Vascular and Endovascular Surgery: A Comprehensive Review

162 Pages·2013·12.64 MB·English

by  Wesley S. Moore

Vascular and Endovascular Surgery
at a Glance
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Vascular and
Endovascular
Surgery at a Glance
Morgan McMonagle MB BCh BAO (Hons)
MD FRCS (Gen Surg)
Consultant Vascular and Trauma Surgeon, HSE South Hospital Group and the
Royal College of Surgeons in Ireland
Formerly Consultant Vascular and Lead Trauma Surgeon at St. Mary’s Hospital
and Imperial College
London, UK
Matthew Stephenson MB BS MSc FRCS
(Gen Surg)
Consultant General Surgeon
Jersey General Hospital
Jersey
This edition first published 2014 © 2014 by John Wiley & Sons, Ltd.
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Library of Congress Cataloging-in-Publication Data
McMonagle, Morgan, author.
Vascular and endovascular surgery at a glance / Morgan McMonagle, Matthew Stephenson.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-49603-9 (pbk. : alk. paper) – ISBN 978-1-118-49606-0 (epub) – ISBN 978-1-118-
49610-7 (epdf) – ISBN 978-1-118-49614-5 – ISBN 978-1-118-78271-2 – ISBN 978-1-118-78281-1
I. Stephenson, Matthew, author. II. Title.
[DNLM: 1. Vascular Diseases–surgery. 2. Blood Vessels–pathology. 3. Vascular Surgical
Procedures. WG 170]
RD598.5
617.4′13–dc23
2013026494
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may
not be available in electronic books.
Cover image: Matthew Stephenson
Cover design by Meaden Creative
Set in 9/11.5 pt TimesLTStd-Roman by Toppan Best-set Premedia Limited
1 2014
Contents
Preface 6 33 Thoracic aortic disease II: Aneurysms 76
List of abbreviations and symbols 7 34 Peripheral vascular disease I: Overview 78
About the companion website 9 35 Peripheral vascular disease II: Assessment 80
36 Peripheral vascular disease III: Management 82
37 The acute limb 84
Part 1 Vascular principles
38 Amputation and rehabilitation 88
 1 Overview of vascular disease 10
39 Vascular trauma: Neck and chest 90
 2 Arterial anatomy 12
40 Vascular trauma: Abdomen and pelvis 92
 3 Venous anatomy 14
41 Peripheral vascular injury 94
 4 Vascular biology 16
42 Compartment syndrome and fasciotomy 96
 5 Vascular pathobiology 18
43 Vascular complications from IVDU 98
 6 Vascular physiology 20
44 Upper limb vascular disease 100
 7 Vascular pharmacology 22
45 Thoracic outlet syndrome 102
 8 Coagulation and thrombosis 24
46 Vasculitis I: Overview 106
 9 Cardiovascular risk factors 26
47 Vasculitis II: Specific conditions 108
10 Best medical therapy 28
48 Raynaud’s and cold injury 110
11 Vascular history taking 30
49 Primary hyperhidrosis 112
12 Examination of the vascular system 32
50 Coagulopathy and thrombophilia 114
13 Ankle Brachial Pressure Index measurement 34
51 Deep venous thrombosis 116
14 Vascular examination: Varicose veins 36
52 Complications of DVT 120
15 Interpreting vascular scars 38
53 Varicose veins and venous hypertension 122
16 Vascular investigations: Overview 40
54 Varicose veins: Treatment 124
17 Vascular ultrasound I 42
55 Vascular ulceration 126
18 Vascular ultrasound II 44
56 General wound care 128
19 Vascular ultrasound III: Specific parameters  46
57 Lymphoedema 130
20 Angiography I: Overview 48
58 The diabetic foot 132
21 Angiography II: Access and imaging 50
59 Haemodialysis access 134
22 Angiography III: Angiointervention 53
60 Mesenteric ischaemia I 136
23 Principles of vascular surgery 56
61 Mesenteric ischaemia II 138
24 Perioperative care of the vascular patient 58
62 Renal vascular disease 140
25 Post-operative complications and management 60
63 Congenital vascular malformations 142
64 Rare and eponymous vascular disorders 144
Part 2 Disease-specific topics 65 High-yield vascular facts 148
26 Carotid disease: Assessment and treatment 62 66 Vascular trials 150
27 Carotid surgery 64
28 Aneurysms 66 Appendix 1: Wires commonly used during angiography and 
29 Abdominal aortic aneurysm I: Overview 68 angiointervention 152
30 Abdominal aortic aneurysm II: Treatment  70 Appendix 2: Catheters commonly used during angiography and 
31 Other aneurysms 72 angiointervention 153
32 Thoracic aortic disease I: Dissection 74 Index 154
Contents  5
Preface
Although the at a Glance series originated as a unique visual, synop- aging patients, including physicians, surgeons, emergency physicians,
sis-style learning aid for undergraduate students, the conceptualisation nurses, podiatrists, paramedics, physiotherapists and occupational
underpinning Vascular and Endovascular Surgery at a Glance is to therapists. Vascular and Endovascular Surgery at a Glance is a suit-
provide both breadth and depth to a completed vascular curriculum able and simplistic learning aid for all professionals dealing with
from undergraduate level through to postgraduate training and exami- vascular disease whilst remaining comprehensive. So whether a quick
nations. We have adhered to the powerfully simplistic, yet accurate explanation is required or a more detailed overview of disease, Vas-
approach of the at a Glance series with coloured illustrations, tables cular and Endovascular Surgery at a Glance will serve as the perfect
and clinical pictures supported by ‘nuts and bolts’ style didactics for learning companion.
rapid and effective learning. Great emphasis has been placed on the Vascular surgery has now become a stand-alone specialty within the
illustrations to simplify the understanding of disease processes, and, UK (separate from general surgery), bringing it in line with Europe,
where possible, supported by clinical and intraoperative photographs. North America and Australia. Evidence-based practice has driven
Although written with little reference to the evidence, for ease of read- improved expectations of care around the globe almost to international
ability, every effort has been made, where possible, to ensure that the fellowship level, whereby outcomes from index vascular cases are
facts presented, especially pertaining to the clinical management of now scrutinised and compared with best international practice. We feel
vascular disease are both accurate and up-to-date. In addition, as vas- Vascular and Endovascular Surgery at a Glance maintains this high
cular surgery is strongly driven by an evidence-based approach, we standard and presents vascular disease and its management from basic
have included a chapter on the principal trials that students at all levels science underpinning the pathology through to clinical examination,
may be expected to know. In addition, we have emphasised the impor- investigations and specific disease findings and its best treatments. Our
tance of the vascular surgeon’s working knowledge and skill in vas- book will serve as a learning tool for vascular disease (basic science
cular imaging, especially Duplex ultrasound, which forms a formal, and clinical) as well as a comprehensive curriculum for trainees and
in-depth part of training and examinations in the USA, Australia and a last-minute study guide for examinees.
Europe, and is now seen as an increasingly important skill armamen- So whether you are looking for a simplified, easy-to-understand and
tarium for the practising vascular specialist in Ireland and the UK. readily accessible approach to vascular disease and its management at
Vascular surgery has often been considered by medical students and undergraduate level, or more complex knowledge for post-graduate
junior trainees to be poorly taught and perhaps ‘too sub-specialised’ MRCS examinations or even a quick but comprehensive knowledge
for learning which often serves to generate learning barriers between and revision guide for vascular fellowship examinations, Vascular and
the learner and subject matter. Yet vascular patients regularly appear Endovascular Surgery at a Glance will fulfill these requirements at all
on undergraduate examinations (both medical and surgical), MRCS- levels. We hope you will also agree.
level postgraduate exams (written and clinical) and fellowship exams
(including general surgery). Atherosclerosis is ubiquitous in the Morgan McMonagle
Western world, making vascular disease ubiquitous for all levels man- Matthew Stephenson
6  Preface
List of abbreviations and symbols
List of abbreviations CT computed tomography
AAA abdominal aortic aneurysm CTA computed tomography angiography
AAI ankle-ankle index CTD connective tissue disease
ABG arterial blood gas CVM congenital vascular malformation
ABPI ankle Brachial Pressure Index CVP central venous pressure
ACE angiotensin-converting enzyme CVS cardiovascular
ACEi angiotensin-converting enzyme inhibitor CXR chest X-ray
ACh acetylcholine DES drug-eluting stent
ACT activated clotting time DIC disseminated intravascular coagulopathy
ADP adenosine diphosphate DP dorsalis pedis
AI angiotensin I DPA dorsalis pedis artery
AII angiotensin II DVT deep vein thrombosis
AK above knee ECG electrocardiogram
AKA above-knee amputation ECM extracellular matrix
AMI acute mesenteric ischaemia EDV end-diastolic velocities
ANA anti-nuclear antibody EEG electroencephalogram
APA antiplatelet agent EEL external elastic lamina
APC activated Protein C eGFR estimated glomerular filtration rate
APR activated Protein C resistance EIA external iliac artery
APS antiphospholipid syndrome ePTFE expanded polytetrafluoroethylene (Teflon)
APTT activated partial thromboplastin time ET endotracheal
ARBs AII receptor blockers EVAR endovascular aneurysm repair
ARDS acute respiratory distress syndrome FBC full blood count
AT antithrombin FMD fibromuscular dysplasia
ATA anterior tibial artery FVII factor VII
ATLS advanced trauma life support aFVII activated factor VII
A-TOS arterial thoracic outlet syndrome FX factor X
AVF arteriovenous fistula aFX activated Factor X
bFGF basic fibroblast growth factor GA general anaesthetic
BK below knee GAGs glycosaminoglycans
BKA below-knee amputation GFR glomerular filtration rate
BMS bare metal stent GI gastrointestinal
BMT best medical therapy GIT gastrointestinal tract
BP blood pressure GP glycoprotein
bpm beats per minute GSW gunshot wound
Ca2+ calcium HbA1c haemoglobin A1c
CABG coronary artery bypass graft HDL high-density lipoprotein
cAMP cyclic adenosine monophosphate HIT heparin-induced thrombocytopenia
CBT carotid body tumour HR heart rate
CCA common carotid artery HSPGs heparan sulfate proteoglycans
CCF congestive cardiac failure HSV herpes simplex virus
CEA carotid endarterectomy IC intermittent claudication
CFA common femoral artery ICA internal carotid artery
CFU colony-forming unit IEL internal elastic lamina
CFV common femoral vein IHD ischaemic heart disease
cGMP cyclic guanosine monophosphate IMA inferior mesenteric artery
CIA common iliac artery IMH intramural haematoma
CIN contrast-induced nephropathy INR international normalized ratio
CK creatinine kinase i.v. intravenous
CKD chronic kidney disease IVC inferior vena cava
CMI chronic mesenteric ischaemia IVDU intravenous drug user
COX cyclooxygenase JGA juxta-glomerular apparatus
CPEX cardiopulmonary exercise testing KTS Klippel-Trenaunay syndrome
CS compartment syndrome LA local anaesthetic
CSVV cutaneous small vessel vasculitis LDL low-density lipoprotein
List of abbreviations and symbols  7