Women’s Health in Interventional Radiology (eBook)

Women’s Health in Interventional Radiology 3
Foreword 7
Preface 9
Disclaimer 11
Contents 13
Contributors 15
Part I: Pelvic Vascular Interventions 17
1: Uterine Artery Embolization 18
Introduction 18
Pathophysiology 19
Clinical Manifestations 20
Anatomy 21
Pelvic Arterial Anatomy 21
Imaging 23
Differential Diagnosis on MR Imaging 27
Adenomyosis 27
Solid Adnexal Mass 28
Focal Myometrial Contraction 28
Uterine Leiomyosarcoma 28
Patient Encounter 28
Indications 28
Contraindications 29
Consult, Consent, and Preparation 30
Patient Preparation 31
Technique 32
Equipment and Materials 32
Contrast Media 32
Catheters and Wires 32
Embolic Agents 33
Vascular Closure Devices 33
Procedure Start 33
Step by Step 34
Technical Points, Pitfalls, and Pearls 40
Postoperative Care, Discharge Instructions, and Follow-Up 41
Pain Management 41
Assessing the Need for Hospital Admission 42
Inpatient Care 42
Care After Discharge 42
Repeat Treatment 43
Outcomes 43
Complications 46
Summary and Conclusions 47
References 47
2: Pelvic Varices Embolization 52
Introduction 52
Pathophysiology 52
Clinical Manifestations 53
Anatomy 53
Veins of the Pelvis 53
Imaging 55
Patient Encounter 57
Indications and Contraindications 57
Consult, Consent, and Preparation 58
Technique 59
Materials 59
Catheters and Wires 59
Embolic Agents 59
Coils 59
Occlusion Balloons 60
Contrast Agents 61
Procedure Start 61
Step by Step 61
Hints, Technical Pitfalls, and Pearls 70
Post-Operative Care, Discharge Instructions, and Follow-up 70
Outcomes 70
Complications 72
Summary and Conclusions 73
References 73
Part II: Fallopian Tube Interventions 75
3: Fallopian Tube Recanalization 76
Introduction 76
Pathophysiology 76
Clinical Manifestations 78
Anatomy 78
The Female Reproductive Organs 78
Imaging 80
The Hysterosalpingogram (HSG) 80
Patient Encounter 81
Indications and Contraindications 81
Consult, Consent, and Preparation 81
Technique 82
Materials 82
Vaginal Speculum 82
Transcervical Catheters 83
Catheters and Wires 83
Contrast Agents 85
Cervical Os Finder, Cervical Dilator, Uterine Sound 85
Procedure Start 85
Step by Step 85
Hints, Technical Pitfalls, and Pearls 89
Postoperative Care, Discharge Instructions, and Follow-Up 90
Outcomes 90
Complications 91
Summary and Conclusions 92
References 92
4: Fallopian Tube Occlusion 95
Introduction 95
Anatomy 97
Female Reproductive Anatomy 97
Imaging 97
Patient Encounter 98
Indications and Contraindications 98
Consult, Consent, and Preparation 98
Patient Preparation 99
Technique 100
Equipment and Materials 100
Vaginal Speculum 100
Guide Sheath 100
Essure ® Occlusion Device 100
Catheter 100
Procedure Start 101
Step by Step 103
Hints, Technical Pitfalls, and Pearls 104
Postoperative Care, Discharge Instructions, and Follow-Up 105
Alternative Imaging for Confirmation 111
Outcomes 114
Complications 115
Summary and Conclusions 115
References 116
Part III: Spine Interventions 117
5: Kyphoplasty and Vertebroplasty 118
Introduction 118
Pathophysiology 118
Anatomy 119
Anatomy of the Spine 119
Imaging 120
Patient Encounter 123
Indications and Contraindications 123
Consult, Consent, and Preparation 127
Technique 127
Equipment and Materials 127
Radiopaque Bone Cement 127
Cement Infusion Systems 129
NeedlesVertebroplasty 129
NeedlesKyphoplasty 129
Balloon Tamp: Kyphoplasty 129
Bone Biopsy Devices and Drills 129
Vertebroplasty or Kyphoplasty Kits 130
Contrast 131
Procedure Start 131
Step by Step 132
Balloon Kyphoplasty 132
Vertebroplasty 136
Radiofrequency Kyphoplasty: Overview and Technique 139
Hints, Technical Points, Pitfalls, and Pearls 140
Postoperative Care, Discharge Instructions, and Follow-Up 140
Outcomes 141
Vertebroplasty 141
Kyphoplasty 141
Controversy over Outcomes 142
Cost 144
Complications 144
Summary and Conclusions 145
References 146
6: Spine Pain Management 148
Introduction 148
Pathophysiology 148
Clinical Manifestations 149
Anatomy 149
Anatomy of the Spine 149
Imaging 149
Patient Encounter 149
Indications and Contraindications 149
Consult, Consent, and Preparation 150
Technique 150
Equipment and Materials 150
Needles 150
Contrast 150
Local Anesthesia 151
Steroids 151
Procedure Start 151
Step by Step 151
Lumbar Nerve Block 151
Thoracic Nerve Block 154
Cervical Nerve Block 154
Sacral Nerve Block 154
Epidural Spine Injection 155
Hints, Technical Pitfalls, and Pearls 156
Postoperative Care, Discharge Instructions, and Follow-up 157
Outcomes 157
Complications 157
Summary and Conclusions 158
References 158
Part IV: Lower Extremity Venous Interventions 160
7: Lower Extremity Venous Ablation and Sclerotherapy 161
Introduction 161
Pathophysiology 161
Clinical Manifestations 162
Anatomy 163
Lower Extremity Venous Anatomy 163
Imaging 163
Patient Encounter 172
Indications and Contraindications 172
Consult and Consent 173
Review of Benefits and Risks of Various Procedures 174
Sclerotherapy 174
Radiofrequency Ablation 174
Endovenous Laser Therapy 175
Bilateral Procedures 176
Patient Preparation 176
Technique 176
Equipment and Materials 176
Sclerotherapy Materials 177
RFA and Laser Materials 177
Procedure Start 177
Step by Step 179
Sclerotherapy 179
RFA and EVLT 180
Hints, Technical Pitfalls, and Pearls 182
Postoperative, Discharge, and Follow-Up 182
Outcomes 183
Sclerotherapy 183
RFA 183
EVLT 185
Complications 185
Summary and Conclusions 185
References 186
Index 188