennsylvaniaPhiladelphia, PennsylvaniaStephen G.F. Ho, MD, FRCPCClinical Professor of Radiology25

University of British ColumbiaVancouver, British Columbia, CanadaDavid M. Hovsepian, MDClinical Professor of RadiologyStanford University School of MedicineStanford, CaliforniaDavid W. Hunter, MD, FSIR, FACRProfessor Emeritus of RadiologyUniversity of MinnesotaMinneapolis, MinnesotaJonathan J. Iglesias, MDMiami Cardiac and Vascular InstituteMiami, FloridaMaxim Itkin, MDAssociate Professor of Radiology and SurgeryUniversity of Pennsylvania Medical CenterPhiladelphia, PennsylvaniaM. Fuad Jan, MBBS, MD, FACC, FACCPAurora Cardiovascular ServicesAurora Health CareMilwaukee, WisconsinD. Thor Johnson, MD, PhDAssistant Professor of RadiologyUniversity of Colorado School of MedicineAurora, ColoradoMichele H. Johnson, MD, FACRProfessor, Diagnostic Radiology, Surgery(Otolaryngology) and NeurosurgeryYale University School of MedicineNew Haven, ConnecticutRathachai Kaewlai, MDDepartment of Diagnostic and Therapeutic RadiologyMahidol UniversityBangkok, ThailandS. Lowell Kahn, MD, MBAAssistant Professor, Surgery and Interventional RadiologyTufts University School of MedicineSpringfield, MassachusettsJohn A. Kaufman, MD, MS, FSIRFrederick S. Keller Professor of Interventional RadiologyOregon Health and Science UniversityPortland, OregonFrederick S. Keller, MDProfessor of Interventional RadiologyOregon Health and Science University26

Portland, OregonNeil M. Khilnani, MDAssociate Professor of Clinical RadiologyWeill Cornell MedicineNew York, New YorkJin Hyoung Kim, MD, PhDAssistant Professor of RadiologyUniversity of Ulsan College of MedicineSeoul, South KoreaK. Pallav Kolli, MDAssistant Professor of Clinical RadiologyUniversity of California, San FranciscoCalifornia, San FranciscoSebastian Kos, EBIR, FCIRSEChairman, Institute of Radiology and Nuclear MedicineHirslanden Klinik St. AnnaLuzern, SwitzerlandJoshua D. Kuban, MDFellow, Vascular and Interventional RadiologyAlpert Medical School of Brown UniversityProvidence, Rhode IslandDavid A. Kumpe, MD, FSIRProfessor of Radiology, Surgery, and NeurosurgeryUniversity of Colorado School of MedicineAurora, ColoradoMarcus A. Lehman, MDAssistant Professor of AnesthesiologyUniversity of CincinnatiCincinnati, OhioEvan Lehrman, MDAssistant Professor of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan Francisco, CaliforniaRiccardo Lencioni, MD, FSIR, EBIRProfessor of RadiologyPisa University School of MedicinePisa, ItalyRobert J. Lewandowski, MD, FSIRAssociate Professor of RadiologyNorthwestern UniversityChicago, IllinoisDavid Li, MD, PhDAssistant Professor of RadiologyDivision of Interventional Radiology27

New York-Presbyterian Hospital/WeillCornell Medical CenterNew York, New YorkLeonard J. Lind, MD, FCCMProfessor of Clinical AnesthesiologyUniversity of Ci

Title: Handbook of interventional radiologic procedures / [edited by] Krishna Kandarpa, Lindsay Machan, Janette D. Durham. . 46 Biopsy Procedures of the Lung, Mediastinum, and Chest Wall Matth