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Moore's Vascular and Endovascular Surgery E-Book

Moore's Vascular and Endovascular Surgery E-Book

Wesley S. Moore

(2018)

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Book Details

Abstract

Using an easy-to-read, user-friendly format and hundreds of review questions that facilitate effective studying, Vascular and Endovascular Surgery: A Comprehensive Review, 9th Edition, contains the essential information you need for exam success and daily reference. Dr. Wesley Moore and a team of international experts cover everything from foundational concepts to the latest developments in the field, with each specialist providing a complete summary of a particular area of expertise. Extensive updates throughout the text keep you current with all that’s new in this rapidly expanding field.

  • Features five new chapters: Congenital Arterial Malformations; Atherectomy and Arterial Closure Devices; Carotid Body Tumors; Building a Hybrid Operating Suite including Robotic Capability; and Management of Venous Leg Ulcers.
  • Provides up-to-date coverage of the increasingly important role of endovascular intervention in the vascular surgeon’s practice.
  • Details the latest medical management of vascular disease including treatment of hypertension, risk factor modification, and the use of anti-platelets, anti-coagulants, and statins.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Moore’s Vascular and Endovascular Surgery i
Copyright Page ii
Contributors iii
Preface to the Ninth Edition x
Preface to the First Edition xi
Table Of Contents xiii
1 Introduction 1
1 A History of Vascular Surgery 1
Prologue 1
Successful Arterial Suture 2
Abdominal Aortic Aneurysms 4
Development of Vascular Prostheses 4
Modern Management of Aortic Aneurysms 5
Peripheral Arterial Aneurysms 6
Occlusive Arterial Disease 6
Arterial Trauma 9
Extracranial Cerebrovascular Arterial Occlusions 9
Visceral Vascular Occlusions 10
Extraanatomic Bypass and Vascular Infections 11
Venous Surgery 11
Highlights in Diagnostic Modalities 12
Vascular Access Surgery 13
Thoracic Outlet Syndromes 14
Questions 14
Bibliography 15
References 16.e1
2 Embryology of the Vascular System 17
Keywords 17.e1
Early History 17
Heart 19
Arteries 20
Veins 25
Growth of New Vessels 29
References 31.e1
2 General Principles 32
3 Anatomy, Physiology, and Pharmacology of the Vascular Wall 32
Abstract 32.e1
Keywords 32.e1
Normal Anatomy 32
Arterial Anatomy 32
Venous Anatomy 33
Acute Regulation of Blood Flow and Vessel Diameter 34
Vasodilators 34
Vasoconstrictors 34
Long-Term Adaptations of the Arterial Wall 35
Regulation of Medial and Intimal Thickening 35
Arterial Stiffening 37
Cell-Cell Communication Within the Vascular Wall 37
Possible Therapies for Prevention of Restenosis 38
Regulation of Hemostasis 39
Summary 40
Review Questions 40
References 40.e1
4 Anatomy and Surgical Exposure of the Vascular System 41
Abstract 41.e1
Keywords 41.e1
General Principles 41
Exposure of the Carotid Artery 41
Exposure of the Vertebral Artery 43
Exposure of the Aortic Arch 46
Exposure of the Brachiocephalic Artery 46
Exposure of the Right Subclavian Artery 47
Exposure of the Proximal Common Carotid Arteries 48
Exposure of the Left Subclavian Artery 48
Exposure of the Descending Thoracic Aorta 49
Exposure of the Superior Vena Cava 49
Exposure of the Axillary Artery 50
Exposure of the Brachial Artery 51
Exposure of the Radial Artery 51
Exposure of the Ulnar Artery 52
Exposure of the Abdominal Aorta 52
Transperitoneal Approaches 52
Retroperitoneal Approaches 54
Exposure of the Celiac Trunk 54
Exposure of the Superior Mesenteric Artery 55
Exposure of the Renal Arteries 55
Exposure of the Inferior Mesenteric Artery 56
Exposure of the Iliac Arteries 56
Exposure of the Inferior Vena Cava 57
Exposure of the Portal, Superior Mesenteric, and Splenic Veins 58
Exposure of Common Femoral Artery 58
Exposure of Deep Femoral Artery 58
Exposure of Superficial Femoral Artery 59
Exposure of Popliteal Artery 59
Exposure of the Anterior Tibial Artery 61
Exposure of the Posterior Tibial Artery 61
Exposure of the Peroneal Artery 62
Review Questions 62
Bibliography 63
References 63.e1
5 Hemodynamics for the Vascular Surgeon 64
Abstract 64.e1
Keywords 64.e1
Basic Principles of Arterial Hemodynamics 64
Fluid Pressure 64
Fluid Energy 64
Fluid Energy Losses 65
Bernoulli’s Principle 65
Viscous Energy Losses and Poiseuille’s Law 65
Inertial Energy Losses 66
Vascular Resistance 66
Blood Flow Patterns 67
Laminar Flow 67
Turbulent Flow 68
Boundary Layer Separation 68
Pulsatile Flow 68
Bifurcations and Branches 69
Tangential Stress and Tension 69
The Properties of Arterial Walls in Specific Conditions 70
Aging and atherosclerosis. 70
Endarterectomy. 70
Aneurysms. 70
Hemodynamics of Arterial Stenosis 71
Energy Losses 71
Bruits and Poststenotic Dilatation 71
Critical Arterial Stenosis 71
Effect of Stenosis Length and Multiple Stenoses 72
Arterial Flow Patterns in Human Limbs 73
Collateral Circulation 73
Distribution of Vascular Resistance and Blood Flow 73
Arterial Pulses and Waveforms 74
Pressure and Flow in Normal Limbs 74
Pressure and Flow in Limbs With Arterial Obstruction 74
Vascular Steal 75
Multiple-Level Occlusive Disease 75
Subclavian Steal Syndrome 76
Extraanatomic Bypass Grafts 76
Hemodynamic Principles and the Treatment of Arterial Disease 76
Direct Arterial Intervention 76
Vasodilators 77
Sympathectomy 77
Rheologic Agents 77
Hemodynamics of the Venous System 77
Normal Pressure and Flow Relationships 78
Resting Venous Pressure 78
Pressure Changes During Exercise 79
Venous Flow Patterns 79
Abnormal Pressure and Flow Relationships 80
Hemodynamic Principles and the Treatment of Venous Disease 82
Conclusion 82
Review Questions 83
Bibliography 83
References 84.e1
6 Hemostasis and Thrombosis 85
Abstract 85.e1
Keywords 85.e1
Introduction 85
Hemostasis 85
Components of Hemostasis 85
Vessel Response 85
Platelet Activation 85
Fibrin Formation 87
Coagulation Inhibition 87
Fibrinolysis. 88
Preoperative Evaluation 88
Clinical Evaluation 88
Laboratory Screening 88
Platelet Disorders 89
Qualitative Disorders of Platelet Function 90
Disorders of Secondary Hemostasis 90
Congenital Disorders 90
Acquired Disorders 91
Management of Anticoagulation 92
Treatment Strategies for Vitamin K Antagonist–Associated Bleeding 92
Treatment Strategies for Direct Oral Anticoagulant-Associated Bleeding 93
Perioperative Management 93
Thrombosis 95
Prothrombotic Conditions 95
Inherited Prothrombotic Conditions 95
Acquired Prothrombotic Conditions 96
Indications and Timing for Thrombophilia Screening 98
Venous Thromboembolism 98
Arterial Thromboembolism 99
Caveats in Management of Thrombosis and Thrombophilia 100
Review Questions 102
Bibliography 103
References 103.e1
7 Atherosclerosis 104
Abstract 104.e1
Keywords 104.e1
Pathology 104
General Concepts 104
Fatty Streaks 105
Endothelium 107
Media 107
Macrophages 107
Gelatinous Plaques 107
Fibrous Plaques 107
Complicated Plaques 108
Theories of Atherogenesis 108
Lipid Hypothesis 108
Thrombogenic Hypothesis 108
Mesenchymal Hypothesis: Hemodynamic Effects 109
Monoclonal Hypothesis: Smooth Muscle Proliferation 109
Response-to-Injury Hypothesis 109
Lesion Arrest or Regression 110
Medical Management 111
General Considerations 111
Clinical Management 112
Drug Therapy for Hyperlipidemia 112
Control of Associated Risk Factors 112
Cigarette Smoking 112
Hypertension 113
Exercise 113
Diabetes 113
Antioxidants and Oxidative Stress 114
Iron Hypothesis 114
Antiplatelet and Anticoagulant Therapy 115
Vasoactive Drugs 116
Future Directions and Perspectives 116
Atherosclerosis and Infection 116
Proteinomics 116
Iron Metabolism 116
Comprehensive Risk Reduction Programs 116
Gut Microbiome 117
New Pharmacologic Agents 117
Summary 117
Review Questions 118
References 118.e1
8 Nonatherosclerotic Vascular Disease 119
Abstract 119.e1
Keywords 119.e1
Vasospastic Disorders 119
Systemic Vasculitis 122
Large Vessel Vasculitis 123
Giant Cell Arteritis Group 123
Systemic giant cell arteritis (temporal arteritis). 124
Takayasu disease. 124
Radiation-Induced Arterial Damage 125
Medium Vessel Vasculitis 126
Polyarteritis Nodosa 126
Kawasaki Disease 126
Drug Abuse Arteritis 128
Behçet Disease 128
Cogan Syndrome 129
Small Vessel Vasculitis 130
Hypersensitivity Vasculitis Group 130
Vasculitis of Connective Tissue Diseases 130
Vasculitis Associated With Malignancy 131
Buerger Disease 131
Heritable Arteriopathies 133
Marfan Syndrome 133
Ehlers-Danlos Syndrome 134
Cystic Medial Necrosis 134
Loeys-Dietz Syndrome 135
Neurofibromatosis 135
Pseudoxanthoma Elasticum 135
Arteria Magna Syndrome 136
Congenital Conditions Affecting the Arteries 136
Abdominal Coarctation 136
Persistent Sciatic Artery 137
Popliteal Entrapment Syndromes 138
Fibromuscular Dysplasia 139
Cystic Adventitial Disease 141
External Iliac Endofibrosis 141
Compartment Syndrome 141
Review Questions 144
Bibliography 145
Selected References 145
References 145.e1
9 Venous Vascular Malformations 146
Abstract 146.e1
Keywords 146.e1
Historical Notes 146
Definition of Vascular Malformations and Vascular Tumors 146
Development of the Vascular System 146
Classification 147
Genetics 149
Incidence 150
Clinical Presentation and Physical Exam 150
Imaging Studies 152
Treatment 152
Indications 152
Conservative Treatment 153
Embolization 153
Sclerotherapy 154
Laser Treatment 154
Surgical Excision 154
Recommendation of Invasive Treatment of Venous Vascular Malformations 155
Complex Malformations 155
Klippel–Trenaunay Syndrome 155
Conclusions 155
Review Questions 156
Bibliography 156
References 156.e1
10 Congenital Arterial Malformations 157
Keywords 157.e1
Definition, Incidence, and Clinical Significance 157
Development of the Vascular System 157
Historical Background and Classification 158
Extratruncular Arteriovenous Malformations 158
Natural History and Clinical Presentation 158
Genetic Basis 160
Evaluation and Diagnostic Imaging 160
General Treatment Principles 162
Treatment Indications and Timing 162
Surgical Treatment 163
Embolization 163
Combined Treatment 165
Truncular Arterial Malformations 167
Aberrant Right Subclavian Artery 167
Right-Sided Aortic Arch 167
Aortic Ring 167
Persistent Sciatic Artery 168
Aortic Coarctation 168
Mid-Aortic Syndrome 169
Conclusions 170
Review Questions 170
Selected References 171
References 171.e1
11 Antibiotic Prophylaxis in Vascular Disease Management 172
Abstract 172.e1
Keywords 172.e1
Introduction 172
Prophylactic Antibiotic Therapy 172
Clinical Significance of Graft Infection 172
Principles of Antibiotic Prophylaxis 172
Bacteriology of Graft Infection 173
Pathogenesis of Graft Infection 174
Skin Flora 175
Gastrointestinal Flora 175
Arterial Colonization 175
Hematogenous and Lymphatogenous Seeding 176
Other Local and Systemic Factors 176
Experimental Investigations 176
Clinical Investigations 176
Early Experience 176
Prospective Trials 177
Local Therapies 177
Hemodialysis Access 178
Major Limb Amputation 178
Arterial Closure Devices 178
Angiography, Inferior Vena Cava Filter 178
Lower Extremity Superficial Venous Insufficiency Treatment 179
Autologous Vein Graft Reconstruction of Lower Extremity 179
Comparisons of Antibiotic Regimens 179
Current Status of Antibiotic Prophylaxis 179
Antibiotic Selection 179
Resistant Bacteria 181
Antibiotic Administration 181
Primary Arterial Infections 182
Historical Perspective 182
Definitions 182
Pathogenesis 182
Oslerian Mycotic Aneurysms: Embolization of Infected Cardiac Vegetations 182
Microbial Arteritis With Aneurysm Formation: Hematogenous Seeding 182
Infected Aneurysms 183
Arterial Injury With Contamination 183
Arteritis From Contiguous Spread 183
Other Forms of Arterial Infection 183
Causative Organisms 184
Anatomic Distribution 185
Clinical Presentation 186
Diagnostic Testing 186
Blood Cultures 186
Arterial Cultures 187
Molecular Diagnosis of Arterial Infection 187
Nuclear Imaging: Tagged White Blood Cell Scans 187
Computed Tomography and Magnetic Resonance Imaging 187
Angiography 188
Hybrid Positron Emission Tomography and Computed Tomographic Scan 188
Timing of Diagnosis 188
Natural History 188
Principles of Management 189
Control of Sepsis 189
Nonoperative Therapy 189
Arterial Reconstruction 189
Antibiotic-impregnated grafts. 190
Vein grafts. 190
Human allografts. 190
Extraanatomic Reconstruction 190
In situ reconstruction. 190
In situ reconstruction with graft. 190
In situ reconstruction with biological grafts. 191
In situ reconstruction: endovascular repair. 191
Management of Mycotic Aneurysms According to Location 192
Thoracic Aneurysms 192
Suprarenal Aneurysms 192
Infected Femoral Pseudoaneurysms 192
Mesenteric Artery Infections 193
Arterial Infections of the Upper Extremity 193
Conclusions 193
Chronic Suppression Therapy 193
Summation 194
Review Questions 194
References 195.e1
12 Patterns of Diabetic Vascular Disease 196
Abstract 196.e1
Introduction 196
Epidemiology of Diabetes Mellitus and Vascular Disease 196
Pathophysiology of Vascular Disease and Diabetes Mellitus 196
Arteriographic Patterns of Vascular Disease in Diabetes Mellitus 197
Distribution of Foot Wounds in Diabetic Vascular Disease 197
Patterns of Foot Infections in Diabetic Vascular Disease 198
Microbiology of Diabetic Foot Ulceration 198
Osteomyelitis Complicating Diabetic Foot Infection 199
Patterns of Health-Related Quality of Life and Diabetic Vascular Disease 199
Common Presentations of Diabetic Vascular Disease 199
Predicting Patterns of Wound Healing and Amputation in Diabetic Vascular Disease 200
Patterns of Care for Diabetic Vascular Disease 201
Trends in Cost of Care of Diabetic Foot Ulcerations 201
Conclusions 201
References 201.e1
13 Medical Management of Vascular Disease―Including Pharmacology of Drugs Used in Vascular Disease Management 202
Abstract 202.e1
Keywords 202.e1
Introduction 202
Atherosclerosis—Basic Principles and Medical Management 202
Risk Factors for Atherosclerotic Disease and Modification Strategies 202
Smoking 202
Diabetes Mellitus 202
Hypertension 203
Dyslipidemia 203
Metabolic Syndrome 204
Emerging Novel Risk Factors 204
Surveillance and Secondary Prevention 205
Pharmacology of Drugs Used in the Management of Vascular Disease (Table 13.1) 205
Anticoagulants 205
Heparin 205
Structure and mechanism of action. 205
Clinical use. 205
Adverse reactions. 205
Heparin-induced thrombocytopenia. 205
Protamine 208
3 Arterial Occlusive Disease 259
16 Vascular Grafts 259
Abstract 259.e1
Keywords 259.e1
Autologous Vein 259
Saphenous Vein 259
Arm Vein 260
Femoral Vein 261
Autologous Artery 261
Prosthetic Grafts 261
Biological Grafts 262
Tissue-Engineered Grafts 262
Endovascular Stent-Grafts 263
Review Questions 263
References 263.e1
17 Introduction to Endovascular Surgery 264
Abstract 264.e1
Keywords 264.e1
Gaining Arterial Access 264
Essential Tools 264
Vessel Dilators 264
Introducer Sheaths With Hemostasis Valves 264
Guidewires 265
Stainless Steel Guidewires 265
Hydrophilic Guidewires 266
Catheters 266
Diagnostic and Guide Catheters 266
Simple and Complex Curve Catheters 266
Angioplasty 267
Balloon Catheter Characteristics 267
Advances in Balloon Construction 267
Ideal Balloon Catheter 267
Stents 268
Balloon-Expandable Stents 268
Self-Expanding Stents 268
Stent Considerations 269
Conclusion 269
Review Questions 269
References 270.e1
18 Atherectomy and Arterial Closure Devices 271
Abstract 271.e1
Keywords 271.e1
Atherectomy Devices 271
Introduction 271
History 271
Overview of Atherectomy Data 271
Devices (Table 18.1) 271
Directional Atherectomy 271
SilverHawk, TurboHawk, HawkOne Plaque Excision System (Medtronic, Minneapolis, Minnesota) 271
Results. 272
Complications. 273
Indications and ideal lesions. 274
Orbital Atherectomy 274
Diamondback (CSI, St. Paul, Minnesota) 274
Results. 275
Complications. 275
Indications and ideal lesions. 275
Rotational Atherectomy 275
Jetstream (Boston Scientific, Marlborough, Massachusetts) 275
Results and complications. 275
Indications and ideal lesions. 276
Laser Atherectomy 276
CVX-300 Excimer Laser (Spectranetics, Colorado Springs, Colorado) 276
Results. 276
Complications. 276
Indications and ideal lesions. 277
Follow-Up After Atherectomy 277
Atherectomy as an Adjunct for Challenging Lesions 277
Arterial Closure Devices 277
Introduction 277
Devices 278
Suture closure 278
Perclose A-T and Perclose ProGlide. 278
Prostar Xl. 278
Mechanical nonsuture closure 278
StarClose SE. 278
Extravascular sealant 278
Cordis Mynxgrip and Mynx Ace. 278
Cordis Exoseal. 279
Cardiva Vascade. 279
Intravascular sealant 279
St. Jude Angio-Seal. 279
Morris FISH CombiClose and ControlClose. 279
Manual compression assistance 279
Cardiva Catalyst II and III. 279
Self-sealing access 280
Arstasis Axera Access. 280
Complications 280
Hemorrhagic 280
Ischemic 280
Infectious 280
Conclusions 281
Review Questions 281
Bibliography 281
References 281.e1
19 Extracranial Cerebrovascular Disease 282
Abstract 282.e1
Keywords 282.e1
Historical Review 282
Natural History of Extracranial Arterial Occlusive Disease 283
Pathology of Extracranial Arterial Occlusive Disease 286
Atherosclerosis 286
Fibromuscular Dysplasia 287
Coils and Kinks 288
Aneurysms 288
Takayasu Arteritis 289
Radiation Therapy Injury 290
Recurrent Carotid Stenosis 291
Pathogenetic Mechanisms of Transient Ischemic Attacks and Cerebral Infarction 292
Arterial Thrombosis 292
Flow-Related Ischemic Events 293
Cerebral Emboli 293
Lacunar Infarction 295
Clinical Syndromes of Extracranial Arterial Occlusive Disease 295
Transient Ischemic Attacks 296
General Considerations 296
Carotid Artery Transient Ischemic Attacks 296
Vertebrobasilar System Transient Ischemic Attacks 297
Cerebral Infarction 297
Role of the Vascular Laboratory 297
Asymptomatic Patients 297
Symptomatic Patients 297
Brain Scans and Angiography 298
Surgical Considerations and Technique 299
Anesthesia and Hemodynamic Monitoring 299
Carotid Bifurcation Endarterectomy 299
Indications 299
Technique 300
Internal Carotid Artery Dilatation 302
4 Arterial Aneurysm Disease 540
36 Descending Thoracic and Thoracoabdominal Aortic Aneurysms 540
Natural History 540
Pathology and Etiology 541
Clinical Manifestation 542
Diagnosis 542
Thoracic Aneurysm Classification 543
Preoperative Evaluation 543
Surgical Technique 544
Immediate Spinal Neurologic Deficit 549
Delayed Spinal Neurologic Deficit and Cerebrospinal Fluid Drainage 550
Postoperative Renal Failure 551
Postoperative Gastrointestinal Complications 551
Survival 551
Aneurysms Associated With Type B Aortic Dissection 552
Ruptured Thoracic Aortic Aneurysms 552
Conclusion 552
Review Questions 552
References 553.e1
37 Endovascular Repair of Thoracic Aortic Aneurysm 554
Abstract 554.e1
Keywords 554.e1
Indications for Thoracic Endovascular Repair 554
Preoperative Planning: Imaging 554
Anatomic Considerations 555
Sizing 555
Access 555
Landing Zones 555
Management of the Left Subclavian Artery 556
Management of the Celiac Axis 557
Stent-Graft Description 557
Gore C-TAG 557
Medtronic Valiant 558
Cook TX2 With Pro-Form and Zenith Alpha 558
Bolton Relay 559
Operative Technique and Deployment 559
Investigational Devices 560
Results 561
Early Results 561
Technical Success 561
Mortality 561
Neurologic Complications 561
Vascular Complications 562
Endoleaks 562
Late Results 562
Late Survival 562
Migration 563
Sac Behavior and Aortic Rupture 563
Stent-Graft Collapse 563
Conclusion 563
Review Questions 563
Bibliography 563
References 564.e1
38 Combined Endovascular and Surgical (Hybrid) Approach to Aortic Arch and Thoracoabdominal Aortic Pathology 565
Abstract 565.e1
Keywords 565.e1
Patient Selection 565
Indications 565
Anatomy Considerations 565
Open Versus Hybrid Approach 565
Aortic Arch Aneurysm 565
Thoracoabdominal Aneurysm 566
Contraindications 567
Debranching the Aortic Arch 567
Left Subclavian Artery 567
Partial Arch Debranching 568
Complete Arch Debranching 568
Ascending Aorta Replacement With Complete Arch Debranching 570
Staging and Stent-Graft 570
Debranching Thoracoabdominal Aneurysms 571
Origin of the Visceral Bypass Grafts 571
Abdominal Debranching Techniques 571
Exposure of the Visceral Vessels 572
Constructing the Bypass 573
Staging and Stent-Graft 573
Special Considerations 574
Aortic Dissections 574
Combined Aortic Arch and Thoracoabdominal Aneurysm 575
Contained and Symptomatic Aneurysms 575
Spinal Protection 575
Postoperative Management 576
Results 578
Aortic Arch Debranching 578
Hybrid Thoracoabdominal Aneurysm Repair 580
Summary 581
Review Questions 581
References 582.e1
39 Fenestrated-Branched and Parallel Stent-Grafts for Endovascular Repair of Aortic Arch and Thoracoabdominal Aortic Aneurysms 583
Abstract 583.e1
Keywords 583.e1
Introduction 583
Historical Perspectives 583
Indications 583
Definitions 584
Preoperative Assessment 584
Clinical Risk Evaluation 584
Medical Genetics Evaluation 584
Imaging Evaluation 584
Access 585
Sealing Zones 585
Side-Branch Involvement 586
Endovascular Techniques 586
Perioperative Measures 587
Hybrid Endovascular Rooms 587
Contrast Use and Radiation Safety 587
Positioning 587
Arterial Access 588
Intraoperative Anticoagulation 588
Thoracoabdominal Aortic Aneurysms 588
Specific Designs 588
Staging 588
Fenestrated and Branched Stent-Grafts 588
Multibranched Stent-Grafts 594
Physician-Modified Endovascular Grafts 594
Parallel Grafts 597
Aortic Arch Aneurysms 600
Specific Designs 600
Preparation and Setup 600
Subclavian Artery Revascularization 600
Arterial Access 605
Cook Inner Branch Arch Stent-Graft 605
Gore Thoracic Branch Endoprosthesis 607
Parallel Arch Stent-Grafts 611
Results 612
Thoracoabdominal Aortic Aneurysms 612
Fenestrated and Branched Stent-Grafts 612
Parallel Stent-Grafts 616
Aortic Arch Aneurysms 616
Fenestrated and Branched Stent-Grafts 616
Conclusion 617
References 617.e1
40 Acute and Chronic Aortic Dissection 618
Abstract 618.e1
Keywords 618.e1
Introduction 618
Classification 618
Temporal Classification 618
Anatomic Classification 618
DeBakey Classification 618
Stanford Classification 618
Incidence and Survival Rates of Aortic Dissection 619
Pathophysiology of Aortic Dissection 619
Cystic Medial Degeneration 619
Aortic Wall Stress 619
Hypertension 620
Other Risk Factors 620
Genetics 620
Natural History of Aortic Dissection 620
Clinical Presentation 621
Malperfusion Syndrome 622
Diagnostic Pitfalls 622
Diagnostic Imaging 622
Chest Radiography 622
Computed Tomography Angiography 622
Echocardiography 623
Magnetic Resonance Angiography 623
Angiography 623
Management of Type a Aortic Dissection 623
Management of Acute Type B Aortic Dissection 625
Optimal Medical Treatment 625
Surgical Management of Complicated Acute Type B Aortic Dissection 626
Techniques of Endovascular Repair 627
Techniques of Endovascular Fenestration 627
Techniques of Open Surgical Repair 628
Management of Chronic Descending Thoracic Aortic Dissection 629
Medical Management 629
Endovascular Repair of Uncomplicated Type B Dissection 629
Endovascular Repair of Descending Thoracic Aortic Dissection-Related Aneurysmal Degeneration 630
Open Repair of Descending Thoracic Aorta Dissection-Related Aneurysmal Degeneration 631
Hybrid Repairs 631
Review Questions 631
References 632.e1
41 Aneurysms of the Aorta and Iliac Arteries 633
Abstract 633.e1
Keywords 633.e1
Screening 634
Pathogenesis of Aortic Aneurysms 635
Aneurysm Enlargement 637
Clinical Manifestations 638
Diagnostic Methods 639
Imaging Modalities 639
Risk of Aneurysm Rupture 641
Risks of Surgical Treatment 643
Late Survival 644
Assessment of Cardiac Risk 645
Indications for Aneurysms of the Abdominal Aorta Repair 646
Operative Technique 647
Incision and Exposure 647
Aneurysm Repair 648
Repair of Ruptured Aneurysm 649
Complications of Aortic Aneurysm Repair 650
Unusual Problems Associated With Abdominal Aortic Aneurysms 652
Saccular Aneurysms 652
Venous Anomalies 652
Inflammatory Aneurysm 653
Horseshoe Kidney 653
Associated Intraabdominal Pathology and Concomitant Surgical Procedures 653
Aortocaval Fistula 654
Mycotic Aortic Aneurysms 654
Iliac Artery Aneurysms 656
Open Versus Endovascular Repair 657
Review Questions 657
Bibliography 658
References 658.e1
42 Endovascular Repair of Juxtarenal (Chimney), Infrarenal, and Iliac Artery Aneurysms 659
Abstract 659.e1
Keywords 659.e1
Patient Selection 659
Endovascular Treatment of Juxtarenal Aortic Aneurysms 659
Setting 660
Endovascular Stent-Graft Planning and Placement for Infrarenal Aortic Aneurysms 660
Endovascular Repair of Common and Internal Iliac Artery Aneurysms 662
Common Iliac Artery Aneurysms 662
Iliac Branch Devices 663
Internal Iliac Artery Aneurysms 663
Endovascular Repair of Juxtarenal Aortic Aneurysms 663
Encroachment Technique 664
Snorkel Technique 665
Postoperative Complications 665
Local 665
Systemic 665
Late Complications 666
Postoperative Surveillance 667
Midterm Outcomes 668
Review Questions 668
References 669.e1
43 Open Surgical and Endovascular Management of Ruptured Abdominal Aortic Aneurysm 670
Keywords 670.e1
Open Surgical Management— Key Points 670
Crucial Diagnostic Triad 670
Other Diagnoses That Can Be Mimicked by a Ruptured Abdominal Aortic Aneurysm 670
Strategies in Planning Operative Treatment 670
Key Technical Points for Open Repair of Ruptured Abdominal Aortic Aneurysms 671
Endovascular Management 672
History 672
Theoretical Considerations 672
A Single-Center Experience 672
Collected World Experience 673
Why Are Results Variable? 673
Standard Approach or Protocol 673
Fluid Restriction (Hypotensive Hemostasis) 673
Treatment Site 673
Anesthesia and Catheter-Guidewire Placement 673
Supraceliac Aortic Sheath Placement and Balloon Control 674
Endograft Type and Configuration 674
Abdominal Compartment Syndrome 674
Endovascular Aneurysm Repair for Highest-Risk Patients 674
Are Further Randomized Controlled Comparisons of Endovascular Aneurysm Repair Needed? 674
Review Questions 674
References 674.e1
44 Laparoscopic Aortic Surgery for Aneurysm and Occlusive Disease 675
Key Words 675.e1
Introduction 675
Techniques 675
Laparoscopic Aortobifemoral Bypass 675
Laparoscopic Repair of an Abdominal Aortic Aneurysm 676
Hybrid Remodeling Techniques Post–Endovascular Aneurysm Repair 677
Advantages of Laparoscopic Procedures 678
Exclusion Criteria and Disadvantages of the Laparoscopic Approach 678
Laparoscopy in the Context of Endovascular Aneurysm Repair and Open Surgery 678
Learning Curve 679
Lack of Randomized Controlled Trials 679
Conclusion 679
Review Questions 680
References 680.e1
45 Building a Hybrid Operating Suite Including Robotic Capability 681
Abstract 681.e1
Keywords 681.e1
Planning a Hybrid Room 681
Do You Need a Hybrid Room? 681
Where Should You Build the Hybrid Room? 682
Understanding the Finances 682
Planning for Construction 683
Learning From Experience 683
Designing the Hybrid Room 684
The Imaging System 684
Table Considerations 684
Staffing 684
The Control Room 685
Video Transmission 685
Utilization 685
Robotics in the Hybrid Room 685
Future Directions 685
Conclusion 686
Review Questions 686
References 686.e1
46 Splanchnic and Renal Artery Aneurysms 687
Abstract 687.e1
Keywords 687.e1
Splanchnic Artery Aneurysms 687
Splenic Artery Aneurysms 687
Hepatic Artery Aneurysms 690
Superior Mesenteric Artery Aneurysms 692
Celiac Artery Aneurysms 693
Gastric and Gastroepiploic Artery Aneurysms 693
Jejunal, Ileal, and Colic Artery Aneurysms 694
Pancreaticoduodenal and Gastroduodenal Artery Aneurysms 694
Renal Artery Aneurysms 696
True Renal Artery Aneurysms 696
Renal Artery Dissection 697
Review Questions 698
Bibliography 699
References 699.e1
47 Aneurysms of the Peripheral Arteries 700
Abstract 700.e1
Keywords 700.e1
Peripheral Aneurysms 700
Femoral Artery Aneurysms 700
Incidence and Cause 700
Natural History 700
Diagnosis 701
Indications for Aneurysm Repair 701
Treatment 701
Outcomes 702
Popliteal Artery Aneurysms 702
Incidence and Cause 702
Natural History 703
Diagnosis 703
Indications for Aneurysm Repair 703
Treatment 703
Outcomes 705
Infrapopliteal Aneurysm 707
5 Venous Disease 740
49 Venous Thromboembolic Disease 740
Pathophysiology of Venous Thrombosis 740
Epidemiology 741
Biomarkers 741
Risk Factors 741
Age 741
Immobilization 741
Travel 742
History of Venous Thromboembolism 742
Obesity 743
Malignancy 743
Surgery 743
Trauma 743
Inherited Thrombophilia 743
Pregnancy 744
Oral Contraceptives and Hormonal Therapy 744
Central Venous Catheters 744
Inflammatory Bowel Disease 744
Systemic Lupus Erythematosus 744
Initial Anticoagulation for Venous Thromboembolic Disease Treatment 744
Low-Molecular-Weight Heparins 745
Vitamin K Antagonists 745
Fondaparinux 745
Dabigatran 746
Apixaban 746
Rivaroxaban 746
Edoxaban 746
Future Anticoagulants 746
Duration of Anticoagulation 746
Vein Wall Abnormalities After Deep Venous Thrombosis 748
Definition of Postthrombotic Syndrome and Diagnosis 748
Prevention of Postthrombotic Syndrome by Preventing Deep Venous Thrombosis 749
Primary Deep Venous Thrombosis 749
Recurrent Deep Venous Thrombosis 749
Identifying Patients at Risk of Recurrent Deep Venous Thrombosis 749
Compression and Ambulation for Acute Deep Venous Thrombosis to Decrease Postthrombotic Syndrome 749
Active Thrombus Removal to Decrease Postthrombotic Syndrome 749
Other Consideration for Postthrombotic Syndrome 750
Pharmacologic Interventions 750
Deep System Reconstruction 750
Biomarkers 750
Endothelial Protection 751
Diagnosis and Treatment of Superficial Thrombophlebitis 751
Inferior Vena Caval Interruption 752
Inferior Vena Cava Filter Devices 753
Retrievable Optional Filters 753
Review Questions 755
Bibliography 756
References 756.e1
50 Thrombolysis and Mechanical Thrombectomy for Deep Venous Thrombosis and Pulmonary Embolism 757
Abstract 757.e1
Keywords 757.e1
Introduction 757
Acute Iliofemoral Venous Thrombosis 757
Natural History Studies 758
Venous Thrombectomy 759
6 Complications in Vascular Surgery 858
58 Neointimal Hyperplasia 858
Abstract 858.e1
Keywords 858.e1
Pathology 858
Pathophysiology 859
Hemodynamic and Mechanical Factors 860
Platelets 862
Inflammatory Cells 862
Growth Factors 866
Coagulation and Fibrinolytic Pathways 866
Nitric Oxide 867
Reactive Oxygen Species 868
Stem and Progenitor Cells 870
Adiponectin and Periadventitial Adipose Tissue 871
Vasa Vasorum 872
Conclusion 873
Review Questions 873
References 874.e1
59 Prosthetic Graft Infection 875
Abstract 875.e1
Keywords 875.e1
Incidence 875
Classification 875
Microbiology 875
Cause and Pathophysiology 876
Intraoperative Contamination 876
Hematogenous Spread 876
Direct Contamination 876
Prevention 877
Diagnosis 878
Clinical Presentation 878
Laboratory Studies 878
Imaging 878
Ultrasonography 879
Computed Tomography 879
Magnetic Resonance Imaging 880
Angiography 880
White Blood Cell Scanning 880
Gastrointestinal Endoscopy 880
Management of Graft Infection: General Principles 881
Preoperative Preparation 881
Antibiotic Therapy 881
Revascularization 881
Graft Excision 881
Debridement 883
Treatment of Specific Graft Site Infections 883
Aortic Grafts 883
Aortoiliac and Aortic Interposition Grafts 883
Aortobifemoral Grafts 885
Femoropopliteal Bypass Grafts 887
Endovascular Stent-Grafts 888
Conclusions 889
Review Questions 889
References 889.e1
60 Noninfectious Complications in Vascular Surgery 890
Abstract 890.e1
Keywords 890.e1
Aortoiliac Surgery 890
Perioperative Bleeding 890
Operative Bleeding 890
Postoperative Bleeding 892
Thrombosis 895
Lytic Therapy for Graft Thrombosis 899
Mechanical Thrombectomy 900
Atheroembolism 901
Preoperative Embolism 901
Intraoperative Embolism 901
Declamping Hypotension 902
Acute Renal Failure 902
Intestinal Ischemia 904
Gastrointestinal Complications 907
Abdominal Compartment Syndrome 908
Abdominal Wall Hernias 908
Chylous Ascites 909
Spinal Cord Ischemia 910
Ureteral Injury and Obstruction 911
Impotence 912
Retrograde Ejaculation 913
Anastomotic False Aneurysm 914
Recurrent Anastomotic Aneurysm 915
Infrainguinal Arterial Reconstruction 915
Bleeding 916
Thrombosis 916
Wound Complications 920
Graft Surveillance 921
Vein Grafts 921
Graft Dilatation 923
Dacron Grafts 923
Umbilical Vein 923
Polytetrafluoroethylene 924
Edema 924
Lymphoceles and Lymph Leaks 925
Review Questions 925
References 926.e1
61 Management of Complications After Endovascular Abdominal Aortic Aneurysm Repair 927
Early Complications 927
Access 927
Iliac Artery Complications 927
Acute Neck Complications 930
Late Complications 932
Endoleak 932
Branched or Fenestrated Endografts 936
Limb Occlusion 936
Graft Infection 936
Open Conversion 936
Conclusions 937
Bibliography 937
References 937.e1
7 Miscellaneous Topics 938
62 Diabetic Foot Complications 938
Abstract 938.e1
Keywords 938.e1
Pathogenesis and Presentation of Diabetic Foot Ulcers and Infections 938
Role of the Surgeon in the Early Management of Diabetic Foot Infections 939
Operative Treatment of Deep Soft Tissue Infections of the Foot 940
Role of the Vascular Surgeon 940
Early and Late Follow-Up After Revascularization and/or Reconstruction 941
Review Questions 941
References 941.e1
63 The Wound Care Center and Limb Salvage 942
Normal Wound Healing 942
Acute Wounds 942
Hemostasis 942
Inflammation 942
Proliferation 943
Remodeling 944
Chronic Wounds 944
Assessment of Wound Healing Capability 944
Patient Assessment 945
Assessment of Wound Characteristics 945
Diagnostic Studies for the Nonhealing Wound 945
Treatment of Nonhealing Wounds 946
Elimination of Edema 946
Debridement 946
Autolytic Debridement 946
Enzymatic Debridement 948
Mechanical Debridement 948
Biosurgical Debridement 949
Sharp Debridement 949
Treatment of Infection 949
Management of the Exudate 949
Dressing the Nonhealing Wound 950
Growth Factors 950
Tissue Transfer 951
Hyperbaric Oxygen Therapy 952
Vacuum-Assisted Closure 952
New Therapies for Nonhealing Wounds 952
Organization of a Wound Care Program 952
Personnel 953
Facility 953
Revascularization in Patients With Nonhealing Wounds 953
Options for Revascularization 953
Nonrevascularization 953
Angioplasty 953
Bypass 954
Conclusion 955
Review Questions 955
References 955.e1
64 Lower Extremity Amputation 956
Abstract 956.e1
Keywords 956.e1
Overview and Historical Perspective 956
Patient Evaluation and Preparation for Amputation 956
Acute Ischemia 957
Progressive Chronic Ischemia 958
Gangrene Complicated by Infection 959
Amputation for Trauma 960
Determination of Amputation Level 960
Lower Extremity Amputation Levels 964
Toe Amputation 964
Indications 964
Contraindications 964
Surgical Technique 964
Advantages and Disadvantages 964
Rehabilitation Potential 965
Ray Amputation 965
Indications 965
Contraindications 965
Surgical Technique 965
Advantages and Disadvantages 965
Transmetatarsal Amputation 966
Indications 966
Contraindications 966
Surgical Technique 966
Advantages and Disadvantages 966
Answers 1018
Chapter 3 1018
Chapter 4 1018
Chapter 5 1018
Chapter 6 1018
Chapter 7 1018
Chapter 8 1018
Chapter 9 1018
Chapter 10 1018
Chapter 11 1019
Chapter 13 1019
Chapter 14 1019
Chapter 15 1019
Chapter 16 1019
Chapter 17 1019
Chapter 18 1019
Chapter 19 1019
Chapter 20 1019
Chapter 21 1019
Chapter 22 1020
Chapter 23 1020
Chapter 24 1020
Chapter 25 1020
Chapter 26 1020
Chapter 27 1020
Chapter 28 1020
Chapter 29 1020
Chapter 30 1020
Chapter 31 1020
Chapter 32 1021
Chapter 33 1021
Chapter 34 1021
Chapter 35 1021
Chapter 36 1021
Chapter 37 1021
Chapter 38 1022
Chapter 40 1022
Chapter 41 1022
Chapter 42 1022
Chapter 43 1022
Chapter 44 1022
Chapter 45 1022
Chapter 46 1022
Chapter 47 1023
Chapter 48 1023
Chapter 49 1023
Chapter 50 1023
Chapter 51 1023
Chapter 52 1023
Chapter 53 1023
Chapter 54 1023
Chapter 55 1023
Chapter 56 1024
Chapter 57 1024
Chapter 58 1024
Chapter 59 1024
Chapter 60 1024
Chapter 62 1024
Chapter 63 1024
Chapter 64 1025
Chapter 65 1025
Chapter 66 1025
Chapter 67 1025
Index 1026
A 1026
B 1032
C 1034
D 1038
E 1040
F 1043
G 1044
H 1045
I 1048
J 1050
K 1050
L 1050
M 1052
N 1053
O 1054
P 1055
Q 1059
R 1059
S 1060
T 1064
U 1066
V 1067
W 1070
X 1070
Y 1070
Z 1070
Inside Back Cover ibc1