Table Of ContentVascular Surgery
Springer-Verlag London Ltd.
George Geroulakos, Hero van Urk, Robert W.
Hobson II, and Keith D. Calligaro (Eds)
Vascular Surgery
Cases, Questions and Commentaries
Springer
George Geroulakos, MD, FRCS, DIC, PhD
Consultant Vascular Surgeon and Senior Lecturer
Charing Cross Hospital and Ealing Hospital
Imperial College of Science, Technology and Medicine, London, UK
Hero van Urk, MD, PhD, FRCS
Professor of Vascular Surgery
University Hospital Rotterdam
Rotterdam, The Netherlands
Robert W. Hobson II, MD
Professor of Surgery and Physiology
Director, Division of Vascular Surgery
UMDNJ-NJMS
Newark, New Jersey, USA
Keith D. Calligaro, MD
Chief, Section of Vascular Surgery
Pennsylvania Vascular Associates
Pennsylvania Hospital
Philadelphia, Pennsylvania, USA
British Library Cataloguing in Publication Data
Vascular surgery: cases, questions and commentaries
1. Blood vessels - Surgery
I. Geroulakos, George
617.4'15
ISBN 978-1-4471-3872-3
Library of Congress Cataloging-in-Publication Data
Vascular surgery: cases, questions, and commentaries I George Geroulakos ... [et al.], eds.
p.;cm.
Includes bibliographical references and index.
ISBN 978-1-4471-3872-3 ISBN 978-1-4471-3870-9 (eBook)
DOI 10.1007/978-1-4471-3870-9
1. Blood-vessels-Surgery-Problems, exercises, etc. I. Geroulakos, George, 1956-
[DNLM: 1. Vascular Diseases-surgery-Problems and Exercises. 2. Vascular Surgical
Procedures-methods-Problems and Exercises. WG 18.2 V331 2002]
RD598.5 .V3748 2002
617.4'13'0076-dc21 2002021750
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ISBN 978-1-4471-3872-3
©Springer-Verlag London 2003
Originally published by Springer-Verlag London Berlin Heidelberg in 2003
Softcover reprint of the hardcover 1st edition 2003
2nd printing 2003
3rd printing 2005
The use of registered names, trademarks, etc. in this publication does not imply, even in the
absence of a specific statement, that such names are exempt from the relevant laws and regulations
and therefore free for general use.
Product liability: The publisher can give no guarantee for information about drug dosage and
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Typeset by Expo Holdings, Malaysia
28/3830-5432 Printed on acid-free paper SPIN 11406006
This book is dedicated to the memory of
Polychronia Geroulakos, Senior Sister in the
Geroulakos Clinic in Sparta, Greece. For
almost 40 years she looked tirelessly after
the patients of this institution in an
exemplary manner leaving a legacy of
high standards.
• * ,.. • * ,..
• b • Union Europeenne de edecins Specialistes .It- VAASCULAR •.
* U.E.1 * Division of Vascular Surgery
M.S
• f.. •
• SURGERY •
• * • Assoe1 Ol<ld ,., :n "" Specia!i:, So<; "' ol Su ry ,.. * •
&
Europe n S)aro of Vascu' r SurtJ• ry ass.od~! w the Eur pi!an Bo.'lrd tf Svg ry
President J G Kretz Vice President J H NI M:IIfe Secretary c D L•ap•s
ENDORSEMENT
Vascular diseases are still the No 1 killer of the human race and only through research and
training on the part of the professionals and education of the public can this battle be won.
The harmonization of training in the European Union of the Vascular Surgeons is of
utmost importance. The European Board of Vascular Surgery among other activities is
organizing annual examinations for its diploma, currently for the fifth consecutive year.
Although reading of standard textbooks and working knowledge of the current literature is
essential, the need for a comprehensive presentation of problem-based vascular surgery is
of paramount importance for both preparing trainees for exit examinations and helping
vascular specialists in the everyday management of difficult cases. In that aspect the book
"Vascular Surgery. Cases, Questions and Commentaries", by Mr G. Geroulakos, Prof.
H. van Urk, Dr R.W. Hobson II and Dr K. Caligaro promises to fill an existing gap and to be
of great help in preparation for Board-type examinations.
The European Board of Vascular Surgery gladly endorses the book.
C.D. Liapis
Secretary General
UEMS Division and Board of Vascular Surgery
Athens, 30 November 2002
Foreword
This book is rather unique among textbooks in vascular surgery. Most cover the
surgical management of vascular diseases, in whole or in part, in standard textbook
fashion, with the text organized to cover the topics methodically in a didactic
manner, and supported by tables, illustrations and references. Others have special
purposes, such as atlases on technique or algorithm based books on decision
making. All have their place, but if the educational goals are training of the young
surgeon, self-assessment and continuing medical education for the practitioner or
preparation for oral examination, this book fills a special need, and fills it very well
by breaking away from the didactic approach.
It has long been recognized by educators that retention of knowledge, i.e. true
learning, are much better achieved using the Socratic method of questions and
answers, as opposed to simply reading or being told facts. In this book this
approach is developed and presented in a very effective manner. In each "chapter",
one is presented with a case report representing a real life scenario. The case
reports-scenarios in this book together cover most of vascular surgery experience.
Following the case report, one is presented with questions and answers based on
various aspects of the case, forcing the reader to commit to an answer. Whether the
answer is right or wrong is not critical, in fact getting a wrong answer may be more
beneficial in terms of correcting knowledge and retaining information. The com
mentary and conclusions that follow analyze the choice of answers, correct and
incorrect, and discuss them in concise, authoritative detail, many of which are truly
"pearls of information". The conclusion then summarizes the current state of
knowledge on the clinical issues under consideration. Numerous references are
included. Together, these components constitute one of the most effective vehicles
for self-education in vascular surgery today. Importantly, all aspects of manage
ment are covered: diagnostic evaluation and appropriate treatment, whether it is
non-operative or interventional, endovascular or open surgery.
To accomplish their goals the editors have gathered together a large number of
experienced contributors, many well-known for their special areas of interest within
vascular surgery, reflected in the contributions they make to this book. As such, the
book should be useful to future and practicing vascular surgeons all over the world.
It is full of statements covering most of the current state of knowledge in vascular
surgery, and it does so in an entertaining and effective manner.
Robert B. Rutherford MD, FACS, FRCS
Emeritus Professor of Surgery
University of Colorado
ix
Preface
This book is a unique collection of real life case histories written by experts that
highlight the diversity of problems that may be encountered in vascular surgery.
Each case scenario is interrupted by several questions that aim to engage the reader
in the management of the patient and to give him the opportunity to test his knowl
edge. The comments reflect to as much as possible the principles of evidence based
medicine and provide the answers to the questions.
Several chapters are authored by individuals that contributed to the development
of innovations in the management and prevention of vascular disease and are of
interest for both the vascular trainee and the experienced vascular specialist.
The goal of this book is to help vascular trainees review for Board and other
examinations as well as to provide vascular surgeons who wish to expand or refresh
their knowledge with an update and interactive source of information relevant to
case scenarios that could be encountered in their practice.
The European Boards in Vascular Surgery is a relatively new examination.
Although the American Boards in Vascular Surgery were established many years
earlier, there are no "dedicated" guides to cover the needs of these examinations.
We hope that our book will provide a helpful hand that does not come from the
standard text books, but directly from daily practice and therefore contains a high
content of "how to do it" and "why we do it". The references show the close relation
between daily practice and "evidence based" practice, and we hope the two are not
too different.
We would like to thank all the authors who have contributed generously their
knowledge and time to this project.
George Geroulakos
Hero van Urk
Keith D Calligaro
Robert Hobson II
xi
Contents
I. Arterial Aneurysms
1. Preoperative Assessment of Perioperative Risk on a Chronic Heavy
Smoker with a Large Aneurysm
D Poldermans ........................................................................................................... 3
2. Abdominal Aortic Aneurysm
A d'Audiffret and /P Becquemin ............................................................................. 11
3. Endoluminal Treatment of Infrarenal Abdominal Aortic
Aneurysm
H Verhagen, GH White and T Perdikides ............................................................. 17
4. Ruptured Abdominal Aortic Aneurysm
M Y apanis and A W Bradbury ................................................................................. 29
5. Thoracoabdominal Aortic Aneurysm
NJ Morrissey, LH Hollier and JH jacobson II ......................................................... 37
6. Aortic Dissection
BT Muller and W Sandmann ................................................................................. 49
7. Popliteal Artery Aneurysm
JD Woody and MS Makaroun 57
8. Renal Artery Aneurysm
L Reiher and W Sandmann ..................................................................................... 63
9a. Anastomotic Aneurysms
B Neary and Jl Earnshaw ....................................................................................... 69
9b. False Aneurysm in the Groin Following Coronary Angioplasty
SS Kang ..................................................................................................................... 77
II. Acute Ischaemia
10. Acute Thrombosis
S Srivastava and K Durie! 85
11. Arterial Embolism
A Nevelsteen 89
xiii
