Vascular Surgery: Cases, Questions and Commentaries PDF
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Vascular 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 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be repro duced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. 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 application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 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
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