tailieunhanh - Introduction of endovascular interventions: Part 2

(BQ) Continued part 1, part 2 of the document Introduction of endovascular interventions has contents: Catheter-Based management of peripheral, aortoiliac interventions, access site complications, acute deep vein hrombosis, chronic venous disorders, and other contents. Invite you to refer. | CHAPTER 13 Catheter-Based Management of Peripheral AVMs Allan M. Conway1 Alfio Carroccio1 and Robert J. Rosen2 1Division ofVascular Surgery Lenox Hill Hospital Donald and Barbara Zucker School of Medicine at Hofstra Northwell Health New York NY USA 2Division of Radiology Lenox Hill Heart Vascular Institute Lenox Hill Hospital Donald and Barbara Zucker School of Medicine at Hofstra Northwell Health New York NY USA Summary Proper diagnosis is key to treatment - the intervention-alist must understand the range of conditions and their natural history. Hemangiomas are benign endothelial tumors of infancy with a natural history of spontaneous involution no specific treatment is required in most cases. Vascular malformations are congenital lesions usually sporadic with no family history they grow with the individual and never involute spontaneously. They may or may not require treatment. Vascular malformations can be high flow arteriovenous shunting or low flow venous or lymphatic . Cli- nical presentation and treatment is different for each. High-flow arteriovenous malformation AVMs can cause distal ischemia venous hypertension bleeding and rarely high output cardiac states. An asymptomatic mass may not require any treatment. AVMs tend to grow with the individual and change slowly over time increased growth and symptoms may be seen in female patients during puberty or pregnancy. Treatment of high-flow lesions must be directed at reducing or eliminating the nidus as in fistulas proximal occlusion of feeders is ineffective or worse. The approach to high-flow lesions is usually via superselective catheterization and embolization using adhesives nBCA casting agents Onyx or tissue toxic agents ethanol . If a small vessel nidus is present particles or microspheres may be used although they have a tendency to early recurrence. Low-flow lesions are usually treated by direct injection of sclerosing agents ethanol Sotradecol sodium tetradecyl sulfate STS etc. under fluoroscopic or

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