Current Therapy in Vascular and Endovascular Surgery

Front Matter
Copyright
Contributors
Preface
Cerebrovascular Disease
1 Cerebrovascular Disease
Pathology of Carotid
Artery Atherosclerosis
Geometry of
The Carotidbifurcation
Hemodynamic Conditions At Thecarotid Bifurcation
Carotid Bifurcation Atherosclerosis
2
Carotid and Vertebral Artery Fibrodysplasia
Carotid Artery Fibrodysplasia
Vertebral Artery Fibrodysplasia
3
Carotid Artery Dissections
Clinical Pathophysiology
Diagnosis
Treatment
Outcomes
4
Carotid Artery Kinks and Coils
ETIOLOGY
EPIDEMIOLOGY
IMAGING AND DIAGNOSIS
MANAGEMENT AND TREATMENT
5
Giant Cell Arteritis
PATHOPHYSIOLOGY
CLINICAL FEATURES
DIAGNOSIS
MEDICAL TREATMENT
SURGICAL TREATMENT
PROGNOSIS
6
Arteriographic Evaluation of Cerebrovascular Disease
INDICATIONS FOR CATHETER-BASED ANGIOGRAPHY
Diagnostic Indications
Intraoperative Indications
Surveillance
ANGIOGRAPHIC PROCEDURES
Access to the Arterial System
Sheath and Catheter Principles
Contrast Agents
Vessel Selection
Catheter Positioning
Angiographic Images
Angiographic Anatomy
Embolic Precautions
Injection Rates
Sedation and Anesthesia Requirements
Postangiography Orders
COMPLICATIONS OF CEREBRAL ANGIOGRAPHY
Neurologic Complications
Nonneurologic Complications
7
Computed Tomography in Cerebrovascular Disease
8
Magnetic Resonance Imaging and Positron Emission Tomography in the Evaluation of Cerebrovascular Disease
MAGNETIC RESONANCE IMAGING
POSITRON EMISSION TOMOGRAPHY
CONCLUSION
9
Duplex Scanning and Spectral Analysis of Carotid Bifurcation Atherosclerotic Disease
IMPORTANT CONCEPTS
GRADING OF STENOSIS
Use of Velocity Criteria
Limitations of Duplex Velocity Criteria
Other Methods of Grading ICA Stenosiswith Ultrasound
DUPLEX SCANNING AND STROKE RISK STRATIFICATION: FUTURE PERSPECTIVES
10
Transcranial Doppler in the Evaluation of Cerebrovascular Disease
TECHNIQUE
CLINICAL INDICATIONS
Cerebral Ischemia
Vasomotor Reactivity
Cerebral Embolization
Subarachnoid Hemorrhage
Sickle Cell Disease
Cerebral Circulatory Arrest
FUNCTIONAL TRANSCRANIAL DOPPLER
THERAPEUTIC TRANSCRANIAL DOPPLER
SUMMARY
11
Medical Treatment to Prevent Transient Ischemic Attacks and Ischemic Stroke
MODIFICATION OF RISK FACTORS
Hypertension
Tobacco Abuse
Diabetes Mellitus
Hyperlipidemia
Antiplatelet Medication
Lifestyle Interventions to Prevent Stroke
CARDIOEMBOLIC STROKE PREVENTION
Atrial Fibrillation
Carotid Artery Stenosis
STROKE PREVENTION IN SPECIAL PATIENT POPULATION
SECONDARY PREVENTION OF TRANSIENT ISCHEMIC ATTACKAND STROKE
SECONDARY PREVENTION OF CARDIOEMBOLIC STROKE
Antiplatelet Agents for Secondary Preventionof Stroke or Transient Ischemic Attack
CONCLUSION
12
Medical Therapy Including Fibrinolytic Therapy of Acute Ischemic Stroke
DIAGNOSIS
TREATMENT
PREVENTING FUTURE STROKES
Strokes of Unknown Onset and Wake-up Strokes
INTRAARTERIAL THROMBOLYSIS
13
Diabetes as a Risk Factor in Atherosclerotic Cerebrovascular Disease
DIABETES AND CEREBROVASCULAR DISEASE
Stroke Characteristics in Diabetes
Pathophysiology of Stroke in Diabetes and Hyperglycemia
PREVENTION OF STROKE IN PATIENTS WITH DIABETES
Glycemic Control
Antihypertensive Therapy
Lipid-Lowering Therapy
Antiplatelet and Anticoagulation Therapy
DIABETES AND SURGICAL INTERVENTION FOR CEREBROVASCULAR DISEASES
GLYCEMIC CONTROL IN THE SETTING OF ACUTE ISCHEMIC STROKE
CONCLUSION
14
Selection of Patients for Carotid Endarterectomy versus Carotid Artery Stenting
CAROTID STENTING VERSUS ENDARTERECTOMY: MAJORTRIAL DATA
TREATMENT OF ASYMPTOMATIC CAROTID ARTERY STENOSIS
TREATMENT OF SYMPTOMATIC CAROTID ARTERY STENOSIS
LIMITATIONS OF TRANSFEMORAL CAROTID ARTERY STENTING WITH DISTAL FILTER PROTECTION
15
Technical Aspects of Percutaneous Carotid Angioplasty and Stenting for Arteriosclerotic Disease
PREPROCEDURAL EVALUATION
ARTERIAL ACCESS
CAROTID IMAGING AND SHEATH ACCESS
Aortic Arch Angiogram
Selective Common Carotid Catheterization
Carotid Sheath Access
CEREBRAL PROTECTION
Technique for Using Distal Filters
Proximal Occlusion and Flow-Reversal Devices
ANGIOPLASTY AND STENTING
COMPLETION ANGIOGRAM
MANAGEMENT OF THE ACCESS SITE
POSTOPERATIVE CARE ANDFOLLOW-UP
16
Reversal of Cerebral Blood Flow to Prevent Stroke during Percutaneous Carotid Artery Angioplasty and Stenting
IMPACT OF EMBOLIZATION
PRINCIPLES OF FLOW REVERSAL
CLINICAL RESULTS WITH THEFIRST-GENERATION FLOW-REVERSAL SYSTEM
SECOND-GENERATION FLOW-REVERSAL SYSTEM AND EMPIRE TRIAL
17
Embolic Protection Devices to Prevent Stroke during Percutaneous Angioplasty and Stenting
DEVICE CHARACTERISTICS
SELECTION OF DEVICES
TECHNIQUE
CLINICAL TRIAL RESULTS
CONCLUSIONS
18
Blood Pressure Instability after Percutaneous Carotid Angioplasty and Stenting
PATHOPHYSIOLOGY OF HEMODYNAMIC INSTABILITY ASSOCIATED WITH CAROTID INTERVENTIONS
HEMODYNAMIC INSTABILITY TRIGGERED BY CAROTID ARTERY INTERVENTIONS
FACTORS PREDICTING HEMODYNAMIC INSTABILITY DURING CAROTID INTERVENTIONS
MANAGEMENT OF HEMODYNAMIC INSTABILITY INDUCED BY CAROTID ANGIOPLASTY AND STENTING
19
Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy and Carotid Stenting
PATHOPHYSIOLOGY
INCIDENCE
RISK FACTORS
CLINICAL MANIFESTATIONS
DIAGNOSIS
TREATMENT
20
Treatment of Recurrent Carotid Artery Stenosis After Percutaneous Angioplasty and Stenting
INCIDENCE
DIAGNOSIS
NATURAL HISTORY
CLINICAL SIGNIFICANCE
TREATMENT
CONCLUSION
21
Technical Aspects of Conventional Carotid Endarterectomy for Atherosclerotic Disease
SURGICAL TECHNIQUE
POSTOPERATIVE CARE
POSTOPERATIVE RESULTS
22
Technical Aspects of Eversion Carotid Endarterectomy for Atherosclerotic Disease
METHODS
SHUNTING AND EVERSION ENDARTERECTOMY
UNUSUAL PROBLEMS AND TROUBLESHOOTING
23
Patch Graft Closure with Carotid Endarterectomy
PATCH CLOSURE VERSUS PRIMARY CLOSURE
ROLE OF SELECTIVE PATCHING
CHOICE OF PATCH MATERIAL
CONCLUSIONS
24
Management of the Infected Carotid Artery Patch
INFECTING MICROORGANISMS
CLINICAL PRESENTATION
RELATIONSHIP WITH PERIOPERATIVE INFECTION
INVESTIGATION OF PROSTHETIC PATCH INFECTION
MANAGEMENT OF PROSTHETIC PATCH INFECTION
CONCLUSION
25
Role of Shunting During Carotid Endarterectomy
SELECTIVE SHUNTING
Awake Carotid Endarterectomy
Carotid Back Pressure Measurement
Electroencephalographic Monitoring
Transcranial Doppler
Cerebral Oximetry
ROUTINE SHUNTING
CONCLUSIONS
26
Intraoperative Assessment of the Technical Adequacy of Carotid Endarterectomy
ANGIOGRAPHY
DOPPLER STUDIES
DUPLEX SCANNING
FOLLOW-UP STUDIES
CURRENT RECOMMENDATIONS
27
Intraoperative Recognition and Treatment of Cerebral Ischemia During Carotid Endarterectomy
REGIONAL ANESTHESIA
GENERAL ANESTHESIA
INTRAOPERATIVE TREATMENT
Hypoperfusion
Embolization
Fronds
Dissection
Thrombosis
28
Early Postoperative Recognition and Management of Acute Stroke After Carotid Endarterectomy
EVALUATION
Portable Duplex Sonography
Magnetic Resonance Imaging andComputed Tomography
Angiography
SURGICAL REEXPLORATION
ENDOVASCULAR NEURORESCUE
MEDICAL MANAGEMENT
CEREBRAL HYPERPERFUSION VERSUS MICROEMBOLIC SHOWERS
29
Regional and Local Anesthesia for Carotid Endarterectomy
30 Carotid Endarterectomy or Stenting for Evolving Stroke Secondary
to Carotid Artery Atherosclerosis
THROMBOLYSIS AND CAROTID ENDARTERECTOMY IN ACUTE CERVICAL CAROTID OCCLUSION
CAROTID ARTERY STENTING IN ACUTE CERVICAL CAROTID OCCLUSION
CAROTID ARTERY STENTING FOR EMERGENT REVASCULARIZATION FOR ACUTE ISCHEMIC STROKE
CONCLUSION
31
Timing of Carotid Endarterectomy After Fixed Stroke Secondary to Carotid Artery Atherosclerosis
32
Carotid Occlusion and Near-Carotid Occlusion of the Extracranial Internal Carotid Artery
INTERNAL CAROTID ARTERY OCCLUSION
Acute Occlusion, Asymptomatic
Acute Occlusion, Symptomatic
Chronic Occlusion, Asymptomatic
Chronic Occlusion, Symptomatic
CAROTID STRING SIGN
SUMMARY
33
Blood Pressure Instability After Carotid Endarterectomy
INCIDENCE
ETIOLOGY
TREATMENT
34
Relevance of External Carotid Artery Disease in Internal Carotid Artery Occlusion
ANATOMY OF CEREBRAL COLLATERAL CIRCULATION
EVALUATION OF THE PATIENT WITH SYMPTOMATIC OCCLUSION OF THE INTERNAL CAROTID ARTERY
CURRENT INDICATIONS AND RESULTS OF SURGICAL TREATMENT
TECHNIQUE OF EXTERNAL CAROTID ENDARTERECTOMY
RECOMMENDATIONS
35
Intracranial Occlusive Disease and Aneurysms: Influence on Carotid Revascularization Outcomes
INTRACRANIAL OCCLUSIVE DISEASE
INTRACRANIAL ANEURYSMS
36
Pathology of Carotid Artery Restenosis
DESCRIPTIVE PATHOLOGY
PATHOGENESIS
Cell Proliferation
Extracellular Matrix Synthesis
Thrombus Organization
Artery Wall Remodeling
Predictors of Carotid Restenosis after Endarterectomy
37
Treatment of Recurrent Stenosis After Previous Carotid Endarterectomy
OPTIMAL IMAGING FOR ASSESSMENT OF CAROTID RESTENOSIS
TREATMENT OPTIONS FOR RECURRENT CAROTID ARTERY STENOSIS
Repeat CEA for Recurrent Carotid Stenosis
Other Surgical Options for RecurrentCarotid Stenosis
Endovascular Procedures
Carotid Endarterectomy versus Carotid Artery Stenting
38
Management of Concomitant Carotid and Coronary Arterial Disease
CARDIAC RISK STRATIFICATION PRIOR TO CAROTID ENDARTERECTOMY
CAUSES OF STROKE FOLLOWING CORONARY REVASCULARIZATION
RELATIONSHIP OF CAROTID STENOSIS TO PERIOPERATIVE STROKE
TIMING OF CAROTID AND CORONARY OPERATIONS
CONCOMITANT CAROTID AND CORONARY ARTERY OPERATIONS
STAGED VERSUS COMBINED CAROTID AND CORONARY ARTERY OPERATIONS
CONCLUSION
39
The Role of Extracranial–Intracranial Bypass in Current Practice
HISTORICAL PERSPECTIVE
PROCEDURAL CHARACTERISTICS
Preoperative Evaluation
Procedural Considerations
Postprocedural Follow-up and Management
CURRENT DATA
CONCLUSIONS
40
Open Surgical Treatment of Fibromuscular Dysplasia of the Carotid Artery
OPERATIVE TECHNIQUES
Open Dilation
Resection and Interposition Graft Reconstruction
SURGICAL RESULTS
41
Endovascular Treatment of Fibromuscular Dysplasia of the Carotid Artery
INDICATIONS
TECHNIQUE
RESULTS
SUMMARY
42
Vertebral Artery Reconstruction for Vertebrobasilar Ischemia
PATIENT EVALUATION
INDICATIONS FOR OPERATION
SURGICAL REPAIR
Transposition of the Proximal VA to the Common
Carotid Artery
Proximal Subclavian–Vertebral Bypass
Distal VA Reconstruction (Bypass)
Reconstruction and Decompressionof the VA of the C0–C1 Level
43
Endovascular Angioplasty and Stenting for Proximal Subclavian Artery Stenosis
CLINICAL EVALUATION AND DIAGNOSIS
INDICATIONS FOR TREATMENT
TECHNICAL PRINCIPLES OF ENDOVASCULAR THERAPY
RESULTS OF SUBCLAVIAN ARTERY ANGIOPLASTY AND STENTING
ENDOVASCULAR VERSUS SURGICAL INTERVENTION
CONCLUSION
44
Subclavian to Carotid Arterial Transposition
45
Carotid–Subclavian Bypass and Other Nonanatomic Revascularizations for Proximal Subclavian Artery Stenosis
ANATOMY
CAROTID–SUBCLAVIAN BYPASS
OTHER NONANATOMIC SUBCLAVIAN ARTERY RECONSTRUCTIONS
46
Conventional Surgical and Endovascular Treatment of Innominate Artery Atherosclerosis
CLINICAL PRESENTATION
DIAGNOSIS
TREATMENT
Surgical Techniques
Endovascular Techniques
CONCLUSIONS
47
Extracranial Carotid Artery Aneurysms
TRUE CAROTID ARTERY ANEURYSMS
Incidence
Manifestations
Treatment
TRAUMATIC FALSE ANEURYSMS OF THE CAROTID ARTERY
Incidence
Treatment
FALSE ANEURYSMS FOLLOWING CAROTID ARTERY ENDARTERECTOMY
Incidence
Treatment
48
Carotid Body Tumors
CLINICAL PRESENTATION
DIAGNOSIS
PREOPERATIVE EMBOLIZATION
SURGICAL INDICATIONS
SURGICAL APPROACH
SURGICAL RESULTS
49
Radiation-Induced Arteritis
COMPARISON WITH ARTERIOSCLEROSIS
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
Subclavian–Axillary Lesions
Extracranial Cervical Lesions
Abdominal Aorta and Its Branches
MANAGEMENT
Carotid Lesions
Subclavian–Axillary Lesions
Lesions of the Abdominal Aorta and Its Branches
SURVEILLANCE AND PREVENTION
50
Surgical Treatment of Takayasu Arteritis
CLINICAL FEATURES
MEDICAL TREATMENT
SURGICAL TREATMENT
Transluminal Angioplasty
Arterial Reconstruction
Surgical Results
Upper Extremity
Arterial Disease
51
Pathology of Upper Extremity Arterial Disease
VASOSPASM
INTRINSIC ARTERIAL DISEASE
Atherosclerosis
Inflammatory Diseases
Connective Tissue Disorders
Aneurysms
EMBOLISM
TRAUMA
Iatrogenic Injuries
Occupational Trauma
Athletic Injuries
MEDICAL CONDITIONS
52
Upper Extremity Revascularization
DIAGNOSTIC EVALUATION
ENDOVASCULAR TREATMENT
SURGICAL TREATMENT
COMMON APPROACHES TO THE UPPER EXTREMITY VESSELS
Subclavian Artery and Proximal Axillary Artery
Distal Axillary Artery
Brachial, Proximal Radial, and Ulnar Arteries
Distal Arteries
SURGICAL RESULTS
53
Diagnosis and Treatment of Upper Extremity Vasospastic Disease
RAYNAUD’S SYNDROME
Primary Raynaud’s Syndrome
Secondary Raynaud’s Syndrome
Disorders That Mimic Raynaud’s Syndrome
TREATMENT
Conservative Therapy
Pharmacologic Therapy
Lumbar Sympathectomy
54
Extremity Causalgia: Reflex Sympathetic Dystrophy
DIFFERENTIAL DIAGNOSIS
MEDICAL THERAPY
SUMMARY
55
Thoracic Sympathectomy
ANATOMY OF THE CERVICAL AND THORACIC SYMPATHETIC GANGLIA
PHYSIOLOGY OF SYMPATHETIC NERVOUS SYSTEM
Indications for Cervicodorsal Sympathectomy
THERAPEUTIC OPTIONS
Medical Therapy
Surgical Therapy
Conclusion
56
Etiology and Anatomic Pathology of Thoracic Outlet Syndrome
ANATOMY
PATHOPHYSIOLOGY
Neurogenic Thoracic Outlet Syndrome
Venous Thoracic Outlet Syndrome
Arterial Thoracic Outlet Syndrome
SUMMARY
57
Diagnosis of Thoracic Outlet Syndrome
NEUROGENIC THORACIC OUTLET SYNDROME
Clinical Presentation
Physical Examination
VENOUS THORACIC OUTLET SYNDROME
Clinical Presentation
ARTERIAL THORACIC OUTLET SYNDROME
Clinical Presentation
Management and Indications for Surgery
58
Conservative Treatment for Thoracic Outlet Syndrome
ASSESSMENT FOR PHYSICAL THERAPY
COMMENT
59
Transaxillary Operative Management of Thoracic Outlet Syndrome
OPERATIVE TECHNIQUE
60
Supraclavicular Operative Approach for Thoracic Outlet Syndrome
MANAGEMENT OF NEUROGENIC THORACIC OUTLET SYNDROME
Positioning and Initial Exposure
Mobilization of the Scalene Fat Pad
Anterior Scalenectomy
Brachial Plexus Mobilization
Middle Scalenectomy
Division of the Posterior First Rib
Division of the Anterior First Rib
Cervical Rib Resection
Pectoralis Minor Tenotomy
MANAGEMENT OF VENOUS THORACIC OUTLET SYNDROME
MANAGEMENT OF ARTERIAL THORACIC OUTLET SYNDROME
CLOSURE, POSTOPERATIVE CARE, AND RECOVERY
61
Treatment of Arterial Complications in Thoracic Outlet Syndrome
ANATOMIC FEATURES
CLINICAL PRESENTATION
DIAGNOSIS
TREATMENT
62
Subclavian and Axillary Artery Aneurysms
SUBCLAVIAN ARTERY ANEURYSMS
ABCDABERRANT SUBCLAVIAN ARTERY ANEURYSMS
AXILLARY ARTERY ANEURYSMS
DIAGNOSIS AND EVALUATION
OPERATIVE TREATMENT
ENDOVASCULAR REPAIR
RESULTS
63
Buerger’s Disease
DIAGNOSIS
NONOPERATIVE MANAGEMENT
Patient Education
Smoking Cessation
Pharmacologic Therapy
Pain Control
Local Wound Care
OPERATIVE MANAGEMENT
Arterial Reconstruction
Sympathectomy
Amputation
64
Ergotism
PHARMACOLOGY
CLINICAL PRESENTATION OF ERGOTISM
ERGOT ALKALOIDS AND DRUG INTERACTIONS
TREATMENT
65
Hypothenar Hammer Syndrome
PREVALENCE OF DISEASE
ANATOMY AND PATHOPHYSIOLOGY
DIAGNOSTIC EVALUATION
MANAGEMENT
Aortic Aneurysm
66
Pathogenesis of Abdominal Aortic Aneurysms
BIOMECHANICAL WALL STRESS ANDSTRUCTURAL PATHOLOGY
INTRALUMINAL THROMBUS
MATRIX METALLOPROTEINASES AND ENDOGENOUS PROTEASES
AORTIC MEDIAL DECOMPENSATION
INFLAMMATION AND AUTOIMMUNITY
PATHOGEN INVOLVEMENTAND AUTOIMMUNITY
OXIDATIVE STRESS
ADVENTITIAL MODIFICATION
MODELS OF ABDOMINAL AORTIC ANEURYSM AND FUTURE RESEARCH
SUMMARY
67
Genetics of Abdominal Aortic Aneurysms
THE HERITABILITY OF ABDOMINAL AORTIC ANEURYSMS VERSUS THORACIC AORTIC ANEURYSMS
INHERITANCE OF ABDOMINAL AORTIC ANEURYSM
IDENTIFYING GENES ASSOCIATED WITH ABDOMINAL AORTIC ANEURYSMS
LINKAGE STUDIES
GENOME-WIDE ASSOCIATION STUDIES
FUTURE RESEARCH
CONCLUSION
68
Pathogenesis of Inflammatory Aortic Aneurysms
PATHOLOGY
ETIOLOGY
A Severe Variant of Aortic Aneurysm
A Generalized Autoimmune Process
An Immunoglobulin G4–Related Systemic Disease
CONCLUSION
69
Pathophysiology of Aortic Dissection
EARLY ANATOMIC CHANGESIN AORTIC DISSECTION
ISCHEMIC COMPLICATIONSOF AORTIC DISSECTION
FALSE LUMEN EXPANSION
70
Arteriomegaly and Aneurysmosis
ETIOLOGY
CLASSIFICATION
SURGICAL MANAGEMENT
CONCLUSION
71
Vascular Complications of Marfan Syndrome, Ehlers–Danlos Syndrome, and Loeys–Dietz Syndrome
MARFAN SYNDROME
Affected Organ Systems
Treatment
EHLERS–DANLOS SYNDROME
Affected Organ Systems
Treatment
Prognosis
LOEYS–DIETZ SYNDROME
Affected Organ Systems
Treatment
72
Ultrasonography in the Evaluation of Abdominal Aortic Aneurysms
SCREENING FOR ABDOMINAL AORTIC ANEURYSM
ULTRASONOGRAPHIC FOLLOW-UP OF ABDOMINAL AORTIC ANEURYSM
Abdominal Aortic and Iliac Artery Aneurysms
Follow-up after Endovascular Aneurysm Repair
73
Angiography in the Evaluation of Abdominal Aortic Aneurysm
INDICATIONS FOR CATHETER-BASED ARTERIOGRAPHY
PLANNING ABDOMINAL AORTIC ANEURYSM REPAIR
74
Magnetic Resonance Imaging in the Evaluation of Abdominal Aortic Aneurysm
75
Computed Tomography and Computed Tomographic Arteriography in the Evaluation of Abdominal Aortic Aneurysms
DATA SETS
SCAN PARAMETERS
RECONSTRUCTION
INITIAL AORTIC ASSESSMENT
ANALYSIS OF DISEASE EXTENT
ANEURYSM SIZE
ASSESSMENT OF THE PROXIMAL AND DISTAL NECKS
TORTUOSITY
AORTIC BRANCH ASSESSMENT
RELATIONAL BRANCH VESSEL GEOMETRY
AORTIC COMPUTED TOMOGRAPHY AFTER OPEN OR ENDOVASCULAR TREATMENT
76
Selection of Patients with Aortic Aneurysms for Open Surgical or Endovascular Repair
OPEN REPAIR OF ABDOMINAL AORTIC ANEURYSM
ENDOVASCULAR ANEURYSM REPAIR
OPEN VERSUS ENDOVASCULAR ANEURYSM REPAIR: THE DATA
Endovascular versus Open Repair of Abdominal Aortic Aneurysm Trial
Dutch Randomized Endovascular Aneurysm Management Trial
Open Versus Endovascular Repair Trial
The Medicare Population
INTEGRATION OF TRIAL DATA INTO CLINICAL DECISION MAKING
Mortality
Rates of Reintervention
Cost
Quality of Life
EVAR VERSUS MEDICAL MANAGEMENT IN PATIENTSAT TOO-HIGH RISK FOR OPEN REPAIR
SUMMARY
77
Management of Small Abdominal Aortic Aneurysms
RUPTURE RISK
LIFE EXPECTANCY
OPERATIVE RISK
OPERATIVE DECISION MAKING
GROWTH AND MEDICAL MANAGEMENT
SURVEILLANCE RECOMMENDATIONS
78
Endovascular Treatment of Nonruptured Infrarenal Aortic and Aortoiliac Aneurysms
PROCEDURAL PLANNING AND ANATOMIC MEASUREMENTS
DEVICE OVERSIZING
ENDOVASCULAR STENT DEPLOYMENT TECHNIQUES
Imaging
Access
Anatomic Aims
Aortic Neck
Contralateral Limb Cannulation
Iliac Anatomy
LONG-TERM DATA AND FUTURE DIRECTIONS
79
Endovascular Treatment of Pararenal and Suprarenal Abdominal Aortic Aneurysms
TECHNIQUE
LIMITATIONS
PUBLISHED RESULTS
EVOLUTION
80
Endovascular Treatment of Inflammatory Abdominal Aortic Aneurysms
CLINICAL FEATURES
ENDOVASCULAR MANAGEMENT
RUPTURED INFLAMMATORY ABDOMINAL AORTIC ANEURYSMS
SUMMARY
81
Endovascular Treatment of Ruptured Infrarenal Aortic Aneurysms
THEORETICAL CONSIDERATIONS
A SINGLE CENTER EXPERIENCE
COLLECTED WORLD EXPERIENCE
WHY ARE RESULTS VARIABLE?
Standard Approach or Protocol
Fluid Restriction (Hypotensive Hemostasis)
Treatment Site
Anesthesia and Catheter-Guidewire Placement
Supraceliac Aortic Sheath Placementand Balloon Control
Endograft Type and Configuration
Abdominal Compartment Syndrome
Endovascular Aneurysm Repair for Highest-Risk Patients
IS A RANDOMIZED, CONTROLLED COMPARISON OF ENDOVASCULAR AND OPEN REPAIR NEEDED
82
Management of Coexistent Splanchnic and Renal Artery Occlusive Disease
SPLANCHNIC OCCLUSIVE DISEASE AND ENDOVASCULAR ANEURYSM REPAIR
RENAL ARTERY OCCLUSIVE DISEASE AND ENDOVASCULAR ANEURYSM REPAIR
83
Internal Iliac Artery Embolization as an Adjunct to Endovascular Aneurysm Repair
RELEVANT ANATOMY
EMBOLIZATION TOOLS
Pushable Coils
Detachable Coils
Vascular Occlusion Plug
TECHNIQUE
Embolization of Internal Iliac Arteries
COMPLICATIONS
84
Endovascular Iliac Branch Devices for Iliac Aneurysms
RATIONALE
DEVICE DESIGN
DEVICE DEPLOYMENT
RESULTS
DISCUSSION
85
Iliac Artery Conduits for Endovascular Access
ILIAC ARTERY ACCESS
REMOTE FEMORAL ARTERY ACCESS
86
Conversion to Open Surgical Treatment After Failed Endovascular Aortic Aneurysm Repair
INDICATIONS
PREOPERATIVE CONSIDERATIONS
OPERATIVE TECHNIQUES
POSTOPERATIVE CONSIDERATIONS
87 Treatment of Endovascular Leaks After Aortic Endografting
TYPE I ENDOLEAK
TYPE II ENDOLEAK
TYPE III ENDOLEAK
TYPE IV ENDOLEAK
TYPE V ENDOLEAK
CONCLUSIONS
88
Management of Acute Limb Ischemia Complicating Aortic Reconstruction
SCOPE OF THE PROBLEM
ETIOLOGY
PREVENTION
DIAGNOSIS
MANAGEMENT
Medical
Interventional
Open Surgical
89
Intestinal and Renal Ischemia Complicating Open and Endovascular Abdominal Aortic Reconstructions
RENAL COMPLICATIONS
Open Repair
Endovascular Repair
INTESTINAL COMPLICATIONS
Open Repair
Endovascular Repair
90
Neurologic Complications after Open and Endovascular Aortic Surgery
SPINAL CORD INJURY
STROKE
DIRECT NERVE INJURY
Retrograde Ejaculation
Peripheral Neuropathy
91
Postoperative Surveillance of Thoracic and Abdominal Aortic Endografts
RATIONALE FOR POSTOPERATIVE SURVEILLANCE
ELEMENTS OF COMPLETE SURVEILLANCE
Computed Tomography Angiography
Magnetic Resonance Angiography
Multiview Radiographs
Duplex Ultrasound with or without Contrast
Intravascular Pressure Sensor
FOLLOW-UP SCHEDULE
92
Treatment of Aortic Endograft Migration
DEFINITION
INCIDENCE
RISK FACTORS FOR MIGRATION
TREATMENT
Endovascular Treatment
Hybrid Treatment
Open Treatment
93
Open Transperitoneal Surgical Treatment of Nonruptured Infrarenal Aortic Aneurysms
ANATOMIC PREOPERATIVE PLANNING
TECHNIQUE
Exposure
Clamping
Aneurysmorrhaphy
Unclamping
Closure
POSTOPERATIVE CARE
Myocardial Infarction
Bleeding
Acute Pulmonary Decompensation Resulting in Reintubation
Deep Vein Thrombosis
Kidney Dysfunction
Ischemic Colitis
Lower Extremity Ischemia
EARLY SURVIVAL
94
Open Surgical Treatment of Ruptured Infrarenal Aortic Aneurysms
DIAGNOSIS
PROCEDURE
OUTCOMES
95
Surgical Treatment of Infected Abdominal Aortic Aneurysms
DIAGNOSIS
MANAGEMENT
OUTCOMES
96
Surgical Treatment of Inflammatory Abdominal Aortic Aneurysms
CLINICAL PRESENTATION
OPERATIVE MANAGEMENT
97
Open Surgical Treatment of Pararenal and Suprarenal Abdominal Aortic Aneurysms
PRESENTATION AND DIAGNOSIS
OPERATIVE CONSIDERATIONS
OUTCOMES
98
Retroperitoneal Approach for Elective Abdominal Aortic Aneurysmectomy
INDICATIONS AND CONTRAINDICATIONS
SURGICAL TECHNIQUES
Left Posterolateral Retroperitoneal Approach
Right Retroperitoneal Approach
Retroperitoneal Exposure for Failed Endovascular Aneurysm Repair
OUTCOMES
99
Autotransfusion in Aortic Reconstruction
AUTOLOGOUS PREOPERATIVE DEPOSIT
INTRAOPERATIVE AUTOTRANSFUSION IN ELECTIVE AND EMERGENCY AORTIC PROCEDURES
INDICATIONS FOR TRANSFUSION
100
Surgical Treatment of Abdominal Aortic Aneurysm–Inferior Vena Cava Fistula
CLINICAL PRESENTATION
SURGICAL TREATMENT
101
Management of Primary Aortoenteric Fistulas
ETIOLOGY
DIAGNOSIS
TREATMENT
102
Renal Ectopia and Renal Fusion in Patients Requiring Abdominal Aortic Operations
EMBRYOLOGY
ANATOMIC SUBGROUPS OF RENAL ECTOPIA
Ipsilateral Renal Ectopia
Horseshoe Kidney
Crossed Renal Ectopia
PREOPERATIVE IMAGING
THERAPEUTIC ALTERNATIVES
Open Surgical Approach
Open Surgical Technique
Endovascular Approaches
COMPLICATIONS AND RESULTS
103
Venous Anomalies Encountered During Aortic Reconstruction
RETROAORTIC OR CIRCUMAORTIC LEFT RENAL VEIN
TRANSPOSED OR DUPLICATE INFERIOR VENA CAVA
104
Open and Endovascular Repair of Abdominal Aortic Aneurysms in Kidney Transplant Patients
INDICATIONS
RENAL PROTECTION
Preoperative Measures
Intraoperative Techniques
OPEN AORTIC RECONSTRUCTION
Technique
Complications
Follow-up
ENDOVASCULAR AORTIC RECONSTRUCTION
Technique
Complications
Follow-up
RUPTURED ABDOMINAL AORTIC ANEURYSM IN KIDNEY TRANSPLANT PATIENTS
105
Open Abdominal Aortic Aneurysm Repair and Concurrent Nonvascular Disease
SYNCHRONOUS DISEASE
GALLBLADDER AND HEPATOBILIARY DISEASE
PANCREATIC DISEASE
UPPER GASTROINTESTINAL TRACT
LOWER GASTROINTESTINAL TRACT
GENITOURINARY TRACT
GYNECOLOGIC DISEASE
RARE TUMORS AND SPINE DISORDERS
ABDOMINAL WALL
106
Recognition and Treatment of Abdominal Compartment Syndrome Following Ruptured Abdominal Aortic Aneurysm Repair
DETECTION
PATHOPHYSIOLOGY
Cardiovascular Derangements
Pulmonary Derangements
Renal Derangements
Gastrointestinal Derangements
Hepatic Derangements
Central Nervous System Derangements
Abdominal Wall Derangements
RISK FACTORS
CLINICAL PRESENTATION
CURRENT MANAGEMENT
Nonsurgical Management
Surgical Management
Outcome after Surgical Management
107
Endovascular Treatment of Thoracic Aortic Aneurysms
STENT GRAFTS
INDICATIONS
TECHNIQUE
RESULTS
108
Endovascular Graft Completion of Elephant Trunk Thoracic Aneurysm Repair
SECOND-STAGE ENDOVASCULAR PROCEDURE
RESULTS
109
Thoracic and Abdominal Aortic Debranching in the Endovascular Treatment of Thoracoabdominal Aortic Aneurysms
AORTIC ARCH AND PROXIMAL DESCENDING AORTIC ANEURYSM DEBRANCHING
ASCENDING, ARCH, AND MORE EXTENSIVE ANEURYSMS
DEBRANCHING OF THORACOABDOMINAL ANEURYSMS
Thoracoceliac with Thoracomesenteric–Left Renal Bypass (Antegrade Bypass)
Iliomesenteric Reconstructions (Retrograde Bypass)
Complete Visceral Revascularization (Retrograde)
POSTOPERATIVE CONSIDERATIONS
110
Endograft (VORTEC) Reconstruction of Aortic Branches Allowing Endovascular Treatment of Aortic Aneurysms
ORIGINAL TECHNIQUE
INCISION AND TRANSECTION TECHNIQUES
RESULTS
DISCUSSION
111
Multibranched Endovascular Repair of Thoracoabdominal Aortic Aneurysm
MULTIBRANCHED THORACOABDOMINAL STENT GRAFTS
STANDARDIZATION
STANDARD STENT GRAFT
PLANNING THE REPAIR
ADJUNCTIVE PROCEDURES
STENT GRAFT IMPLANTATION
RADIATION SAFETY
RESULTS
112
Open Surgical Treatment of Thoracic Aortic Aneurysms
INDICATIONS FOR REPAIR
OPERATIVE PLANNING
Comorbidity Assessment
MEASURES FOR END-ORGAN PROTECTION
Extracorporeal Circulation by Atriofemoral Perfusion
Hypothermic Arrest
Alternative Perfusion Techniques
Spinal cord protection
SURGICAL TECHNIQUE
POSTOPERATIVE MANAGEMENT
SURGICAL RESULTS
113
Open Surgical Treatment of Thoracoabdominal Aortic Aneurysms
CLASSIFICATION OF THORACOABDOMINAL AORTIC ANEURYSMS
CLINICAL MANIFESTATIONS
OPEN SURGICAL TECHNIQUE
RISK OF IMMEDIATE NEUROLOGIC DEFICIT
RISK OF DELAYED NEUROLOGIC DEFICIT
RISK OF KIDNEY DYSFUNCTION
POSTOPERATIVE GASTROINTESTINAL COMPLICATIONS
SURVIVAL AND LONG-TERM OUTCOMES
114
Paraplegia Prevention in Thoracic and Thoracoabdominal Aortic Aneurysm Repair
ASSISTED CIRCULATION
INTERCOSTAL REIMPLANTATION
MOTOR EVOKED POTENTIALS
HYPOTHERMIA
CEREBROSPINAL FLUID DRAINAGE
ENDOGRAFT THORACIC AND THORACOABDOMINAL AORTIC ANEURYSM REPAIR
115
Nonoperative Medical Management of Acute Aortic Dissection
EPIDEMIOLOGY
CLINICAL SIGNS AND SYMPTOMS
INITIAL MEDICAL THERAPY
ASCENDING AORTA
DESCENDING AORTA
LONG-TERM FOLLOW-UP
116 Endovascular Treatment of Aortic Dissection
ROLE OF IMAGING
VASCULAR ACCESS
EXCLUDING THE FALSE LUMEN
MALPERFUSION
CHRONIC AORTIC DISSECTION
117
Open Surgical Treatment of Aortic Dissection
CLASSIFICATION
OPERATIVE TREATMENT
Surgery for Acute Proximal Aortic Dissection
Surgery for Chronic Proximal Aortic Dissection
Surgery for Acute Distal Aortic Dissection
Surgery for Chronic Distal Aortic Dissection
POSTOPERATIVE CARE
118
Natural History and Open Treatment of Isolated Iliac Artery Aneurysms
EPIDEMIOLOGY
CLINICAL FINDINGS
DIAGNOSIS
NATURAL HISTORY
INDICATIONS FOR TREATMENT
TREATMENT
POSTOPERATIVE CARE
119
Endovascular Management of Isolated Iliac Artery Aneurysms
PREOPERATIVE PLANNING AND IMAGING
OPERATIVE TECHNIQUE
RESULTS
ISOLATED INTERNAL ILIAC ARTERY ANEURYSMS
FUTURE THERAPY
120
Long-Term Alterations in Large-Caliber Arterial Prostheses Used for Aortic Repair
EARLY HOST RESPONSES TO IMPLANTED MATERIALS
Protein Deposition
Platelet Deposition and Coagulation
Inflammation
Mesenchymal Cell Infiltration
MID- TO LONG-TERM PROSTHETIC HEALING
LONG-TERM PHYSICAL ALTERATIONS
Dilatation
Other Changes
121 Surgical Treatment
of Pediatric Abdominal Aortic Aneurysms
ETIOLOGIES
SURGICAL OPTIONS
Lower Extremity
Aneurysm
122 Arteriosclerotic
Femoral Artery Aneurysms
PATHOGENESIS
PATTERN OF DISEASE
NATURAL HISTORY
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
RESULTS
123
Infected Femoral Artery False Aneurysms
ETIOLOGY
PRESENTATION AND DIAGNOSIS
TREATMENT
Ligation
Reconstruction
124
Obturator Foramen Bypass Grafts in Groin Sepsis
PATIENT SELECTION
OPERATIVE PROCEDURE: ANATOMIC CONSIDERATIONS
RESULTS
125
Open Surgical Treatment of Popliteal Artery Aneurysms
CLINICAL PRESENTATION
DIAGNOSIS AND IMAGING
SURGICAL MANAGEMENT
SURVEILLANCE
126
Endovascular Treatment of Popliteal Artery Aneurysms
PREOPERATIVE EVALUATION
CONTRAINDICATIONS FOR ENDOVASCULAR REPAIR
STENT GRAFTS
ENDOVASCULAR PROCEDURE AND FOLLOW-UP
RESULTS OF ENDOVASCULAR REPAIR
Aortoiliac
Occlusive Disease
127 Conventional Arteriography, Magnetic Resonance Angiography, and Computed Tomographic Arteriography of
Aortoiliac Occlusive Disease
DIGITAL SUBTRACTIONARTERIOGRAPHY
COMPUTED TOMOGRAPHY ANGIOGRAPHY
MAGNETIC RESONANCE ANGIOGRAPHY
CONCLUSION
128
Physiologic and Noninvasive Studies to Document Severity and Extent of Aortoiliac Occlusive Disease
SYMPTOMS AND SIGNS
EXTREMITY PRESSURE MEASUREMENTS AND DOPPLER ANALYSIS
DUPLEX ULTRASONOGRAPHY
129
Selecting Treatment for Patients with Aortoiliac Occlusive Disease
CONSERVATIVE MEDICAL TREATMENT
CRITERIA INFLUENCING CHOICE OF REVASCULARIZATION TECHNIQUES
Patient Factors
Operator and Resource Factors
Anatomic and Technical Factors
CONCLUSIONS
130
Percutaneous Arterial Angioplasty with and without Stenting for Atherosclerotic Aortic and Iliac Artery Occlusive Disease
INDICATIONS
TECHNIQUE
RESULTS
131
Aortofemoral Bypass for Atherosclerotic Aortoiliac Occlusive Disease
PROCEDURE SELECTION
OPERATIVE MANAGEMENT
Operative Approach
Tunnel Construction
Proximal Graft Anastomosis
Femoral Anastomosis
RESULTS OF AORTOFEMORAL BYPASS GRAFTS
132
Endarterectomy for Atherosclerotic Aortoiliac Occlusive Disease
OPERATIVE TECHNIQUE
RESULTS
133
Management of Juxtarenal Aortic Occlusive Disease by Retroperitoneal and Transperitoneal Exposure of the Pararenal and Suprarenal Aorta
TRANSPERITONEAL EXPOSURE OF THE SUPRACELIAC AORTA AND CELIAC ARTERY
TRANSPERITONEAL APPROACH TO SUPERIOR MESENTERIC ARTERY AND PARARENAL AORTA
LEFT RETROPERITONEAL APPROACH TO THE ABDOMINAL AORTA
TRANSPERITONEAL APPROACH TO THE COMPLETE ABDOMINAL AORTA WITH LEFT MEDIAL VISCERAL ROTATION
DISCUSSION
134
Acute Aortic Occlusion
ETIOLOGY
CLINICAL PRESENTATION AND DIAGNOSIS
PRINCIPLES OF MANAGEMENT
PREOPERATIVE EVALUATION
OPERATIVE PLANNING
THROMBOEMBOLECTOMY
AXILLOBIFEMORAL AND AORTOBIFEMORAL BYPASS
PERCUTANEOUS ENDOVASCULAR TREATMENT
ADEQUACY OF REVASCULARIZATION AND ADJUNCTIVE PROCEDURES
ISCHEMIA AND REPERFUSION INJURY
OUTCOME
135
Aortic Graft Limb Occlusion
ETIOLOGY
CLINICAL PRESENTATION
MANAGEMENT
Open Surgical Treatment
Surgical Technique
Interventional Management
RESULTS
136
Open and Endovascular Treatment of Anastomotic Aneurysms after Aortoaortic, Aortoiliac, and Aortofemoral Bypass
INCIDENCE
PATHOPHYSIOLOGY
PRESENTATION
EVALUATION AND DIAGNOSIS
OPEN SURGICAL TREATMENT
ENDOVASCULAR TREATMENT
RESULTS
137
Combined Laparoscopic and Endovascular Treatment of Aortic Diseases
OPERATIVE TECHNIQUE
LAPAROSCOPIC REMODELLING OF THE AORTA AFTER ENDOVASCULAR ANEURYSM REPAIR
EXCLUSION CRITERIA FOR LAPAROSCOPIC REMODELING AFTER ENDOVASCULAR ANEURYSM REPAIR
LAPAROSCOPY-ASSISTED THORACIC ENDOVASCULAR ANEURYSM REPAIR
RESULTS OF HYBRID PROCEDURES AND LAPAROSCOPIC TECHNIQUES AFTER ENDOVASCULAR ANEURYSM REPAIR
DISCUSSION
THE ROLE OF LAPAROSCOPIC AORTIC SURGERY
138
Abdominal Aortic Coarctation and Hypoplasia
ETIOLOGY
CLINICAL MANIFESTATIONS
MANAGEMENT
RESULTS
139
Descending Thoracic Aorta to Femoral Bypass
INDICATIONS
SURGICAL TECHNIQUE
RESULTS
140
Axillofemoral Bypass
GENERAL PRINCIPLES AND PATIENT SELECTION
PREOPERATIVE EVALUATION
TECHNIQUE
POSTOPERATIVE CARE ANDFOLLOW-UP
RESULTS AND INFLUENCE OF PATIENT AND GRAFT FACTORS
CONTINUING EVOLUTION OF THE ROLE OF AXILLOFEMORAL BYPASS
141
Unilateral Retroperitoneal Iliofemoral Bypass
TREATMENT ALGORITHM FOR ILIAC OCCLUSIVE DISEASE
RETROPERITONEAL ILIOFEMORAL BYPASS: SURGICAL TECHNIQUE
RESULTS
142
Femorofemoral Bypass for Aortoiliac Occlusive Disease
GENERAL PRINCIPLES AND PATIENT SELECTION
PREOPERATIVE EVALUATION
TECHNIQUE
POSTOPERATIVE CARE ANDFOLLOW-UP
RESULTS AND INFLUENCE OF PATIENT AND GRAFT FACTORS
CONTINUING EVOLUTION OF THE ROLE OF FEMOROFEMORAL BYPASS
143
Diagnosis of Aortic Graft Infection
PRESENTATION
DIAGNOSISThe diagnosis of aortic graft
Computed Tomography
Magnetic Resonance Imaging
Sinography
Endoscopy
Other Techniques
CONCLUSIONS
144
Treatment of Aortic Graft Infection with Autologous Femoral Vein
GRAFT EXCISION
OPTIONS FOR RECONSTRUCTION
Extraanatomic Reconstruction
In-Situ Reconstruction
PREOPERATIVE EVALUATION
SURGICAL MANAGEMENTAND TECHNIQUE
POSTOPERATIVE CARE ANDFOLLOW-UP
145
In-Situ Treatment of Aortic Graft Infection with Prosthetic Grafts and Allografts
ANTIBIOTIC OR SILVER-COATED PROSTHETIC GRAFTS
CRYOPRESERVED ARTERIAL ALLOGRAFTS
PROSTHETIC GRAFT PRESERVATION
146
Aortic Graft–Enteric Fistula
PRESENTATION
PREOPERATIVE EVALUATION
MANAGEMENT
The Stable Patient
The Unstable Patient
147
Vasculogenic and Postoperative Neurogenic Impotence
NORMAL ERECTILE AND EJACULATORY FUNCTION
VASCULOGENIC ERECTILE DYSFUNCTION
CORRELATION BETWEEN ERECTILE DYSFUNCTION AND CARDIOVASCULAR DISEASE
THE METABOLIC SYNDROME AND ERECTILE DYSFUNCTION
POSTOPERATIVE NEUROGENIC SEXUAL DYSFUNCTION
CONCLUSION
148
Drug Therapy of Erectile Dysfunction
BASIC PRINCIPLES
PHOSPHODIESTERASE 5 INHIBITORS
PENILE INJECTION THERAPY
INTRAURETHRAL ALPROSTADIL
TESTOSTERONE
NONDRUG TREATMENTS FOR ERECTILE DYSFUNCTION
Vacuum Constriction Devices
Penile Implants
THE PRINCETON GUIDELINES
149
Management of Groin Lymphocele and Lymph Fistula
INCIDENCE
CLINICAL PRESENTATION AND DIAGNOSIS
PREVENTION
TREATMENT
Treatment Options
Operative Technique
150
Management of Chyloperitoneum and Chylothorax after Aortic Reconstruction
LYMPHATIC ANATOMY IN THE ABDOMEN AND THORAX
DIAGNOSIS OF CHYOPERIOTNEUM AND CHYLOTHORAX
MANAGEMENT OF CHYLOPERITONEUM AND CHYLOTHORAX
SUMMARY
151
Coronary Artery Disease in Patients with Aortoiliac Occlusive Disease and Abdominal Aortic Aneurysm
IMPORTANCE OF CORONARY ARTERY DISEASE
PREOPERATIVE CARDIAC RISK ASSESSMENT
POSTOPERATIVE CARE
152
Pulmonary Risks in Patients Being Treated for Aortic Aneurysms and Occlusive Disease
PULMONARY COMPLICATIONS OF OPEN VASCULAR SURGERY
IMPACT OF PULMONARY COMPLICATIONS FOLLOWING OPEN ABDOMINAL AORTIC ANEURYSM REPAIR ON PATIENT OUTCOMES
APPROACHES TO REDUCE PULMONARY COMPLICATIONS VASCULAR SURGERY
Endovascular Repair
Anesthesia Technique
Administration of Prophylactic Noninvasive Perioperative Ventilation
RISK FACTORS FOR PULMONARY COMPLICATIONS
MODIFICATION OF RISK FACTORS
CONCLUSIONS
153
The Metabolic Syndrome in the Modern World
DEFINITION
ETIOLOGY
Obesity
Hypertension: The Role of Adipocytes
Atherosclerosis: Disturbed Endothelium andthe Inflammatory Process
TREATMENT
Hypertension
Hyperlipidemia
Insulin Resistance
154
Smoking as a Risk Factor in Atherosclerotic Cardiovascular Disease
PATHOPHYSIOLOGY
Vasomotor Dysregulation
Inflammation
Thrombosis
Metabolism
EVIDENCE IN CARDIOVASCULAR DISEASE
Coronary Heart Disease
Cerebrovascular Disease
Aortic Aneurysm
Peripheral Arterial Disease
SMOKING CESSATION
CONCLUSIONS
155
Smoking Cessation
IDENTIFYING SMOKERS
MOTIVATING PATIENTS TO QUIT
HELPING THOSE WHO WISH TO QUIT
SUCCESSFUL STRATEGIES
156
Treatment of Dyslipidemia and Hypertriglyceridemia
RISK ASSESSMENT AND LDL CHOLESTEROL GOALS
GOALS FOR NON-HDL CHOLESTEROL
DIET AND EXERCISE GUIDELINES AND RECOMMENDATIONS
PHARMACOTHERAPY FOR HIGH LDL CHOLESTEROL
PHARMACOTHERAPY FOR LOWNON-HDL CHOLESTEROL
ADVERSE EFFECTS OF LIPID TREATMENT
157
Hypertension as a Risk Factor in Atherosclerotic Cardiovascular Disease
MEASUREMENT OF BLOOD PRESSURE IN THE OFFICE
MEASUREMENT OF BLOOD PRESSURE IN THE HOSPITAL
HYPERTENSION AND CARDIOVASCULAR RISK
TREATMENT OF HYPERTENSION
Initial Treatment
Combination Therapies
Therapeutic Blood Pressure Targets
158
Homocysteine as a Risk Factor in Atherosclerotic Cardiovascular Disease
NOMENCLATURE
PATHOPHYSIOLOGY
HOMOCYSTEINE AND PERIPHERAL VASCULAR DISEASE EXPRESSION
Aortic Disease
Cervical Artery Disease
Peripheral Artery Occlusive Disease
TREATMENT
159
Nitric Oxide and Vascular Disease
PHYSIOLOGY OF NITRIC OXIDE IN THE VASCULATURE
PATHOPHYSIOLOGY OF NITRIC OXIDE IN THE VASCULATURE
Atherosclerosis
Restenosis
Hypertension
Angiogenesis
CONCLUSIONS
160
Integrative Therapies in Vascular Disease
DIET
EXERCISE
SMOKING CESSATION
MIND–BODY CONNECTION
NATURAL PRODUCTS FOR PERIPHERAL ARTERIAL DISEASE
Ginkgo biloba Leaf Extract
Inositol Nicotinate
Propionyl-l-Carnitine
Padma 28
Policosanol
l-Arginine
Mesoglycan
Others
NATURAL PRODUCTS FOR PERIPHERAL VENOUS DISEASE
Hesperidin
Horse Chestnut Seed Extract (Aesculus hippocastanum)
Grape Seed Extract (Vitis vinifera)
Rutin
Gotu Kola Extract (Centella asiatica)
Pycnogenol (Pinus pinaster)
Others
SURGICAL ISSUES RELATED TO NATURAL PRODUCTS
Coagulation Issues
Sedative–Hypnotic Interactions
Drug–Herb Interactions
CARDIAC EFFECTS OF NONCARDIAC HERBS
CONCLUSION
Lower Extremity
Occlusive Disease
161
Magnetic Resonance Arteriography for Assessment of Infrainguinal Occlusive Disease
FUNDAMENTAL PRINCIPLESOF MAGNETIC RESONANCEARTERIOGRAPHY
CLINICAL EXPERIENCE WITHMAGNETIC RESONANCEARTERIOGRAPHY
162
Doppler Pressure Evaluation of Infrainguinal Occlusive Disease
PHYSIOLOGY OF ARTERIAL OBSTRUCTION
TECHNIQUE
ANKLE PRESSURE MEASUREMENT
SEGMENTAL LIMB PRESSURE MEASUREMENT
EXERCISE TESTING
TOE PRESSURES
LIMITATIONS
SUMMARY
163
Duplex Imaging of Infrainguinal Occlusive Disease
EQUIPMENT AND TECHNIQUE
VELOCITY WAVEFORMS AND CRITERIA DEFINING STENOSES
CLINICAL APPLICATIONS
Color Flow Duplex Scanning in Preparationfor Endovascular Therapy
Arterial Duplex Mapping Instead of Arteriography before Operation
Arterial Duplex-Guided Endovascular Therapy
164
Intravascular Ultrasound for Imaging of Diseased Arteries
INTRAVASCULAR ULTRASOUND IMAGING
CLINICAL UTILITY
ANGIOPLASTY
ATHERECTOMY
STENT DEPLOYMENT
ABDOMINAL ENDOLUMINAL GRAFTS
THORACIC ENDOLUMINAL GRAFTS
165
Selecting Patients for Open Surgical or Endovascular Treatment of Lower Extremity Occlusive Disease
PATIENT SELECTION FOR TREATMENT AND THERAPEUTIC OPTIONS
ENDOVASCULAR INTERVENTIONS
OPEN SURGICAL PROCEDURES
166
Percutaneous Angioplasty With and Without Stenting for Lower Extremity Occlusive Disease
SUPERFICIAL FEMORAL ARTERY
Angioplasty
Angioplasty with Stenting
POPLITEAL ARTERY
Angioplasty
Stenting
INFRAPOPLITEAL ARTERIES
Angioplasty
Stenting
167
Subintimal Recanalization for Lower Limb Occlusive Disease
TECHNIQUE
OUTCOMES
168
Endovascular Grafts in the Treatment of Lower Extremity Occlusive Disease
INDICATIONS
TECHNIQUE
RESULTS
169
Percutaneous Cryoplasty and Laser Treatment of Lower Extremity Occlusive Disease
LASER PHYSICS
LASER EFFECTS ON TARGET TISSUE
SPECIFIC LASER SYSTEMS
Yttrium–Aluminum–Garnet Laser
Argon Laser
CO2 Laser
Excimer Laser
CLINICAL APPLICATION OF LASER ANGIOPLASTY
CRYOPLASTY
170
Duplex-Guided Balloon Angioplasty for Infrainguinal Arterial Occlusive and Aneurysmal Disease
DUPLEX-GUIDED INFRAINGUINAL ARTERIAL ANGIOPLASTY
Preoperative Evaluation
Technique
Technical Success and Predictors of Technical Failure
Thromboembolic Complications
Adjunctive Infrapopliteal Balloon Angioplasty
Follow-up, Patency, and Limb Salvage
DUPLEX-GUIDED ENDOVASCULAR REPAIR OF POPLITEAL ARTERY ANEURYSMS
Technique
Follow-up, Patency, Morbidity, and Mortality
CONCLUSION
171
Reversed and Nonreversed Transposed Autogenous Vein Grafting for Atherosclerotic Lower Extremity Occlusive Disease
PATIENT SELECTION AND PREOPERATIVE EVALUATION
OPERATIVE TECHNIQUE
POSTOPERATIVE CARE
RESULTS
172
Short Vein Grafts from the Distal Superficial Femoral, Popliteal, or Infrapopliteal Arteries to More Distal Arteries for Limb Salvage
GENERAL CONSIDERATIONS
IMPROVED GRAFT PATENCY RATES
DECREASED INCIDENCEOF VEIN GRAFT STENOSES
INCREASED VEIN UTILIZATION
FEWER VEIN HARVEST COMPLICATIONS
OTHER ADVANTAGES
DISADVANTAGES
173
In-Situ Saphenous Vein Graft for Lower Extremity Occlusive Disease
OPERATIVE TECHNIQUE
Preparation
Equipment
Procedure
TECHNICAL COMMENTARY
POSTOPERATIVE FOLLOW-UP
174
Arm Veins for Lower Extremity Arterial Reconstruction
ANATOMY
PREOPERATIVE ASSESSMENT
INDICATIONS AND CONTRAINDICATIONSFOR ARM VEIN GRAFTS
OPERATIVE TECHNIQUE
Harvesting of the Vein
Implantation
RESULTS
COMPLICATIONS AND MANAGEMENT
COMMENTS
175
Composite Sequential Bypass for Lower Extremity Occlusive Disease
INDICATIONS
TECHNIQUE
RESULTS
176
Expanded Polytetrafluoroethylene and Dacron Grafts for Atherosclerotic Lower Extremity Occlusive Disease
INDICATIONS FOR PROSTHETIC BYPASS
DATA
TECHNICAL CONSIDERATIONS
CONCLUSIONS
177
Human Umbilical Vein and Other Biografts for Atherosclerotic Lower Extremity Occlusive Disease
HUMAN UMBILICAL VEIN GRAFTS
Technical Features
Patency Data
Comparative Studies
Complications
CRYOPRESERVED VASCULAR CONDUITS
Preparation of the Allograft
Immunology
Clinical Outcomes
Complications
Infected Field
COLD-PRESERVED VESSELS
BOVINE GRAFTS
CONCLUSIONS
178
Deep Femoral Patch Angioplasty for Atherosclerotic Occlusive Disease of the Lower Extremity
INDICATIONS
TECHNIQUES
179
Superficial Femoral Artery Endarterectomy for Atherosclerotic Lower Extremity Occlusive Disease
OPEN ENDARTERECTOMY
SEMICLOSED ENDARTERECTOMY
COMPARISON OF ENDARTERECTOMY TO BYPASS
ENDARTERECTOMY IN PERSPECTIVE
INDICATIONS
180
Percutaneous Mechanical Thrombectomy and Fibrinolytic Therapy for Acute Thrombosis of Lower Extremity Arteries and Grafts
PERCUTANEOUS MECHANICAL THROMBECTOMY DEVICES
MECHANISMS OF CLOT FORMATION AND DISSOLUTION
FIBRINOLYTIC AGENTS
INDICATIONS FOR THROMBOLYTIC THERAPY
Patient Selection
Lesion Selection
TECHNIQUES OF THROMBOLYSIS
Initiation of Thrombolytic Therapy
RESULTS
COMPLICATIONS
181
Operative Thrombectomy for Acute Thrombosis of Lower Extremity Bypass Grafts
PREOPERATIVE PLANNING
TECHNIQUE
182
Surveillance of Lower Extremity Bypass Grafts
MECHANISMS AND HEMODYNAMICS OF GRAFT FAILURE
ESSENTIALS OF GRAFT SURVEILLANCE
183
Open Surgery and Endovascular Management of Failing Infrainguinal Bypass Graft
PATHOLOGY OF THE FAILING VEIN GRAFT
FACTORS INFLUENCING REPAIR CHOICE
Time after Graft Implantation
Stenosis Length
Lesion Location
Graft Occlusion
TECHNICAL CONSIDERATIONSFOR REPAIR
Endovascular Repair
Open Operation
OUTCOMES
CONCLUSIONS
184
Complications and Treatment of Persistent Sciatic Arteries
CLINICAL CHARACTERISTICS
DIAGNOSTIC CONSIDERATIONS
TREATMENT
185
Popliteal Artery Adventitial Cystic Disease
ETIOLOGY
CLINICAL PRESENTATION
DIAGNOSIS
TREATMENT
186
Chronic Compartment Syndrome and Functional Popliteal Artery Entrapment
EVALUATION
TREATMENT
Chronic Compartment Syndrome
Popliteal Entrapment
Recovery
RESULTS AND DISCUSSION
187
Exercise in Peripheral Arterial Disease
SYSTEMIC DISEASES ALWAYS REQUIRE SYSTEMIC CARE
EFFICACY OF EXERCISE TRAINING
SCIENCE AND MECHANISMS OF EXERCISE BENEFIT
Blood Flow
Change in Muscle Metabolism
Inflammation and Muscle Injury
Changes in Microcirculation and Endothelial Function
Hemorheologic Response
Walking Economy
CLAUDICATION TRAINING TREATMENT PROTOCOL
EFFECT OF EXERCISE ON ATHEROSCLEROSIS RISK FACTORS
ALL CLAUDICATION THERAPIES ARE EFFECTIVE AND CAN BE USED TOGETHER
POTENTIAL OBSTACLES TO THERAPEUTIC SUCCESS
CONCLUSIONS
188
Pharmacologic Management of Intermittent Claudication
NATURE OF THE PROBLEM
CONCOMITANT CORONARY ARTERY DISEASE
RHEOLOGIC AGENTS
VASODILATOR THERAPY
ADDRESSING ENDOTHELIAL DYSFUNCTION
CONCLUSION
189
Cutaneous Ulcers in the Neuroischemic Diabetic Foot
ETIOLOGY AND PATHOPHYSIOLOGY
DISTRIBUTION
CLASSIFICATION OF DIABETICFOOT ULCERS
REVASCULARIZATION
ACHIEVING ULCER CLOSURE
190
Lumbar Sympathectomy for Lower Extremity Ischemic Ulcers
ANATOMY AND PHYSIOLOGY
CLINICAL RESULTS
INDICATIONS AND PATIENT SELECTION
SURGICAL TECHNIQUE
COMPLICATIONS
RECOMMENDATIONS
191
Biologic Therapies for Patients with Critical Limb Ischemia
GENE THERAPY TRIALS
STEM CELL THERAPY TRIALS
SUMMARY
192
Bone Marrow Stem Cell Treatment for Critical Limb Ischemia
CELL BIOLOGY OF VASCULOGENESIS
PIONEERING WORK
CURRENT CLINICAL TRIALS
193
Prothrombotic States and Vascular Thromboses
ANTITHROMBIN III DEFICIENCY
PROTEIN C AND S DEFICIENCY
ANTIPHOSPHOLIPID SYNDROME
FACTOR V LEIDEN
PROTHROMBIN G20210A MUTATION
HEPARIN-INDUCED THROMBOCYTOPENIA AND THROMBOSIS
GUIDELINES
194
Role of Antithrombotic Drugs in Maintaining Graft Patency
PLATELET INHIBITORS
Cilostazol
Aspirin
Thienopyridines
Clopidogrel
Glycoprotein IIb/IIIa Antagonists
Dextran-like Compounds
Bleeding Risks with Antiplatelet Agents
ANTICOAGULATION
Vitamin K Antagonists
Vitamin K Antagonists Plus Aspirin
CONCLUSION
195
Complications of Heparin Anticoagulation Therapy
NONBLEEDING COMPLICATIONS
Heparin-Induced Thrombocytopenia
Heparin-Induced Osteoporosis
Heparin-Induced Skin Lesions
BLEEDING COMPLICATIONS
CONCLUSIONS
Embolic Diseases of
the Extremities
196 Arterial Macroembolism
DIAGNOSIS AND ANATOMY
PERIOPERATIVE AND POSTOPERATIVE MEDICAL THERAPY
OPERATIVE SETTING AND TECHNIQUES
POSTOPERATIVE MANAGEMENT AND COMPLICATIONS
197
Paradoxical Embolism
PATHOPHYSIOLOGY
DIAGNOSIS
TREATMENT
198
Atheroembolism
PATHOGENESIS
CLINICAL SYNDROMES
CLINICAL PICTURES
EVALUATION
TREATMENT
199
Operative Revascularization for Trash Foot
CLINICAL PRESENTATIONAND DIAGNOSIS
MEDICAL THERAPY AND THROMBOLYSIS
PEDAL AND PERIMALLEOLAR THROMBOEMBOLECTOMY
PEDAL ARTERY BYPASS
200
Anticoagulant and Lytic Therapy for Arterial Thromboembolism in Extremities
PERIOPERATIVE MANAGEMENT
THROMBOLYSIS AND RESULTS
Pharmacology of Fibrinolytic Agents
Outcome Studies of Thrombolysis versusPrimary Operation
New-Generation Fibrinolytics
THROMBECTOMY DEVICES
POSTINTERVENTION TREATMENT
CONCLUSIONS
201
Balloon Catheter Embolectomy for Macroembolization in the Extremities
PREOPERATIVE DIAGNOSIS AND MANAGEMENT
OPERATIVE TECHNIQUE
OPERATIVE ADJUNCTS
OUTCOMES
202
Noninvasive Methods of Diagnosing Cardiac and Noncardiac Sources of Macroemboli
ECHOCARDIOGRAPHY
DIAGNOSTIC VASCULAR LABORATORY STUDIES
COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING
DIAGNOSTIC APPROACH TOA PATIENT WITH PERIPHERAL ARTERIAL EMBOLI
Amputation
203
Minor Amputations
INDICATIONS
SURGICAL TECHNIQUE
Transphalangeal Toe Amputation
Transmetatarsal (Ray) Toe Amputation
Transmetatarsal Foot Amputation
POSTOPERATIVE MANAGEMENT
COMPLICATIONS
OUTCOMES
204
Below-Knee Amputation
DETERMINING AMPUTATION LEVEL
SURGICAL TECHNIQUE
POSTOPERATIVE CARE
RESULTS AND COMPLICATIONS
205
Above-Knee Amputation and Hip Disarticulation
ABOVE-KNEE AMPUTATION
Indications
Operative Technique
Postoperative Care and Perioperative Outcome
Long-Term Outcome
HIP DISARTICULATION
206
Upper Extremity Amputations
SHOULDER DISARTICULATION
TRANSHUMERAL AMPUTATION
TRANSRADIAL AMPUTATION
KRUKENBERG AMPUTATION
WRIST DISARTICULATION
207
Rehabilitation of the Amputee
BEFORE AMPUTATION
AMPUTATION LEVEL
POSTOPERATIVE RESIDUAL LIMB MANAGEMENT AND THERAPY
PROSTHETIC RESTORATION
Vascular Trauma
208 Conventional and
Computed Tomographic Arteriography in Penetrating Vascular Injuries
IMAGING FOR PENETRATINGVASCULAR INJURIES OF THE NECK
IMAGING FOR PENETRATINGVASCULAR INJURIES OF THE THORAX
IMAGING FOR PENETRATINGVASCULAR INJURIES OF THEABDOMEN
IMAGING FOR PENETRATING VASCULAR INJURIES OF THE EXTREMITIES
209
Nonarteriographic Diagnosis of Penetrating Vascular Trauma
HISTORICAL BACKGROUND
ARTERIAL PRESSURE MEASUREMENTS
DUPLEX ULTRASONOGRAPHY
MINIMAL ARTERIAL INJURY
ROLE OF THE SERIAL PHYSICAL EXAMINATION
210
Penetrating and Blunt Injuries of the Carotid Artery
PENETRATING CAROTID ARTERY INJURIES
Operative Approach
Outcomes
BLUNT CAROTID ARTERY INJURIES
Treatment
Outcomes
211 Penetrating and
Blunt Injuries ofthe Vertebral Artery
ETIOLOGY
TREATMENT
212
Blunt Arterial Injuries of the Shoulder: Open and Endovascular Therapy
PRESENTATION AND DIAGNOSIS
OPEN OPERATIVE MANAGEMENT
ENDOVASCULAR MANAGEMENT
213
Penetrating Injuries to the Aortic Arch and Intrathoracic Great Vessels
ARTERIAL INJURIES IN THE MEDIASTINUM
Epidemiology
Clinical Presentation
Diagnosis
Management
Outcomes
SPECIFIC ARTERIAL INJURIES
Innominate Injury
Subclavian Injury
Common Carotid Injury
214
Open and Endovascular Management of Blunt and Penetrating Nonaortic Abdominal Vascular Injury
ZONES OF INJURY
VENA CAVA INJURIES
CELIAC ARTERY INJURIES
HEPATIC ARTERY INJURIES
PORTAL VEIN INJURIES
SUPERIOR MESENTERIC ARTERY INJURIES
RENAL ARTERY INJURIES
215
Aortic Injury
INCIDENCE
PATHOPHYSIOLOGY
PRESENTATION AND DIAGNOSIS
TIMING OF REPAIR
OPERATIVE REPAIR
Open Thoracic Technique
Open Abdominal Technique
Endovascular Technique
CHANGE IN PARADIGM
216
Complications of Upper and Lower Extremity Percutaneous Arterial Puncture and Catheterization
COMPLICATIONS OF LOWER EXTREMITY ARTERIAL PUNCTURES
Bleeding
Pseudoaneurysm
Arteriovenous Fistula
Thrombosis, Dissection, and Distal Embolization
Femoral Neuropathy
Vascular Closure Devices
COMPLICATIONS OF UPPER EXTREMITY PUNCTURES
217
Open and Endovascular Treatment of Penetrating Extremity Arterial Injuries
RESUSCITATION AND SURGICAL ASSESSMENT
OPEN OPERATIVE MANAGEMENT
ENDOVASCULAR MANAGEMENT
COMPLETION IMAGING
POSTOPERATIVE CONSIDERATIONS
218
Blunt Popliteal Artery Injuries
DIAGNOSIS
Physical Examination
Imaging
TREATMENT
Vascular Repair
Fasciotomy
Orthopedic and Soft Tissue Injury
Postoperative Management
OUTCOME
219
Fasciotomy for Compartmental Hypertension and Acute Compartment Syndrome
PATHOPHYSIOLOGY
CLINICAL PRESENTATION AND DIAGNOSIS
OBJECTIVE TESTS IN THE DIAGNOSIS OF COMPARTMENTAL HYPERTENSION
FASCIOTOMY
Indications
Techniques
Immediate and Late Effects
220
Ischemia-Induced Muscle Myonecrosis, Myoglobinuria, and Secondary Kidney Failure
PATHOPHYSIOLOGY
DIAGNOSIS
MANAGEMENT
221
Vascular Injury Secondary to Drug Abuse
ARTERIAL INJURY
Pathophysiology
Presentation
Evaluation and Diagnosis
Treatment
VENOUS INJURY
Superficial Thrombophlebitis
Deep Vein Thrombophebitis
Mycotic Venous Aneurysm
Chronic Venous Disease
222
Cold Injury
HYPOTHERMIA
FROSTBITE
NONFREEZING INJURIES
TREATMENT
223
Pediatric Iatrogenic Vascular Injury
LOWER EXTREMITY AND FEMORAL ARTERY
UPPER EXTREMITY AND BRACHIAL ARTERY
ABDOMINAL AORTA
CERVICAL AND CAROTID ARTERY
Mesenteric
Vascular Disease
224 Arteriography
Evaluation of Splanchnic Artery Occlusive Disease
VASCULAR ANATOMY
Celiac Artery
Superior Mesenteric Artery
Inferior Mesenteric Artery
TECHNIQUE
ARTERIOGRAPHY DIAGNOSIS
Occlusive Disease at the Origins ofthe Splanchnic Arteries
Occlusive Disease of Splanchnic Artery Branches
Distal Splanchnic Arterial Occlusive Disease
Nonocclusive Mesenteric Ischemia
225
Duplex Scanning in the Diagnosis of Splanchnic Artery Occlusive Disease
TECHNIQUE OF MESENTERIC DUPLEX SCANNING
FASTING DOPPLER MESENTERIC ARTERY WAVEFORMS
FASTING DUPLEX CRITERIA FOR MESENTERIC ARTERY STENOSIS
POSTPRANDIAL MESENTERIC DUPLEX SCANNING
EVALUATION OF MESENTERIC ARTERY BYPASS GRAFTS
EVALUATION OF STENTED SUPERIOR MESENTERIC ARTERIES
INTERMITTENT CELIAC AXIS COMPRESSION
226
Acute Embolic and Thrombotic Mesenteric Ischemia
CLINICAL PRESENTATION
Acute Embolic Mesenteric Ischemia
Acute Thrombotic Mesenteric Ischemia
DIAGNOSIS
TREATMENT
Surgical Treatment
Endovascular Treatment
Surgical versus Endovascular Therapy for Acute Mesenteric Embolus and Thrombosis
227 Endovascular Therapy for Chronic Mesenteric Ischemia
DIAGNOSIS
TREATMENT
Selection
Techniques
RESULTS
Symptom Relief
Morbidity and Mortality
Restenosis, Symptom Recurrence,and Reintervention
Survival
228
Transaortic Splanchnic Endarterectomy for Chronic Mesenteric Ischemia
DIAGNOSIS AND EVALUATION OF CHRONIC MESENTERIC ISCHEMIA
TECHNIQUE OF TRANSAORTIC SPLANCHNIC ENDARTERECTOMY
OUTCOME
PATIENT SELECTION
229
Arterial Bypass for Chronic Mesenteric Ischemia
TREATMENT OPTIONS
ANTEGRADE VERSUS RETROGRADE BYPASS
SINGLE- VERSUS MULTI-VESSEL BYPASS
TECHNICAL DETAILS
SURGICAL RESULTS
230
Operative Treatment of Pediatric Splanchnic Arterial Occlusive Disease
CLINICAL PRESENTATION
ETIOLOGY OF SPLANCHNIC ARTERIAL OCCLUSIVE LESIONS
OPERATIVE THERAPY
OUTCOMES
231
Celiac Artery Compression Syndrome
CLINICAL MANIFESTATIONS
ANATOMIC BASIS OF ARTERIAL ENTRAPMENT
PHYSIOLOGIC CONSEQUENCESOF ARTERIAL ENTRAPMENT
DIAGNOSTIC EVALUATION
OPERATIVE TREATMENT
Conventional Open Surgical Approach
Laparoscopic and Endoscopic Surgical Approaches
Endovascular Management
SURGICAL OUTCOMES
232
Nonocclusive Mesenteric Ischemia
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
233
Venous Thrombosis Within the Splanchnic Circulation
MESENTERIC VEIN THROMBOSIS
Epidemiology
Risk Factors
Clinical Presentation
Diagnosis
Medical Management
Surgical and Interventional Management
Outcomes
PORTAL VEIN THROMBOSIS
SPLENIC VEIN THROMBOSIS
BUDD–CHIARI SYNDROME
234
Celiac, Hepatic, and Splenic Artery Aneurysms
CELIAC ARTERY ANEURYSMS
Clinical Presentation
Management
HEPATIC ARTERY ANEURYSMS
Clinical Presentation
Management
SPLENIC ARTERY ANEURYSMS
Clinical Presentation
Management
235
Mesenteric Artery Aneurysms
SUPERIOR MESENTERIC ARTERY ANEURYSMS
INFERIOR MESENTERIC ARTERY ANEURYSMS
JEJUNAL, ILEAL, AND COLIC ARTERY ANEURYSMS
236
Gastroduodenal and Pancreaticoduodenal Artery Aneurysms
PSEUDOANEURYSMS
Clinical Manifestations
Diagnosis
TREATMENT
TRUE ANEURYSMS
Diagnosis
Clinical Manifestations
Treatment
237
Vascular Malformations and Arteriovenous Fistulas of the Gastrointestinal Tract
ARTERIOVENOUS FISTULAS
VASCULAR MALFORMATIONS
Renovascular
Disease
238 Pathology of
Arteriosclerotic, Fibrodysplastic, and Developmental Renal Artery Occlusive Disease
RENAL ARTERY FIBRODYSPLASIA
Intimal Fibroplasia
Medial Fibroplasia
Perimedial Dysplasia
DEVELOPMENTAL RENAL ARTERY STENOSES
RENAL ARTERY ARTERIOSCLEROSIS
239
Conventional Arteriographic and Computed Tomography Arteriographic Diagnosis of Renovascular Hypertension
CATHETER ANGIOGRAPHY
COMPUTED TOMOGRAPHY ARTERIOGRAPHY
240
Magnetic Resonance Angiographic Diagnosis of Renovascular Disease
PATIENT PREPARATION
INTERPRETING THE IMAGE
241
Duplex Scanning in the Evaluation of Renal Arterial Occlusive Disease
SCANNING TECHNIQUE
INTERPRETATION
CLINICAL APPLICATIONS
242
Renovascular Hypertension and Renal Artery Occlusive Disease
PATHOPHYSIOLOGY OF RENOVASCULAR HYPERTENSION
CLINICAL EVIDENCE OF RENIN–ANGIOTENSIN ACTIVATION
243
Renal Insufficiency and Renal Artery Occlusive Disease
PATHOPHYSIOLOGY
PREVALENCE
NATURAL HISTORY
DIAGNOSIS
MANAGEMENT
Selected References
244
Selection of Patients for Open Surgical or Endovascular Treatment of Renal Artery Arteriosclerotic Disease
CONDITIONS IN FAVOR OF OPEN RENAL ARTERY REVASCULARIZATION
CONDITIONS IN FAVOR OF ENDOVASCULAR RENAL ARTERY REVASCULARIZATION
CONCLUSION
Selected References
245
Percutaneous Arterial Dilation and Stenting for Arteriosclerotic Renovascular Hypertension and Ischemic Nephropathy
PATIENT SELECTION
TECHNIQUES OF RENAL ARTERY STENTING
ASTRAL AND STAR TRIALS
RESULTS OF RETROSPECTIVE OBSERVATIONAL STUDIES OFRENAL ARTERY STENTING
Selected References
246
Percutaneous Arterial Dilation for Fibrodysplastic Renovascular Hypertension
TREATMENT
OUTCOMES
247
Transaortic Renal Artery Endarterectomy for Renal Artery Atherosclerosis
OPERATIVE TECHNIQUE
Exposure
Axial Aortorenal Endarterectomy
Transaortic Renal Artery Endarterectomy
Direct Renal Artery Endarterectomy
POSTOPERATIVE CARE
248
Aortorenal Bypass for Renovascular Hypertension in Adults
PREOPERATIVE PREPARATION
OPERATIVE MANAGEMENT
Surgical Strategy
Operative Exposure
Renal Artery Bypass
Operative Duplex Sonography
OUTCOMES
249
Alternative Renal Artery Reconstruction Techniques: Hepatorenal, Splenorenal, Iliorenal, and Mesorenal Bypass Procedures
SPLENORENAL BYPASS
HEPATORENAL AND GASTRODUODENAL BYPASS
ILIORENAL BYPASS
MESORENAL BYPASS
250
Ex Vivo Arterial Repair for Renovascular Hypertension Secondary to Fibrodysplasia
THERAPY
SURGICAL TECHNIQUE
Incision
Nephrectomy
Ex Vivo Reconstruction
Autotransplantation of the Kidney
RESULTS
Complications
251
Operative Evaluation of Renal and Visceral Arterial Reconstructions Using Duplex Sonography
252
Surgical Treatment of Renovascular Hypertension in Children
OPERATIVE THERAPY
Types of Surgery
General Tenets
Concomitant Nonrenal Procedures
DISCUSSION
OUTCOMES
253
Renal Artery Dissection
ENDOVASCULAR PROCEDURE-INDUCED DISSECTION
BLUNT TRAUMA–RELATED DISSECTION
SPONTANEOUS DISSECTION
254
Renal Artery Atheroembolism
ETIOLOGY
DIAGNOSIS
TREATMENT
255
Renal Vein Thrombosis
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
DIAGNOSIS
TREATMENT
Neonates
Adults
256
Treatment of Renal Artery Aneurysms
PATHOGENESIS
CLINICAL PRESENTATION
TREATMENT
Indications
Surgical Exposure
Specific Interventions
OUTCOMES
257
Renal Arteriovenous Malformations And Arteriovenous Fistulas
CLASSIFICATION
INCIDENCE
CLINICAL FEATURES
ANGIOGRAPHIC DIAGNOSIS
MANAGEMENT
Congenital Arteriovenous Malformations
Arteriovenous Fistula
Traumatic Arteriovenous Fistula
258
Endovascular Renal Denervation
RESISTANT HYPERTENSION ANDTHE ROLE OF SYMPATHETIC NERVOUS SYSTEM
ENDOVASCULAR RENAL DENERVATION
CLINICAL EVALUATION OF RENAL DENERVATION
ALTERNATIVE APPROACHESTO RENAL DENERVATION
EFFECT OF RENAL DENERVATION ON PHYSIOLOGIC PARAMETERS
SAFETY OF THE PROCEDURE
RENAL DENERVATION FOR OTHER CONDITIONS
Arteriovenous Fistulas and
Arteriovenous Malformations
259
Classification of Peripheral Arteriovenous and Venous Malformations
260
Imaging of Peripheral Vascular Fistulas and Arteriovenous Malformations
IMAGING MODALITIES
MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY
ULTRASONOGRAPHY
COMPUTED TOMOGRAPHY
IMAGING FEATURES OF VASCULAR ANOMALIES
Capillary Malformations
Venous Malformations
Lymphatic Malformations
Arteriovenous Malformations
Mixed Malformations and Syndromes
Vascular Tumors
Arteriovenous Fistulas
261
Treatment of Congenital Vascular Malformations in Children and Adults
TREATMENT GUIDELINES
Surgical Treatment
Endovascular Treatment
262
Treatment of Traumatic Arteriovenous Fistulas
ETIOLOGY AND PATHOPHYSIOLOGY
CLINICAL PRESENTATION AND DIAGNOSIS
TREATMENT
Management Options
Treatment at Specific Sites
Angioaccess Surgery
263
External Methods of Angioaccess
INDICATIONS FOR CENTRAL VENOUSACCESS
Chemotherapy
Hemodialysis
TYPES OF CENTRAL VENOUSCATHETERS
Acute-Care Devices
Transition Access Devices
Tunneled Catheters
Implanted Ports
TECHNIQUES FOR INSERTION
Internal Jugular Approach
Subclavian Vein Approach
Femoral Vein Approach
Other Approaches
COMPLICATIONS OF CENTRAL VENOUS CATHETERIZATION
Pneumothorax
Vascular Injury
Arrhythmia
Air Embolism
Infection
Mechanical Complications
264
Direct Arteriovenous Communication Angioaccess
PREOPERATIVE EVALUATION
LOCATION OF THE FISTULA
TECHNIQUE
COMPLICATIONS
Graft Stenosis
Steal Syndrome with Hand Ischemia
Central Vein Stenosis
MATURATION OF THE FISTULA
FOLLOW-UP
265
Bridge Grafts for Angioaccess
PREOPERATIVE CONSIDERATIONS
BRIDGE GRAFTS
SURGERY
266
Role of Surveillance for Hemodialysis Access
JUSTIFICATION
CLINICAL MONITORING AND SURVEILLANCE TECHNIQUES
RECOMMENDATIONS FROM NATIONAL GUIDELINES
EVIDENCE TO SUPPORT SURVEILLANCE
PRACTICAL RECOMMENDATIONS
267
Thrombotic Complications of Arteriovenous Access
RISK FACTORS FOR THROMBOSISOF ARTERIOVENOUS ACCESS
Inflow Disease
Anastomotic Factors
Complications with the Type of Conduit
Systemic Factors
Intradialytic Factors
CLINICAL PRESENTATION
MANAGEMENT
Patient Selection
Contraindications to Thrombectomy
TREATMENT TECHNIQUES
Standard Percutaneous Technique
Standard Open Technique
Thrombolysis
Mechanical Thrombectomy
Balloon Angioplasty
Stent and Stent-Graft Placement
COMPLICATIONS OF THROMBOLYSIS AND THROMBECTOMY
Local Complications
Distant Complications
Systemic Complications
268
Ambulatory Treatment of Dialysis Access Stenosis
TECHNIQUE OF ULTRASOUND-GUIDED FISTULA TREATMENT
OFFICE-BASED MANAGEMENT OF ARTERIOVENOUS ACCESS UNDER FLUOROSCOPIC GUIDANCE
FOLLOW-UP
Venous Disease
269
Coagulation Cascade and Thrombosis
BASIC COAGULATION PATHWAYS
NATURAL ANTICOAGULANTS BALANCE THROMBOSIS
PHYSIOLOGIC THROMBOLYSIS
ORGAN HEMOSTASIS: ENDOTHELIUM
INFLAMMATION AND THROMBOSIS
863RESOLUTION OF THROMBOSIS
INTERPLAY OF ARTERIAL AND VENOUS THROMBOSIS
FACTORS THAT INCREASE RISK OF VENOUS THROMBOEMBOLISM
BIOMARKERS FOR VENOUS THROMBOEMBOLISM
270
Pathophysiology of Acute Venous Thrombosis
RISK FACTORS FOR ACUTE VENOUS THROMBOEMBOLISM
PATHOPHYSIOLOGY OF ACUTE VENOUS THROMBOEMBOLISM
SUMMARY
271
Ultrasonography for the Diagnosis of Venous Disease
EVALUATION OF REFLUX
EVALUATION OF OBSTRUCTION
EVALUATION OF CONGENITAL MALFORMATION
272
Computed Tomographic Venography and Magnetic Resonance Venography
COMPUTED TOMOGRAPHY VENOGRAPHY
MAGNETIC RESONANCE VENOGRAPHY
273
Invasive Methods of Diagnosing Acute and Chronic Venous Disease
INTRAVASCULAR ULTRASONOGRAPHY
CONTRAST VENOGRAPHY
IMAGING OF ACUTE AND CHRONIC VENOUS THROMBOSIS
274
Natural History of Acute Venous Thrombosis
VENOUS THROMBOGENESIS ANDTHE EARLY NATURAL HISTORY OF DEEP VEIN THROMBOSIS
COMPLICATIONS OF ACUTE DEEP VEIN THROMBOSIS
CLINICAL IMPLICATIONS OF NATURAL HISTORY STUDIES
SUMMARY
275
Nonoperative Treatment of Acute Lower Extremity Venous Thrombosis
PATIENTS WITH DEEP VEIN THROMBOSIS
PATIENTS WITH THE POST-THROMBOTIC SYNDROME
276
New and Alternative Anticoagulants
FONDAPARINUX
APIXABAN
RIVAROXABAN
EDOXABAN
DABIGATRAN
FUTURE ANTICOAGULANTS
277
Warfarin-Induced Skin Necrosis
CLINICAL PRESENTATION
LABORATORY PRESENTATION
PATHOPHYSIOLOGY
PREVENTION AND MANAGEMENT
PROGNOSIS
278
Endovascular Thrombolysis and Mechanical Clot Removal for Acute Symptomatic Lower Extremity Deep Vein Thrombosis
MECHANISM OF THROMBOLYSIS
EVALUATION
ENDOVASCULAR STRATEGIESOF THROMBUS REMOVAL
QUALITY OF LIFE, VEIN VALVE FUNCTION, AND RECURRENCE
CONCLUSION
279
Open Surgical Treatment of Acute Iliofemoral and Inferior Vena Cava Thrombosis
INDICATIONS FOR INTERVENTION
SURGICAL THROMBECTOMY
COMPLICATIONS AND RESULTSOF SURGICAL THROMBECTOMY
NEW DEVELOPMENTS TO IMPROVE SURGICAL VENOUS THROMBECTOMY
280
Treatment of Acute Upper Extremity Venous Occlusion
CATHETER-ASSOCIATED DEEP VEIN THROMBOSIS OF THE UPPER EXTREMITY
TREATMENT
COMPLICATIONS
281
Lower Extremity Superficial Vein Thrombophlebitis
282
Pathology and Classification of Chronic Venous Disease
IN SEARCH OF COMPLETEAND ACCURATE DIAGNOSIS
CLUES TO CHRONIC VENOUS DISEASE
SKIN PATHOLOGY AND CLINICAL CLASSIFICATION
REFINEMENT IN C, E, A, AND P:2004 CONSENSUS
VENOUS CLINICAL SEVERITY SCORING
DISABILITY SCORE
QUALITY OF LIFE
SUMMARY
283
Endovascular Treatment of Chronic Venous Occlusion
PATHOPHYSIOLOGY
DIAGNOSIS
TREATMENT
RESULTS
284
Endovascular Laser Treatment of Varicose Veins
PATIENT SELECTION
TECHNIQUE
FOLLOW-UP
COMPLICATIONS
CLINICAL EXPERIENCE
285
Endovascular Radiofrequency Treatment of Varicose Veins
PROCEDURE
POST-TREATMENT CARE
RESULTS
286
Injection Treatment of Lower Extremity Varicose Veins
SCLEROSANTS
LIQUID SCLEROTHERAPY
FOAM SCLEROTHERAPY
SCLEROTHERAPY FOR SUPERFICIAL VARICES AND TELANGIECTASES
SAPHENOUS SCLEROTHERAPY
RESULTS OF CLINICAL TRIALS
SYSTEMIC COMPLICATIONS
287
Excision of Varicose Veins
IMPORTANCE OF TREATING TRUNCAL INCOMPETENCE
PRINCIPLES OF TREATING VARICOSITIES
EXCISION OF VARICOSE VEINS
288
Open Surgical Treatment of Chronic Venous Insufficiency
INDICATIONS FOR DETAILED VENOUS EVALUATIONS
PRIMARY VENOUS INSUFFICIENCY
SECONDARY VENOUS INSUFFICIENCY
RESULTS
COMPLICATIONS
CONCLUSION
289
Nonoperative Management of Chronic Venous Insufficiency
COMPRESSION THERAPY
Elastic Stockings
Paste Boots
Compressive Bandages
Legging Orthosis
Pneumatic Compression Devices
PHARMACOLOGIC THERAPIES
Diuretics
Zinc
Fibrinolytic Agents
Phlebotrophic Agents
Hemorheologic Agents
Prostaglandins
TOPICAL THERAPIES
290
Pathophysiology of Venous Varicosities and Venous Ulcers
MACROSCOPIC ALTERATIONS
MICROSCOPIC ALTERATIONS
EXTRACELLULAR MATRIX ALTERATIONS
CYTOKINE REGULATION AND TISSUE FIBROSIS
MATRIX METALLOPROTEINASES AND THEIR INHIBITORS IN VENOUS ULCER HEALING
REGULATION OF VENOUS ULCER FORMATION AND HEALING
SUMMARY
291
Open Surgical, Endoscopic, and Endovascular Treatment of Perforating Veins
ANATOMY AND FUNCTION OF PERFORATORS
New Nomenclature
Common Sites of Perforating Veins
PATHOPHYSIOLOGY
DIAGNOSIS OF PERFORATOR INCOMPETENCE
CLINICAL OUTCOMES FOLLOWING PERFORATOR ABLATION
Determining the Role of and Indication for Ablation
Effect of Interrupting ICPVs on Ulcer Healingand Recurrence
Effect of Treating GSV Incompetence Aloneon Ulcer Healing and Recurrence
NEWER TECHNIQUES FOR ICPV ABLATION
Sclerotherapy
Endovenous Ablation
Radiofrequency Ablation for Venous Ulcer
CURRENT APPROACH
292
Nonoperative Treatment of Venous Ulcers
COMPRESSION THERAPY AND CHRONIC VENOUS ULCERWOUND THERAPY
PHARMACOLOGIC TREATMENT
TREATMENT WITH TOPICAL GROWTH FACTORS
THERAPEUTIC MODULATION OF MATRIX METALLOPROTEINASE
HUMAN SKIN EQUIVALENTS AND BIOLOGIC MATRICES
293
Renal Vein Entrapment: The Nutcracker Syndrome
ANATOMIC FEATURES
CLINICAL FEATURES
DIAGNOSTIC STUDIES
TREATMENT
Surgical Treatment
Endovascular Treatment
294
Pelvic Venous Flow Disorder
VENOUS ANATOMY OF THE PELVIS
PATHOPHYSIOLOGY
SYMPTOMS
DIAGNOSIS
TREATMENT
RESULTS AND OUTCOMES
295
Endovascular Treatment of Vena Cava Occlusion
CLINICAL PRESENTATION
IMAGING EVALUATION
VASCULAR ACCESS FOR ENDOVASCULAR TREATMENT
TECHNIQUE OF VENOUS RECANALIZATION
TREATMENT ENDPOINTS
SPECIAL CASES
POSTOPERATIVE FOLLOW-UP
AREAS OF UNCERTAINTY AND OPPORTUNITY FOR FUTURE DEVELOPMENT
296
Open Surgical Treatment of Thrombotic Vena Cava Occlusion
SUPERIOR VENA CAVA SYNDROME
Clinical Presentation
Surgical Technique
Results
INFERIOR VENA CAVA THROMBOSIS
Clinical Presentation
Open Surgical Treatment
Results
297
Primary and Secondary Vena Cava Tumors
TUMOR TYPES
CLINICAL PRESENTATION
EVALUATION
TREATMENT
OUTCOMES
298
Nonoperative Treatment of Acute Pulmonary Embolism
RISK STRATIFICATION
TREATMENT STRATEGIES
Systemic Fibrinolysis
Catheter-Directed Therapy
Local Fibrinolytic Therapy
Pigtail Fragmentation
Rheolytic Thrombectomy
Rotational Thrombectomy
Ultrasound-Accelerated Thrombolysis
PRACTICAL PERSPECTIVE
299
Surgical Treatment of Acute and Chronic Pulmonary Embolism
ACUTE PULMONARY EMBOLISM
CHRONIC PULMONARY EMBOLISM
CONCLUSION
300
Permanent and Temporary Inferior Vena Cava Filters
INDICATIONS FOR PLACING FILTERS
TYPES OF FILTERS
PLACING THE FILTER
RETRIEVING THE FILTER
COMPLICATIONS OF FILTER PLACEMENT
PROPHYLACTIC FILTER PLACEMENT
301
Venous Aneurysms
POPLITEAL VENOUS ANEURYSMS
ANEURYSMS OF THE SUPERFICIAL VEINS OF THE EXTREMITIES
VENOUS ANEURYSMS OF THE DEEP VEINS OF THE EXTREMITIES
VENOUS ANEURYSMS OF THE VEINS OF THE NECK AND FACE
THORACIC VENOUS ANEURYSMS
AZYGOS VEIN ANEURYSMS
SUBCLAVIAN AND INNOMINATE VENOUS ANEURYSMS
ABDOMINAL VENOUS ANEURYSMS
Lymphatic Disease
302
Lymphedema
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY
CLASSIFICATION
EVALUATION AND DIAGNOSIS
TREATMENT
303
Lymphedema: Medical and Physical Therapy
STRUCTURE AND FUNCTION OF THE LYMPHATIC SYSTEM
PATHOPHYSIOLOGY
PRIMARY AND SECONDARY LYMPHEDEMA
GRADES OF LYMPHEDEMA
TREATMENT
REHABILITATIVE TREATMENT
Elevation
Skin Hygiene
Exercise
Specialized Massage
Compression
Intermittent Vasopneumatic Compression
304
Surgical Treatment of Lymphedema
INDICATIONS FOR SURGICAL TREATMENT
EXCISIONAL OPERATIONS
MICROSURGICAL LYMPH VESSEL RECONSTRUCTIONS
LYMPHATIC GRAFTING
CONCLUSION