Vascular Diagnosis

538 Pages·2004·76.44 MB·English

by  M. Ashraf Mansour

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VASCULAR DIAGNOSIS ISBN: 0-721-69426-8
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NOTICE
Vascular Surgery is an ever-changing field. Standard safety precautions must be followed, but as
new research and clinical experience broaden our knowledge, changes in treatment and drug therapy
may become necessary or appropriate. Readers are advised to check the most current product infor-
mation provided by the manufacturer of each drug to be administered to verify the recommended
dose, the method and duration of administration, and contraindications. It is the responsibility of
the licensed prescriber, relying on experience and knowledge of the patient, to determine dosages
and the best treatment for each individual patient. Neither the publisher nor the authors assume
any liability for any injury and/or damage to persons or property arising from this publication.
Previous edition copyrighted 1994.
Library of Congress Cataloging-in-Publication Data
Vascular diagnosis/[edited by] M. Ashraf Mansour, Nicos Labropoulos. – 1st ed.
p.; cm.
Includes bibliographical references and index.
ISBN 0-7216-9426-8
1. Blood-vessels—Diseases—Diagnosis. 2. Blood-vessels—Surgery. I. Mansour, M.
Ashraf. II. Labropoulos, Nicos.
[DNLM: 1. Vascular Diseases—diagnosis. 2. Diagnostic Imaging—methods.
3. Diagnostic Techniques, Cardiovascular. WG 500 V33121 2004]
RC691.5.V365 2004
616.1′3–dc22 2004042977
Acquisitions Editor:Hilarie Surrena
Developmental Editor:Donna L. Morrissey
Project Manager:Mary Stermel
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
Vascular Diagnosis is dedicated to our parents and families who supported us.
Contributors
Ali F. AbuRahma, MD George Berdejo, BA, RVT
Professor of Surgery and Chief of Vascular Surgery, Technical Director, Vascular Laboratories, Montefiore Hospital;
Department of Surgery, Robert C. Byrd Health Sciences Center Weiler Hospital; and Albert Einstein College of Medicine,
of West Virginia University; Medical Director, Vascular Laboratory, New York, New York
Charleston Area Medical Center; Charleston, West Virginia
Luke P. Brewster, MD
Samuel S. Ahn, MD Resident, General Surgery, Loyola University Medical Center,
Clinical Professor of Surgery, University of California, Los Angeles, Maywood, Illinois
Los Angeles, California
Marc Cairols, MD, FRCS (London), PhD
Enrico Ascher, MD Professor of Surgery, University of Barcelona;
Chief, Vascular Surgery, Division of Vascular Surgery, Chief, Department of Vascular Surgery,
Maimonides Medical Center, Brooklyn, New York Hospital Universitari de Bellvitge; Catalonia, Spain
J. Dennis Baker, MD Sandra C. Carr, MD
Professor, Department of Surgery, David Geffen School of Medicine Assistant Professor, Department of Surgery, Univer-
at UCLA; Chief, Vascular Surgery Section, Department of Surgery, sity of Wisconsin School of Medicine, Madison,
VA Medical Center; Los Angeles, California Wisconsin
William H. Baker, MD, FACS John J. Castronuovo, Jr., MD
Professor Emeritus, Surgery, Stritch School of Medicine, Clinical Professor of Surgery, University of Medicine and Dentistry,
Loyola University of Chicago, Maywood, Illinois New Jersey Medical School, Newark, New Jersey; Chairman,
Division of Vascular Surgery and Director of Noninvasive
Hisham Bassiouny, MD Vascular Laboratory, Morristown Memorial Hospital, Morristown,
Professor, Vascular Surgery, and Director, Vascular Laboratory, New Jersey
Department of Surgery, University of Chicago, Chicago, Illinois
Joaquim J. Cerveira, MD
Kirk W. Beach, PhD, MD Assistant Professor of Surgery, Department of Surgery,
Research Professor, Department of Surgery, UMDNJ–New Jersey Medical School, Newark, New Jersey
University of Washington, Seattle, Washington
Benjamin B. Chang, MD
Phillip J. Bendick, PhD Assistant Professor, Department of Surgery,
Director, Peripheral Vascular Diagnostic Center; Albany Medical School; Attending Vascular Surgeon,
Director of Surgical Research, William Beaumont Hospital; Department of Surgery–Vascular Surgery,
Royal Oak, Michigan Albany Medical Center Hospital;
Albany, New York
Marshall E. Benjamin, MD
Associate Professor of Surgery, University of Maryland School Vasana Cheanvechai, MD
of Medicine, Baltimore, Maryland; Chief of Surgery, Assistant Professor of Surgery, University of Maryland School of
North Arundel Hospital, Glen Burnie, Maryland Medicine, Baltimore, Maryland
vii
viii Contributors
Jeremy Collins, BS Anil Hingorani, MD
Department of Radiology, Feinberg School of Medicine, Vascular Surgeon, Division of Vascular Surgery,
Northwestern University, Chicago, Illinois Maimonides Medical Center, Brooklyn, New York
Robert F. Cuff, MD Kim J. Hodgson , MD
Clinical Instructor, Department of Surgery, Professor and Chair, Division of Vascular Surgery,
Michigan State University, East Lansing, Michigan Southern Illinois University School of Medicine, Springfield, Illinois
Ronald L. Dalman, MD Douglas B. Hood, MD
Associate Professor of Surgery, Department of Surgery, Assistant Professor of Surgery and Radiology,
Division of Vascular Surgery, Stanford University School University of Southern California, Keck School of Medicine,
of Medicine, Stanford, California; Chief, Vascular Surgery, Los Angeles, California
Surgical Service, Veterans Affairs Palo Alto Health Care System,
Palo Alto, California Bonnie Johnson, RDMS, RVT, FSVU
Director, Vascular Laboratory Services, Division of Vascular Surgery,
R. Clement Darling III, MD Stanford University Medical Center, Stanford, California
Professor, Department of Surgery, Albany Medical College;
Stavros K. Kakkos, MD, MSc
Chief, Division of Vascular Surgery, Albany
Department of Vascular Surgery, Faculty of Medicine,
Medical Center Hospital;
Imperial College, London, United Kingdom
Albany, New York
Steven S. Kang, MD
Diana Eastridge, MS, RN/CNP
Vascular Surgeon, Miami Cardiac and Vascular Institute,
Nurse Practitioner, Division of Vascular Surgery,
Baptist Health South Florida, Miami, Florida
Northwestern Memorial Hospital, Chicago, Illinois
Kenneth K. Kao
Victor Erzurum, MD
Department of Surgery, UCLA, Los Angeles, California
The Cleveland Clinic, Beachwood Family Health and Surgery Center,
Beachwood, Ohio
John K. Karwowski, MD
Vascular Surgery Fellow, Department of Surgery,
Julie Ann Freischlag, MD
Division of Vascular Surgery, Stanford University School of Medicine,
William Stewart Halsted Professor, Chair, Department of Surgery,
Stanford, California
and Surgeon in Chief, Johns Hopkins Medical Institutions,
Baltimore, Maryland
Sandra L. Katanick, RN, RVT, FSVU, CAE
Executive Director, Intersocietal Accreditation Commission,
George Geroulakos, MD, FRCS, DIC, PhD
Columbia, Maryland
Senior Lecturer in Vascular Surgery, Imperial College of Science
Technology and Medicine; Consultant Vascular Surgeon, Jenifer Kidd, RVT, DMU, AMS
Charing Cross and Ealing Hospital; London, United Kingdom Emeritus Director, Camperdown Vascular Laboratory, Sydney,
Australia
Peter Gloviczki, MD
Professor of Surgery, Mayo Clinic College of Medicine; Chair, Mark J. W. Koelemaij, MD, PhD
Division of Vascular Surgery and Director, Gonda Vascular Center, Vascular Surgery Fellow and Clinical Epidemiologist,
Mayo Clinic; Rochester, Minnesota Academic Medical Center, University of Amsterdam, Amsterdam,
The Netherlands
Maura Griffin, MSc, DIC, PhD
Chief Vascular Ultrasonographer, The Vascular Noninvasive George E. Kopchok, BS
Screening and Diagnostic Centre, London, United Kingdom Department of Surgery, Harbor-UCLA Medical Center, Torrance,
California
Thomas M. Grist, MD
Professor, Department of Radiology, University of Wisconsin School Paul B. Kreienberg, MD
of Medicine, Madison, Wisconsin Assistant Professor, Department of Surgery, Albany Medical College;
Attending Vascular Surgeon, Department of Surgery–Vascular Surgery,
Jennifer K. Grogan, MD Albany Medical Center Hospital; Albany, New York
Research Fellow, Department of Surgery, University of Chicago,
Chicago, Illinois Efthyvoulos Kyriakou
Department of Computational Intelligence, The Cyprus Institute of
Brian G. Halloran, MD Neurology and Genetics, Nicosia, Cyprus
Adjunct Clinical Assistant Professor of Surgery, University of Michigan;
Attending Vascular Surgeon, St. Joseph Mercy Hospital; Ann Arbor, Nicos Labropoulos, PhD, DIC, RVT
Michigan Associate Professor of Surgery, Director, Vascular Laboratory,
Loyola University Chicago, Stritch School of Medicine,
John Preston Harris, MD, FRACS, FRCS, FACS, DDU Maywood, Illinois
Professor of Vascular Surgery, University of Sydney; Head,
Division of Surgery and Director, Vascular Laboratory, Brajesh K. Lal, MD
Royal Prince Alfred Hospital; Sydney, Australia Assistant Professor, Surgery–Division of Vascular Surgery,
UMDNJ–New Jersey Medical School, Newark, New Jersey
Jennifer Heller, MD
Assistant Professor of Surgery, Johns Hopkins School of Medicine; Everett Y. Lam, MD
Assistant Professor of Surgery, Johns Hopkins Bayview Medical Resident, Division of Vascular Surgery, Oregon Health & Sciences
Center; Baltimore, Maryland University, Portland, Oregon
Contributors ix
Jason T. Lee, MD Mark D. Morasch, MD
Vascular Surgery Fellow, Division of Vascular Surgery, Assistant Professor of Surgery, Division of Vascular Surgery,
Stanford University Medical Center, Stanford, California Feinberg School of Medicine, Northwestern University; Attending
Surgeon, Northwestern Memorial Hospital; Chicago, Illinois
Dink A. Legemate, MD, PhD
Professor of Vascular Surgery and Clinical Epidemiologist, Terry Needham, RVT, FSVT
Academic Medical Center, University of Amsterdam, Amsterdam, Director, Heart and Vascular Department, Erlanger Health System,
The Netherlands Chattanooga, Tennessee
Luis R. Leon, Jr., MD, RVT Stephen C. Nicholls, MD
Peripheral Vascular Surgery Fellow, Loyola University Medical Center, Associate Professor, Department of Surgery, Division of
Maywood, Illinois Vascular Surgery, University of Washington School of Medicine;
Chief of Vascular Surgery, Harborview Medical Center; Seattle,
Fred N. Littooy, MD Washington
Professor of Surgery, Loyola University Medical Center,
Loyola University School of Medicine, Maywood, Illinois Andrew Nicolaides, MD, FRCS
Emeritus Professor of Vascular Surgery, Imperial College;
Joann Lohr, MD Honorary Consultant Surgeon, Ealing Hospital; London,
Director, John J. Cranley Vascular Laboratory, United Kingdom; Specialist Scientist, Department of Biological
Good Samaritan Hospital, Cincinnati, Ohio Sciences, University of Cyprus, Nicosia, Cyprus
Thanila A. Macedo, MD Paul J. Nordness, MD
Instructor in Radiology, Mayo Clinic College of Medicine; Fellow, Section of Vascular Surgery, Ochsner Clinic Foundation,
Senior Associate Consultant, Mayo Clinic, Rochester, Minnesota New Orleans, Louisiana
M. Ashraf Mansour, MD, RVT, FACS Gustavo S. Oderich, MD
Associate Professor of Surgery, Program Director, Vascular Surgery, Vascular Surgery Fellow, Mayo Clinic College of Medicine,
Michigan State University, Grand Rapids Medical Education and Rochester, Minnesota
Research Center, Grand Rapids, Michigan
Kathleen J. Ozsvath, MD
Natalia Markevich, MD, RVT Assistant Professor, Department of Surgery–Vascular Surgery,
Division of Vascular Surgery, Maimonides Medical Center, Albany Medical College; Attending Vascular Surgeon,
Brooklyn, New York Department of Surgery, Albany Medical Center Hospital;
Albany, New York
Jon S. Matsumura, MD
Associate Professor of Surgery, Northwestern University Feinberg Jean M. Panneton, MD
School of Medicine; Active Staff, Northwestern Memorial Hospital; Associate Professor of Surgery, Mayo Medical School;
Active Staff and Chief of Vascular Surgery, Chicago VA Healthcare Consultant, Director of Clinical Research, Mayo Clinic
System Westside; Chicago, Illinois and Mayo Foundation; Rochester, Minnesota
James May, MD, MS, FRACS, FACS Peter J. Pappas, MD
Bosch Professor of Surgery, University of Sydney; Vascular Surgeon, Chief, Section of Vascular Surgery at University Hospital,
Royal Prince Alfred Hospital; Sydney, Australia Department of Surgery, Division of Vascular Surgery,
UMDNJ–New Jersey Medical School, Newark, New Jersey
Manish Mehta, MD, MPH
Assistant Professor, Department of Surgery, Albany Medical College; Sheela T. Patel, MD
Attending Vascular Surgeon, Department of Surgery–Vascular Surgery, Senior Fellow, Vascular Surgery and Endovascular Surgery,
Albany Medical Center Hospital; Albany, New York University of Arizona Health Sciences Center, Tucson, Arizona
Mark H. Meissner, MD Philip S. K. Paty, MD
Associate Professor, Vascular Surgery, and Acting Instructor, Associate Professor, Department of Surgery, Albany Medical College;
Interventional Radiology, University of Washington School of Attending Vascular Surgeon, Department of Surgery–Vascular Surgery,
Medicine, Seattle, Washington Albany Medical Center Hospital; Albany, New York
Joseph L. Mills, Sr., MD William H. Pearce, MD
Professor of Surgery, University of Arizona Health Sciences Center; Violet R. and Charles A. Baldwin Professor of Vascular Surgery,
Chief, Division of Vascular and Endovascular Surgery and Director, Department of Surgery, Northwestern University,
Noninvasive Vascular Laboratory, University Physicians, Inc; Feinberg School of Medicine; Chief, Division of Vascular Surgery,
Tucson, Arizona Department of Surgery, Northwestern Memorial Hospital;
Chicago, Illinois
Gregory L. Moneta, MD
Professor of Surgery and Chief, Vascular Surgery, Brian G. Peterson, MD
Oregon Health & Science University, Portland, Oregon General Surgery Resident, Department of Surgery, McGaw
Medical Center, Northwestern University, Chicago, Illinois
Samuel R. Money, MD
Clinical Associate Professor of Surgery, Tulane University School Michael A. Ricci, MD
of Medicine; Head, Section of Vascular Surgery, Roger H. Allbee Professor of Surgery, Division of Vascular Surgery,
Ochsner Clinic Foundation; New Orleans, Louisiana University of Vermont College of Medicine, Burlington, Vermont
x Contributors
Sean P. Roddy, MD William D. Turnipseed, MD
Assistant Professor, Department of Surgery, Albany Medical College; Preceptor, Volunteer Staff, Surgery, University of Wisconsin School
Attending Vascular Surgeon, Department of Surgery–Vascular Surgery, of Medicine, Madison, Wisconsin
Albany Medical Center Hospital; Albany, New York
Frank Veith, MD
Heron E. Rodriguez, MD Professor of Surgery, Montefiore Hospital of the Albert Einstein
Assistant Professor of Surgery and Radiology, College of Medicine; Vice Chairman, Department of Surgery and
Loyola University Stritch School of Medicine; Attending Surgeon, William von Liebig Chair of Vascular Surgery, Montefiore Hospital;
Loyola University Medical Center; Maywood, Illinois New York, New York
Robert B. Rutherford, MD, FACS, FRCS(G) Reese A. Wain, MD
Emeritus Professor of Surgery, University of Colorado School Attending Surgeon, Vascular Surgery, Winthrop University Hospital,
of Medicine, Denver, Colorado Mineola, New York; Attending Surgeon, Stony Brook University,
Stony Brook, New York
Sergio X. Salles-Cunha, PhD, RVT, FSVU
Technical Director, The Vascular Institute of New York, Fred A. Weaver, MD
Maimonides Medical Center, Brooklyn, New York Professor and Chief, Division of Vascular Surgery,
University of Southern California, Keck School of Medicine,
Russell H. Samson, MD, FACS, RVT Los Angeles, California
President, Mote Vascular Foundation, Inc., Sarasota, Florida
Franklin W. West, BSN, RN, RVT, RVS, CCP
Gretchen Schwarze, MD Director of Professional Services, Pacific Vascular Inc.,
Clinical Associate, Department of Surgery, University of Chicago, Bothell, Washington
Chicago, Illinois
Geoffrey H. White, MD, FRACS
Dhiraj M. Shah, MD Associate Professor of Surgery, University of Sydney; Head,
Professor of Surgery, Department of Surgery, Albany Medical College; Department of Vascular Surgery, Royal Prince Alfred Hospital;
Director, Institute for Vascular Health and Disease, Albany Medical Sydney, Australia
Center Hospital; Albany, New York
Rodney White, MD
Maureen K. Sheehan, MD Professor of Surgery, UCLA School of Medicine, Los Angeles,
Vascular Surgery Fellow, University of Pittsburgh Medical Center, California; Chief, Vascular Surgery and Associate Chair,
Pittsburgh, Pennsylvania Department of Surgery, Harbor–UCLA Medical Center, Torrance,
California
Gail P. Size, RVT, RVS, RCVT, FSVU
President, Inside Ultrasound, Inc., Pearce, Arizona James S. T. Yao, MD, PhD
Magerstadt Professor of Surgery, Division of Vascular Surgery,
Timothy M. Sullivan, MD Feinberg School of Medicine, Northwestern University;
Senior Associate Consultant, Divisions of Vascular Surgery and Attending Surgeon, Division of Vascular Surgery,
Interventional Radiology, Mayo Clinic; Associate Professor of Surgery, Northwestern Memorial Hospital; Attending Surgeon,
Mayo Medical School; Vascular Surgeon, Saint Marys Hospital, Division of Vascular Surgery, Department of Veterans Affairs
Mayo Medical Center; Rochester, Minnesota Hospital; Chicago, Illinois
Algirdas Edvardas Tamosiunas, MD, PhD, RVT, RDMS R. Eugene Zierler, MD
Associate Research Professor, Clinic of Gastroenterology and Professor of Surgery, Department of Surgery,
Abdominal Surgery, Faculty of Medicine, Vilnius University; University of Washington; Medical Director,
Director, Vascular Laboratory, Vilnius University Hospital Vascular Diagnostic Service, University of Washington Medical
Santariskiu Klinikos; Vilnius, Lithuania Center; Seattle, Washington
Apostolos K. Tassiopoulos, MD Robert M. Zwolak, MD, PhD
Clinical Assistant Professor, Department of Cardiovascular Surgery, Professor of Surgery, Dartmouth Medical School;
Rush Medical College; Senior Attending, Department of Surgery, Attending Vascular Surgeon and Medical Director,
Division of Vascular Surgery, The John H. Stroger Jr. Hospital of Noninvasive Vascular Laboratory,
Cook County; Chicago, Illinois Dartmouth Hitchcock Medical Center; Lebanon, New Hampshire
Preface
Disorders of arteries and veins are prevalent in our society. The selection of appropriate
tests supplements careful physical examination and completes the clinical evaluation of
patients with vascular disease. Vascular Diagnosis is about the detection and manage-
ment of vascular disease. The field is rapidly expanding, and technological innovations
are occurring with regularity. Refinements in imaging equipment and software are being
introduced at a steady pace, making it difficult to stay current. At the same time, vascular
laboratories have proliferated nationwide to fill the needs of patients and physicians.
Demand for experienced vascular technologists has increased. Meanwhile, concerns
about the quality of work in some of these diagnostic centers have led some to demand
stricter supervision by regulatory bodies. It is estimated that there are more than 10,000
vascular laboratories in North America; however, only one fifth have received certifi-
cation by the Intersocietal Commission for the Accreditation of Vascular Laboratories.
This book is intended to provide a comprehensive overview of the diagnosis of vascular
disease and a source of information on establishing and maintaining an accredited
vascular laboratory.
The last edition of Vascular Diagnosis was edited by the late Eugene Bernstein,
MD, and published by Mosby in 1993. Dr. Bernstein conceived the idea of publishing a
book dedicated to the noninvasive diagnosis of vascular disease in conjunction with a
postgraduate course that assembled experts from around the world. The course and the
book were very successful, and the latter was considered by many to be the standard in
the field. In the last decade, many changes and innovations have occurred in the diag-
nosis and treatment of vascular disease. Endovascular repair of aortic aneurysms is now
a commonly performed operation. Carotid stenting will soon be approved as an accepted
modality to treat carotid stenosis. Endovenous procedures with laser or radiofrequency
are gaining widespread acceptance. As devices become smaller, minimally invasive tech-
niques are facilitated. Patients and practitioners are constantly demanding less invasive
techniques and shorter hospital stays. It is now commonplace to have patients discharged
on the following day after endovascular abdominal aortic aneurysm repair or a carotid
intervention. In that last edition, Dr. Bernstein stated: “Rapid and profound strides have
been made since the first edition of this book….” Indeed, much has changed in this
last decade.
xi
xii Preface
Physicians from multiple backgrounds and specialties are now involved in the diag-
nosis of vascular disease. The concept of the “vascular center”—embracing specialists
from different training paradigms to treat patients with vascular disease—is promulgated
as the right model for the present and future. As public awareness of vascular disease
increases, a growing number of patients are seeking to be screened and educated about
their atherosclerotic risk factors and cardiovascular disease. The vascular laboratory is
playing a central role in this revolution by providing fast and precise answers to frequent
questions. The earlier version of the vascular laboratory relied on physiologic methods
of blood flow measurement such as blood pressure and waveforms. Currently, there is
more emphasis on imaging blood vessels and observing blood flow with ultrasound
machines or with computed tomographic angiography and magnetic resonance angiography.
By necessity, some of the tools we use every day are located outside the vascular labora-
tory; nevertheless, their inclusion in the discussion of vascular diagnosis is germane.
Vascular Diagnosisis organized into three major parts with over 50 chapters. Tables
are used liberally, and we placed an emphasis on providing images, black and white as
well as color, for illustration. The first part covers some fundamental issues related to
the vascular laboratory and principles of vascular diagnosis. The second part has five
sections concerned with imaging the various regions of the body. The third part contains
a collection of miscellaneous topics such as coding and reimbursement and database
maintenance.
M. Ashraf Mansour, MD
Nicos Labropoulos, PhD
Acknowledgments
The completion of this book would not have been possible without the help and advice
of some of our colleagues and mentors, as well as many individuals who have contributed
time and effort to see this project through.
Robert Rutherford, MD, David Sumner, MD, and William Baker, MD, offered sugges-
tions and encouragement. Others have contributed chapters or made suggestions to
make the book more user friendly. Many individuals at Elsevier, including Donna L.
Morrissey, Joe Rusko, and Hilarie Surrena, helped in assembling the work and meeting
our deadlines.
xiii