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.
For this Sixth Edition the authorship team across the series has been expanded to include additional European and World experts, with an increased emphasis on global practice. Throughout all six volumes the contents have been extensively revised in line with recently published evidence. Detailed supportive key references are provided and are also included within the comprehensive list of references in the accompanying ebook. Links to recommended online videos have been added where appropriate.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within the major sub-specialties of general surgery.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
Vascular surgery is developing at a rapid pace, especially in the field of medical therapy and endovascular interventions. This new edition aims to put these developments into context, and give a balanced view with regard to technological advances and more traditional techniques. Vascular and endovascular practitioners will find this a very useful resource in their day to day clinical practice.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Vascular and Endovascular Surgery | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Series Editors’ preface | vii | ||
| Editors’ preface | ix | ||
| Acknowledgements | ix | ||
| Evidence-based practice in surgery | xi | ||
| Contributors | xiii | ||
| Chapter 1: Epidemiological risk factors for PAD, risk stratification and risk factor management | 1 | ||
| Introduction | 1 | ||
| Epidemiology of PAD | 1 | ||
| Natural history of PAD: limb-specific, cardiovascular morbidity and mortality | 3 | ||
| Limb-specific outcomes | 3 | ||
| Association of PAD with atherosclerotic disease in other arterial beds | 4 | ||
| Association of PAD with subsequent cardiovascular morbidity and mortality | 4 | ||
| Epidemiological risk factors for PAD, risk stratification and risk factor management (Fig. 1.3) | 5 | ||
| Age and gender | 6 | ||
| Cigarette smoking | 6 | ||
| Diabetes mellitus | 6 | ||
| Blood pressure management (Fig. 1.4) | 7 | ||
| Dyslipidaemia | 8 | ||
| Antiplatelet therapy | 10 | ||
| Conclusions | 11 | ||
| Key references | 12 | ||
| Chapter 2: Assessment of chronic lower limb ischaemia | 13 | ||
| Introduction | 13 | ||
| Intermittent claudication | 13 | ||
| Rare causes of ischaemia | 16 | ||
| Persistent sciatic artery | 16 | ||
| Cystic adventitial disease (CAD) | 17 | ||
| Popliteal artery entrapment | 18 | ||
| Fibromuscular dysplasia (FMD) | 18 | ||
| Endofibrosis of the iliac artery | 19 | ||
| Buerger's disease | 19 | ||
| History and examination | 19 | ||
| History | 19 | ||
| Examination | 20 | ||
| Exercise challenge | 20 | ||
| ABPI measurement using a hand-held Doppler device | 21 | ||
| Toe pressures | 22 | ||
| Risk factors | 22 | ||
| Vascular laboratory | 23 | ||
| Waveform assessment and segmental pressures | 23 | ||
| Transcutaneous oximetry | 24 | ||
| Duplex ultrasound (DUS) | 24 | ||
| Assessment of suprainguinal arteries | 26 | ||
| Assessment of femoro-popliteal segment | 26 | ||
| Radiological investigations | 26 | ||
| Magnetic resonance angiography (MRA) | 26 | ||
| Technique | 27 | ||
| Contraindications | 27 | ||
| Computed tomographic angiography | 28 | ||
| Contrast media | 29 | ||
| Catheter angiography | 31 | ||
| Technique | 31 | ||
| Carbon dioxide (CO2) angiography | 32 | ||
| Chapter 3: Medical treatment of chronic lower limb ischaemia | 36 | ||
| Introduction | 36 | ||
| PAD diagnosis and screening | 36 | ||
| Modifying cardiovascular risk | 38 | ||
| Smoking cessation | 38 | ||
| Treatment of diabetes | 39 | ||
| Additional lifestyle modifications | 39 | ||
| Management of dyslipidaemia | 39 | ||
| Antiplatelet and antithrombotic medications | 39 | ||
| Blood pressure medication | 39 | ||
| Homocysteine-lowering medications | 40 | ||
| Medical treatment for symptomatic PAD | 40 | ||
| Exercise | 40 | ||
| Pharmacologic interventions | 40 | ||
| Naftidrofuryl oxalate | 41 | ||
| Cilostazol | 41 | ||
| Levocarnitine | 41 | ||
| HMG-CoA reductase inhibitors (Statin) | 41 | ||
| Pentoxifylline | 41 | ||
| Ramipril | 41 | ||
| Other medications | 41 | ||
| Intermittent Pneumatic Compression | 42 | ||
| Angiogenesis | 42 | ||
| Conclusions | 42 | ||
| Key references | 43 | ||
| Chapter 4: Intervention for chronic lower limb ischaemia | 44 | ||
| Introduction | 44 | ||
| Presenting symptoms | 44 | ||
| Exercise therapy | 44 | ||
| Medical therapy | 45 | ||
| Global trends toward revascularisation treatment | 45 | ||
| A regional approach to intervention | 45 | ||
| Aorto-iliac occlusive disease | 45 | ||
| Revascularisation of aorto-iliac disease | 46 | ||
| Surgical treatment for aorto-iliac disease | 46 | ||
| Percutaneous treatment for aorto-iliac disease | 46 | ||
| Percutaneous vs open surgery for aorto-iliac occlusive disease revascularisation | 47 | ||
| Angioplasty vs stent vs covered stent | 48 | ||
| Common femoral artery disease | 49 | ||
| Common femoral endarterectomy | 49 | ||
| Profundaplasty | 49 | ||
| Percutaneous treatment for the common femoral artery | 50 | ||
| Superficial femoral artery disease | 50 | ||
| Surgical bypass | 50 | ||
| Percutaneous treatment for the superficial femoral artery | 51 | ||
| Nitinol self-expanding stents | 52 | ||
| Stent grafts | 52 | ||
| Atherectomy | 52 | ||
| Drug-coated balloon angioplasty | 52 | ||
| Drug-eluting stents | 52 | ||
| Surgical bypass vs percutaneous intervention | 53 | ||
| Popliteal artery disease | 53 | ||
| Percutaneous treatment for the popliteal artery | 54 | ||
| Atherectomy | 54 | ||
| Nitinol, self-expanding stents | 54 | ||
| Novel devices for the popliteal artery | 54 | ||
| Infrapopliteal artery disease | 54 | ||
| Surgical bypass for infrapopliteal disease | 55 | ||
| Percutaneous treatment for infrapopliteal disease | 55 | ||
| Percutaneous Transluminal Angioplasty | 55 | ||
| Drug-coated balloon angioplasty | 56 | ||
| Bare-metal stents | 56 | ||
| Drug-eluting stents | 56 | ||
| Choice of revascularisation method for the infrapopliteal arteries | 57 | ||
| The angiosome concept | 58 | ||
| Primary amputation | 58 | ||
| Disclosure | 59 | ||
| Key references | 59 | ||
| Chapter 5: The diabetic foot | 62 | ||
| Introduction | 62 | ||
| Epidemiology | 62 | ||
| Development of foot ulceration | 62 | ||
| Diabetic peripheral neuropathies | 62 | ||
| Diagnosis of neuropathy | 63 | ||
| Peripheral artery disease (PAD) | 63 | ||
| Biomechanical aspects | 64 | ||
| Other risk factors | 64 | ||
| Management | 65 | ||
| The ‘at-risk’ foot | 65 | ||
| Ulcer management | 65 | ||
| Neuropathic ulcers | 66 | ||
| Ischaemic and neuroischaemic ulcers | 67 | ||
| Infection | 67 | ||
| Topical wound healing agents | 68 | ||
| Medical problems on the surgical ward | 68 | ||
| Charcot neuro-osteoarthropathy | 69 | ||
| Key references | 70 | ||
| Chapter 6: Amputation, rehabilitation and prosthetic developments | 71 | ||
| Introduction | 71 | ||
| Epidemiology | 71 | ||
| Indications for amputation | 72 | ||
| Level selection | 72 | ||
| Surgical considerations | 73 | ||
| Transfemoral amputation | 74 | ||
| Through-knee amputation | 74 | ||
| Transtibial amputation | 75 | ||
| Foot amputation | 75 | ||
| Rehabilitation | 76 | ||
| Planning | 76 | ||
| Stump management | 76 | ||
| Pain management | 77 | ||
| Early postoperative rehabilitation | 77 | ||
| Primary prosthetic rehabilitation | 77 | ||
| Sport activities for amputees | 78 | ||
| Prostheses | 78 | ||
| Prosthetic developments | 79 | ||
| Rehabilitation for the bariatric patient | 80 | ||
| Key references | 81 | ||
| Chapter 7: Revision vascular surgery | 83 | ||
| Introduction | 83 | ||
| Graft occlusion | 83 | ||
| Factors influencing graft occlusion | 83 | ||
| Local factors | 83 | ||
| General factors | 84 | ||
| Prevention of graft thrombosis | 85 | ||
| Management of graft stenosis (the failing graft) | 85 | ||
| Management of the occluded (failed) graft | 86 | ||
| Role of thrombolysis | 86 | ||
| Suprainguinal graft thrombosis | 87 | ||
| Infrainguinal graft thrombosis | 87 | ||
| Graft infection | 88 | ||
| Causes | 88 | ||
| Prevention | 88 | ||
| Presentation | 88 | ||
| Bacteriology | 89 | ||
| Diagnosis | 89 | ||
| Management | 90 | ||
| General principles | 90 | ||
| Infrarenal aortic graft infection | 90 | ||
| Graft aneurysms | 94 | ||
| True aneurysms | 94 | ||
| False aneurysms | 95 | ||
| Carotid artery | 96 | ||
| Infection | 96 | ||
| Aneurysm formation | 97 | ||
| Revision after CAS | 97 | ||
| Revision surgery after EVAR | 97 | ||
| Revision surgery after infected EVAR | 98 | ||
| Revision after TEVAR | 98 | ||
| Aortobronchial fistula | 98 | ||
| Aorto-oesophageal fistula | 99 | ||
| Infection | 99 | ||
| Key references | 100 | ||
| Chapter 8: Management of acute lower limb ischaemia | 102 | ||
| Introduction | 102 | ||
| Aetiology | 102 | ||
| Embolism | 102 | ||
| Atheroembolism | 103 | ||
| Thrombosis | 103 | ||
| Other causes | 104 | ||
| Recent changes | 106 | ||
| Clinical features | 106 | ||
| Initial management | 107 | ||
| Revascularisation | 107 | ||
| Irreversible (category III) leg ischaemia | 107 | ||
| Immediately threatened (category IIb ischaemia) | 108 | ||
| Threatened (category IIa ischaemia)/viable (category I ischaemia) | 108 | ||
| Choice between surgery and thrombolysis: the evidence | 109 | ||
| Peripheral artery thrombolysis | 110 | ||
| Contraindications (Box 8.2) | 110 | ||
| Technique | 110 | ||
| Percutaneous thrombectomy devices | 112 | ||
| Complications | 112 | ||
| Outcome | 114 | ||
| Surgical management | 114 | ||
| Balloon catheter embolectomy | 114 | ||
| Completion angiography | 116 | ||
| Failed embolectomy | 116 | ||
| Further management | 117 | ||
| Overall prognosis | 117 | ||
| Conclusions | 118 | ||
| Key references | 118 | ||
| Chapter 9: Vascular trauma | 120 | ||
| Introduction | 120 | ||
| Mechanism of injury | 120 | ||
| Blunt trauma | 120 | ||
| Penetrating trauma | 120 | ||
| Sequelae of vascular injuries | 120 | ||
| Clinical assessment | 121 | ||
| History | 121 | ||
| Examination | 121 | ||
| Diagnosis | 123 | ||
| Resuscitation and initial management | 123 | ||
| Special investigations | 123 | ||
| Plain radiography | 123 | ||
| Angiography | 123 | ||
| Ultrasound | 124 | ||
| General principles of management of vascular injury | 124 | ||
| Venous injuries | 125 | ||
| Endovascular management of vascular trauma | 125 | ||
| Cervical vascular injuries | 126 | ||
| Carotid artery injuries | 126 | ||
| Mechanism | 126 | ||
| Clinical signs | 126 | ||
| Diagnosis | 127 | ||
| Management | 127 | ||
| Operative technique | 128 | ||
| Vertebral artery injuries | 128 | ||
| Subclavian and axillary vascular injuries | 128 | ||
| Endovascular management of cervical vascular injuries | 129 | ||
| Thoracic vascular injuries | 129 | ||
| Clinical presentation and initial management | 130 | ||
| Diagnostic studies | 130 | ||
| Chest radiography | 130 | ||
| Angiography | 131 | ||
| Other imaging modalities | 131 | ||
| Treatment | 131 | ||
| Endovascular repair | 131 | ||
| Surgical repair | 131 | ||
| Abdominal vascular injuries | 131 | ||
| Diagnosis | 131 | ||
| Management | 132 | ||
| Aortic injury | 133 | ||
| Visceral artery injury | 133 | ||
| Renal artery injury | 133 | ||
| Inferior vena cava injury | 133 | ||
| Pelvic vascular injury | 134 | ||
| Extremity vascular trauma | 134 | ||
| Diagnosis | 134 | ||
| General principles of management | 134 | ||
| Vascular injuries to the upper limb (Fig. 9.16) | 135 | ||
| Brachial artery injuries | 135 | ||
| Distal arterial injuries to the upper limb | 136 | ||
| Vascular injuries to the lower limb | 136 | ||
| Femoral vascular injuries | 136 | ||
| Popliteal vascular injury | 136 | ||
| Resuscitative endovascular balloon occlusion of the aorta (REBOA) | 137 | ||
| Chapter 10: Extracranial cerebrovascular disease | 140 | ||
| Introduction | 140 | ||
| Aetiology and risk factors | 140 | ||
| Large-vessel thromboembolism | 140 | ||
| Small-vessel disease | 140 | ||
| Cardiogenic brain embolism | 140 | ||
| Haematological disorders | 141 | ||
| Non-atheromatous carotid diseases | 141 | ||
| Fibromuscular dysplasia (FMD) | 141 | ||
| Arteritis | 142 | ||
| Carotid aneurysm | 142 | ||
| Carotid dissection | 142 | ||
| Carotid body tumour | 143 | ||
| Presentation of carotid disease | 144 | ||
| Asymptomatic cerebrovascular disease | 144 | ||
| Symptomatic cerebrovascular disease | 144 | ||
| Carotid territory | 144 | ||
| Vertebrobasilar | 145 | ||
| Non-hemispheric | 145 | ||
| Investigation of carotid disease severity | 145 | ||
| Duplex ultrasound | 145 | ||
| Catheter angiography | 147 | ||
| Magnetic resonance angiography | 147 | ||
| Computed tomographic angiography (CTA) | 147 | ||
| Comparison of methods | 147 | ||
| Management of cerebrovascular disease | 147 | ||
| Best medical therapy’ | 147 | ||
| Management of carotid disease | 149 | ||
| Symptomatic carotid artery disease | 149 | ||
| Randomised trials comparing CEA with CAS in symptomatic patients | 152 | ||
| New ischaemic lesions on MR imaging | 153 | ||
| Asymptomatic carotid artery disease | 153 | ||
| Comparison of CEA and CAS in randomised trials | 154 | ||
| CEA/CAS and coronary bypass | 154 | ||
| Emergency CEA | 156 | ||
| Vertebral artery revascularisation | 156 | ||
| Surgical management of carotid disease – carotid endarterectomy | 156 | ||
| Anaesthesia | 156 | ||
| Technique | 157 | ||
| Perioperative monitoring and completion assessment | 157 | ||
| Operative complications | 158 | ||
| Cranial nerve injuries | 158 | ||
| Wound complications | 158 | ||
| Perioperative stroke | 158 | ||
| Long-term follow-up and restenosis | 159 | ||
| Patch infection | 159 | ||
| Endovascular treatment of carotid disease | 159 | ||
| Assessing suitability for CAS | 159 | ||
| Dual antiplatelet therapy | 160 | ||
| CAS technique | 160 | ||
| Cerebral protection devices | 161 | ||
| Distal protection devices | 161 | ||
| Distal balloon occlusion | 161 | ||
| Distal filter devices | 162 | ||
| Flow reversal/flow arrest (endovascular clamping) | 162 | ||
| Does stent design influence outcome? | 164 | ||
| Periprocedural haemodynamic problems | 164 | ||
| Haemodynamic depression | 164 | ||
| Hyperperfusion and intracranial haemorrhage | 164 | ||
| Management of post-CAS and CEA stroke | 165 | ||
| Distal embolism | 165 | ||
| Thrombosis | 166 | ||
| Dissection | 166 | ||
| Key references | 167 | ||
| Chapter 11: Vascular disorders of the upper limb | 168 | ||
| Introduction | 168 | ||
| Clinical examination | 168 | ||
| Occlusive disease | 168 | ||
| Brachiocephalic artery | 168 | ||
| Aorto-brachiocephalic bypass | 169 | ||
| Brachiocephalic endarterectomy | 169 | ||
| Endovascular treatment | 169 | ||
| Subclavian artery | 170 | ||
| Carotid–subclavian bypass | 170 | ||
| Carotid transposition | 170 | ||
| Crossover grafts | 170 | ||
| Endovascular treatment | 171 | ||
| Upper arm arteries | 173 | ||
| Lower arm and hand arteries | 173 | ||
| Aneurysmal disease | 173 | ||
| Upper arm artery aneurysms | 175 | ||
| Lower arm and hand artery aneurysms | 175 | ||
| Ulnar artery aneurysm or hypothenar hammer syndrome | 175 | ||
| Upper limb embolism | 176 | ||
| Other causes of acute ischaemia | 176 | ||
| Thoracic outlet syndrome | 177 | ||
| Neurogenic thoracic outlet compression syndrome (N-TOCS) | 177 | ||
| Diagnosis | 177 | ||
| Treatment | 177 | ||
| Transaxillary resection of first rib | 177 | ||
| Arterial thoracic outlet compression syndrome | 179 | ||
| Surgical management | 179 | ||
| Combined supraclavicular and infraclavicular approach | 179 | ||
| Subclavian–axillary vein thrombosis | 181 | ||
| Primary SVT | 182 | ||
| Diagnosis | 182 | ||
| Treatment | 182 | ||
| Secondary SVT | 183 | ||
| Key references | 184 | ||
| Chapter 12: Primary and secondary vasospastic disorders (Raynaud's phenomenon) and vasculitis | 187 | ||
| Introduction | 187 | ||
| Raynaud's phenomenon | 187 | ||
| Pathophysiology | 189 | ||
| Neural mechanisms | 189 | ||
| Vascular mechanisms | 189 | ||
| Intravascular mechanisms | 189 | ||
| Clinical features | 189 | ||
| Investigations | 189 | ||
| Management | 190 | ||
| General measures | 190 | ||
| Drug therapy | 191 | ||
| Calcium channel blockers | 191 | ||
| Other vasodilators | 192 | ||
| Prostaglandins | 192 | ||
| Other treatments | 192 | ||
| Sympathectomy | 192 | ||
| Conclusion | 192 | ||
| Connective tissue diseases | 192 | ||
| Vasculitis | 193 | ||
| Takayasu's arteritis | 194 | ||
| Buerger's disease (thromboangiitis obliterans) | 195 | ||
| Giant cell arteritis | 196 | ||
| Polyarteritis nodosa | 197 | ||
| Small-vessel vasculitis | 198 | ||
| ANCA-associated vasculitis (AAVs) | 198 | ||
| Immune complex-mediated vasculitis | 199 | ||
| Primary cutaneous small-vessel vasculitis | 200 | ||
| Key references | 200 | ||
| Chapter 13: Peripheral and abdominal aortic aneurysms | 201 | ||
| Introduction | 201 | ||
| Epidemiology | 201 | ||
| Pathophysiology | 202 | ||
| Proteolysis | 202 | ||
| Inflammation | 202 | ||
| Biomechanics | 202 | ||
| Genetics | 203 | ||
| Clinical features | 203 | ||
| Screening | 203 | ||
| Diagnosis | 204 | ||
| Principles of management | 204 | ||
| Preoperative assessment | 205 | ||
| Repair of intact abdominal aortic aneurysm | 205 | ||
| Open repair | 206 | ||
| Operative repair of ruptured abdominal aortic aneurysm | 206 | ||
| EVAR | 207 | ||
| Indications and eligibility for EVAR | 207 | ||
| Patient assessment and EVAR technique | 208 | ||
| EVAR-related complications and device failure | 208 | ||
| Endoleak | 208 | ||
| Graft migration and dislocation | 209 | ||
| Kinking and occlusion | 209 | ||
| Other EVAR-related complications | 209 | ||
| Surveillance after EVAR | 209 | ||
| Outcomes after EVAR | 210 | ||
| The future of EVAR | 212 | ||
| Infected aneurysms | 214 | ||
| Mycotic aneurysms | 215 | ||
| Microbial aneurysmal arteritis | 215 | ||
| Clinical features and management principles of infected aneurysms | 215 | ||
| Peripheral aneurysms | 215 | ||
| Iliac aneurysms | 215 | ||
| Common femoral aneurysms | 216 | ||
| True femoral aneurysms | 216 | ||
| False femoral aneurysms | 216 | ||
| Popliteal artery aneurysms | 216 | ||
| Key references | 219 | ||
| Chapter 14: Thoracic and thoraco-abdominal aortic disease | 221 | ||
| Introduction | 221 | ||
| Imaging of the thoracic aorta | 221 | ||
| Thoracic aortic aneurysms (TAAs) | 222 | ||
| Classification and aetiology | 222 | ||
| Incidence, clinical presentation and indications for treatment | 223 | ||
| Technique of surgical repair | 223 | ||
| Endovascular repair of thoracic aneurysms | 223 | ||
| Neurological complications following endovascular thoracic procedures | 225 | ||
| Outcome of treatment | 226 | ||
| Recommendations for practice | 226 | ||
| Thoraco-abdominal aortic aneurysms (TAAAs) | 226 | ||
| Classification and aetiology | 226 | ||
| Incidence, clinical presentation and indications for treatment | 226 | ||
| Technique of surgical repair | 227 | ||
| Results of surgical repair of thoraco-abdominal aneurysms | 228 | ||
| Endovascular repair of thoraco-abdominal aortic aneurysms | 228 | ||
| Results of endovascular repair of TAAA | 228 | ||
| Hybrid visceral revascularisation and endovascular repair of thoraco-abdominal aortic aneurysms | 229 | ||
| Recommendations for practice | 230 | ||
| Thoracic dissection and acute aortic syndrome | 231 | ||
| Pathology, classification and clinical presentations | 231 | ||
| Investigation of suspected acute aortic syndrome | 232 | ||
| Initial management of acute aortic dissection | 233 | ||
| Endovascular management of complicated acute type B thoracic dissection | 233 | ||
| Early management of uncomplicated type B dissection | 234 | ||
| Treatment of chronic type B dissections | 234 | ||
| Management of intramural haematoma and penetrating aortic ulcer | 235 | ||
| Recommendations for practice | 235 | ||
| Traumatic aortic injury (TAI) | 235 | ||
| Recommendations for practice | 236 | ||
| Aorto-oesophageal and aortopulmonary fistula | 236 | ||
| Chapter 15: Disorders of the renal and mesenteric circulation | 238 | ||
| Renal vascular disease | 238 | ||
| Renal artery disease | 238 | ||
| Atherosclerotic renovascular disease | 238 | ||
| Prevalence | 238 | ||
| Definitions | 238 | ||
| Pathophysiology | 238 | ||
| Clinical presentation | 239 | ||
| Diagnosis5,6 | 239 | ||
| Management | 240 | ||
| Renal revascularisation | 240 | ||
| Surgical treatment | 240 | ||
| Endovascular treatment | 241 | ||
| Revascularisation versus medical therapy | 242 | ||
| Renal stenting during treatment of aortic aneurysmal disease | 242 | ||
| Renal artery denervation | 243 | ||
| Other renal vascular disorders | 244 | ||
| Renal artery aneurysm | 244 | ||
| Renal trauma | 244 | ||
| Fibromuscular dysplasia | 244 | ||
| Post-transplant renal artery stenosis | 244 | ||
| Mid-aortic syndrome | 244 | ||
| Mesenteric vascular disease | 245 | ||
| Acute thromboembolic occlusion of the superior mesenteric artery | 245 | ||
| Mesenteric ischaemia | 246 | ||
| Chronic mesenteric ischaemia | 246 | ||
| Acute mesenteric venous thrombosis | 248 | ||
| Non-occlusive mesenteric ischaemia | 248 | ||
| Key references | 250 | ||
| Chapter 16: Central venous and dialysis access | 251 | ||
| Introduction | 251 | ||
| Central venous access | 251 | ||
| Indications | 251 | ||
| Methods | 251 | ||
| Complications | 251 | ||
| Temporary dialysis access | 252 | ||
| Methods | 252 | ||
| Complications of CVCs | 252 | ||
| Insertion | 252 | ||
| Catheter dysfunction | 252 | ||
| Catheter-locking solutions | 252 | ||
| Catheter lumen thrombosis | 253 | ||
| Central vein thrombosis | 253 | ||
| Fibrin sheaths | 253 | ||
| Catheter-related infection | 253 | ||
| Permanent dialysis access | 254 | ||
| Access planning | 254 | ||
| Preoperative assessment | 254 | ||
| Duplex ultrasound | 255 | ||
| Venography | 255 | ||
| Primary access | 255 | ||
| Secondary and tertiary access | 256 | ||
| Factors affecting access patency | 257 | ||
| Access failure | 258 | ||
| Failure to mature | 258 | ||
| Stenosis and thrombosis | 258 | ||
| Prevention of access failure | 258 | ||
| Access surveillance | 258 | ||
| Access salvage | 258 | ||
| AVF stenosis | 258 | ||
| AVG stenosis | 259 | ||
| AVF and AVG thrombosis | 260 | ||
| Other access complications | 260 | ||
| Infection | 260 | ||
| Haemorrhage | 261 | ||
| Steal | 261 | ||
| Carpal tunnel syndrome | 262 | ||
| Cardiac failure | 262 | ||
| Venous hypertension and central vein obstruction | 262 | ||
| Aneurysm | 263 | ||
| Cannulation | 264 | ||
| Access in children | 264 | ||
| Key references | 264 | ||
| Chapter 17: Varicose veins | 266 | ||
| Introduction | 266 | ||
| Pathophysiology | 266 | ||
| Normal venous function | 266 | ||
| Chronic venous hypertension | 266 | ||
| Varicose veins | 266 | ||
| Epidemiology and natural history | 267 | ||
| Clinical presentation | 268 | ||
| Thread veins and reticular veins (CEAP C1) | 268 | ||
| Varicose veins (CEAP C2) | 268 | ||
| Oedema and skin changes (CEAP C3–C4) | 268 | ||
| Chronic venous ulceration: healed or active (CEAP C5–C6) | 269 | ||
| Clinical assessment | 270 | ||
| History | 270 | ||
| Patient examination | 270 | ||
| Hand-held Doppler and other bedside tests | 270 | ||
| Venous investigations | 270 | ||
| Colour duplex ultrasound scanning | 270 | ||
| Other venous investigations | 271 | ||
| Treatment | 272 | ||
| Conservative options, medications and compression | 272 | ||
| Conservative options | 272 | ||
| Venoactive drugs and pharmacotherapy | 272 | ||
| Compression stockings and garments | 272 | ||
| Principles of endovenous and surgical interventions | 273 | ||
| Informed consent | 273 | ||
| Endovenous thermal ablation | 273 | ||
| Setting and anaesthesia | 274 | ||
| Technique | 274 | ||
| Endovenous laser ablation (EVLA) | 275 | ||
| Radiofrequency ablation (RFA) | 275 | ||
| Other modalities for thermal ablation | 275 | ||
| Complications | 275 | ||
| Ultrasound-guided foam sclerotherapy (UGFS) | 276 | ||
| Setting and anaesthesia | 276 | ||
| Technique | 276 | ||
| Choice of sclerosant | 277 | ||
| Complications | 277 | ||
| Non-thermal, non-tumescent endovenous modalities | 277 | ||
| Mechanochemical ablation (MOCA) | 277 | ||
| Cyanoacrylate glue closure | 277 | ||
| Traditional surgery for varicose veins | 277 | ||
| Setting and anaesthesia | 277 | ||
| Technique | 278 | ||
| Complications | 278 | ||
| Treatment of recurrent varicose veins | 278 | ||
| Areas of controversy | 279 | ||
| Treatment of incompetent perforating veins | 279 | ||
| Management of varicosities | 279 | ||
| Saphenous preserving interventions | 280 | ||
| Thromboprophylaxis after endovenous procedures | 280 | ||
| Compression after superficial venous interventions | 280 | ||
| Evidence for varicose vein interventions | 280 | ||
| Endovenous thermal ablation | 280 | ||
| Ultrasound-guided foam sclerotherapy | 281 | ||
| Mechanochemical ablation and cyanoacrylate glue closure | 281 | ||
| Choosing between treatment modalities | 281 | ||
| Rationing of varicose vein treatments | 282 | ||
| Atypical varicose veins | 282 | ||
| Vulval and pelvic varices | 282 | ||
| Congenital causes of varicose veins | 282 | ||
| Conclusions | 282 | ||
| Key references | 283 | ||
| Chapter 18: Chronic leg swelling | 285 | ||
| Chronic venous insufficiency (CVI) | 285 | ||
| Clinical features | 285 | ||
| Skin changes | 285 | ||
| Varicose veins | 285 | ||
| Pain | 285 | ||
| Swelling | 285 | ||
| Ulceration | 286 | ||
| Epidemiology | 286 | ||
| Aetiology | 286 | ||
| Macrocirculation | 286 | ||
| Deep and superficial reflux | 286 | ||
| Perforating vein reflux | 286 | ||
| Microcirculation | 287 | ||
| Classification | 287 | ||
| Investigation | 287 | ||
| Hand-held Doppler | 288 | ||
| Duplex scanning | 288 | ||
| Venography | 288 | ||
| Computed tomography venography | 288 | ||
| Magnetic resonance imaging | 288 | ||
| Intravascular ultrasound | 288 | ||
| Functional measurements | 288 | ||
| Ambulatory venous pressure measurement | 288 | ||
| Plethysmography | 288 | ||
| Treatment | 288 | ||
| General measures | 288 | ||
| Graduated elastic compression | 289 | ||
| Intermittent pneumatic compression | 290 | ||
| Laser and electromagnetic therapy | 290 | ||
| Pharmacotherapy | 290 | ||
| Dressings | 290 | ||
| Emollients | 290 | ||
| Oxpentifylline (pentoxifylline) | 290 | ||
| Nutrition | 290 | ||
| Superficial venous intervention | 290 | ||
| Superficial venous surgery | 290 | ||
| Perforating vein surgery | 290 | ||
| Deep venous valvular reconstruction | 291 | ||
| Skin grafting | 291 | ||
| Endovascular management of venous outflow obstruction | 291 | ||
| Venous bypass | 291 | ||
| Preventing the post-thrombotic limb | 292 | ||
| Summary | 292 | ||
| Dependency and inactivity | 292 | ||
| Lymphoedema | 292 | ||
| Aetiology | 292 | ||
| Primary | 293 | ||
| Secondary | 294 | ||
| Presentation | 294 | ||
| History | 294 | ||
| Examination | 294 | ||
| Clinical staging | 295 | ||
| Investigation | 295 | ||
| Duplex ultrasonography | 295 | ||
| Lymphangioscintigraphy (isotope lymphography) | 295 | ||
| Computed tomography | 295 | ||
| Magnetic resonance imaging | 296 | ||
| Interstitial magnetic resonance lymphangiography | 296 | ||
| Fluorescence microlymphangiography | 296 | ||
| Contrast lymphangiography | 296 | ||
| Treatment | 296 | ||
| General measures | 296 | ||
| Manual lymphatic drainage | 296 | ||
| Graduated elastic compression | 296 | ||
| Intermittent pneumatic compression | 296 | ||
| Thermal treatment | 297 | ||
| Complex decongestive physiotherapy (complex physical therapy) | 297 | ||
| Prevention of infection | 297 | ||
| Drugs | 297 | ||
| Surgical treatments | 297 | ||
| Debulking operations | 297 | ||
| Bypass procedures | 298 | ||
| Key references | 299 | ||
| Chapter 19: The acutely swollen leg | 301 | ||
| Introduction | 301 | ||
| Pathophysiology of oedema | 301 | ||
| Medical history | 301 | ||
| Physical examination | 302 | ||
| Differential diagnosis | 302 | ||
| Musculotendinous rupture | 302 | ||
| Baker's cyst | 302 | ||
| Cellulitis and erysipelas | 302 | ||
| Necrotising fasciitis | 302 | ||
| Lymphoedema | 303 | ||
| Bilateral swelling | 303 | ||
| Deep venous thrombosis | 303 | ||
| Pathophysiology of DVT | 303 | ||
| Clinical decision rules | 303 | ||
| Imaging techniques | 304 | ||
| Treatment of DVT | 305 | ||
| Prognosis | 306 | ||
| Iliofemoral deep vein thrombosis | 307 | ||
| Post-thrombotic syndrome | 307 | ||
| Catheter-directed thrombolysis | 308 | ||
| New treatment modalities | 308 | ||
| EKOS endowave | 308 | ||
| Angiojet | 309 | ||
| Other PMT devices | 309 | ||
| The future | 309 | ||
| Chapter 20: Vascular anomalies | 312 | ||
| Introduction | 312 | ||
| Classification | 312 | ||
| Vascular tumours | 312 | ||
| Infantile haemangioma | 312 | ||
| Diagnosis and imaging | 314 | ||
| Complications and structural associations | 314 | ||
| Management | 314 | ||
| Congenital haemangioma | 314 | ||
| Tufted angioma | 315 | ||
| Kaposiform haemangioendothelioma (KHE) | 315 | ||
| Vascular malformations | 315 | ||
| Capillary malformations | 315 | ||
| Salmon patch (naevus simplex; erythema nuchae) | 315 | ||
| Port-wine stains (naevus flameus) | 315 | ||
| Low-flow vascular malformations | 316 | ||
| Low-flow venous malformations (LFVM) | 316 | ||
| Low-flow lymphatic malformations (LFLM) | 316 | ||
| Diagnosis and imaging | 317 | ||
| Management | 317 | ||
| High-flow vascular malformations | 318 | ||
| Diagnosis and imaging: | 319 | ||
| Management | 320 | ||
| Follow-up and outcomes | 320 | ||
| Conclusions | 321 | ||
| Index | 323 |