BOOK
Vascular and Endovascular Surgery E-Book
Jonathan D Beard | Peter A. Gaines | Ian Loftus
(2013)
Additional Information
Book Details
Abstract
Vascular and Endovascular Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of this sub-specialty that is relevant to their general surgical practice. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
This is a title in the Companion to Specialist Surgical Practice series whose eight volumes are an established and highly regarded source of information for the specialist general surgeon.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within each major surgical sub-specialty.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
- An expanded authorship team across the series includes additional European and World experts with an increased emphasis on global practice.
- The contents of the series have been extensively revised in line with recently published evidence.
- The revision of the content reflects the continued move towards non-invasive imaging, medical therapy and endovascular techniques, culminating in a new chapter on Future Developments.
- Many of the chapters reflect the collaborative nature of a modern vascular service and are co-authored by a vascular surgeon and a vascular radiologist.
- The authorship team has been expanded with input from vascular nursing and rehabilitation experts.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Vascular and Endovascular Surgery: A COMPANION TO SPECIALIST SURGICAL PRACTICE | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Series Editors' preface | xi | ||
| Editors' preface | xiii | ||
| Evidence-based practice in surgery | xv | ||
| Further reading | xvii | ||
| General vascular | xvii | ||
| Rare vascular disorders | xvii | ||
| Imaging | xvii | ||
| Specialist | xvii | ||
| Websites | xvii | ||
| Chapter 1: Epidemiology and risk factor management of peripheral arterial disease | 1 | ||
| Introduction | 1 | ||
| Epidemiology of PAD | 1 | ||
| Investigative techniques for epidemiological screening | 2 | ||
| Prevalence and incidence of PAD | 2 | ||
| Natural history of PAD: cardiovascular and lower limb outcomes | 3 | ||
| Asymptomatic disease | 3 | ||
| Intermittent claudication | 3 | ||
| Critical limb ischaemia | 4 | ||
| The Reduction of Atherothrombosis for Continued Health (REACH) registry | 4 | ||
| Epidemiological risk factors for PAD and randomised trials of disease-modifying therapy for secondary prevention | 4 | ||
| CV risk factors in general | 4 | ||
| Risk factors for PAD | 4 | ||
| Age and gender | 5 | ||
| Cigarette smoking | 5 | ||
| Diabetes | 6 | ||
| Blood pressure (BP) | 6 | ||
| Renin–angiotensin–aldosterone system blockade | 7 | ||
| Serum lipids | 7 | ||
| Evidence for dietary control or supplementation | 9 | ||
| Antiplatelet therapy | 11 | ||
| Exercise therapy | 11 | ||
| Conclusions | 12 | ||
| References | 13 | ||
| Chapter 2: Assessment of chronic lower limb ischaemia | 16 | ||
| Introduction | 16 | ||
| Intermittent claudication (IC) | 16 | ||
| Critical ischaemia | 17 | ||
| Rare causes of ischaemia | 18 | ||
| Persistent sciatic artery | 18 | ||
| Cystic adventitial disease (CAD) | 19 | ||
| Popliteal artery entrapment | 19 | ||
| Fibromuscular dysplasia (FMD) | 20 | ||
| Buerger's disease | 20 | ||
| History and examination | 20 | ||
| History | 20 | ||
| Examination | 20 | ||
| Exercise challenge | 21 | ||
| ABPI measurement using a hand-held Doppler device | 22 | ||
| Toe pressures | 22 | ||
| The ischaemic angle | 23 | ||
| Risk factors | 23 | ||
| Vascular laboratory | 23 | ||
| Waveform assessment and segmental pressures | 23 | ||
| Laser Doppler and transcutaneous oximetry | 24 | ||
| Duplex ultrasound (DUS) | 25 | ||
| Assessment of suprainguinal arteries | 25 | ||
| Assessment of infrainguinal arteries | 26 | ||
| Radiological investigations | 27 | ||
| Contrast media | 27 | ||
| Magnetic resonance angiography (MRA) | 29 | ||
| Chapter 3: Medical treatment of chronic lower limb ischaemia | 36 | ||
| Introduction | 36 | ||
| PAD diagnosis and screening | 37 | ||
| Modifying cardiovascular risk | 38 | ||
| Medical treatments for symptomatic PAD | 39 | ||
| Exercise | 39 | ||
| Drug treatment | 40 | ||
| Vasoactive drugs | 40 | ||
| Prostanoids | 40 | ||
| Angiogenesis | 41 | ||
| Gene therapy | 41 | ||
| Cell therapy | 41 | ||
| Spinal cord stimulation | 41 | ||
| Lumbar sympathectomy | 41 | ||
| Intermittent pneumatic compression | 41 | ||
| Conclusions | 41 | ||
| References | 42 | ||
| Chapter 4: Intervention for chronic lower limb ischaemia | 45 | ||
| Introduction | 45 | ||
| Patient selection | 45 | ||
| Cost-effectiveness | 46 | ||
| TASC recommendations | 47 | ||
| Suprainguinal endovascular intervention | 48 | ||
| Abdominal aorta | 48 | ||
| Iliac arteries | 48 | ||
| When is an iliac lesion significant? | 49 | ||
| Who should have an angioplasty or a stent? | 49 | ||
| Iliac stenoses | 50 | ||
| Iliac occlusions | 51 | ||
| Complications | 51 | ||
| Bleeding and pseudoaneurysm development | 51 | ||
| Arterial rupture | 51 | ||
| Embolisation | 51 | ||
| Stent-related complications | 51 | ||
| Suprainguinal open surgical intervention | 51 | ||
| Aorto-bifemoral bypass | 54 | ||
| Axillo-bifemoral bypass | 54 | ||
| Unilateral iliofemoral bypass | 55 | ||
| Iliofemoral crossover | 56 | ||
| Femorofemoral crossover | 56 | ||
| Femoral endarterectomy and profundaplasty | 56 | ||
| Infrainguinal reconstruction | 57 | ||
| Choice of graft material | 59 | ||
| In situ versus reversed vein | 60 | ||
| Prosthetic grafts | 60 | ||
| Graft surveillance | 61 | ||
| Infrainguinal endovascular intervention | 61 | ||
| Femoropopliteal angioplasty | 61 | ||
| Subintimal angioplasty | 61 | ||
| Femoropopliteal stents | 61 | ||
| Drug-eluting stents/balloons | 63 | ||
| Covered stent grafts | 64 | ||
| Crural artery intervention | 65 | ||
| Infrainguinal bypass versus angioplasty | 65 | ||
| Non-interventional treatment for CLI | 66 | ||
| Iloprost | 66 | ||
| Spinal cord stimulation | 66 | ||
| Sympathectomy | 66 | ||
| Calf and foot compression | 66 | ||
| References | 67 | ||
| Chapter 5: The diabetic foot | 73 | ||
| Introduction | 73 | ||
| Epidemiology | 73 | ||
| Aetiology of foot ulceration | 74 | ||
| Diabetic neuropathy | 74 | ||
| Peripheral vascular disease | 75 | ||
| Biomechanical aspects | 78 | ||
| Other risk factors | 78 | ||
| The pathway to ulceration | 79 | ||
| Management | 79 | ||
| The ‘at-risk’ foot | 79 | ||
| Ulcer management | 80 | ||
| Neuropathic ulcers | 80 | ||
| Ischaemic and neuroischaemic ulcers | 81 | ||
| Infection | 83 | ||
| Larva debridement therapy | 85 | ||
| Medical problems on the surgical ward | 85 | ||
| Charcot neuroarthropathy | 85 | ||
| References | 87 | ||
| Chapter 6: Amputation, rehabilitation and prosthetic developments | 90 | ||
| Introduction | 90 | ||
| Epidemiology | 90 | ||
| Indications for amputation | 91 | ||
| Level selection | 91 | ||
| Surgical considerations | 92 | ||
| Transfemoral amputation | 93 | ||
| Through-knee amputation | 93 | ||
| Transtibial amputation | 93 | ||
| Foot amputation | 94 | ||
| Rehabilitation | 94 | ||
| Planning | 95 | ||
| Stump management | 95 | ||
| Pain management | 95 | ||
| Early postoperative rehabilitation | 96 | ||
| Primary prosthetic rehabilitation | 96 | ||
| Sport activities for amputees | 96 | ||
| Prostheses | 97 | ||
| Prosthetic developments | 97 | ||
| Rehabilitation for the bariatric patient | 99 | ||
| References | 100 | ||
| Chapter 7: Revision vascular surgery | 102 | ||
| Introduction | 102 | ||
| Graft occlusion | 102 | ||
| Factors influencing graft occlusion | 102 | ||
| Local factors | 102 | ||
| General factors | 103 | ||
| Prevention of graft thrombosis | 104 | ||
| Management of graft stenosis (the failing graft) | 104 | ||
| Management of the failed graft | 104 | ||
| Role of thrombolysis | 104 | ||
| Suprainguinal graft thrombosis | 105 | ||
| Infrainguinal graft thrombosis | 106 | ||
| Graft infection | 106 | ||
| Causes | 106 | ||
| Prevention | 107 | ||
| Presentation | 107 | ||
| Bacteriology | 107 | ||
| Diagnosis | 108 | ||
| Management | 109 | ||
| General principles | 109 | ||
| Infrarenal aortic graft infection | 109 | ||
| Graft aneurysms | 111 | ||
| True aneurysms | 111 | ||
| False aneurysms | 111 | ||
| Carotid artery | 114 | ||
| Infection | 114 | ||
| Aneurysm formation | 114 | ||
| Revision after CAS | 114 | ||
| Revision surgery after EVAR | 115 | ||
| Revision after thoracic endovascular aortic repair (TEVAR) | 116 | ||
| Aortobronchial fistula | 116 | ||
| Aorto-oesophageal fistula | 116 | ||
| Infection | 116 | ||
| References | 117 | ||
| Chapter 8: Management of acute lower limb ischaemia | 122 | ||
| Introduction | 122 | ||
| Aetiology | 122 | ||
| Embolism | 122 | ||
| Atheroembolism | 122 | ||
| Thrombosis | 123 | ||
| Other causes | 124 | ||
| Recent changes | 126 | ||
| Clinical features | 126 | ||
| Initial management | 126 | ||
| Revascularisation | 127 | ||
| Irreversible (category III) leg ischaemia | 127 | ||
| Immediately threatened (category IIb ischaemia) | 128 | ||
| Threatened (category IIa ischaemia)/viable (category I ischaemia) | 128 | ||
| Choice between surgery and thrombolysis: the evidence | 129 | ||
| Peripheral arterial thrombolysis | 129 | ||
| Contraindications (Box 8.2) | 129 | ||
| Technique | 130 | ||
| Percutaneous thrombectomy devices | 133 | ||
| Complications | 133 | ||
| Outcome | 133 | ||
| Surgical management | 134 | ||
| Balloon catheter embolectomy | 135 | ||
| Completion angiography | 135 | ||
| Failed embolectomy | 136 | ||
| Further management | 136 | ||
| Overall prognosis | 137 | ||
| Conclusions | 137 | ||
| References | 138 | ||
| Chapter 9: Vascular trauma | 140 | ||
| Introduction | 140 | ||
| Mechanism of injury | 140 | ||
| Blunt trauma | 140 | ||
| Penetrating trauma | 140 | ||
| Sequelae of vascular injuries | 140 | ||
| Clinical assessment | 142 | ||
| History | 142 | ||
| Examination | 142 | ||
| Diagnosis | 142 | ||
| Resuscitation and initial management | 142 | ||
| Special investigations | 143 | ||
| Plain radiography | 143 | ||
| Arteriography | 143 | ||
| Ultrasound | 143 | ||
| Axial imaging | 143 | ||
| General principles of management of vascular injury | 143 | ||
| Venous injuries | 144 | ||
| Endovascular management of vascular trauma | 145 | ||
| Cervical vascular injuries | 146 | ||
| Carotid artery injuries | 146 | ||
| Mechanism | 146 | ||
| Clinical signs | 146 | ||
| Diagnosis | 147 | ||
| Management | 147 | ||
| Operative technique | 147 | ||
| Vertebral artery injuries | 148 | ||
| Endovascular management of cervical injuries | 148 | ||
| Thoracic vascular injuries | 148 | ||
| Clinical presentation and initial management | 148 | ||
| Diagnostic studies | 149 | ||
| Chest radiography | 149 | ||
| Angiography | 149 | ||
| Other imaging modalities | 149 | ||
| Treatment | 149 | ||
| Endovascular repair | 150 | ||
| Surgical repair | 150 | ||
| Abdominal vascular injuries | 150 | ||
| Diagnosis | 150 | ||
| Management | 150 | ||
| Aortic injury | 151 | ||
| Iliac injury | 151 | ||
| Visceral artery injury | 151 | ||
| Renal artery injury | 152 | ||
| Inferior vena cava injury | 152 | ||
| Pelvic vascular injury | 152 | ||
| Extremity vascular trauma | 152 | ||
| Diagnosis | 152 | ||
| General principles of management | 152 | ||
| Vascular injuries to the upper extremity (Fig. 9.14) | 154 | ||
| Subclavian and axillary injuries | 154 | ||
| Vascular injuries to the lower limb | 155 | ||
| Femoral vascular injuries | 155 | ||
| Popliteal vascular injury | 155 | ||
| References | 156 | ||
| Chapter 10: Extracranial cerebrovascular disease | 160 | ||
| Introduction | 160 | ||
| Aetiology and risk factors | 160 | ||
| Large-vessel thromboembolism | 160 | ||
| Small-vessel disease | 160 | ||
| Cardiogenic brain embolism | 160 | ||
| Haematological disorders | 161 | ||
| Non-atheromatous carotid diseases | 161 | ||
| Fibromuscular dysplasia (FMD) | 161 | ||
| Arteritis (see also Chapter 12) | 161 | ||
| Carotid aneurysm | 162 | ||
| Carotid dissection | 162 | ||
| Carotid body tumour | 163 | ||
| Presentation of carotid disease | 163 | ||
| Asymptomatic cerebrovascular disease | 163 | ||
| Symptomatic cerebrovascular disease | 164 | ||
| Carotid territory | 164 | ||
| Vertebrobasilar | 165 | ||
| Non-hemispheric | 165 | ||
| Investigation of carotid disease | 165 | ||
| Duplex ultrasound | 166 | ||
| Catheter angiography | 166 | ||
| Magnetic resonance angiography | 167 | ||
| Computed tomography angiography (CTA) | 168 | ||
| Management of cerebrovascular disease | 168 | ||
| ‘Best medical therapy’ | 168 | ||
| Surgical management of carotid disease | 170 | ||
| Symptomatic carotid artery disease | 170 | ||
| Asymptomatic carotid artery disease | 173 | ||
| CEA/CAS and coronary bypass | 174 | ||
| Emergency CEA | 175 | ||
| Vertebral artery revascularisation | 175 | ||
| Surgical management of carotid disease – carotid endarterectomy | 175 | ||
| Anaesthesia | 175 | ||
| Technique | 176 | ||
| Patch or primary closure? | 176 | ||
| Routine, selective or never shunt? | 176 | ||
| Perioperative monitoring | 176 | ||
| Completion assessment | 177 | ||
| Operative complications | 177 | ||
| Cranial nerve injuries | 177 | ||
| Wound complications | 177 | ||
| Perioperative stroke | 177 | ||
| Long-term follow-up and re-stenosis | 178 | ||
| Patch infection | 178 | ||
| Endovascular treatment of carotid disease | 179 | ||
| Results of CAS | 179 | ||
| Ongoing controversies | 179 | ||
| Is CEA or CAS safer in the hyperacute period after onset of symptoms? | 179 | ||
| Importance of perioperative MI | 180 | ||
| A surgeon's perspective | 180 | ||
| An interventionist's perspective | 180 | ||
| New ischaemic lesions on MRI | 181 | ||
| Assessing suitability for CAS | 181 | ||
| Dual antiplatelet therapy | 182 | ||
| CAS technique | 182 | ||
| Embolic protection devices | 183 | ||
| Distal balloon occlusion | 183 | ||
| Distal filters | 183 | ||
| Flow reversal/flow arrest (endovascular clamping) | 183 | ||
| Does stent design influence outcome? | 184 | ||
| Periprocedural haemodynamic problems | 184 | ||
| Haemodynamic depression | 184 | ||
| Hyperperfusion | 185 | ||
| Post-CAS care | 185 | ||
| Achievement and maintenance of competence | 185 | ||
| References | 186 | ||
| Chapter 11: Vascular disorders of the upper limb | 190 | ||
| Introduction | 190 | ||
| Clinical examination | 190 | ||
| Occlusive disease | 190 | ||
| Brachiocephalic artery | 190 | ||
| Aorto-brachiocephalic bypass | 191 | ||
| Brachiocephalic endarterectomy | 191 | ||
| Endovascular treatment | 191 | ||
| Subclavian artery | 192 | ||
| Carotid–subclavian bypass | 192 | ||
| Carotid transposition | 192 | ||
| Crossover grafts | 193 | ||
| Endovascular treatment | 195 | ||
| Upper arm arteries | 195 | ||
| Lower arm and hand arteries | 195 | ||
| Aneurysmal disease | 196 | ||
| Upper arm artery aneurysms | 197 | ||
| Lower arm and hand artery aneurysms | 197 | ||
| Ulnar artery aneurysm or hypothenar hammer syndrome | 197 | ||
| Upper limb embolism | 198 | ||
| Other causes of acute ischaemia | 198 | ||
| Thoracic outlet syndrome | 199 | ||
| Neurogenic thoracic outlet compression syndrome (N-TOCS) | 199 | ||
| Diagnosis | 199 | ||
| Treatment | 199 | ||
| Transaxillary resection of first rib | 199 | ||
| Arterial thoracic outlet compression syndrome | 201 | ||
| Surgical management | 201 | ||
| Combined supraclavicular and infraclavicular approach | 201 | ||
| Subclavian–axillary vein thrombosis | 203 | ||
| Primary SVT | 204 | ||
| Diagnosis | 204 | ||
| Treatment | 204 | ||
| Secondary SVT | 205 | ||
| References | 206 | ||
| Chapter 12: Primary and secondary vasospastic disorders (Raynaud's phenomenon) and vasculitis | 210 | ||
| Introduction | 210 | ||
| Raynaud's phenomenon | 210 | ||
| Pathophysiology | 212 | ||
| Neurogenic | 212 | ||
| Interactions between blood and blood vessel walls | 212 | ||
| Inflammatory and immunological mechanisms | 212 | ||
| Genetic factors | 212 | ||
| Clinical features | 212 | ||
| Investigations | 213 | ||
| Management | 214 | ||
| General measures | 214 | ||
| Drug therapy | 214 | ||
| Calcium channel blockers | 214 | ||
| Other vasodilators | 215 | ||
| Prostaglandins | 215 | ||
| Other drugs | 216 | ||
| Sympathectomy | 216 | ||
| Conclusion | 216 | ||
| Connective tissue disease | 216 | ||
| Vasculitis | 217 | ||
| Takayasu's arteritis | 218 | ||
| Buerger's disease (thromboangiitis obliterans) | 218 | ||
| Giant cell arteritis | 219 | ||
| Polyarteritis nodosa | 220 | ||
| Wegener's granulomatosis | 221 | ||
| Cutaneous vasculitis/small-vessel vasculitis | 221 | ||
| Idiopathic cutaneous vasculitis | 221 | ||
| Necrotising vasculitis associated with infections, drugs or CTD | 222 | ||
| Cutaneous vasculitis as a manifestation of systemic disease | 222 | ||
| Conclusion | 222 | ||
| References | 223 | ||
| Chapter 13: Peripheral and abdominal aortic aneurysms | 226 | ||
| Definition of an aneurysm | 226 | ||
| Prevalence of arterial aneurysms | 226 | ||
| Pathogenesis of aortic aneurysms | 226 | ||
| Infrarenal abdominal aortic aneurysms | 227 | ||
| Symptomatic and ruptured AAAs | 227 | ||
| Inflammatory abdominal aortic aneurysms (IAAAs) | 227 | ||
| Population screening for AAAs | 227 | ||
| Principles of AAA management | 228 | ||
| Surveillance of patients with small aneurysms | 228 | ||
| AAA repair | 228 | ||
| Investigation of the patient with known AAA | 229 | ||
| Preprocedural imaging | 229 | ||
| Elective open AAA repair | 229 | ||
| Minimally invasive open AAA repair | 230 | ||
| Emergency open AAA repair | 230 | ||
| Outcome following open surgical AAA repair | 230 | ||
| Endovascular AAA repair (EVAR) | 231 | ||
| Indications and eligibility for EVAR | 231 | ||
| EVAR devices | 231 | ||
| Patient assessment and EVAR technique | 232 | ||
| EVAR-related complications and device failure | 232 | ||
| Endoleak | 232 | ||
| Graft migration and dislocation | 233 | ||
| Kinking and occlusion | 233 | ||
| Other EVAR-related complications | 233 | ||
| Surveillance after EVAR | 234 | ||
| Outcomes after EVAR | 235 | ||
| The future of EVAR | 237 | ||
| Infected aneurysms | 238 | ||
| True mycotic aneurysms | 238 | ||
| Microbial aneurysmal arteritis | 239 | ||
| Clinical features and management principles of infected aneurysms | 239 | ||
| Peripheral aneurysms | 239 | ||
| Iliac aneurysms | 239 | ||
| Common femoral aneurysms | 239 | ||
| True femoral aneurysms | 240 | ||
| False femoral aneurysms | 240 | ||
| Popliteal artery aneurysms | 241 | ||
| References | 242 | ||
| Chapter 14: Thoracic and thoraco-abdominal aortic disease | 246 | ||
| Introduction | 246 | ||
| Imaging of the thoracic aorta | 246 | ||
| Thoracic aortic aneurysms (TAAs) | 247 | ||
| Classification and aetiology | 247 | ||
| Incidence and clinical presentation | 247 | ||
| Indications for treatment | 247 | ||
| Technique of surgical repair | 247 | ||
| Endovascular repair of thoracic aneurysms | 247 | ||
| Management of the spinal cord during endovascular thoracic procedures | 249 | ||
| Outcome of treatment | 249 | ||
| Recommendations for practice | 249 | ||
| Thoraco-abdominal aortic aneurysms (TAAAs) | 249 | ||
| Surgical management | 250 | ||
| Adjunctive surgical techniques | 250 | ||
| Results of surgical repair of thoraco-abdominal aneurysms | 251 | ||
| Hybrid visceral revascularisation and endovascular repair of thoraco-abdominal aortic aneurysms | 251 | ||
| Total endovascular repair of thoraco-abdominal aortic aneurysms | 253 | ||
| Recommendations for practice | 254 | ||
| Thoracic dissection and acute aortic syndrome | 254 | ||
| Pathology and classification | 254 | ||
| Conventional management of acute aortic dissection | 255 | ||
| Endovascular management of acute type B thoracic dissection | 255 | ||
| Endovascular treatment of chronic dissections | 257 | ||
| Recommendations for practice | 257 | ||
| Traumatic aortic injury (TAI) | 257 | ||
| Recommendations for practice | 258 | ||
| References | 258 | ||
| Chapter 15: Renal and intestinal vascular disease | 262 | ||
| Renal artery disease | 262 | ||
| Fibromuscular dysplasia (FMD) | 262 | ||
| Arteritis | 262 | ||
| Atherosclerotic renal vascular disease | 263 | ||
| Definition and pathology | 263 | ||
| Pathophysiology | 263 | ||
| Renal function | 263 | ||
| Hypertension | 263 | ||
| Diagnosis and presentation | 264 | ||
| ARVD and cardiovascular disease | 264 | ||
| Management options | 264 | ||
| Medical therapy | 264 | ||
| Antihypertensive therapy | 264 | ||
| Endovascular treatment of ARVD | 264 | ||
| Imaging and work-up | 265 | ||
| Procedure (Fig. 15.1c–e) | 265 | ||
| Complications | 266 | ||
| Results of angioplasty and stenting | 266 | ||
| Stenting versus PTA | 266 | ||
| Re-stenosis and drug-eluting stents | 267 | ||
| Surgical treatment | 267 | ||
| Renal artery denervation | 268 | ||
| Intestinal vascular disease | 269 | ||
| Intestinal ischaemia | 270 | ||
| Acute mesenteric ischaemia (AMI) | 270 | ||
| Aetiology and incidence | 270 | ||
| Pathophysiology | 270 | ||
| Diagnosis and treatment | 270 | ||
| Mesenteric venous thrombosis | 271 | ||
| Non-occlusive mesenteric thrombosis | 271 | ||
| Chronic mesenteric ischaemia (CMI) | 271 | ||
| Aetiology and incidence | 271 | ||
| Diagnosis | 271 | ||
| Surgical intervention | 272 | ||
| Endovascular options | 273 | ||
| Coeliac axis compression syndrome | 274 | ||
| Visceral aneurysms | 274 | ||
| Aetiology and incidence | 274 | ||
| Diagnosis and treatment | 274 | ||
| Acknowledgements | 275 | ||
| References | 275 | ||
| Chapter 16: Central venous and dialysis access | 279 | ||
| Introduction | 279 | ||
| Central venous access | 279 | ||
| Indications | 279 | ||
| Methods | 279 | ||
| Complications | 279 | ||
| Temporary dialysis access | 280 | ||
| Methods | 280 | ||
| Complications of CVCs | 280 | ||
| Insertion | 280 | ||
| Catheter dysfunction | 280 | ||
| Catheter-locking solutions | 280 | ||
| Catheter lumen thrombosis | 281 | ||
| Central vein thrombosis | 281 | ||
| Fibrin sheaths | 281 | ||
| Catheter-related infection | 281 | ||
| Permanent dialysis access | 282 | ||
| Access planning | 282 | ||
| Preoperative assessment | 282 | ||
| Duplex ultrasound | 283 | ||
| Venography | 283 | ||
| Primary access | 283 | ||
| Secondary and tertiary access | 284 | ||
| Factors affecting access patency | 285 | ||
| Access failure | 286 | ||
| Failure to mature | 286 | ||
| Stenosis and thrombosis | 286 | ||
| Prevention of access failure | 286 | ||
| Access surveillance | 286 | ||
| Access salvage | 287 | ||
| AVF stenosis | 287 | ||
| AVG stenosis | 288 | ||
| AVF and AVG thrombosis | 288 | ||
| Other access complications | 288 | ||
| Infection | 288 | ||
| Haemorrhage | 289 | ||
| Steal | 289 | ||
| Carpal tunnel syndrome | 290 | ||
| Cardiac failure | 290 | ||
| Venous hypertension and central vein obstruction | 291 | ||
| Aneurysm | 291 | ||
| Cannulation | 292 | ||
| Access in children | 292 | ||
| References | 293 | ||
| Chapter 17: Varicose veins | 298 | ||
| Introduction | 298 | ||
| Pathophysiology | 298 | ||
| Normal venous function | 298 | ||
| Chronic venous hypertension | 298 | ||
| Varicose veins | 298 | ||
| Epidemiology and natural history | 299 | ||
| Clinical presentation | 300 | ||
| Thread veins and reticular veins (CEAP C1) | 300 | ||
| Varicose veins (CEAP C2) | 300 | ||
| Oedema and skin changes (CEAP C3–C4) | 300 | ||
| Chronic venous ulceration (CEAP C5–C6) | 301 | ||
| Clinical assessment | 301 | ||
| History | 301 | ||
| Patient examination | 301 | ||
| Venous investigations | 302 | ||
| Hand-held Doppler and other bedside tests | 302 | ||
| Duplex ultrasound scanning | 302 | ||
| Other investigations | 302 | ||
| Treatment | 302 | ||
| Conservative options, drugs and compression therapy | 303 | ||
| Conservative options | 303 | ||
| Pharmacotherapy | 303 | ||
| Compression stockings | 303 | ||
| Principles of surgical and endovenous intervention | 304 | ||
| Pre-procedure marking | 304 | ||
| Marking the GSV or SSV | 304 | ||
| Marking of varicosities | 304 | ||
| Informed consent | 304 | ||
| Traditional surgery | 304 | ||
| Setting and anaesthesia | 304 | ||
| Great saphenous vein surgery | 304 | ||
| Small saphenous vein surgery | 305 | ||
| Redo varicose vein surgery | 305 | ||
| Complications | 305 | ||
| Endovenous thermal ablation | 306 | ||
| Setting and anaesthesia | 306 | ||
| Summary of technique | 306 | ||
| Endovenous laser ablation (EVLA) | 307 | ||
| Radiofrequency ablation (RFA) | 307 | ||
| Complications | 307 | ||
| Ultrasound-guided foam sclerotherapy (UGFS) | 308 | ||
| Setting and anaesthesia | 308 | ||
| Technique | 308 | ||
| Complications | 308 | ||
| Treatment of incompetent perforating veins | 309 | ||
| Management of varicosities | 309 | ||
| Other treatment options | 310 | ||
| Preserving the saphenous vein | 310 | ||
| Novel endovenous therapies | 310 | ||
| Evidence for traditional and endovenous intervention | 310 | ||
| Traditional surgery | 310 | ||
| Endovenous thermal ablation | 311 | ||
| Ultrasound-guided foam sclerotherapy | 311 | ||
| Deciding between treatment modalities | 311 | ||
| Cost-effectiveness of treatments | 311 | ||
| Atypical varicose veins | 312 | ||
| Vulval and pelvic varices | 312 | ||
| Congenital causes of varicose veins | 312 | ||
| Conclusions | 312 | ||
| References | 313 | ||
| Chapter 18: Chronic leg swelling | 316 | ||
| Chronic venous insufficiency (CVI) | 316 | ||
| Clinical features | 316 | ||
| Swelling | 316 | ||
| Skin changes | 316 | ||
| Ulceration | 316 | ||
| Varicose veins | 316 | ||
| Pain | 316 | ||
| Epidemiology | 317 | ||
| Aetiology | 317 | ||
| Macrocirculation | 317 | ||
| Deep and superficial reflux | 317 | ||
| Perforating vein reflux | 317 | ||
| Microcirculation | 318 | ||
| Classification | 318 | ||
| Investigation | 318 | ||
| Hand-held Doppler | 319 | ||
| Duplex scanning | 319 | ||
| Venography | 319 | ||
| Functional measurements | 319 | ||
| Ambulatory venous pressure measurement | 319 | ||
| Plethysmography | 319 | ||
| Treatment | 319 | ||
| General measures | 319 | ||
| Graduated elastic compression | 320 | ||
| Intermittent pneumatic compression | 320 | ||
| Laser and electromagnetic therapy | 320 | ||
| Pharmacotherapy | 320 | ||
| Dressings | 320 | ||
| Emollients | 321 | ||
| Oxpentifylline (pentoxifylline) | 321 | ||
| Nutrition | 321 | ||
| Superficial venous intervention | 321 | ||
| Superficial venous surgery | 321 | ||
| Perforating vein surgery | 321 | ||
| Deep venous reconstruction | 321 | ||
| Venous bypass | 321 | ||
| Skin grafting | 322 | ||
| Endovascular management of venous outflow obstruction | 322 | ||
| Preventing the post-thrombotic limb | 322 | ||
| Summary | 323 | ||
| Dependency and inactivity | 323 | ||
| Lymphoedema | 323 | ||
| Aetiology | 323 | ||
| Primary | 323 | ||
| Secondary | 324 | ||
| Presentation | 324 | ||
| History | 324 | ||
| Examination | 325 | ||
| Clinical staging | 325 | ||
| Investigation | 325 | ||
| Duplex ultrasonography | 326 | ||
| Lymphangioscintigraphy (isotope lymphography) | 326 | ||
| Computed tomography | 326 | ||
| Magnetic resonance imaging (MRI) | 326 | ||
| Interstitial magnetic resonance lymphangiography | 326 | ||
| Fluorescence microlymphangiography (FML) | 326 | ||
| Contrast lymphangiography | 327 | ||
| Treatment | 327 | ||
| General measures | 327 | ||
| Manual lymphatic drainage | 327 | ||
| Graduated elastic compression | 327 | ||
| Intermittent pneumatic compression (IPC) | 327 | ||
| Thermal treatment | 327 | ||
| Complex decongestive physiotherapy (complex physical therapy) | 327 | ||
| Prevention of infection | 328 | ||
| Drugs | 328 | ||
| Surgical treatments | 328 | ||
| Debulking operations | 328 | ||
| Bypass procedures | 328 | ||
| References | 329 | ||
| Chapter 19: The acutely swollen leg | 334 | ||
| Introduction | 334 | ||
| Pathophysiology of oedema | 334 | ||
| Medical history | 334 | ||
| Physical examination | 335 | ||
| Differential diagnosis | 335 | ||
| Musculotendinous rupture | 335 | ||
| Baker's cyst | 335 | ||
| Cellulitis and erysipelas | 335 | ||
| Necrotising fasciitis | 335 | ||
| Lymphoedema | 336 | ||
| Bilateral swelling | 336 | ||
| Deep venous thrombosis | 336 | ||
| Pathophysiology of DVT | 336 | ||
| Clinical decision rules | 336 | ||
| Imaging techniques | 337 | ||
| Treatment of DVT | 338 | ||
| Prognosis | 339 | ||
| Iliofemoral deep vein thrombosis | 339 | ||
| Post-thrombotic syndrome | 339 | ||
| Catheter-directed thrombolysis | 340 | ||
| New treatment modalities | 341 | ||
| EKOS endowave | 341 | ||
| Trellis-8 | 342 | ||
| Angiojet | 342 | ||
| The future | 342 | ||
| References | 343 | ||
| Chapter 20: Vascular anomalies | 346 | ||
| Introduction | 346 | ||
| Vascular tumours | 346 | ||
| Haemangioma of infancy | 346 | ||
| Infantile haemangioma | 346 | ||
| Subglottic haemangiomata | 347 | ||
| Parotid gland haemangiomata | 347 | ||
| PHACE syndrome2 | 347 | ||
| Diagnosis and imaging | 347 | ||
| Management of haemangiomata of infancy | 347 | ||
| Congenital haemangioma4 | 348 | ||
| Other vascular tumours | 348 | ||
| Vascular malformations | 348 | ||
| Classification | 348 | ||
| Low-flow malformations | 348 | ||
| Capillary malformations | 348 | ||
| Salmon patch (naevus simplex; erythema nuchae) | 348 | ||
| Port-wine stains (naevus flameus) | 349 | ||
| Venous malformations | 349 | ||
| Imaging | 349 | ||
| Management of venous malformations | 350 | ||
| Lymphatic malformations | 350 | ||
| Management9 | 350 | ||
| High-flow malformations | 350 | ||
| Imaging | 351 | ||
| Management | 351 | ||
| Embolisation | 351 | ||
| Embolisation and surgery | 352 | ||
| Results | 353 | ||
| Conclusions | 353 | ||
| References | 353 | ||
| Chapter 21: Future developments | 355 | ||
| Introduction | 355 | ||
| Cholesterol-lowering and antiplatelet therapy | 355 | ||
| Novel cholesterol-lowering secondary prevention therapies | 355 | ||
| Increasing high-density lipoprotein (HDL) | 355 | ||
| Cholesterol ester transfer protein inhibitors | 355 | ||
| Niacin | 356 | ||
| Apolipoprotein A-I and mimetic peptides | 357 | ||
| Summary: therapy to increase levels of HDL cholesterol | 357 | ||
| Lipoprotein metabolism and inflammatory response | 357 | ||
| Secretory phospholipase A2 inhibitors | 358 | ||
| Lipoprotein-associated phospholipase A2 inhibitors | 358 | ||
| Novel antiplatelet agents | 358 | ||
| Thrombin receptor antagonists: protease-activated receptor 1 (PAR-1) | 359 | ||
| Vorapaxar: phase III trials | 359 | ||
| P2Y12 receptor antagonists | 359 | ||
| EP3 receptor antagonists | 359 | ||
| Summary: novel antiplatelet agents | 359 | ||
| Angiogenesis | 360 | ||
| Target genes in use for gene therapy in peripheral arterial disease | 361 | ||
| Gene therapy vectors | 361 | ||
| Non-viral methods | 361 | ||
| Viral methods | 361 | ||
| Delivery methods of vectors | 361 | ||
| Vascular endothelial growth factor (VEGF) | 361 | ||
| Phase I clinical trials | 361 | ||
| Index | 371 |