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 |