Haimovici's Vascular Surgery E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 3633

Veröffentlichungsjahr: 2012

Beschreibung

To improve the diagnosis and management of patients with vascular disease turn to the most authoritative and trusted reference for 36 years and counting . . .

The role of the vascular surgeon has evolved. Vascular surgeons now perform minimally invasive vascular procedures and provide comprehensive care in addition to open surgery.

Haimovici’s Vascular Surgery, now in its 6th edition, has been extensively updated to provide you with:

• Expert perspectives on how the vascular surgery field has evolved so you continue to stay on the leading edge of this dynamic field
• Concise and practical advice about what these changes and new areas of practice mean to you – the practitioner and  trainee in the fields of vascular surgery, interventional cardiology and interventional radiology
• Fundamental principles and best practices to treat traditional and new modalities that are now part of the vascular surgeons purview

What’s new in this edition?

• Full-color photographs and illustrations
• Complete coverage of the latest diagnostic imaging modalities, including intravascular ultrasound and computed tomography
• Expanded information on the most effective minimally invasive treatment options, including those for diseases of the carotid artery, lower extremity and abdominal aorta
• Full coverage of non-surgical techniques that vascular surgeons may add to their repertoire.

Time-saving feature exclusive to the 6th edition
To help you identify actionable information quickly, each chapter now highlights the most relevant clinical information. Apply what you learn to your own practice immediately.

Leseprobe

Table of Contents

Cover

Dedication

Title page

Copyright page

Preface

Preface to the Fifth Edition

Contributors

List of Abbreviations

PART I: Vascular Imaging Techniques and Physiologic Testing

CHAPTER 1 Arterial and Venous Duplex Scanning

Ultrasound basics

Carotid and vertebral-artery duplex scanning

Peripheral artery duplex scanning

Visceral arteries

Venous disease

Chronic venous insufficiency

Selected miscellaneous examinations

CHAPTER 2 Duplex Arteriography for Lower Extremity Revascularization

Materials and methods

Results

Conclusions

CHAPTER 3 Fundamentals of Angiography

Basic concepts of angiographic imaging

Angiographic equipment

Contrast agents

Sources of error with angiography

Basics of radiation safety

CHAPTER 4 Arteriographic Patterns of Atherosclerotic Occlusive Disease of the Lower Extremity

Methods of study

Aortoiliac patterns

Femoropopliteal patterns

Tibioperoneal patterns

Collateral circulation in occlusive patterns of femoropopliteal and tibioperoneal segments

CHAPTER 5 Computed Tomography in Vascular Disease

Introduction

Basic principles

Helical, multidetector and dual source computed tomography

Vascular techniques and protocols

Interpretation principles

Clinical applications

Comments

Future directions: plaque imaging

CHAPTER 6 Magnetic Resonance Angiography

Introduction

Principles

Clinical applications

Neuroimaging

Conclusions

CHAPTER 7 Intravascular Ultrasound Imaging

Device development and imaging configurations

Intravascular ultrasound imaging techniques

Clinical utility of intravascular ultrasound

PART II: Basic Science in Vascular Diseases

CHAPTER 8 Hemodynamics of Vascular Disease: Applications to Diagnosis and Treatment

Normal blood flow

Arterial stenoses

Stenosis as part of a larger arterial circuit

Bypass grafts

Conclusions

CHAPTER 9 Atherosclerosis: Biological and Surgical Considerations

Historical perspective

Epidemiology

Normal anatomy

Theories of atherosclerosis

Morphology and hemodynamics

Stages of atherosclerosis

Risk factors

Therapeutic implications

CHAPTER 10 Neointimal Hyperplasia: Basic Considerations

What is neointimal hyperplasia?

Pathophysiology of NIH

Neointimal hyperplasia as a response to injury

Interventions to treat neointimal hyperplasia

Acknowledgments

CHAPTER 11 Therapeutic Angiogenesis

Introduction

Biology of vessel formation

Therapeutic angiogenesis

Stem cell therapy

Summary and future perspective

Acknowledgements

CHAPTER 12 Thrombogenesis and Thrombolysis

Normal coagulation and anticoagulation

Medications

Disorders of coagulation

Perioperative considerations

Acknowledgments

CHAPTER 13 Etiology of Abdominal Aortic Aneurysms

Definitions

Epidemiology—prevalence and mortality

Risk factors

Family history

Molecular genetics

Atherosclerosis and abdominal aortic aneurysms

Structural physiology

Structural pathophysiology

Changes related to normal aging

Enzymatic degradation

Inflammation

Autoimmunity

Infection

Abdominal arterial aneurysms and popliteal artery aneurysms

Conclusion

CHAPTER 14 An Evidence-based Approach to Cardiopulmonary Risk Assessment for Vascular Surgery Procedures

Cardiac evaluation

Cardiac risk assessment guidelines

Respiratory failure

Conclusion

PART III: Basic Open Vascular Techniques

CHAPTER 15 Vascular Sutures and Anastomoses

Exposure and mobilization of arteries

Clamping of an artery

Arterial ligation

Arteriotomy

Vascular anastomoses

CHAPTER 16 Patch-graft Angioplasty

Indications

Patch-graft material

Methods and techniques of patching

Conclusion

CHAPTER 17 Endarterectomy

Principles of endarterectomy

Semiclosed endarterectomv

Open endarterectomy

Combined procedures

Comments: endarterectomy-versus-percutaneous balloon catheterization

CHAPTER 18 Balloon Angioplasty of Peripheral Arteries and Veins

History

Pathophysiology

Indications

Technique

Assessment of results

Complications

Recommended follow-up and surveillance

CHAPTER 19 Stents for Peripheral Arteries and Veins

General principles of vascular stents

Biologic response to intravascular stent placement

Indications for stent placement

Relative contraindications to stent placement

Complications

Stents in iliac arteries

Stents in femoropopliteal arteries

Infrapopliteal stents

Stents in peripheral veins

Future stents

Summary

CHAPTER 20 Thrombolytic Therapy for Peripheral Arterial and Venous Thrombosis

Plasmin and the fibrinolytic system

Thrombolytic agents

Arterial thrombolysis

Venous thrombolysis

Conclusion

PART IV: Open Surgical Exposure of Arteries

CHAPTER 21 Exposure of the Carotid Artery

Anatomic review

Technique of carotid exposure

CHAPTER 22 The Vertebrobasilar System: Anatomy and Surgical Exposure

Exposure of the vertebral artery

CHAPTER 23 Trans-sternal Exposure of the Great Vessels of the Aortic Arch

Left subclavian artery

Innominate, right subclavian, and common carotid arteries

Conclusions

CHAPTER 24 Extrathoracic Surgical Exposure for Distal Revascularization of Brachiocephalic Branches

Historical background

Clinical background

Carotid–subclavian bypass technique

AxiIIary–axillary bypass graft technique

Subclavian–subclavian bypass

Conclusion

CHAPTER 25 Open Surgical Exposure of Upper Extremity Arteries

Exposure of subclavian artery

Exposure of axillary artery

Exposure of brachial artery

Exposure of radial and ulnar arteries

Exposure of carotid artery

CHAPTER 26 Transperitoneal Exposure of Abdominal Aorta and Iliac Arteries

Anatomic review

Physiopathologic considerations in aortic surgery

Transperitoneal exposure of iliac arteries

CHAPTER 27 Retroperitoneal Exposure of Abdominal Aorta

Retroperitoneal infrarenal aortic exposure

Retroperitoneal approach for juxtarenal and suprarenal aortic exposure

Pitfalls of retroperitoneal aortic reconstruction

CHAPTER 28 Retroperitoneal Exposure of Iliac Arteries

Anatomic review

Exposure of external iliac artery

Combined iliac and femoral exposures

CHAPTER 29 Open Surgical Exposures of Arteries in the Lower Extremity

Femoral artery

Popliteal artery

Leg arteries

Dorsalis pedis

Plantar arteries

PART V: Cerebrovascular Insufficiency

CHAPTER 30 Medical Management of Carotid Artery Disease

Objectives of medical management

Hyperhomocysteinemia

Antithrombotic therapy

Optimal medical treatment: “classic” versus contemporary

Conclusion and recommendations

CHAPTER 31 Carotid Endarterectomy: Indications, Techniques, and Results

Indications for CEA

Operative technique

Results

Perioperative complications

Long-term results of CEA

Reoperative carotid endarterectomy

CHAPTER 32 Eversion Carotid Endarterectomy

Introduction

Methods

Results

Conclusion

CHAPTER 33 Carotid Stenting: Indications, Techniques, and Results

Current indications

Current techniques

Results, contraindications, and future directions

CHAPTER 34 Cerebral Protection Devices During Carotid Stenting

Introduction

The debate around cerebral protection devices

Types of cerebral protection devices

Device selection

Conclusion

CHAPTER 35 Vertebrobasilar Disease: Surgical Management

Low-flow mechanism

Embolic mechanism

Mixed etiology

Pathology of the vertebral artery

Syndrome of vertebrobasilar ischemia

Surgical management

CHAPTER 36 Nonatherosclerotic Cerebrovascular Disease

Inflammatory processes

Temporal arteritis

Takayasu’s arteritis

Behçet’s disease

Elongation and Coiling of the Carotid Artery

Aneurysms of the extracranial carotid artery

Carotid dissection

Fibromuscular disease of the carotid artery

Carotid body tumors

Injuries to the carotid artery from radiation

Recurrent carotid stenosis after endarterectomy

PART VI: Aortic and Iliac Aneurysms

CHAPTER 37 Indications, Techniques and Results of Open Repair of Ascending and Transverse Aortic Arch Aneurysms

Introduction

History

Diagnosis

Indications for surgery

Preoperative assessment

Operative technique, general

Results of general technique

Extensive aneurysm of the aorta: elephant trunk

Conclusion

Acknowledgments

CHAPTER 38 Hybrid Repair of Aortic Arch Aneurysms

Introduction

Anatomic considerations

Pathology

Natural history

Preoperative evaluation

Treatment

Hybrid approaches

CHAPTER 39 Endovascular Management of Thoracic Aortic Aneurysms and Dissections

Introduction

Endografts for TEVAR

Indications for TEVAR

Anatomic considerations for TEVAR

Preoperative planning

Operative approaches and technical considerations

Results of TEVAR

Complications of TEVAR

Endovascular treatment of type-B aortic dissection

Conclusion

CHAPTER 40 Open Repair of Thoracoabdominal Aortic Aneurysms

Indications for operation

Preoperative evaluation

Open surgical repair

Postoperative management

Outcomes

Surveillance for additional aortic disease

Acknowledgments

CHAPTER 41 Open Repair of Abdominal Aortic Aneurysms

Introduction

Etiology and pathogenesis

Risk factors

Risk of aneurysm rupture

Clinical presentation

Diagnosis

Preoperative evaluation

Treatment

Uncommon aneursyms

Surgical timing

Perioperative management

Perioperative outcomes

Postoperative complications

Conclusions

CHAPTER 42 Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms

Introduction

Endograft design

Aortoiliac morphology: selection and planning

Anesthetic considerations

The endovascular suite

Surgical technique: arterial access

Endovascular technique: stent-graft deployment

Adjunctive procedures

Renal-artery intervention

Outcomes

Surveillance

Repeat intervention

Ruptured aortic aneurysms

Future direction

CHAPTER 43 Fenestrated and Branched Stent Grafts for the Treatment of Complex Aortic Aneurysms

Introduction

Historical aspects

Current techniques of fenestrated and branched endografts

Technical aspects

Results

Summary

CHAPTER 44 Endovascular Treatment of Ruptured Infrarenal Aortic and Iliac Aneurysms

Obstacles to use of endovascular grafts in the ruptured aneurysm setting

Suitable endografts for endovascular repair in the rAAA setting

Early experience with endovascular treatment of rAAAs

Hypothesis regarding endovascular treatment of rAAAs and current management plan

Control of bleeding and blood pressure: restricted resuscitation or hypotensive hemostasis and proximal balloon control

Experience with endovascular treatment of rAAAs

Abdominal compartment syndrome

Collected world experience with endovascular graft treatment of rAAAS

Advantages of endovascular treatment of rAAAs

Discussion

CHAPTER 45 Open Surgical Treatment of Isolated Iliac Aneurysms

Incidence

Surgical management

CHAPTER 46 Endovascular Grafts in the Treatment of Isolated Iliac Aneurysms

Methods for endovascular graft repair

Surveillance considerations for isolated iliac aneurysms treated endovascularly

Conclusions

CHAPTER 47 Infected Aortic Grafts: General Considerations and Techniques

Prevention of aortic-graft infections

Clinical presentation

Diagnosis

Treatment

Conclusion

CHAPTER 48 Para-anastomotic Aortic Aneurysms: General Considerations and Techniques

Incidence of para-anastomotic aortic aneurysms

True para-anastomotic aortic aneurysms

False para-anastomotic aortic aneurysms

Infected para-anastomotic aortic aneurysms

Presentation

Management

Operative techniques and results

Endovascular treatment of para-anastomotic aortic aneurysms

Selection of operative approach

Surveillance

PART VII: Visceral Vessels

CHAPTER 49 Surgery of the Celiac Artery for Occlusive Disease and Arcuate Ligament Syndrome

Surgical anatomy of the celiac trunk and its branches

Occlusive disease of the celiac artery

Surgical bypass for visceral occlusive disease

Median arcuate ligament syndrome

Conclusion

CHAPTER 50 Management of Acute and Chronic Mesenteric Ischemia

Historical background

Acute mesenteric-artery ischemia

Mesenteric venous thrombosis

Chronic mesenteric-artery ischemia

Conclusion

CHAPTER 51 Endovascular Treatment of Mesenteric Occlusive Disease

Introduction

Pathophysiology and anatomy

Types of mesenteric lschemia

Clinical presentation

Workup

Endovascular treatment

Endovascular technique

Treatment of celiac artery compression syndrome

Clinical data

Other considerations

Conclusion

CHAPTER 52 Renal Artery Revascularization

Background

Physiology of renovascular hypertension

Clinical diagnosis of renovascular hypertension

Laboratory and radiologic diagnosis of renovascular hypertension

Endovascular treatment of renovascular disease

Operative management

Surgical techniques for renal artery reconstruction

Renal artery aneurysm repair

Results of renal artery reconstruction

CHAPTER 53 Renal Artery Fibrodysplasia and Renovascular Hypertension

Consequences of fibrodysplastic renovascular disease

Types of renal artery fibrodysplasia

Diagnosis of fibrodysplastic renovascular hypertension

Treatment

CHAPTER 54 Visceral Artery Aneurysms

Splenic artery aneurysm

Hepatic artery aneurysm

Superior mesenteric artery aneurysm

Celiac artery aneurysm

Gastroduodenal and pancreaticoduodenal aneurysms

Gastric and gastroepiploic artery aneurysm

Rare visceral artery aneurysms

Summary

PART VIII: Lower Extremity Occlusive and Non-Occlusive Arterial Disease

CHAPTER 55 Acute Arterial Occlusion of the Lower Extremities

Demographics and pathophysiology

Diagnosis

Therapeutic alternatives

Summary

CHAPTER 56 Aortoiliac Occlusive Disease

Clinical manifestations

Diagnosis

Arteriography

Imaging alternatives

Hemodynamic assessment of multilevel disease

Indications for operation

Surgical treatment

Direct operative procedures

The operative procedure

Special considerations

Results of direct aortoiliofemoral reconstruction

Postoperative complications

Conclusions

CHAPTER 57 Endovascular Treatment of Aortoiliac Artery Stenosis and Occlusions

Introduction

Presentation

Patient management

Procedural details

Outcomes

Summary

CHAPTER 58 Infrainguinal Arterial Disease

Historical perspective

The extent of the problem

The economics of failed limb salvage

Clinical assessment

Clinical classification of infrainguinal occlusive disease

Anatomic classification

Investigations

Management options

On the horizon

Conclusions

CHAPTER 59 Bypasses to Plantar Arteries and Other Branches of Tibial Arteries

Introduction

Anatomic exposure and techniques

Results

Conclusion

CHAPTER 60 Role of Surgical Options for Critical Lower Limb Ischemia

Toe and foot amputations, debridements, and conservative treatment

History of aggressive approach to limb salvage in patients with critical ischemia due to arteriosclerosis and evolution of the relationship between open bypass surgery and angiographic techniques and endovascular treatments

Early use of endovascular techniques (angioplasty and stenting) with bypass surgery

Current and future relationship between endovascular treatments and open bypass surgery

Specific open surgical revascularization procedures

Newer techniques for redo procedures after failed bypasses: thrombectomy and total or partial rescue of a failed ptfe bypass or a totally new bypass

Conclusions

CHAPTER 61 Adjuvant Surgical Techniques for Limb Salvage

Alternative autogenous conduit

Prosthetic conduit

Adjuvant clinical techniques

Allograft

CHAPTER 62 Endovascular Treatment of Infrapopliteal Arteries

Introduction

Clinical and anatomic issues in endovascular treatment of the infrapopliteal arteries

Techniques and specific tips for angioplasty and stenting of the infrapopliteal arteries

Results of endovascular treatment

Other options in the endovascular treatment of infrapopliteal lesion

Strategy in endovascular treatment of the infrapopliteal arteries

Summary

CHAPTER 63 Popliteal Artery Aneurysms

Historical background

Epidemiology

Etiology

Clinical presentation

Diagnostic evaluation

Indications for repair

Open surgical techniques

Endovascular repair

Results

CHAPTER 64 Endovascular Treatment of Popliteal Artery Aneurysms: The Role of Stent-Grafts and Thrombolysis

Introduction

Endovascular popliteal artery aneurysm repair

Thrombolysis

Conclusion

CHAPTER 65 Duplex-guided Balloon Angioplasty for Infrainguinal Arterial Occlusive and Aneurysmal Disease

Introduction

Duplex-guided infrainguinal arterial angioplasties

Duplex-guided endovascular repair of popliteal artery aneurysms

Conclusion

CHAPTER 66 Extra-anatomic Bypasses

Conventional extra-anatomic bypasses

Axillobifemoral bypass

Extended extra-anatomic bypasses

CHAPTER 67 Infected Extracavitary Prosthetic Grafts

Presentation and diagnosis

Management

Conclusions

CHAPTER 68 Popliteal Entrapment and Chronic Compartment Syndrome: Unusual Causes for Claudication in Young Adults

Popliteal entrapment

Diagnosis

Treatment

Summary

Chronic compartment syndrome

Treatment

Summary

CHAPTER 69 Lumbar Sympathectomy: Current Indications and Techniques

Introduction

Physiologic consequences

Assessment of lumbar sympathetic block

Lumbar sympathetic block techniques

Chemical lumbar sympathectomy

Clinical indications and results

CHAPTER 70 Nonatherosclerotic Diseases of Small Arteries

Small and medium vessels

Acute thrombosis of small arteries

Collagen diseases (immune arteritis)

Vasospastic diseases

Mixed organic and vasospastic diseases

Hematologic disorders

CHAPTER 71 Intraoperative Assessment and Postoperative Surveillance of Vascular Reconstructions

Intraprocedural assessment

Surveillance beyond the procedure room

Summary

PART IX: Vascular Trauma

CHAPTER 72 Vascular Trauma

General operative principles

Vascular injuries in specific anatomic locations

Peripheral vascular trauma

Special management problems

CHAPTER 73 Ankle and Foot Fasciotomy for Compartment Syndrome of the Foot

Clinical presentation

Signs and symptoms

The role of compartment pressure measurements

Compartments of the foot

Foot fasciotomy

Ankle fasciotomy

Approach to extended ankle and foot fasciotomy

Results

Conclusion

CHAPTER 74 Post-traumatic Pain Syndrome: Complex Regional Pain Syndrome

Incidence/etiology

Classification/terminology

Summary of the key features of CRPS

Syndrome types

Pathogenesis

Clinical presentation

Symptoms and signs

Comprehensive adjunctive clinical tests

Diagnostic evaluation

Diagnostic sympathetic block

Treatment

Sympathectomy

Overall results of treating CRPS

PART X: Upper Extremity Vascular Disease

CHAPTER 75 Vasospastic Disease of the Upper Extremity: Primary Raynaud’s Syndrome

Introduction

Epidemiology

Pathogenesis

Risk factors

Clinical presentation

Laboratory testing

Treatment

CHAPTER 76 Arterial Surgery of the Upper Extremity

Clinical evaluation

Diagnosis

Proximal arterial lesions

Distal arterial lesions

Aneurysms of upper-extremity arteries

Treatment

CHAPTER 77 Neurogenic Thoracic Outlet Syndrome and Pectoralis Minor Syndrome

Historical background

Types of TOS

Anatomy

Etiology

What’s new? NPMS

Histopathology

Clinical manifestations

Diagnostic tests

Conservative treatment

Surgical treatment

Surgical techniques

Complications of surgery

Results of treatment

Pathophysiology

CHAPTER 78 Venous Thoracic Outlet Syndrome

Introduction

Anatomy

Pathophysiology

Presentation

Diagnosis

Treatment

Prognosis

CHAPTER 79 Arterial Thoracic Outlet Syndrome

Historical background

Clinical background

The subclavian artery

Clinical manifestations

Differential diagnosis

Diagnostic tests

Treatment

Results

Conclusion

CHAPTER 80 Upper Thoracic Sympathectomy: Conventional Technique

Neuroanatomy of upper thoracic sympathetic chain

Indications

Operative techniques

Pitfalls and complications

CHAPTER 81 Thoracoscopic Sympathectomy

Introduction

Surgical anatomy of the sympathetic trunk

Indications

Nomenclature and surgical technique

Results

Conclusion

PART XI: Arterial-Venous Malformation, Access for Hemodialysis and Portal Hypertension

CHAPTER 82 Arteriovenous Fistulas and Vascular Malformations

Historical note

Etiology

Pathophysiology

Acquired arteriovenous fistulas

Diagnosis

Vascular malformations

Classifications

Malformations with arteriovenous shunting

Visceral arteriovenous malformations

Klippel–Trénaunay syndrome

Conclusion

CHAPTER 83 Vascular Access for Dialysis

Historical background

Prerequisites for a dialysis vascular access

Techniques for vascular access

Acute temporary vascular access

Chronic vascular access

CHAPTER 84 Portal Hypertension

Historical background

Anatomy and pathophysiology

Etiology of portal hypertension

Evaluation of patients with portal hypertension

Complications of portal hypertension

Surgical techniques

Budd–chiari syndrome

Portal hypertension in children

Devascularization and esophageal transection

Liver transplantation

CHAPTER 85 Endovascular Treatment of Portal Hypertension

Pathogenesis of portal hypertension

Transjugular intrahepatic portosystemic shunt

Balloon occluded retrograde transvenous obliteration

Endovascular management of Budd–Chiari Syndrome

Sinistral portal hypertension

Conclusion

PART XII: Venous and Lymphatic Disorders

CHAPTER 86 Clinical Application of Objective Testing in Venous Insufficiency

Essential background

Ceap classification

Diagnostic approach

Duplex assessment of venous reflux

Reflux examination development

Validation of duplex testing

Duplex determination of patterns of venous reflux

Valve incompetence in limbs with venous ulceration

Correction of deep venous reflux by superficial venous stripping

Proximal reflux affects distal deep venous function

Hemodynamic testing

Conclusion

CHAPTER 87 Varicose Veins

Introduction

Saphenectomy

Thermal ablation

Chemical ablation

Ambulatory phlebectomy and transilluminated powered phlebectomy

CHIVA

ASVAL

Compression

Recurrent varicose veins

Vulvar varices

CHAPTER 88 Superficial Thrombophlebitis

Introduction

Clinical presentation

Etiology

Pathology

Diagnosis

Treatment

CHAPTER 89 Acute Deep Vein Thrombosis and Contemporary Venous Thrombectomy

Etiology

Diagnosis

Management of acute deep venous thrombosis

Treatment strategies

Contemporary venous thrombectomy

Contemporary results

Technique of venous thrombectomy

Conclusions

CHAPTER 90 Acute Upper Extremity Deep Venous Thrombosis

Introduction

UEDVT

UEDVT versus LEDVT

Placement of superior vena cava filters

Hypercoaguable states associated with UEDVT

Combined UEDVT and LEDVT

Conclusions

CHAPTER 91 Vena Cava Filters

Venous thromboembolic disease

Historical background

General overview

Indications for mechanical protection devices

Technical placement of IVC filters

Special patient groups

Specific filters

Permanent filters

Retrievable and temporary filters

Conclusions

CHAPTER 92 Repair of Iliac and Iliocaval Venous Obstructions

Pathophysiology

Clinical features

Diagnosis

Treatment

Technique

Results

Conclusion

CHAPTER 93 Ablation of Major Incompetent Superficial Veins

Endovenous thermal ablation of the saphenous vein

Results of superficial reflux ablation

CHAPTER 94 Management of Perforator-vein Incompetence

Introduction

Current perforator therapies

CHAPTER 95 Ischemic Venous Thrombosis: Phlegmasia Cerulea Dolens and Venous Gangrene

Introduction

Historical background

Pathophysiology

Etiology

Clinical presentation

Diagnosis

Treatment

Conclusions

CHAPTER 96 Diagnosis and Management of Lymphedema

Normal lymphatics

Classification

Etiology

Diagnosis

Diagnostic methods of evaluation

Treatment

PART XIII: Amputations and Rehabilitation

CHAPTER 97 Amputation of the Lower Extremity: General Considerations

General principles

Principles of conservative management (nonsurgical)

Levels of amputation

CHAPTER 98 Major Amputations

General principles

Above-the-knee amputations

Failed grafts and level of amputation

Pitfalls of amputation

Complications of amputation

Below-knee amputations

Through-knee amputation

Advantages of below-the-knee versus above-the-knee amputations

CHAPTER 99 Postoperative and Preprosthetic Management for Lower Extremity Amputations

Hip disarticulation

Transfemoral amputation

Through-the-knee amputation

Transtibial amputation

Syme’s amputation

CHAPTER 100 Prosthetic Fitting and Management of Lower Extremity Amputees

The ideal residual limb

The prosthetic fitting process

Late-effect complications

Amputee adjustment

Acknowledgments

Index

To my son Michael Sam and my daughter Andrea Rachel for being the major source of inspiration and happiness.

Enrico Ascher, July 2012

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Library of Congress Cataloging-in-Publication Data

Haimovici’s vascular surgery. – 6th ed. / editor-in-chief, Enrico Ascher ; co-editors, Frank J. Veith, Peter Gloviczki ; associate editors, Keith D. Calligaro ... [et al.].

p. ; cm.

 Vascular surgery

 Includes bibliographical references and index.

 ISBN 978-1-4443-3071-7 (hardcover : alk. paper)

 I. Haimovici, Henry, 1907-2001. II. Ascher, Enrico. III. Title: Vascular surgery.

 [DNLM: 1. Vascular Surgical Procedures. 2. Vascular Diseases–diagnosis. 3. Vascular Diseases–surgery. WG 170]

 617.4'13–dc23

2011048151

A catalogue record for this book is available from the British Library.

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Cover design by Steve Thompson

Preface

Henry Haimovici was one of the founding fathers of vascular surgery and it has been a privilege and an honor for me to be allowed to help edit yet another version of his book. Henry died on July 10, 2001 at the age of 93 in New York City following a brilliant clinical and academic career as a vascular surgeon. Henry was a prolific scientific researcher and a well respected surgeon-scientist who contributed in many ways for the maturation of vascular surgery. His pioneer work in the understanding of the pathophysiology and treatment of vascular diseases is impressive. One example is the recognition of renal and metabolic complications of extensive venous thrombosis of the lower extremities leading to gangrene. Henry called it “ischemic venous thrombosis” but the condition became popular under the name of phlegmasia cerula dolens. Dr. Haimovici’s leadership position among vascular surgeons worldwide led him to be one of the founders of the International Society for Cardiovascular Surgery as well as a founding co-editor of the Journal of Cardiovascular Surgery. He became president of the prestigious North American Chapter of the ISCVS (1959–1960) and in 1986 he was elected a corresponding member of the French National Academy of Medicine, an honor bestowed upon so few of the great academicians. Henry Haimovici, a mentor and friend, continues to live among us through his many important contributions to vascular surgery.

Since the last edition of Haimovici’s Vascular Surgery in 2004, endovascular surgery and management of venous diseases continued to play an increasingly important role in the daily activities of vascular surgeons. Accordingly, I was elated when both Drs. Frank J. Veith and Peter Gloviczki accepted to be the principal Co-Editors of the current edition. These legendary surgeons have added significantly to the book and I want to thank them for all their contributions. Equally, I need to recognize and thank all the Co-Editors who did an excellent job reviewing the various chapters and for writing their own chapters. Without this superb group of highly talented surgeons the 6th edition would not have come to fruition.

This edition follows the same principles originally outlined by Henry Haimovici, that is, a combination of fundamental surgical principles with well established vascular and endovascular techniques. Of the 100 chapters in this edition, 31 are totally new chapters and most others have been updated. We left most of Haimovici’s chapters unchanged since they are technical in nature and very well described. I believe the readers of this book will find these and all other chapters to be of great value.

I want to thank Dr. Anil P. Hingorani for his contributions to the book and for allowing me the time to complete this and many other projects. Anne Ober, my assistant of 16 years has been very helpful in following-up with the various authors and keeping us on schedule. Lastly, I want to thank Wiley-Blackwell for all their support and guidance during the creation of this edition.

Enrico Ascher, MDNew York, New York 2012

The editor and publishers have made every effort to contact all the copyright holders to obtain their permission to reproduce copyright material. However, if any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.

Enrico Ascher

Preface to the Fifth Edition

It has been nearly three decades since the late Dr Henry Haimovici (1907–2001) first presented to us his landmark publication Vascular Surgery: Principles and Techniques. Even then he observed that, in this historically brief period of time, we had already experienced momentous developments in the magnitude and scope of our specialty. I believe that, unlike any other period of time and unlike any other surgical specialty, we have also maintained the ability to focus and redirect our craft in tandem with, if not in advance of, the changing needs of our patients and the technological advancements available to us. As a great pioneer of vascular surgery, Dr Haimovici was a principal instrument of our success throughout the infancy and maturation of vascular surgery. He was ever committed to its future beyond measure. Henry was also my mentor and a great friend. I am forever indebted to him for the privilege of assuming editorship of this grand textbook.

We are also saddened by the loss of yet another great leader in vascular surgery: D. Eugene Strandness, Jr., MD (1928–2002). Dr Strandness fielded numerous contributions throughout the formative years of noninvasive vascular testing and ultimately established what has now become our most effective asset in the diagnosis of vascular disease—the vascular laboratory. His early work focused on physiologic tests, but he was also responsible for the development and application of direct ultrasonic methods for vascular diagnosis. Working with engineers at the University of Washington, he combined a B-mode imaging system and a Doppler flow detector to create the first duplex scanner. These explorers of science were prolific in their contributions to our specialty through their research, publications, and societal leaderships. It is in their footsteps that the current and successive generations of vascular leaders must walk—and they have left great shoes for them to fill.

We are proud to have returning Section Editors Larry Hollier (Aortic and Peripheral Aneurysms), Eugene Strandness (Imaging Techniques), and Jonathan B. Towne (Acute Arterial Occlusions of the Lower Extremities). We are also fortunate to have joining us K. Craig Kent (Basic Cardiovascular Problems), John J. Ricotta (Cerebrovascular Insufficiency), Keith D. Calligaro (Visceral Vessels), Gregory L. Moneta (Specific Upper Extremity Occlusions), and William H. Pearce (Venous and Lymphatic Surgery) as Section Editors.

This 5th edition of Haimovici’s Vascular Surgery remains true to its heritage of the comprehensive inspection of the practice of vascular surgery. Innovations in operative technique and reflections on noninvasive diagnostic imaging have been examined and each topic has been updated and expanded. This textbook has now included the most current topics regarding endovascular therapy. Extensive changes have been made to this edition—fully 75 chapters have been revised and 25 new chapters have been added.

Enrico Ascher, MDNew York, New York2003

Contributors

Ali F. AbuRahma MDProfessor of SurgeryChief, Vascular and Endovascular SurgeryDirector, Vascular Surgery FellowshipMedical Director, Vascular LaboratoryCo-Director, Vascular Center of ExcellenceRobert C. Byrd Health Sciences CenterWest Virginia UniversityCharleston, WV, USA

Samuel S. Ahn MD, FACSClinical Professor of SurgeryUCLA School of Medicine;Attending SurgeonUCLA Center for the Health SciencesDivision of Vascular SurgeryLos Angeles, CA, USA

Jose I. Almeida MD, FACS, RVTDirector, Miami Vein CenterVoluntary Associate Professor of SurgeryUniversity of Miami—Jackson Memorial HospitalMiami Vein CenterMiami, FL, USA

Enrico Ascher MDChief of Vascular and Endovascular Surgery Lutheran Medical Center;Professor of SurgeryMount Sinai School of MedicineNew York, NY, USA

Javier E. Anaya-Ayala MDResearch Vascular FellowDepartment of Cardiovascular SurgeryMethodist DeBakey Heart and Vascular CenterHouston, TX, USA

Dennis F. Bandyk MDProfessor of SurgeryDivision of Vascular and Endovascular SurgeryUniversity of California San DiegoLa Jolla, CA, USA

Donald T. Baril MDDivision of Vascular SurgeryUniversity of Pittsburgh Medical CenterPittsburgh, PA, USA

Carlos F. Bechara MD, MSAssistant Professor of SurgeryBaylor College of MedicineHouston, TX, USA

John J. Bergan MD, FACSProfessor of SurgeryUniversity of California, San DiegoProfessor of SurgeryUniformed Services of the Health SciencesBethesda, MD, USA

Ramon Berguer MD, PhDProfessor of SurgeryUniversity of MichiganSchool of MedicineAnn Arbor, MI, USA

Todd L. Berland MD, RPVIAssistant Professors of SurgeryNew York University Medical CenterNew York, NY, USA

W. Austin Blevins MDDivision of Vascular TherapyHawaii Permanente Medical GroupKaiser Foundation HospitalHonolulu, HI, USA

Raphael Blochle MDAssistant Professor of SurgeryThe State University of New YorkBuffalo, NY, USA

John C. Bowen MDChairman Emeritus, Department of SurgeryOchsner Clinic FoundationNew Orleans, LA, USA

Colin M. Brady MDDivision of Vascular Surgery and Endovascular TherapyEmory University School of MedicineAtlanta, GA, USA

David C. Brewster MDClinical Professor of SurgeryHarvard Medical School;SurgeonMassachusetts General HospitalBoston, MA, USA

Igor Brichkov MDAttending SurgeonDivision of Thoracic SurgeryMaimonides Medical CenterBrooklyn, NY, USA

Warner P. Bundens MDAssistant Clinical Professor of SurgeryUniversity of CaliforniaSan Diego, CA, USA

John Byrne MDClinical Fellow in Vascular SurgeryAlbany Medical CenterAlbany, NY, USA

Keith D. Calligaro MDAssociate Clinical ProfessorUniversity of Pennsylvania School of Medicine;Chief, Section of Vascular SurgeryPennsylvania HospitalPhiladelphia, PA, USA

Neal S. Cayne MD, FACSAssistant Professor of SurgeryNew York University Medical CenterNew York, NY, USA

Elliot L. Chaikof MD, PhDJohnson and Johnson Professor of SurgeryHarvard Medical School;Chairman, Roberta and Stephen R. Weiner Department of Surgery;Surgeon-in-ChiefBeth Israel Deaconess Medical CenterBoston, MA, USA

Charlie C. Cheng MDAssistant Professor of SurgeryDivision of Vascular Surgery and Endovascular TherapyTexas Vascular CenterThe University of Texas Medical BranchGalveston, TX, USA

Lorraine Choi MDAssistant Professor of SurgeryDivision of Vascular Surgery and Endovascular TherapyTexas Vascular CenterThe University of Texas Medical BranchGalveston, TX, USA

G. Patrick Clagett MDChairman, Division of Vascular and Endovascular Medicine SurgeryUniversity of Texas Southwestern Medical CenterDallas, TX, USA

Anthony J. Comerota MD, FACS, FACCAdjunct Professor of SurgeryUniversity of MichiganDirector, Jobst Vascular InstituteThe Toledo HospitalToledo, OH, USA

Joseph S. Coselli MDProfessor and Chief of the Division of Cardiothoracic SurgeryMichael E. DeBakey Department of SurgeryBaylor College of Medicine;Chief of the Section of Adult Cardiac SurgeryThe Texas Heart Institute at St. Luke’s Episcopal HospitalHouston, TX, USA

Enrique Criado MDProfessor of SurgeryUniversity of Michigan School of MedicineAnn Arbor, MI, USA

Jacob Cynamon MDClinical Professor of RadiologyAlbert Einstein College of Medicine;Director, Division of Vascular and Interventional RadiologyMontefiore Medical CenterBronx, NY, USA

Alan Dardik MD, PhDAssociate Professor of SurgeryDepartment of SurgeryThe Yale University School of MedicineNew Haven, CT, USA

R. Clement Darling III MDProfessor of SurgeryAlbany Medical College;Chief, Division of Vascular SurgeryAlbany Medical CenterAlbany, NY, USA

Mark G. Davies MD, PhD, MBAProfessor of SurgeryWeill Medical College at Cornell UniversityNew York, NY;Department of Cardiovascular SurgeryMethodist DeBakey Heart and Vascular CenterHouston, TX, USA

Brian G. DeRubertis MDAssistant Professor of Surgery David Geffen School of Medicine at UCLALos Angeles, CA, USA

Matthew J. Dougherty MD, FACSAssistant Clinical ProfessorUniversity of PennsylvaniaSection of Vascular SurgeryPennsylvania HospitalPhiladelphia, PA, USA

Jonathan L. Eliason MDAssistant Professor of SurgerySection of Vascular SurgeryUniversity of MichiganAnn Arbor, MI, USA

Calvin B. Ernst MDClinical Professor of SurgeryUniversity of Michigan Medical School;Head, Division of Vascular SurgeryHenry Ford HospitalDetroit, MI, USA

Anthony L. Estrera MDChief of Cardiac SurgeryDepartment of Cardiothoracic and Vascular SurgeryThe University of Texas at Houston Medical SchoolMemorial Hermann Heart and Vascular InstituteHouston, TX, USA

Alik Farber MDChief of Vascular and Endovascular SurgeryBoston Medical Center;Associate Professor of Surgery and RadiologyBoston University School of MedicineBoston, MA, USA

April Farley BSBaylor College of MedicineHouston, TX, USA

Peter L. Faries MD, FACSDivision Chief, Vascular SurgeryProfessor of SurgeryProfessor of RadiologyMount Sinai Medical CenterNew York, NY, USA

Javairiah Fatima MB, BSResident, Department of SurgeryMayo ClinicRochester, MN, USA

Julie A. Freischlag MDThe William Stewart Halsted Professor of SurgeryChair, Department of SurgerySurgeon-in-Chief, Department of SurgeryJohns Hopkins Medical InstitutionsBaltimore, MD, USA

Karan Garg MDSurgery ResidentNew York University Medical CenterNew York, NY, USA

Nicholas J. Gargiulo III MDUniversity of RochesterRochester, NY, USA

Ramyar Gilani MDMichael E. DeBakey Department of SurgeryBaylor College of MedicineHouston, TX, USA

Natalia O. Glebova MD, PhDResident in General SurgeryJohns Hopkins HospitalBaltimore, MD, USA

Peter Gloviczki MDProfessor of SurgeryMayo Medical School;Chair, Division of Vascular SurgeryDirector, Gonda Vascular CenterMayo Clinic and FoundationRochester, MN, USA

Yosef Golowa MDClinical Assistant Professor of RadiologyAlbert Einstein College of Medicine;Attending Radiologist, Division of Vascular and Interventional RadiologyMontefiore Medical CenterBronx, NY, USA

Kapil Gopal MD, MBAAssistant Professor of SurgeryUniversity of Maryland School of MedicineBaltimore, MD, USA

Henry Haimovici MD(deceased)Former Foreign Corresponding MemberFrench National Academy of MedicineParis, FranceFormer Clinical Professor Emeritus of SurgeryAlbert Einstein College of Medicine at Yeshiva UniversityFormer Senior Consultant andChief Emeritus of Vascular SurgeryMontefiore Medical CenterBrooklyn NY, USA

Linda M. Harris MD, FACSAssociate Professor of SurgeryThe State University of New YorkBuffalo, NY, USA

Foster A. Hays BSUniversity of Texas Southwestern Medical CenterDallas, TX, USA

Asher Hirshberg MDProfessor of SurgeryState University of New YorkDownstate College of Medicine;Director of Vascular SurgeryKings County Hospital CenterBrooklyn, NY, USA

Anil Hingorani MDAttending SurgeonLutheran Medical Center;Associate ChairmanThe Vascular Institute of New York;Associate Professor of SurgeryMount Sinai School of MedicineNew York, NY, USA

Jeffrey Hnath MDAlbany Medical College / Albany Medical Center HospitalThe Institute for Vascular Health and DiseaseAlbany, NY, USA

Kim J. Hodgson MDProfessor and ChairDivision of Vascular SurgerySouthern Illinois UniversitySchool of MedicineSpringfield, IL, USA

Frederick L. Hoff MDAssistant Professor of RadiologyDepartment of RadiologyNorthwestern University Medical SchoolChicago, IL, USA

Douglas B. Hood MDAssociate ProfessorDivision of Vascular SurgerySouthern Illinois UniversitySchool of MedicineSpringfield, IL, USA

Joel H. Horovitz MD, FACS, FRCS(C)Vice Chairman, Department of SurgeryDirector, General SurgeryMaimonides Medical CenterBrooklyn, NY, USA

Larry H. Hollier MD, FACS, FACC, FRCS (Eng)Chancellor of Louisiana State UniversityHealth Sciences CenterNew Orleans, LA, USA

Carber C. Huang MDEndovascular Fellow, Division of Vascular SurgeryUCLA School of MedicineLos Angeles, CA, USA

Joseph Huh MDAssociate Professor, Division of Cardiothoracic SurgeryMichael E. DeBakey Department of SurgeryBaylor College of Medicineand Cardiovascular Surgery StaffThe Texas Heart Institute at St. Luke’s Episcopal HospitalHouston, TX, USA

Mark Iafrati MDChief, Vascular SurgeryDirector Vascular Medicine CenterTufts Medical CenterBoston, MA, USA

Juan Carlos Jimenez MD, FACSAssistant Professor of SurgeryGonda (Goldschmied) Vascular CenterDavid Geffen School of Medicine at UCLA;Attending SurgeonRonald Reagan UCLA Medical CenterUCLA-Olive View Medical CenterUCLA-Santa Monica HospitalLos Angeles, CA, USA

Gustavo De Jesús-Gómez MDDivision of Vascular and Endovascular Surgery,University of South Florida College of MedicineTampa, FL, USA

Jeanwan Kang MDVascular Surgery FellowMassachusetts General HospitalDivision of Vascular and Endovascular SurgeryBoston, MA, USA

Manju Kalra MBBSAssociate Professor of Surgeryand Consultant, Division of Vascular and Endovascular SurgeryMayo ClinicRochester, MN, USA

Aoife N. Keeling FFR RCSIInterventional RadiologyNorthwestern University Medical SchoolChicago, IL, USA

K. Craig Kent MDProfessor of SurgeryColumbia Weill Cornell Division of Vascular SurgeryColumbia College of Physicians and SurgeonsWeill Medical College of Cornell UniversityNew York, NY, USA

George Kopchok BSBiomedical EngineerLos Angeles Biomedical Research Institute atHarbor UCLA Medical CenterTorrance, CA, USA

Christopher J. Kwolek MDProgram Director in Vascular SurgeryMassachusetts General HospitalDivision of Vascular and Endovascular SurgeryBoston, MA, USA

Gregory J. Landry MDAssociate Professor of SurgeryDivision of Vascular SurgeryOregon Health and Science UniversityPortland, OR, USA

Peter F. Lawrence MDDirector, Gonda (Goldschmied) Vascular CenterWiley Barker Endowed Chair and Chief of Vascular Surgery David Geffen School of Medicine at UCLALos Angeles, CA, USA

Scott A. LeMaire MDProfessor and Director of ResearchDivision of Cardiothoracic SurgeryMichael E. DeBakey Department of SurgeryBaylor College of Medicineand Cardiovascular Surgery StaffThe Texas Heart Institute at St. Luke’s Episcopal HospitalHouston, TX, USA

Peter H. Lin MDProfessor of SurgeryBaylor College of MedicineHouston, TX, USA

Evan C. Lipsitz MDAssociate Professor of SurgeryChief, Division of Vascular and Endovascular SurgeryMontefiore Medical Center and the Albert Einstein College of MedicineBronx, NY, USA

Bo Liu PhDAssociate ProfessorDepartment of SurgerySchool of Medicine and Public HealthUniversity of WisconsinMadison, WI, USA

Alan B. Lumsden MDProfessor of SurgeryWeill Medical College at Cornell UniversityNew York, NY;Chairman, Department of Cardiovascular SurgeryMedical DirectorMethodist DeBakey Heart and Vascular CenterHouston, TX, USA

Harry Ma MD, PhDVascular SurgeryTufts Medical CenterBoston, MA, USA

Robyn A. Macsata MD, FACSChief, Vascular SurgeryVeterans Affairs Medical CenterWashington DC, USA

Michel S. Makaroun MDDivision of Vascular SurgeryUniversity of Pittsburgh Medical CenterPittsburgh, PA, USA

Jesse M. Manunga, Jr. MDFellow, Division of Vascular and Endovascular SurgeryMayo ClinicRochester, MN, USA

Natalie Marks MD, RVTThe Vascular Institute of New YorkDivision of Vascular Surgery at Maimonides Medical CenterBrooklyn, NY, USA

Kenneth L. Mattox MDDistinguished Service ProfessorMichael E. DeBakey Department of SurgeryBaylor College of MedicineHouston, TX, USA

Manish Mehta MD, MPHAssociate Professor of SurgeryAlbany Medical College / Albany Medical Center HospitalThe Institute for Vascular Health and DiseaseAlbany, NY, USA

Charles C. Miller IIIFoster School of MedicineTexas Tech University Health Sciences CenterEl Paso, TX, USA

Yoshio Mishima MDProfessor and Chairman of SurgeryTokyo Medical and Dental UniversityTokyo, Japan

Lynn S. Model MDDepartment of SurgeryThe Yale University School of MedicineNew Haven, CT, USA

Takki A. Momin MDVascular Surgery FellowGeorgetown University / Washington Hospital CenterWashington DC, USA

Gregory L. Moneta MDProfessor of SurgeryChief, Division of Vascular SurgeryOregon Health Sciences UniversityPortland, OR, USA

Albeir Y. Mousa MDAssistant ProfessorDepartment of SurgeryRobert C. Byrd Health Sciences CenterWest Virginia UniversityCharleston, WV, USA

Peter A. Naughton MDFellow, Vascular SurgeryNorthwestern University Medical SchoolChicago, IL, USA

Peter Neglen MD, PhDUniversity of Mississippi Medical Centerand River Oaks HospitalFlowood, MS, USA

Nicolas Nelken MDDivision of Vascular TherapyHawaii Permanente Medical GroupKaiser Foundation HospitalHonolulu, HI, USA

Richard F. Neville MD, FACSChief, Division of Vascular SurgeryProfessor of SurgeryGeorge Washington UniversityWashington, DC, USA

Audra A. Noel MDAssistant Professor of SurgeryMayo Medical SchoolConsultantDivision of Vascular SurgeryMayo ClinicRochester, MN, USA

Gustavo S. Oderich MDAssociate Professor of SurgeryConsultant, Saint Marys and Methodist HospitalDirector of Endovascular TherapyDirector of Edward Rogers Clinical Research Fellowship ProgramDivision of Vascular and Endovascular SurgeryMayo Clinic College of MedicineRochester, MN, USA

Kenneth Ouriel MDSyntactxNew York, NY, USA

William H. Pearce MDViolet R. and Charles A. Baldwin Professor of Vascular SurgeryDepartment of SurgeryNorthwestern University Medical SchoolChicago, IL, USA

Eric K. Peden MDAssistant Professor of SurgeryWeill Medical College at Cornell UniversityNew York, NY;Department of Cardiovascular SurgeryMethodist DeBakey Heart and Vascular CenterHouston, TX, USA

Bruce A. Perler MD, MBAJulius H Jacobson, II Professor of SurgeryChief, Division of Vascular Surgery & Endovascular TherapyJohn Hopkins UniversitySchool of MedicineBaltimore, MD, USA

Adam H. Power MDClinical Fellow in Vascular and Endovascular SurgeryDivision of Vascular and Endovascular SurgeryMayo Clinic College of MedicineMayo ClinicRochester, MN, USA

William J. Quinones-Baldrich MDProfessor of SurgeryDavid Geffen School of Medicine at UCLA;Director UCLA Aortic CenterRonald Reagan UCLA Medical CenterLos Angeles, CA, USA

Rodeen Rahbar MD, FACSAssistant Professor of SurgeryGeorge Washington UniversityWashington, DC, USA

Jeffrey K. Raines PhD, RVTDirector, Vascular Laboratory and ResearchMiami Vein CenterEmeritus Professor of SurgeryUniversity of Miami Miller School of MedicineMiami, FL, USA

Seshadri Raju MDProfessor Emeritus and Honorary SurgeonUniversity of MS Medical Center;Attending PhysicanRiveroaks HospitalFlowood, MS, USA

Jorge Rey MDThe Institute for Vascular Health and DiseaseAlbany Medical College / Albany Medical Center HospitalAlbany, NY, USA

John J. Ricotta MDChairman of SurgeryWashington Hospital Center and Georgetown UniversityWashington, DC, USA

Joseph J. Ricotta II MD, MSAssistant Professor of SurgeryDirector of Clinical ResearchDirector, International Clinical Research Fellowship in Vascular SurgeryAssociate Program Director, Vascular Surgery FellowshipDivision of Vascular Surgery and Endovascular TherapyEmory University School of MedicineAtlanta, GA, USA

David A. Rigberg, MDAssociate Professor of SurgeryDavid Geffen School of Medicine at UCLALos Angeles, CA, USA

Sean P. Roddy MDAssociate Professor of SurgeryThe Institute for Vascular Health and DiseaseAlbany Medical CollegeAlbany Medical Center HospitalAlbany, NY, USA

Hazim J. SafiDepartment of Cardiothoracic and Vascular SurgeryThe University of Texas at Houston Medical SchoolMemorial Hermann Heart and Vascular InstituteHouston, TX, USA

Russell H. Samson MD, RVT, FACSClinical Associate Professor of Surgery (Vascular) and President, Mote Foundation IncFlorida State University Medical SchoolTallahassee, FL, USA

Richard J. Sanders MDClinical Professor of SurgeryUniversity of Colorado School of MedicineRose Medical CenterDenver, CO, USA

Sartaj S. Sanghera MDSurgical Oncology FellowRoswell Park Cancer InstituteBuffalo, NY, USA

Andres Schanzer MDAssociate Professor of SurgeryUniversity of Massachusetts Medical SchoolDivision of Vascular and Endovascular SurgeryWorcester, MA, USA

Harry Schanzer MD, FACSClinical Professor of SurgeryMount Sinai School of Medicine;Attending SurgeonMount Sinai HospitalNew York, USA

Peter A. Schneider MDDivision of Vascular TherapyHawaii Permanente Medical GroupKaiser Foundation HospitalHonolulu, HI, USA

Gary R. Seabrook MDProfessor of Vascular SurgeryMedical College of WisconsinMilwaukee, WI, USA

Amit R. Shah MDVascular SurgeonMontefiore Medical Center and the Albert Einstein College of MedicineBronx, NY, USA

Tejas R. Shah MDDepartment of SurgeryMount Sinai Medical CenterNew York, NY, USA

Jason P. Shaw MDAttending SurgeonDivision of Thoracic SurgeryMaimonides Medical CenterBrooklyn, NY, USA

Roy SheinbaumDepartment of Cardiothoracic and Vascular SurgeryThe University of Texas at Houston Medical SchoolMemorial Hermann Heart and Vascular InstituteHouston, TX, USA

Alexander Shiferson DODepartment of Vascular SurgeryMaimonides Medical CenterBrooklyn, NY, USA

Anton N. Sidawy MD, MPH, FACSProfessor and ChairmanDepartment of SurgeryGeorge Washington UniversityWashington, DC, USA

Michael B. Silva Jr MDThe Fred J. and Dorothy E. Wolma Professor in VascularSurgery and Professor of RadiologyChief, Division of Vascular Surgery and Endovascular TherapyDirector, Texas Vascular CenterThe University of Texas Medical BranchGalveston, TX, USA

Taylor A. Smith MDDivision of Vascular and Endovascular Surgery Ochsner Medical CenterNew Orleans, LA, USA

James C. Stanley MDHandleman Professor of SurgerySection of Vascular SurgeryUniversity of MichiganAnn Arbor, MI, USA

Yaron Sternbach MDAssociate Professor of SurgeryAlbany Medical College / Albany Medical Center HospitalThe Institute for Vascular Health and DiseaseAlbany, NY, USA

Jan J. Stokosa CP, FAAOPAmerican Prosthetic InstituteStokosa Prosthetic ClinicEast Lansing, MI, USA

David S. Sumner MDDistinguished Professor of SurgeryChief, Section of Peripheral Vascular SurgerySouthern Illinois University School of MedicineSpringfield, IL, USA

Bauer E. Sumpio MD, PhDProfessor and Vice Chairman of SurgeryChief, Vascular SurgeryYale University School of Medicine;Chief, Vascular ServiceYale–New Haven HospitalNew Haven, CT, USA

John B. Taggert MDAlbany Medical College / Albany Medical Center HospitalThe Institute for Vascular Health and DiseaseAlbany, NY, USA

Martin D. Tilson MDAilsa Mellon Bruce Professor of Surgery Columbia University;Director EmeritusDepartment of SurgerySt. Luke’s / Roosevelt HospitalNew York, NY, USA

William D. Turnipseed MDProfessor of SurgeryDivision of Vascular SurgeryUniversity of Wisconsin HospitalMadison, WI, USA

Frank J. Veith MD, FACSDivision of Vascular SurgeryNew York University Medical CenterNew York, NY;The Cleveland ClinicCleveland, OH, USA

Rodney A. White MDChief of Vascular SurgeryHarbor–UCLA Medical Center, Torrance, CA;Professor of Surgery, UCLA School of MedicineLos Angeles, CA, USA

Tze-Woei Tan MDFellow, Vascular SurgeryBoston Medical CenterBoston, MA, USA

Yeongchi Wu MDAssociate Professor of Physical Medicine and RehabilitationNorthwestern University Medical School;Director, Amputee RehabilitationRehabilitation Institute of ChicagoCenter for International RehabilitationChicago, IL, USA

List of Abbreviations

AAA

abdominal aortic aneurysm

AAAP-40

aortic aneurysm-associated protein 40

AASV

anterior accessory saphenous vein

ABF

aortofemoral bypass

ABI

ankle-brachial index

ABPI

ankle brachial pressure index

ACE

angiotensin-converting enzyme

ACP

antegrade cerebral perfusion

ACS

acute coronary syndromes

ACT

activated clotting time

ADP

adenosine diphosphate

AER

abduction external rotation

AIOD

aortoiliac occlusive disease

ALI

acute limb ischemia

AMI

acute mesenteric ischemia

AMP

adenosine monophosphate

AMS

absorbable metal stent

ANA

antinuclear antibody

AP

ambulatory phlebectomy

APC

activated protein C

APG

air plethysmography

ApoA

apoprotein A

ApoB

apoprotein B

aPTT

activated partial thromboplastin time

ARB

angiotensin-receptor blocking agent

ASM

anterior scalene muscle

ASO

arteriosclerosis obliterans

ASVAL

ambulatory selective varices ablation under local anesthesia

ATIII

antithrombin III

ATOS

arterial thoracic outlet syndrome

ATP

adenosine triphosphate

AV

arteriovenous

AVA

arteriovenous anastomosis

AVF

arteriovenous fistula

AVG

arteriovenous grafts

AVM

arteriovenous malformation

AVSS

Aberdeen varicose vein severity score

BAI

blunt aortic injury

BAM

balloon-assisted maturation

BCS

Budd–Chiari syndrome

BCVI

blunt cerebrovascular injury

bFGF

basic fibroblast growth factor

BIPAP

bi-level positive airway pressure

BMAC

bone marrow aspirate concentrate

BMS

bare-metal stent

BP

blood pressure

BPA

blood-pool contrast agents

BRTO

balloon-occluded retrograde transvenous obliteration

CA

carotid artery, contrast angiography

CAA

carotid artery atherosclerosis, celiac artery aneurysm

CABG

coronary artery bypass graft

CACS

celiac artery compression syndrome

CAD

coronary artery disease

cAMP

cyclic adenosine monophosphate

CAS

carotid artery stenting

CBA

cutting-balloon angioplasty

CBP

cardiopulmonary bypass

CCA

common carotid artery

CCS

chronic compartment syndrome

CEA

carotid endarterectomy

CFA

common femoral artery

CFDI

color flow duplex imaging

cGFR

calculated glomerular filtration rate

cGMP

cyclic guanine monophosphate

CGRP

calcitonin gene-related peptide

CHD

coronary heart disease

CHF

congestive heart failure

CIA

common iliac artery

CIN

contrast-induced nephropathy

CLI

critical limb ischemia

CMI

chronic mesenteric ischemia

COPD

chronic obstructive pulmonary disease

CPAP

continuous positive airway pressure

CPB

cardiopulmonary bypass

CRI

chronic renal insufficiency

CRP

C-reactive protein

CRPS

complex regional pain syndrome

CSF

cerebrospinal fluid

CT

computed tomography

CTA

computed tomographic angiography

CTO

chronic total occlusion

CV

contrast venography

CVD

cardiovascular disease, chronic venous disease

CVI

chronic venous insufficiency

DA

duplex arteriography

DAG

diacylglycerol

dAVF

distal arteriovenous fistula

DES

drug-eluting stent

DHCA

deep hypothermic circulatory arrest

DLT

decongestive lymphatic therapy

DR

diameter reduction

DSA

digital subtraction angiography

DSE

dobutamine stress echocardiography

DSRS

distal splenorenal shunt

DTPA

diethylenetriamine pentaacetic acid

DUS

duplex ultrasound

DVP

distal vein patch

DVT

deep vein thrombosis

DWI

diffusion-weighted imaging

DW-MR

diffusion-weighted magnetic resonance

EAST

elevated arm stress test

EC

endothelial cell

ECA

external carotid artery

ECG

electrocardiogram

ECM

extracellular matrix

EDRF

endothelial-dependent relaxing factor

EDS

Ehlers–Danlos syndrome

EDV

end-diastolic velocity

EEG

electroencephalogram

EEL

external elastic lamina

EGF

epidermal growth factor

EHIT

endovenous heat-induced thrombosis

EIA

external iliac artery

ELG

endoluminal graft

ELISA

enzyme-linked immunosorbent assay

eNOS

endothelial nitric oxide synthase

EPC

endothelial progenitor cell

EPD

embolic protection devices

EPSF

early postsurgical fitting

ePTFE

expanded polytetrafluoroethylene

ER-DP

extended-release dipyridamole

E-selectin

endothelial-cell selectin

ESR

erythrocyte sedimentation rate

ESRD

end-stage renal disease

ET

endothelin

EVAR

endovascular aneurysm repair

EVL

endovenous laser

EVPAR

endovascular popliteal artery aneurysm repair

FAP

femoral artery pressure

FAK

focal adhesion kinase

FDA

Food and Drug Administration

FEP

fluorinated ethylene propylene

FEV1

forced expiratory volume in one second

FGF

fibroblast growth factor

FOV

field of view

FXII

factor XII

G-6PD

glucose-6-phosphate dehydrogenase

GA

general anesthesia

G-CSF

granulocyte colony-stimulating factor

GDAA

gastroduodenal aneurysm

GFR

glomerular filtration rate

GFV

graft flow velocity

GRE

gradient echo

GSM

grayscale medium

GSV

great saphenous vein

HAA

hepatic artery aneurysm

HB-EGF

heparin-binding epidermal growth factor

HBOT

hyperbaric oxygen therapy

HCC

hepatocellular carcinoma

HCI

hypobaric compression interface

HDL

high-density lipoprotein

HGF

hepatocyte growth factor

HIF

hypoxia-inducible factor

HIS

hypobaric cushion interface with integrated suspension

HIT

heparin-induced thrombocytopenia

HLA

human leukocyte antigen

HMVEC

human microvascular endothelial cell

HMWK

high-molecular-weight kininogen

HO

heme oxygenase

HRE

hypoxia response element

HRS

hepatorenal syndrome

HSC

hematopoietic stem cell

HSLW

hemoglobin-specific laser wavelengths

HU

Hounsfield unit

HUVEC

human umbilical-vein endothelial cell

IAA

iliac artery aneurysm

IBD

iliac branched device

ICA

internal carotid artery

ICAM

intercellular cell-adhesion molecule

IDE

investigational device exemption

IDL

intermediate-density lipoprotein

IEL

internal elastic lamina

IEUS

intraoperative epiaortic ultrasound

IFN

interferon

IGF

insulin-related growth factor

IH

intimal hyperplasia

IIA

internal iliac artery

IL-1

interleukin 1

IMA

inferior mesenteric artery

iNOS

inducible nitric oxide synthase

INR

international normalized ratio

IP

3

inositol triphosphate

IPG

intraoperative pressure gradient

IPSF

immediate postsurgical fitting

IPV

incompetent perforator veins

IVT

ischemic venous thrombosis

IVUS

intravascular ultrasound

KTS

Klippel–Trénaunay syndrome

LAO

left anterior oblique

LDL

low-density lipoprotein

LDL-C

low-density lipoprotein cholesterol

LE

lupus erythematosus

LE DVT

lower-extremity deep vein thrombosis

LEED

linear endovenous energy density

LHB

left heart bypass

LIMA

left internal mammary artery

LL

laparoscopic lysis

LMWH

low-molecular-weight heparin

LR

lactated Ringer’s

LSV

long saphenous vein

MACE

major adverse cardiac events

MALS

median arcuate ligament syndrome

MAP kinase    

mitogen-activated protein kinase

MCA

middle cerebral artery

MCP-1

monocyte chemoattractant protein 1

MDCTA

multidetector computed tomographic angiography

MEP

motor-evoked potential

MET

metabolic equivalent

MHC

major histocompatability complex

MI

myocardial infarction

MIP

maximal intensity projection

MMP

matrix metalloproteinase

MPA

mycophenoleic acid

MR

magnetic resonance

MRA

magnetic resonance angiography

MRI

magnetic resonance imaging

MRV

magnetic resonance venography

MSC

mesenchymal stem cell

MSM

middle scalene muscle

MVT

mesenteric venous thrombosis

NIH

neointimal hyperplasia

NIV

noninvasive ventilation

NIVL

nonthrombotic iliac vein lesion

NO

nitric oxide

NOS

nitric oxide synthase

NP

naturetic peptide

NPMS

neurogenic pectoralis minor syndrome

NRH

nodular regenerative hyperplasia

NSF

nephrogenic systemic fibrosis

NTOS

neurogenic thoracic outlet syndrome

OLT

orthotopic liver transplantation

PA

popliteal artery

PAA

popliteal artery aneurysm

PAAA

para-anastomotic aortic aneurysm

PACU

post-anesthesia care unit

PAD

peripheral arterial disease

PAF

platelet-activating factor

PAI-1

plasminogen activator inhibitor 1

PAI-2

plasminogen activator inhibitor 2

PAPs

percutaneous ablation of perforators

PC

primary closure

PCA

patient-controlled anesthesia

PCD

phlegmasia cerulea dolens

PCI

percutaneous cardiac intervention

Pco2

partial pressure of carbon dioxide

PDAA

pancreaticoduodenal aneurysm

PDE5

phosphodiesterase type 5

PDGF

platelet-derived growth factor

PE

pulmonary embolism

PEEP

positive end-expiratory pressure

PEG

polyethylene glycol

PGI

2

prostacyclin

PHG

portal hypertensive gastropathy

PICA

posterior inferior cerebellar artery

PM

pectoralis minor

PMM

pectoralis minor muscle

PMS

pectoralis minor syndrome

PMT

pectoralis minor tenotomy, percutaneous mechanical thrombectomy

POBA

plain old balloon angioplasty

PPAR

peroxisome proliferator-activated receptor

PPC

postoperative pulmonary complications

PPG

photoplethysmography

PRF

pulse-repetition frequency

PSGL-1

P-selectin glycoprotein ligand 1

PSS

Paget–Schroetter syndrome

PSV

peak systolic velocity

PTA

percutaneous transluminal angioplasty

PTCV

posterior thigh circumflex vein

PTFE

polytetrafluoroethylene

PTPS

posttraumatic pain syndrome

PV

perforator vein

PVR

pulse-volume recording

QSART

quantitative sudomotor axon reflex test

QST

quantitative sensory testing

RA

renal artery, regional anesthesia

rAAA

ruptured abdominal aortic aneurysm

RAFT

radial artery flow-through

RAR

renal aortic ratio

RCP

retrograde cerebral perfusion

RCT

randomized controlled trial

RFA

radiofrequency ablation

RI

resistive index

RIMA

right internal mammary artery

RP

retroperitoneal

RRD

removable rigid dressing

RSD

reflex sympathetic dystrophy

RSRI

renal systemic renin index

rtPA

recombinant tissue plasminogen activator

RV

renal vein, residual volume

RVRR

renal vein renin ratio

RVT

registered vascular technologist

RVU

relative value units

SA

subclavian artery

SAA

splenic artery aneurysm

SCF

stem cell factor

SCI

spinal cord injury

SCM

sternocleidomastoid

SDF

stroma-derived factor

SEPS

subfascial endoscopic perforator surgery

SFA

superficial femoral artery

SFJ

saphenofemoral junction

SFJT

saphenofemoral junction thrombophlebitis

SIA

subintimal angioplasty

SIP

sympathetically independent pain

SMA

superior mesenteric artery

SMAA

superior mesenteric artery aneurysm

SMC

smooth muscle cell

SMP

sympathetically maintained pain

SNR

signal-to-noise ratio

SSEP

somatosensory-evoked potential

SSFP

steady-state free precession

SSV

short saphenous vein

SSVT

suppurative superficial venous thrombophlebitis

SVC

superior vena cava

SVC-GF

superior vena cava Greenfield filter

SVR

superficial venous reflux

SVT

superficial venous thrombophlebitis

TAA

thoracic aortic aneurysm

TAAA

thoracoabdominal aortic aneurysm

TAO

thromboangiitis obliterans

TASC

TransAtlantic Intersociety Consensus

TBPI

toe brachial pressure index

TCD

transcranial Doppler

TcPo2

transcutaneous oxygen tension

TE

echo time

TEA

transaortic endarterectomy

TEE

transesophageal echocardiography

TEVAR

thoracic endovascular aneurysm repair

TF

tissue factor

TGF

transforming growth factor

TIA

transient ischemic attack

TIMP

tissue inhibitor of metalloproteinases

TIPS

transjugular intrahepatic portosystemic shunt

TMJ

temporomandibular joint

TNF-α

tumor necrosis factor alpha

TOS

thoracic outlet syndrome

TP

transperitoneal

tPA

tissue plasminogen activator

TR

repetition time

TRAK

time-resolved angiography using keyhole

TREATS

time-resolved echo-shared angiography technique

TRICKS

time-resolved imaging of contrast kinetics

TriVex

transilluminated powered phlebectomy

TVS

temporary vascular shunts

UE DVT

upper-extremity deep vein thrombosis

UFH

unfractionated heparin

UGFS

ultrasound-guided foam scleropathy

UGS

ultrasound-guided sclerotherapy

UK

urokinase

ULTT

upper limb tension test

uPA

urokinase plasminogen activator

US

ultrasound

VAA

visceral artery aneurysm

VAS

visual analogue scale

VBI

vertebrobasilar ischemia

VCAM

vascular cell-adhesion molecule

VEGF

vascular endothelial growth factor

VH

virtual histology

VI

vascular innovation

VLA-4

very-late forming antigen 4

VLDL

very-low-density lipoprotein

VM

vascular malformation

VOD

veno-occlusive disease

V/Q

ventilation perfusion

VTE

venous thromboembolic disease

VTOS

venous thoracic outlet syndrome

WBC

white blood cell

WHVP

wedged hepatic vein pressure

WSLW

water-specific laser wavelengths

XRT

radiation therapy

PART I

Vascular Imaging Techniques and Physiologic Testing

CHAPTER 1

Arterial and Venous Duplex Scanning

Gregory L. Moneta

Oregon Health and Science University, Portland, OR, USA

The noninvasive vascular laboratory provides the scientific basis for vascular surgery. It safely provides accurate and quantitative evidence of the presence and physiologic significance of arterial and venous disease. In the modern vascular laboratory ultrasound-based techniques, particularly duplex ultrasound techniques, are most extensively employed.

Ultrasound Basics

Duplex ultrasound was introduced in 1974 with application to the carotid artery. “Duplex” indicates the technique combines B-mode imaging and Doppler analysis of blood-flow direction and velocity. It is extensively utilized for evaluation of carotid arteries, intra-abdominal arteries and veins, and upper- and lower-extremity arteries and veins. Since its inception, engineering and software advances have been extensive and include: 1) improved gray-scale B-mode imaging, 2) low-frequency scan heads permitting deep penetration of the ultrasound beam from the skin surface, 3) improvements in online computer-based microprocessing, and 4) addition of color-flow imaging.

Color flow is a superimposed real-time colorized image of blood flow onto a standard gray-scale B-mode picture. Echoes from stationary tissues generate B-mode images, whereas those interacting with moving substances (blood) generate a phase shift that is processed separately and color coded to give information on the direction and velocity of blood flow that reflects the magnitude and direction of the Doppler shift. Color flow dramatically reduces the time required to perform duplex examinations by allowing more rapid identification of vessels to be examined. It appears essential for duplex examination of some vessels, such as tibial arteries and veins. Color flow and the ability of modern duplex scanners to detect blood flow velocities <5 cm/s make duplex scanning practical in virtually all areas of the body.

Basics of Duplex Ultrasound

A vibrating source produces an ultrasonic wave. In duplex ultrasound the vibrating source is the transducer. Ultrasound transducers are contained within scan heads. Scan heads steer and focus the sound beam produced by the transducer. The ultrasound image is derived from the returning echoes and is dependent on precise steering and focusing of the sound beam.

Transducers convert electrical into vibrational energy to produce the ultrasound wave. Transducers can also convert vibrational energy of returning echoes into electrical signals for analysis by the duplex machine’s software. The frequency of the vibration is determined by the design of the transducer and determines the wavelength of the sound wave. Frequency and wavelength are related, λ = c/f, where λ is the wavelength, c is the speed of sound in tissue, and f is the frequency.

Speed of sound in soft tissues averages 1540 m/s. There is little variation in the soft tissues insonated in clinical use of duplex ultrasound. Wavelength is the principle determinant of how well an ultrasound beam penetrates tissue, and wavelength depends on the frequency of the transducer. The transducer frequency is determined by the design of the transducer and is thus controlled by the manufacturer. For examination of the carotid artery, transducer frequencies of 5 to 7.5 MHz provide optimal tissue penetration for clinical purposes.

As noted above, duplex refers to the combination of Doppler and B-mode (“B” stands for “brightness”) ultrasound in the same device. Both require analysis of reflected echoes of the original sound beam created by the ultrasound transducer. B-mode analyzes the strength (intensity) and origin of the reflected echo. Doppler analyzes shifts in frequency of the original sound wave produced by the transducer.

B-Mode Ultrasound

As a sound wave passes through tissue and moves away from the transducer its strength depends upon how much the beam is scattered, attenuated, and reflected. Strength of reflected echoes depend, in part, upon differences in acoustic impedance between media. When there are major differences in acoustic impedance a large proportion of the sound beam is reflected back to the transducer. Small differences in acoustic impedances result in little reflection and the beam continues to propagate through the tissue.