Difficult Decisions in Vascular Surgery: An Evidence-Based Approach PDF
Preview Difficult Decisions in Vascular Surgery: An Evidence-Based Approach
Diffi cult Decisions in Surgery: An Evidence-Based Approach Christopher L. Skelly Ross Milner Editors Diffi cult Decisions in Vascular Surgery An Evidence-Based Approach Difficult Decisions in Surgery: An Evidence-Based Approach Series editor Mark K. Ferguson Department of Surgery, MC5040 University of Chicago Chicago, IL USA The complexity of decision making in any kind of surgery is growing exponentially. As new technology is introduced, physicians from nonsurgical specialties offer alternative and competing therapies for what was once the exclusive province of the surgeon. In addition, there is increasing knowledge regarding the efficacy of traditional surgical therapies. How to select among these varied and complex approaches is becoming increasingly difficult. These multi-authored books will contain brief chapters, each of which will be devoted to one or two specific questions or decisions that are difficult or controversial. They are intended as current and timely reference sources for practicing surgeons, surgeons in training, and educators that describe the recommended ideal approach, rather than customary care, in selected clinical situations. More information about this series at http://www.springer.com/series/13361 Christopher L. Skelly • Ross Milner Editors Difficult Decisions in Vascular Surgery An Evidence-Based Approach Editors Christopher L. Skelly Ross Milner The University of Chicago Medical Center The University of Chicago Medical Center and Biological Science Division and Biological Science Division Chicago, IL Chicago, IL USA USA ISSN 2198-7750 ISSN 2198-7769 (electronic) Difficult Decisions in Surgery: An Evidence-Based Approach ISBN 978-3-319-33291-8 ISBN 978-3-319-33293-2 (eBook) DOI 10.1007/978-3-319-33293-2 Library of Congress Control Number: 2016963431 © Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland The registered company is Gewerbestrasse 11, 6330 Cham, Switzerland Preface Vascular surgeons are bound together through the shared experience of vascular surgi- cal training. As surgical residents, we operate, we labor, we train, we study, we treat, and we endure clinical challenges that shape and ultimately solidify our decision-mak- ing skills as a natural extension of our selves. As surgeons who have to make snap decisions because of life-threatening vascular emergencies, the skills of surgical deci- sion making are a crucial talent to master. Over the course of the past three decades, the endovascular era disrupted vascular surgery in a way that has changed the profession forever. The endovascular innovation also disrupted the process of clinical decision making. As a result, many surgeons who had trained in the pre-endovascular era were faced with new tools and techniques that were not a natural extension of their clinical training and therefore not a natural extension of themselves. A new level of complexity was added to the snap decision-making process. Conversely, younger surgeons who came into practice after the establishment of endovascular surgery may lack the open approach skill set or the older tools to adequately include in their clinical decision making. Clinical vascular decision making had effectively been changed forever. The objectives of this book are to explain the process of decision making, both on the part of the physician and on the part of the patient; to discuss specific clinical prob- lems in vascular surgery; and to provide recommendations regarding their manage- ment using. The Society for Vascular Surgery (SVS) recognized that clinical decision making had been changed by the endovascular era and in 2006 published “Guideline methodology of the Society for Vascular Surgery including the experience with the GRADE framework.” With this guideline, the profession of vascular surgery effec- tively entered the realm of evidence-based medicine to help guide vascular surgeons in areas that they may be unfamiliar. This text is a natural extension of the SVS goal to improve upon the process of clinical decision making for the practicing vascular sur- geon and to ultimately improve patient outcomes. To accomplish this, it was necessary to assemble a phalanx of authors widely felt to be experts in their fields. They were given the assignment of crucially evaluating evidence on a well-defined topic: one based solely on the existing evidence and another based on their prevailing practice, clinical experience, and teaching. In addition to the analysis of the evidence on the topic, we include a section in each chapter called: A personal view of the data. This v vi Preface section allowed for the authors’ personal opinion of the data and the application to the data. This component we found to complement the evidence perfectly because it allows for the expression of the “art” in the “Art and Science of Medicine.” In other words, we gave the author license to juxtapose any differences between practicing medicine (the snap decisions based on practice) with research medicine (clinical trials). This book is intended as a resource for clinical surgeons and other interested readers who wish to understand how experts in the field assess existing knowledge. As part of the process, authors were asked to assess the evidence quality based on the following criteria. High quality We are very confident that the true effect lies close to that of the estimate of the effect Moderate We are moderately confident in the estimate of effect: The true effect is likely to quality be close to the estimate of effect, but possibility to be substantially different Low quality Our confidence in the effect is limited: The true effect may be substantially different from the estimate of the effect Very low We have very little confidence in the effect estimate: The true effect is likely to quality be substantially different from the estimate of effect What became apparent in going through the process of editing this text was that the quality of data upon which we base many of our decisions in vascular surgery is low to moderate quality. Therefore, this book is not intended to be used as a clinical pathway for management of our vascular surgical patients. As with all clinical care, consideration must be given to the individual needs of patients in the context of that physician–patient relationship. My hope is that readers will find the information and recommendations in this book insightful and intellectually stimulating. I encourage the readers who find a particular chapter interesting to read the original source materials to come up with their own objective conclusions. Furthermore, I encourage students and residents and practicing surgeons to realize that there are gaps in our knowledge that can and should be filled with good strong quality evidence. Producing a book of this caliber in a relatively short time period requires the help of a number of individuals. I would like to thank the students, residents, fellows, and faculty with whom I work on a daily basis for stimulating discussions and the basis for many of the chapters. I would like to thank the authors, co-authors, and their support staff for all of the hard work required to produce this work and my continual pestering and revisions. I am indebted to Michael Sova, Jessica Gonzalez, and Julia Megginson at Springer for keeping my colleagues on track, ushering the manuscripts through to a finished product. I thank my family for their continual patience and unquestioning support. Finally, I am indebted to Mark Ferguson who was my teacher and now my colleague, for his innovative approach to evidence-based medicine and shepherding this concept through the profession of surgery as a whole. Dr. Ferguson has champi- oned a movement away from the time honored traditional training format of “see one, do one, teach one” which as he points out “stifles insight, objectivity and creativity.” Chicago, IL, USA Christopher L. Skelly Chicago, IL, USA Ross Milner Contents Part I Aortic Disease 1 In Patients with Acute Type B Aortic Dissection, Do Current Operative Therapies Reduce Complications Compared to Medical Management? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Nadia Awad and Joseph Lombardi 2 In Patients with a Chronic Type B Dissection, Does Endovascular Treatment Reduce Long Term Complications? . . . . . . . . . . . . . . . . . . . 13 Yana Etkin and Ronald M. Fairman 3 In Patients with a Retrograde Type A Aortic Dissection, Does Treatment Like a Type B Aortic Dissection Improve Outcomes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Reilly D. Hobbs, Prashanth Vallabhajosyula, and Wilson Y. Szeto 4 In Patients with Small AAA, Does Medical Therapy Prevent Growth? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Kenneth R. Ziegler and John A. Curci 5 Challenging AAA Neck Anatomy: Does the Fenestrated or Snorkel/Chimney Technique Improve Mortality and Freedom from Reintervention Relative to Open Repair? . . . . . . . . . . . . . . . . . . . 49 Brant W. Ullery and Jason T. Lee 6 In Patients Who Require Hypogastric Artery Coverage to Treat an AAA with EVAR, Does Preservation Improve Outcomes When Compared to Exclusion of the Vessel? . . . . . . . . . . . . 63 Sina Iranmanesh and Edward Y. Woo 7 In Patients with Aortic Graft Infections, Does EVAR Improve Long Term Survival Compared to Open Graft Resection? . . . . . . . . . 77 M. J. E. van Rijn, E. V. Rouwet, S. ten Raa, J. M. Hendriks, and H. J. M. Verhagen vii viii Contents 8 Does EVAR Improve Outcomes or Quality of Life in Patients Unfit for Open Surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Tadaki M. Tomita and Andrew W. Hoel 9 In Patients with Type 2 Endoleaks Does Intervention Reduce Aneurysm Related Morbidity and Mortality Compared to Observation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Lisa Kang and Brian Funaki 10 Ruptured Abdominal Aortic Aneurysm Treated with Endovascular Repair; Does Decompressive Laparotomy Result in Improved Clinical Outcomes? . . . . . . . . . . . . . 113 Chandler A. Long, Veer Chahwala, and Ravi K. Veeraswamy 11 In a Patient with Blunt Traumatic Aortic Injury, Does TEVAR Improve Survival Compared to Open Repair or Expectant Management? . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Gerald R. Fortuna Jr. and Ali Azizzadeh Part II Lower Extremity Arterial Disease 12 I n Patients with Aortoiliac Occlusive Disease, Does Endovascular Repair Improve Outcomes When Compared to Open Repair? . . . . . 137 Michael S. Hong and William C. Pevec 13 I n Patients with Aortoiliac Occlusive Disease, Does Extra-anatomic Bypass Improve Quality of Life and Limb Salvage? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 George E. Havelka and William H. Pearce 14 I n Patients with Critical Limb Ischemia Does Bypass Improve Limb Salvage and Quality of Life When Compared to Endovascular Revascularization? . . . . . . . . . . . . 163 Jeffrey J. Siracuse and Alik Farber 15 I n Patients with Limb-Threatening Ischemia Who Are Not Candidates for Revascularization Do Non-operative Options Improve Outcomes Compared to Amputation? . . . . . . . . . . . . . . . . . . 171 Craig Weinkauf and Joseph L. Mills Sr. 16 In the Patient with Profunda Artery Disease, Is Open Revascularization Superior to Endovascular Repair for Improving Rest Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Jordan R. Stern and Victor M. Bernhard 17 In Patients with Limb-Threatening Vascular Injuries, Is There a Role of Prophylactic Fasciotomy to Reduce Ischemic Injury? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Melanie Hoehn, Megan Brenner, and Todd E. Rasmussen Contents ix 18 In Patients with Popliteal Entrapment Syndrome, Does Surgery Improve Quality of Life? . . . . . . . . . . . . . . . . . . . . . . . . 207 Rachel E. Heneghan and Niten Singh Part III Mesenteric Disease 19 In Patients with Acute Mesenteric Ischemia Does an Endovascular or Hybrid Approach Improve Morbidity and Mortality Compared to Open Revascularization? . . . . . . . . . . . . 221 Mark Wyers and Fahad Shuja 20 Chronic Mesenteric Arterial Disease: Does an Endovascular/Hybrid Approach Improve Morbidity and Mortality as Compared to Open Revascularization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 Aaron C. Baker and Gustavo S. Oderich 21 In Patients with Mesenteric Ischemia Is Single Vessel Reconstruction Equivalent to Multiple Vessel Revascularization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Omar C. Morcos and Tina R. Desai 22 In Patients with Celiac Artery Compression Syndrome, Does Surgery Improve Quality of Life? . . . . . . . . . . . . . . . . . . . . . . . . 263 Grace Zee Mak 23 I n Patients with Superior Mesenteric Artery Syndrome, Is Enteric Bypass Superior to Duodenal Mobilization? . . . . . . . . . . . 275 Monika A. Krezalek and John C. Alverdy 24 In Patients with Renovascular Hypertension Is There a Role for Open or Endovascular Revascularization Compared to Medical Management? . . . . . . . . . . . . . . . . . . . . . . . . . . 287 Joie C. Dunn, Sung Wan Ham, and Fred A. Weaver 25 Does Endovascular Repair Reduce the Risk of Rupture Compared to Open Repair in Splanchnic Artery Aneurysms? . . . . . . . . . . . . . . . 297 Benjamin J. Pearce Part IV Cerebrovascular Disease 26 In Patients with Asymptomatic Carotid Artery Stenosis Does Current Best Medical Management Reduce the Risk of Stroke Compared to Intervention (Endarterectomy or Stent)? . . . . . . . . . . . 311 James R. Brorson 27 In Patients with Symptomatic Carotid Artery Stenosis Is Endarterectomy Safer Than Carotid Stenting? . . . . . . . . . . . . . . . . . . 321 Benjamin Colvard and Wei Zhou
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