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دانلود کتاب Rutherford's vascular surgery and endovascular therapy
دانلود کتاب جراحی عروق رادرفورد و درمان اندوواسکولار
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Rutherford's vascular surgery and endovascular therapy
ویرایش: 9 نویسندگان: Anton N. Sidawy, Bruce A. Perler سری: ISBN (شابک) : 9780323427913, 2018004364 ناشر: Elsevier Inc. سال نشر: 2019 تعداد صفحات: 3289 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 170 مگابایت
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Front Matter Copyright Dedication Associate Editors Contributors Preface Video Contents Common Abbreviations SECTION 1 Basic Science 1 Epidemiology and Research Methodology Abstract Keywords Epidemiology Brief History Modern Developments Clinical Research Methods Study Design Observational Studies Experimental Studies Special Techniques: Meta-Analysis Outcomes Analysis Bias in Study Design Statistical Methods Regression Analysis Survival Analysis Longitudinal Analysis Propensity Scoring Errors in Hypothesis Testing Statistical and Database Software Economic Analysis Utility Measures Decision Analysis Markov Models and Monte Carlo Simulation Cost-Benefit and Cost-Effectiveness Analysis Evidence in Practice Outcomes Translational Research Selected Key References References 2 Embryology and Developmental Anatomy Abstract Keywords Formation of Embryonic Blood Vessels Molecular Signaling of Vasculogenesis and Angiogenesis Early Angiogenesis Aortic Arch Normal Arch Development Aortic Arch Anomalies Patent Ductus Arteriosus Coarctation of the Aorta Double Aortic Arch Right Aortic Arch Retroesophageal Right Subclavian Artery Development of the Descending (Thoracic and Abdominal) Aorta Development of the Limbs Upper Limb Normal Development Upper Limb Vascular Anomalies Lower Limb Normal Development Lower Limb Vascular Anomalies Persistent Sciatic Artery Popliteal Entrapment Syndrome Development of the Venous System Superior Vena Cava Inferior Vena Cava and Associated Vessels Anomalies Superior Vena Cava Inferior Vena Cava Duplication/Left-Sided Inferior Vena Cava Renal Vein Anomalies Development of the Lymphatic System Selected Key References References 3 Vessel Wall Biology Abstract Keywords Arterial Wall Anatomy Intima Endothelium Nonfenestrated Continuous Fenestrated Continuous Discontinuous Basal Lamina Internal Elastic Lamina Media Adventitia Arterial Wall System Large Arteries Small Arteries Coronary Arteries Arterioles Capillaries Hemodynamics and Vascular Wall Biology Shear Stress Endothelium Media Circumferential Stretch Vein Wall Anatomy Intima Media Adventitia Developmental Concepts in Distinct Vein Wall Anatomy Physiologic Implications of Vein Wall Composition Vein Wall System Venules Veins Venae Cavae Venous Valves Lymphatic Wall Anatomy Lymphatic Wall System Initial Lymphatics Endothelial Microvalves Secondary Valves Precollecting Lymphatics Collecting Lymphatics Selected Key References References 4 Atherosclerosis Atherosclerotic Lesions Theories of Pathogenesis Lipid Hypothesis Response-to-Injury Hypothesis Monoclonal Hypothesis Atherosclerosis as a Chronic Inflammatory Disease Low-Density Lipoprotein Retention Monocytes Macrophages Lymphocytes and Adaptive Immunity Smooth Muscle Cells Calcification Putting It All Together: The Inflammasome C-Reactive Protein Localization of Atherosclerosis Progression/Regression of Plaques Thrombotic Complications of Atherosclerosis Identification of Vulnerable Lesions Selected Key References References 5 Intimal Hyperplasia Response of the Artery to Injury Hemodynamics Systemic Vascular Diseases Intravascular Bare Metal Stents Intravascular Drug-Eluting Stents Intravascular Drug-Eluting Balloons Response of Vein to Injury Healing Response of the Prosthetic Graft Intimal Hyperplasia and Dialysis Access Conclusion Selected Key References References 6 Ischemia-Reperfusion Abstract Keywords Pathophysiology of Ischemia-Reperfusion Injury Injury During Ischemia Injury During Reperfusion Reactive Oxygen Species Generation and Mitochondrial Injury Nitric Oxide Hypothermia Anticoagulants Clinical Manifestations of Ischemia-Reperfusion Injury Lower Extremity Compartment Syndrome Gastrointestinal Ischemia-Reperfusion Injury Renal Ischemia-Reperfusion Injury Myocardial Ischemia-Reperfusion Injury Future Directions in Ischemia-Reperfusion Injury Selected Key References References 7 Arteriogenesis and Angiogenesis Neovascularization Arteriogenesis Cardiovascular Risk Factors Associated With Impaired Arteriogenesis Angiogenesis Sprouting Angiogenesis Regulation of Angiogenesis Lumen Formation Intussusceptive Angiogenesis Remodeling and Pruning Role of Micrornas in Neovascularization Clinical Trials Gene and Protein-Based Therapies Vascular Endothelial Growth Factor Fibroblast Growth Factor Hepatocyte Growth Factor Developmentally Regulated Endothelial Locus-1 Hypoxia-Inducible Factor Cell-Based Therapies Endothelial Progenitor Cells Bone Marrow–Derived Cells Fully Differentiated Cells Selected Key References References 8 Arterial Hemodynamics Basic Concepts Fluid Energy Poiseuille’s Law and Vascular Resistance Normal Pressure and Flow Blood Flow Patterns Laminar and Turbulent Flow Boundary Layer Separation Pulsatile Flow Bifurcations and Branches Arterial Stenosis Energy Losses Critical Stenosis Stenosis Length and Multiple Stenoses Effect of Stenosis on Waveforms Abnormal Pressure and Flow Collateral Circulation Vascular Steal Therapeutic Considerations Arterial Occlusive Disease Arterial Grafts and Anastomoses Aneurysms and Arterial Wall Stress Selected Key References References 9 Venous Pathophysiology Introduction Basic Considerations Endothelium and Hemostasis Venous Biomechanics Deep Venous Thrombosis Venous Thrombosis Pathways Coagulation Cascade Platelets Natural Anticoagulants Thrombolysis Plasminogen Inhibitors and Thrombosis Inflammation and Thrombosis Thrombus Resolution and Vein Wall Remodeling Chronic Venous Insufficiency Historical Perspective and General Background Varicose Veins Pathophysiology of Stasis Dermatitis and Dermal Fibrosis Thrombophlebitis Conclusion Selected Key References References 10 Lymphatic Pathophysiology Anatomy Macroscopic Anatomy Embryonic Development Light Microscopic Anatomy Lymphatic-Specific Markers Ultrastructure Structural-Functional Imaging Physiology General Principles Interstitial (Lymph) Fluid Lymph Nodes Flow-Pressure Dynamics Lymphatic Transport Route Molecular Lymphology Lymphangiogenesis Lymphovascular Genomics Growth/Inhibitory Factors Pathophysiology Overview Lymphedema and Lymphangiodysplasia Chylous and Nonchylous Reflux Infection Fibrosis Adipogenesis Lymphatic Tumors and Tumor Lymphatics Other Lymphangiogenic Disorders Clinical Overview Selected Key References References SECTION 2 Atherosclerotic Risk Factors 11 Atherosclerotic Risk Factors: Smoking Abstract Keywords Epidemiology Biologic Effects of Smoking on the Vasculature Nonvascular Clinical Effects Vascular Clinical Effects Development of Peripheral Arterial Disease Graft Failure and Amputation Smoking and Other Vascular Disease Smoking Cessation Selected Key References References 12 Atherosclerotic Risk Factors: Diabetes Epidemiology Classification of Diabetes Type 1 Type 2 Diabetes and Vascular Disease Coronary Artery Disease Cerebrovascular Disease Peripheral Artery Disease Pathophysiology of Vascular Disease in Diabetes Dysmetabolism and Vascular Dysfunction Platelet Dysfunction and Coagulation Cascade Vascular Evaluation of Patients With Diabetes Treatment of Patients With Diabetes and Peripheral Artery Disease Preventive Foot Care Glycemic Control Risk Factor Control Dyslipidemia Hypertension Antiplatelet Therapy Medical Treatment for Symptomatic Improvement of Peripheral Artery Disease Exercise Therapy Cilostazol Pentoxifylline Statins Angiotensin-Converting Enzyme Inhibitors Referral for Revascularization Summary and Future Directions Selected Key References References 13 Atherosclerotic Risk Factors: Hyperlipidemia Abstract Historical Perspective Physiology and Metabolism of Lipids Chylomicrons Very-Low-Density Lipoproteins Intermediate Density Lipoprotein (Remnant Lipoprotein) Low-Density Lipoprotein High-Density Lipoproteins Pathophysiology of Atherosclerosis Diagnosis of Atherogenic Lipid Disorders Fasting Lipid Profile Non–High-Density Lipoprotein Cholesterol in Risk Assessment Lipoprotein (a) Evolution of the Guidelines for Management and Therapeutic Goals for Lipoprotein Disorders Adult Treatment Panel I Adult Treatment Panel II Adult Treatment Panel III Coronary Heart Disease Risk Equivalents Risk Stratification The 2013 ACC/AHA Guidelines Clinical Trials of the Management of Dyslipidemia in Peripheral Arterial Disease Early Trials Linking Lipid Therapy to Atherosclerosis Nonpharmacologic Therapy for Dyslipidemia Dietary Changes Exercise Pharmacologic Therapy for Dyslipidemia Statins Niacin Fibrate Bile Acid Sequestrants Ezetimibe Omega-3 Fatty Acids Cholesterol Ester Transfer Protein Inhibitors Novel Therapeutic Agents Combination Drug Therapy Homozygous Familial Hypercholesterolemia Selected Key References References 14 Atherosclerotic Risk Factors: Hypertension Epidemiology Scope of the Problem Diagnosis Definition Blood Pressure Measurement Technique Secondary Causes Pathologic Mechanisms of Hypertension and Atherosclerosis Animal Models of Hypertension Renin-Angiotensin System and Atherosclerosis Endothelial Dysfunction and Hypertension Management General Principles Lifestyle Modifications Antihypertensive Therapy Pharmacotherapy General Considerations Thiazide Diuretics Complications/Side Effects Angiotensin Converting Enzyme Inhibitors Complications/Side Effects Angiotensin Receptor Blockers Complications/Side Effects Calcium Channel Blockers Complications/Side Effects Beta Blockers Complications/Side Effects Loop Diuretics Complications/Side Effects Potassium-Sparing Diuretics Complications/Side Effects Aldosterone Receptor Antagonists Complications/Side Effects Alpha Blockers Complications/Side Effects Centrally Acting Alpha Antagonists Complications/Side Effects Direct Vasodilators Complications/Side Effects Renin Inhibitors Complications/Side Effects Emerging Therapies Experimental Invasive Therapies References 15 Atherosclerosis Risk Factors: Familial Arteriosclerosis Abstract Keywords Familial Hypercholesterolemia Familial Hypertension Familial Diabetes Familial Obesity Genetics of Peripheral Artery Disease Influence of Nongenetic Factors Environmental Factors Epigenetic Factors Risk Assessment and Diagnosis Familial Hypertension Familial Diabetes Familial Obesity Risk Management Familial Hypertension Familial Diabetes Familial Obesity Selected Key References References 16 Less Commonly Considered Causes of Atherosclerosis Abstract Keywords The Atherosclerotic Lesion Hyperlipidemia Lipoprotein a Diet Infection Viruses Herpes Simplex Viruses 1 and 2 Enteroviruses, Hepatitis C, Cytomegalovirus Bacteria Helicobacter pylori Chlamydia pneumoniae Oral Pathogens Environmental Toxins Persistent Organic Pollutants Heavy Metals Arsenic Cadmium Mercury Air Pollution Summary Selected Key References References 17 International and Ethnic Trends in Vascular Disease Abstract Keywords International Trends Risk Factors Smoking Diabetes Ischemic Heart Disease Cerebrovascular Disease Peripheral Arterial Disease Aortic Aneurysm Global Strategies Ethnic Trends Trends in the Risks for Cardiovascular Disease Cerebrovascular Disease Peripheral Arterial Disease Aortic Aneurysm Hemodialysis Access Addressing Disparities Selected Key References References SECTION 3 Clinical and Vascular Laboratory Evaluation 18 Clinical Evaluation of the Arterial System Abstract Overview of the Clinical Evaluation Clinical History Physical Examination Synthesis of the History and Physical Examination The Evolving Role of Telemedicine in History and Physical Exam for Vascular Disease History in Patients With Arterial Disease Acute Arterial Occlusion Acute Arterial Occlusion of the Lower Extremity Atheroembolism: “Blue Toes Syndrome” Acute Arterial Occlusion of the Upper Extremity Chronic Obstructive Arterial Disease Lower Extremity Claudication Conditions Mimicking Arterial Claudication Neurogenic Claudication Venous Insufficiency/Venous Claudication Other Considerations in Young Patients Rest Pain Conditions Mimicking Rest Pain Diabetic Neuropathy Complex Regional Pain Syndrome Upper Extremity Effort Discomfort Physical Examination in Patients With Arterial Disease Inspection Ischemic Ulcers Livedo Reticularis Acrocyanosis Pulse Examination Arterial Aneurysms Auscultation Palmar Circulation The Ulcerated Leg Ischemic Ulcers Neurotrophic Ulcers Stasis Ulceration Other Types of Ulcers Ulcer Assessment: What’s Next Selected Key References References 19 Clinical Evaluation of the Venous and Lymphatic Systems Keywords Introduction Anatomic Considerations Deep Veins of the Lower Extremity Superficial Veins of the Lower Extremity Deep Veins of the Upper Extremity Superficial Veins of the Upper Extremity Lymphatics of the Lower Extremity Lymphatics of the Upper Extremity The Clinical Evaluation Venous Obstruction Deep Venous Thrombosis Physical Examination Phlegmasia Superficial Thrombophlebitis Physical Examination Pathophysiology and Clinical History Physical Examination May-Thurner Syndrome Physical Examination Superficial Venous Insufficiency Pathophysiology and Clinical History Physical Examination Klippel-Trenaunay Syndrome Pathophysiology and Clinical History Physical Examination Lymphedema (See Chapter 168) Overview/Pathophysiology Primary Lymphedema Secondary Lymphedema Physical Examination Selected Key References References 20 Vascular Laboratory: Arterial Physiologic Assessment Doppler Ultrasonography Principles of Doppler Ultrasound Aural Interpretation of the Doppler Waveform Qualitative and Quantitative Waveform Analysis Pressure Measurements Ankle-Brachial Index Measurement Basic Technique Prognostic Value of Ankle-Brachial Index Technical Errors Segmental Pressures Digital Pressure Measurement Stress Testing Exercise Testing Reactive Hyperemia Direct Pressure Measurement Penile Pressure Plethysmography Pulse Volume Recording Digital Plethysmography Pulse Contour Reactive Hyperemia Other Methods Transcutaneous Oxygen Tension Laser Doppler and Skin Perfusion Pressure Selected Key References References 21 Vascular Laboratory: Arterial Duplex Scanning Instrumentation and Basic Concepts Blood Flow Imaging Techniques Color Doppler Imaging Power Doppler Imaging B-Flow Imaging Pulsed Doppler Spectral Analysis Measurements Artifacts and Errors Duplex Velocity Spectral Classification of Arterial Stenosis Patient Testing Peripheral Arteries Indications Technique Interpretation Accuracy Iliac Arteries Interpretation Direct Imaging Criteria Indirect Imaging Criteria Accuracy Direct Imaging Indirect Imaging Femoral-Popliteal and Tibial Arteries Limitations Duplex Surveillance Bypass Graft and Intervention Surveillance Vein Grafts Technique Interpretation Prosthetic Grafts Peripheral Interventions Selected Key References References 22 Vascular Laboratory: Venous Physiologic Assessment Ambulatory Venous Pressure Technique Interpretation Accuracy Limitations Plethysmography Strain-Gauge Plethysmography Impedance Plethysmography Photoplethysmography Technique Interpretation Accuracy Limitations Air Plethysmography Technique Interpretation Accuracy Limitations Selective Use of Venous Physiologic Testing Selected Key References References 23 Vascular Laboratory: Venous Duplex Scanning Abstract Keywords Normal B-Mode Imaging Findings Normal Flow Patterns in Veins Diagnosis of Deep Vein Thrombosis Calf Vein Thrombosis Iliac Vein and Inferior Vena Cava Diagnosis of Upper Extremity Deep Vein Thrombosis Limited or Point-of-Care Ultrasound Examinations Determination of Thrombus Age Novel Ultrasound Techniques: Elastography Determining the Duration of Therapy for Acute Deep Vein Thrombosis Diagnosis of Recurrent Thrombosis Superficial Veins Evaluation for Chronic Venous Disease: Venous Insufficiency Perforating Veins Selected Key References Textbooks Clinical Practice Guidelines References SECTION 4 Vascular Imaging 24 Radiation Safety Abstract Keywords Types of Radiation Measurement Absorbed Dose Equivalent Dose Effective Dose Biologic Effects of Radiation Deterministic Effects Stochastic Effects Exposure and Recommended Limits Background Radiation Occupational and Medical Exposure Recommended Dose Limits Principles of Radiation Protection Radiation Safety: Diagnostic Procedures Radiation Safety: Endovascular Procedures Emission Control Time Distance Barriers Technique Monitoring Exposure Radiation and the Endovascular Surgeon Radiation and Pregnancy Declaration of Pregnancy Fetal Risk From Radiation Malformations and Mental Retardation Cancer Risk Recommendations for Pregnant Workers Selected Key References References 25 Arteriography Abstract Keywords Equipment Operating Room Versus Imaging Suite Fixed-Mount Versus Portable Equipment Catheters Contrast Agents Iodinated Contrast Agents Carbon Dioxide Arteriography Devices for Injection of Contrast Agents Power Injection Manual Injection Techniques Image Processing Subtraction Tool and Masking Pixel Shifting View Tracing Roadmapping and Measuring Single-Injection Multiple–Linear Field Arteriography Stage Technique Stepping Technique Limitations of Single-Injection Multiple-Field Arteriography Rotational Arteriography Three-Dimensional Fusion Computed Tomography Maximizing Image Quality During Arteriography Clinical Applications Limitations and Risks Sources of Error With Arteriography Risks From Contrast Agents Systemic Toxicity Cardiac Toxicity Hematologic Toxicity Nephrotoxicity Metformin Prevention of Contrast-Induced Nephropathy Limitations and Risks of CO2 Contrast Future Advances Selected Key References References 26 Venography Keywords Basic Principles Clinical Applications Ascending Venography Deep Venous Thrombosis Technique Interpretation Incompetent Perforating Veins Technique Interpretation Venous Aneurysms and Malformations Technique Interpretation Descending Venography Technique Interpretation Iliac Vein Assessment and Inferior Venacavography Technique Interpretation Venography During Treatment of Iliocaval Stenosis Technique Interpretation Diagnostic Venography of Pelvic Congestion Syndrome Technique Interpretation Venography for Varicoceles Technique Treatment Renal Venography Technique Interpretation Diagnostic Angiography of Mesenteric or Portal Venous Thrombosis Technique Interpretation Diagnostic Venography of Budd-Chiari Syndrome Technique Interpretation Upper Extremity Venography Technique Interpretation Central Thoracic Venography Technique Interpretation Pulmonary Arteriography Technique Interpretation General Limitations and Risks of Venography Future Advances Selected Key References References 27 Computed Tomography Basic Principles Types of Scanners Single-Slice Sequential Computed Tomography Spiral (Helical) Computed Tomography Multislice (Multidetector) Computed Tomography Computed Tomography Angiography Acquisition Parameters Prescan Parameters kVp and mAs Collimation Table Feed and Pitch Patient Positioning Contrast Protocols Dual Energy/Source Computed Tomography Postscan Parameters Increment Slice Width Field of View Windowing Reconstruction Algorithms: Filtered Back Projection and Iterative Reconstruction Dynamic Computed Tomography Scanning Electrocardiogram Triggered and Gated Scanning Postprocessing Multiplanar Reformatting Measurements Three-Dimensional Reconstruction Clinical Application Aortic Disease Peripheral Arterial Occlusive Disease Renovascular Disease Venous Disease Vascular Malformations Limitations and Risks Radiation Dose Contrast-Induced Nephropathy Common Artifacts Partial-Volume Effects Beam-Hardening Artifacts Motion Artifacts Other Common Artifacts Special Pediatric Considerations Future Advances Computed Tomography Versus Duplex Ultrasound and Magnetic Resonance Positron Emission Tomography With Computed Tomography Mobile Computed Tomography and C-Arm Computed Tomography Acknowledgment Selected Key References References 28 Magnetic Resonance Imaging and Arteriography Abstract Keywords Basic Principles Characteristics of Magnetic Resonance Images Magnetic Resonance Pulse Sequences Pulse Sequence Parameters Magnetic Resonance Angiography and Venography Non–Contrast-Enhanced Magnetic Resonance Angiography Contrast-Enhanced Magnetic Resonance Angiography Step-Table Magnetic Resonance Angiography Three-Dimensional Image Processing Hardware and Software for Magnetic Resonance Angiography Clinical Applications of Magnetic Resonance Angiography Aortic Vascular Disease Carotid Vascular Disease Peripheral Vascular Disease Renovascular Disease Mesenteric Vascular Disease Venous Vascular Disease Other Applications Limitations and Risks Scan Artifacts Fat Saturation in Chest Magnetic Resonance Angiography Susceptibility Artifact From Concentrated Gadolinium Susceptibility Metal Artifacts High Intravascular Signal From Thrombus Containing Methemoglobin Contraindications to Magnetic Resonance Imaging Impaired Renal Function and Nephrogenic Systemic Fibrosis Pacemakers and Other Implanted Devices Vascular Stents, Filters, and Coils Recent Advances 3-Tesla Magnetic Resonance Angiography Parallel Imaging Continuous Moving Table and Time-Resolved Magnetic Resonance Angiography Blood Pool Contrast Agents Imaging of Blood Flow Plaque Imaging Computed Tomographic Angiography Versus Magnetic Resonance Angiography Acquisition Speed Dynamic Imaging Calcification and Other Imaging Artifacts Radiation Dose and Contrast Concerns Ease of Use and Convenience Selected Key References References 29 Vascular PET/CT and SPECT/CT Abstract Keywords Basic Principles Single-Photon Emission Computed Tomography, Positron Emission Tomography, and Hybrid Imaging Most Commonly Used Tracers for Vascular Diseases 18F-Fluorodeoxyglucose 18F-Sodium Fluoride Labeled White Blood Cells Other Available Tracers Challenges Clinical Applications Molecular Imaging of Atherosclerosis Fluorodeoxyglucose Uptake in Carotid Plaque Monitoring Treatment With Fluorodeoxyglucose Uptake Fluorodeoxyglucose-Avid Arterial Wall Calcifications Change in Plaque Fluorodeoxyglucose Uptake Over Time Other Tracers for Plaque Imaging Molecular Imaging of Aortic Pathology Abdominal Aortic Aneurysm Aortic Dissection Molecular Imaging of Vasculitis Molecular Imaging of Vascular Graft Infection Radiolabeled White Blood Cell Imaging Fluorodeoxyglucose Positron Emission Tomography Limitations and Risks Future Advances Selected Key References References 30 Intravascular Ultrasound Abstract Key Words Introduction Basic Principles Creating the Image Technology Interpreting the Image Gray Scale Volumetric Three-Dimensional Intravascular Ultrasound Color-Flow Intravascular Ultrasound Virtual Histology Intravascular Ultrasound Clinical Applications Effectiveness of Intravascular Ultrasound Cost Versus Benefits General Benefits of Intravascular Ultrasound Arterial Applications: Carotid and Peripheral Arterial Peripheral Arterial Disease Intravascular Ultrasound-Guided True Lumen Reentry Carotid Applications Endovascular Repair: Abdominal Aortic Aneurysms Preoperative Intravascular Ultrasound Intraoperative Intravascular Ultrasound After Repair Endovascular Repair: Thoracic Aortic Disease Thoracic Aneurysms Blunt Traumatic Aortic Injury Coarctation Dissection Pre- and Intraoperative Intravascular Ultrasound After Deployment Penetrating Aortic Ulcers and Intramural Hematoma Venous Imaging and Applications Venous Thromboembolism Chronic Cerebrospinal Venous Insufficiency Venous Compression Syndromes Limitations and Risks Comparison of Intravascular Ultrasound With Other Imaging Modalities Limitations and Risks of Intravascular Ultrasound Future Advances Selected Key References References 31 The Future of Imaging for Endovascular and Open Surgery Background X-Ray Imaging and Hybrid Operating Rooms Portable C-Arm Imaging Systems Fixed C-Arm Angiographic Imaging Systems Concept of As Low As Reasonably Achievable and “Low”-Dose Radiation to the Patient Protection From Radiation Scatter Designing a Hybrid Operating Suite Advanced 3D Imaging and Image Guidance Techniques Preoperative Imaging and Why This Impacts Procedural Performance C-Arm Cone-Beam Computed Tomography Imaging Image Fusion and Guidance Techniques Needle Guidance Challenges and Next Steps Optical and Electromagnetic Tracking for Image Fusion and Guidance Endovascular Navigation and Catheter Robotics The Future Hybrid Operating Suites Selected Key References References SECTION 5 Perioperative Care 32 Preoperative Evaluation and Management Abstract Keywords/phrases General Preoperative Risk Assessment Cardiac Evaluation Preoperative Medical Versus Interventional Therapy for Cardiac Disease Preoperative Management of Hypertension Pulmonary Evaluation Renal Evaluation Diabetes Adrenal Evaluation Deep Venous Thrombosis Prophylaxis, Thrombotic Risk Factors, and Antithrombotic Therapy Infection Preoperative Anemia and Coagulation Assessment Nutrition Ethical and Legal Concerns/Frailty Assessment Selected Key References References 33 Intraoperative Management Anesthesia General Principles of Anesthesia Anesthesia Levels Local/Regional Anesthesia Moderate Sedation Regional Anesthesia Spinal and Epidural Anesthesia General Anesthesia Vascular Anesthesia Technique and Outcomes Elective Aortic Surgery Ruptured Abdominal Aortic Aneurysms Infrainguinal Reconstructions Carotid Surgery Intraoperative Monitoring Electrocardiography Pulse Oximetry Capnography Arterial Pressure Noninvasive Methods Invasive Methods Advanced Hemodynamic Monitoring Central Venous Catheterization Pulmonary Artery Catheterization Minimally Invasive Hemodynamic Monitoring Transesophageal Echocardiography Neurologic Monitoring Central Nervous System Spinal Nervous System Infection Control and Maintenance of Homeostasis Perioperative Antibiotics Adrenergic Agents Maintenance of Normothermia Glycemic Control Anticoagulation/Antiplatelet Therapy Anticoagulation Antiplatelet Therapy Intraoperative Fibrinolysis Control of Blood Loss/Transfusion Compensatory Responses to Anemia and Blood Loss Risks Associated With Allogeneic Transfusion Transfusion Triggers Transfusion Strategies Venous Thromboembolic Prophylaxis Intraoperative Safety Selected Key References References 34 Postoperative Management Keywords Postoperative Triage Admission to the Intensive Care Unit and High-Dependency Step-Down Unit Organizational Structure of the Intensive Care Unit Hemodynamics and Pressure Monitoring Central Venous Catheters and Central Venous Pressure Peripheral Arterial Lines Pulmonary Artery Catheters Echocardiography Intra-Abdominal Pressure Cardiovascular Complications Hypertension Hypotension Arrhythmias Tachyarrhythmias Atrial Fibrillation Bradyarrhythmias Postoperative Myocardial Infarction Diagnosis ST-Segment Elevation Myocardial Infarction Non–ST-Segment Elevation Myocardial Infarction Pulmonary Management Ventilatory Support Mechanical Ventilation Weaning Indications for Extubation Tracheostomy Bleeding Evaluation of Bleeding Patients Surgical Bleeding Coagulopathy Prolonged Activated Partial Thromboplastin Time and Normal International Normalized Ratio Increased International Normalized Ratio and Normal Activated Partial Thromboplastin Time Normal International Normalized Ratio and Activated Partial Thromboplastin Time Increased International Normalized Ratio and Increased Activated Partial Thromboplastin Time Fluids Infusion of Fluids Electrolyte Management Transfusion of Blood Products Red Blood Cells Platelets Fresh Frozen Plasma Cryoprecipitate Summary of the Transfusion of Blood Products Adjuncts in Hemostasis Complications of Massive Transfusion Renal Failure General Issues Gastrointestinal Ischemia Nutrition Pain Management Deep Venous Thrombosis Prophylaxis Bridging Postoperative Oral Anticoagulation Alcohol Withdrawal Syndrome Sedation and Delirium in the Intensive Care Unit Selected Key References References 35 Hospital Readmissions in Vascular Surgery Abstract Keywords Introduction History Readmission in Vascular Patients Risk Factors for Readmission Interventions to Decrease Readmissions in Vascular Surgery Limitations of 30-Day Readmissions Existing Interventions to Reduce 30-Day Postprocedure Readmissions and Alternative Metrics Conclusions Selected Key References References SECTION 6 Bleeding and Clotting 36 Normal Coagulation Abstract Keywords Introduction Procoagulant, Anticoagulant, and Fibrinolytic Proteins, Inhibitors, and Receptors History and Nomenclature Vitamin-K-Dependent Proteins (See Chapter 39: Anticoagulant Drugs) Cofactor Proteins Soluble Plasma Procofactors Factor V Factor VIII Cell-Bound Cofactors Tissue Factor Thrombomodulin Complexes Intrinsic (Accessory) Pathway Proteins Stoichiometric Inhibitors Antithrombin Tissue Factor Pathway Inhibitor Heparin Cofactor II Endothelium and Platelets (See Chapter 40: Antiplatelet Agents) Endothelium Platelets Clot Proteins Fibrinolysis Proteins (See Chapter 41: Thrombolytic Agents) Fibrinolysis Activators Plasminogen/Plasmin Tissue Plasminogen Activator Urokinase Plasminogen Activator Fibrinolysis Inhibitors Plasminogen Activator Inhibitor-1 α2-Antiplasmin Thrombin-Activatable Fibrinolysis Inhibitor Connectivity and Dynamics of Blood Coagulation Initiation Propagation Termination Elimination/Fibrinolysis Blood Coagulation Monitoring Plasma Clotting Tests Prothrombin Time Activated Partial Thromboplastin Time Thrombin Time Thrombin Generation Assays Platelet Function Tests Platelet Aggregometry Instruments That Simulate Platelet Function in Vitro Whole-Blood Assays Activated Clotting Time Thromboelastography Future Coagulation Assays Acknowledgment Selected Key References References 37 Coagulopathy and Hemorrhage Abstract Keywords Diagnosis and Preoperative Screening for Bleeding Disorders History and Examination Laboratory Testing Risk Stratification Level I Level II Level III Level IV Proper Blood Drawing Specific Laboratory Tests (See Chapter 36) Prothrombin Time Activated Partial Thromboplastin Time Thrombin Time Activated Blood Clotting Time Bleeding Time Thromboelastography and Rotational Thromboelastometry Fibrin Degradation Products Euglobulin Lysis Time Inherited Coagulopathies Platelet Disorders von Willebrand Disease Giant Platelet Disorders Glanzmann’s Thrombasthenia Storage Pool Disorders Hemophilia Pathogenesis Diagnosis Management Acquired Coagulopathies Platelet Disorders Uremia Vitamin-K-Related Disorders Disseminated Intravascular Coagulation Pathogenesis Etiology Clinical Phases Management Primary Fibrinolysis Fibrinolytic System (See Chapter 36) Pathogenesis Etiology/Diagnosis Management Drug-Induced Coagulopathies Heparins Thrombin Inhibitors Oral Anticoagulants Warfarin Direct Oral Anticoagulants Antiplatelet Agents (See Chapter 40) Therapeutic Thrombolysis Hypothermia Acidosis Dilution Treatment Packed Red Blood Cells Platelets Fresh Frozen Plasma Cryoprecipitate Desmopressin Vitamin K Protamine Sulfate Factor VIIa Antifibrinolytic Agents Aminocaproic Acid and Tranexamic Acid Aprotinin Intraoperative Bleeding Mechanical Tools Electrosurgery Argon Beam Coagulator Radiofrequency Devices Topical Hemostatic Agents Mechanical Agents Gelatin Oxidized Cellulose Collagen Polysaccharide Spheres Active Hemostatic Agents Thrombin: Liquid/Gel Products Thrombin: Solid Products Sealants FloSeal, Tisseel, Evicel Dry Fibrin Sealant Dressings Tissue Glue Newer Agents Chitins Chitosans Mineral Zeolite Lysine Analogues Postoperative Bleeding Selected Key References References 38 Hypercoagulable States Pathophysiology Congenital Hypercoagulability Classification Group 1 Thrombophilia Antithrombin Deficiency Pathogenesis and Incidence Types Clinical Presentation and Management Protein C Deficiency Pathogenesis and Incidence Types Clinical Presentation and Management Protein S Deficiency Pathogenesis and Incidence Types Clinical Presentation and Management Group 2 Thrombophilia Factor V Leiden (Activated Protein C Resistance) Pathogenesis and Incidence Clinical Presentation and Management Prothrombin Gene Mutation G20210A Pathogenesis and Incidence Clinical Presentation and Management Elevated Factors VII, XI, and IX Pathogenesis and Incidence Clinical Presentation and Management Other Hyperhomocysteinemia Lipoprotein(a) Sticky Platelet Syndrome Idiopathic (Unprovoked) Venous Thrombosis Acquired Hypercoagulability Antiphospholipid Antibody Syndrome Pathogenesis and Incidence Diagnosis Clinical Presentation and Management Cancer Pathogenesis and Incidence Clinical Presentation and Management Venous Arterial Pregnancy and Oral Contraceptives Pregnancy Pathogenesis and Incidence Clinical Presentation and Management Oral Contraceptives Pathogenesis and Incidence Heparin-Induced Thrombocytopenia Pathogenesis and Incidence Diagnosis and Management Obesity Evaluation of the Patient With Suspected Thrombophilia Selected Key References References 39 Anticoagulant Drugs Introduction Parenteral Anticoagulants: Indirect Inhibitors Heparin Mechanism of Action Pharmacology Monitoring Dosing Limitations Side Effects Bleeding. Thrombocytopenia. Osteoporosis. Elevated Transaminases. Perioperative Management Low-Molecular-Weight Heparin Mechanism of Action Pharmacology Monitoring Dosing Side Effects Bleeding. Thrombocytopenia. Osteoporosis. Perioperative Management Fondaparinux Mechanism of Action Pharmacology Side Effects Perioperative Management Parenteral Direct Thrombin Inhibitors Lepirudin and Desirudin Argatroban Bivalirudin Oral Anticoagulants Warfarin Mechanism of Action Pharmacology Monitoring Dosing Side Effects Bleeding. Skin Necrosis. Pregnancy. Special Problems Periprocedural Management Direct Oral Anticoagulants Mechanism of Action Indications Dosing Monitoring Side Effects Periprocedural Management Management of Bleeding Special Considerations Selected Key References References 40 Antiplatelet Agents Introduction Normal Platelet Function and Platelet Activation Antiplatelet Agents Thromboxane Inhibitors Aspirin Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Thienopyridines (Adenosine Diphosphate Receptor Antagonists) Clopidogrel Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Drug-Drug Interactions. Clopidogrel Resistance. Ticlopidine Ticagrelor Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Drug-Drug Interactions. Prasugrel Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Cangrelor Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Glycoprotein IIB/IIIA (GPIIB/IIIA) Inhibitors Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Phosphodiesterase Inhibitors Dipyridamole Mechanism of Action. Indications and Dose. Side-Effect Profile. Perioperative Management. Protease-Activated Receptor-1 Inhibitors Vorapaxar Mechanism of Action. Indications and Dose. Side-Effect Profile. Atopaxar Clinical Use of Antiplatelet Agents in Vascular Disease Cardiovascular Death, Stroke, or Myocardial Infarction Peripheral Artery Disease Perioperative Management of Dual Antiplatelet Therapy Selected Key References References 41 Thrombolytic Agents Abstract Keywords History Thrombolytic Drug Administration Systemic/Intravenous Thrombolysis Catheter-Directed Thrombolysis Catheter-Directed Thrombolysis With Mechanical Thrombectomy Monitoring Complications Hemorrhagic Antigenicity Related Catheter Related Embolic Contraindications Thrombolytic Agents Biologic, Naturally Occurring Plasminogen Activators Streptokinase Urokinase Recombinant Plasminogen Activators Recombinant Urokinase Alteplase Reteplase Tenecteplase Direct-Acting Agents Plasmin Clinical Applications Acute Myocardial Infarction Pulmonary Embolism Acute Ischemic Stroke Acute Limb Ischemia Deep Venous Thrombosis Arteriovenous Graft Occlusion Central Catheter Occlusion Miscellaneous Uses Selected Key References References SECTION 7 Complications 42 Systemic Complications Abstract Keywords Epidemiology Prevalence of Coronary Disease Definition of Adverse Postoperative Cardiac Events Myocardial Infarction Type-1 Myocardial Infarction Type-2 Myocardial Infarction Unstable Angina Pectoris Congestive Heart Failure Life-Threatening Arrhythmia Cardiac Death The Pathophysiology of Perioperative Myocardial Infarction Perioperative Myocardial Injury and Mortality Incidence of Cardiac Complications Following Major Vascular Surgery Abdominal Aortic Surgery Lower-Extremity Bypass Carotid Endarterectomy Preoperative Cardiac Evaluation Clinical Risk Assessment Cardiac Risk Indices Preoperative Laboratory Testing Complete Blood Count Creatinine Blood Sugar Natriuretic Peptides Cardiac Troponin C-Reactive Protein Rest Electrocardiogram Chest X-Ray Echocardiography Ambulatory ST Segment Monitoring Preoperative Investigation for Coronary Artery Disease Noninvasive (Stress) Testing Exercise Stress Testing Myocardial Perfusion Imaging Dobutamine Stress Echocardiography Positron Emission Tomography Cardiac Magnetic Resonance Imaging Computed Tomography Coronary Angiography Preoperative Coronary Angiography and Revascularization Class I Class III: No Benefit Medical Prophylaxis Beta Blockade Statins Aspirin Dual Antiplatelet Therapy After Coronary Stenting Treatment Selected Key References References 43 Respiratory Complications Preoperative Risk Stratification Patient-Related Risk Factors Procedure-Related Risk Factors Laboratory Test Risk Factors Pulmonary Risk Indices Perioperative Risk Reduction Preoperative Risk Reduction Intraoperative Risk Reduction Postoperative Risk Reduction Clinical Manifestations Atelectasis Bronchospasm Pneumonia Acute Respiratory Failure Acute Respiratory Distress Syndrome Transfusion-Related Acute Lung Injury Management Strategies High-Flow Nasal Oxygen Noninvasive Positive Pressure Ventilation Mechanical Ventilation Adjuncts to Mechanical Ventilation Selected Key References References 44 Systemic Complications Abstract Keywords Renal Anatomy Renal Function Neuroendocrine Modulators of Renal Function Paracrine and Endocrine Modulators of Renal Function Acute Kidney Injury After Vascular and Endovascular Procedures General Approach to Patients With Renal Dysfunction Acute Kidney Injury: Causes—Prerenal Acute Kidney Injury Causes—Postrenal Acute Kidney Injury Causes—Parenchymal Ischemic Injury to the Kidney Acute Ischemic Renal Injury Chronic Ischemia and Ischemic Nephropathy Toxic Injury and Angiography Contrast-Induced Acute Kidney Injury Nephropathy Altered Renal Function During Aortic Surgery Fluid Shifts Associated With Aortic Surgery Renal Failure Associated With Aortic Surgery Protection of Renal Function During Aortic Surgery Acknowledgment Selected Key References References 45 Neurologic Complications Keywords Structure of a Peripheral Nerve Causes of Nerve Damage Ischemic Nerve Injury Acute Ischemic Neuropathy Chronic Ischemic Neuropathy Traumatic Nerve Injury Other Causes of Nerve Injury Diagnostic Evaluation History and Physical Examination Vascular Testing Neurologic Testing Electromyography and Nerve Conduction Studies General Principles of Treatment Acute Ischemic Neuropathy Pain Control Trauma Specific Nerve Injuries Brachial Plexus and Upper Extremity Nerve Injuries Anatomy Etiology Surgical Dissection Compression Hemodialysis Access Radial Artery Procedures Clinical Findings Treatment and Prognosis Spinal Cord and Lumbosacral Plexus Injury Anatomy Etiology Ischemia Trauma Compression Clinical Findings Treatment and Prognosis Femoral Nerve Injury Anatomy Etiology Traction Surgical Trauma Compression Ischemia Clinical Findings Treatment and Prognosis Saphenous Nerve and Sural Nerve Injury Anatomy Etiology Surgical Trauma Thermal Injury Clinical Findings Treatment and Prognosis Tibial and Peroneal Nerve Injury Anatomy Etiology Clinical Findings Treatment and Prognosis Other Nerves Selected Key References References 46 Graft Thrombosis Abstract Keywords Prevention: Intraoperative Graft Assessment Inspection, Palpation, and Measurement of Flow Arteriography Ultrasonography Continuous-Wave Doppler B-Mode Ultrasonography Duplex Ultrasonography Angioscopy Intravascular Ultrasonography Miscellaneous Modalities Graft Thrombosis: Pathogenesis Graft Thrombosis: Therapeutic Approach Documentation of Graft Thrombosis Assessment of Neurologic Status Anticoagulation Etiologic Assessment Early Graft Failure (0 to 30 Days) Late Graft Failure (>30 Days) Acknowledgment Selected Key References References 47 Graft Infection Abstract Keywords Incidence Classification Pathogenesis Etiology Cellular and Biomolecular Events Clinical Sources of Infection Perioperative Contamination Bacteremia Mechanical Erosion Involvement by a Contiguous Infectious Process Impaired Host Defenses Bacteriology Prevention Principles Topical Antibiotics Prophylactic Antibiotics Diagnosis Clinical Manifestations Imaging Studies Contrast-Enhanced Computed Tomography and Computed Tomographic Angiography Ultrasonography Magnetic Resonance Imaging Functional White Blood Cell Scanning Endoscopy Computed Tomography—Guided Aspiration Versus Operative Findings Culture Techniques Surgical Treatment and Outcomes Treatment Considerations Graft Preservation Graft Excision and Extra-anatomic Bypass Need for Revascularization Graft Excision Timing of Limb Revascularization In Situ Graft Replacement Autologous Graft Replacement Neo-Aortoiliac System Reconstruction Antibiotic-Treated Prosthetic Grafts Cryopreserved Arterial Allografts Treatment Adjuncts Antimicrobial Agents Antibiotic-Loaded Beads Local Tissue Flap Coverage Endograft Device Infection Selected Key References References 48 Anastomotic Aneurysms Keywords Incidence and Anatomic Location Pathogenesis Local Factors Arterial Wall Degeneration Suture Line Disruption Graft Failure Infection and/or Inflammation Technical Errors Mechanical Stress Systemic Factors Prevention Clinical Diagnosis History and Physical Examination Imaging Surgical Treatment Indications for Treatment Principles of Treatment Open Repair Femoral Anastomosis Aortic Anastomosis Iliac Anastomosis Carotid Anastomosis Endovascular Repair Femoral Anastomosis Aortic Anastomosis Iliac Anastomosis Carotid Anastomosis Outcomes Selected Key References References 49 Local Complications Primary Aortoenteric Fistula Incidence, Etiology, and Pathogenesis Secondary Aortoenteric Fistula Incidence and Etiology Pathogenesis Infection Pulsatile Pressure Technical Error Aortoenteric Fistula After Endovascular Repair Clinical Presentation Diagnosis Investigations Computed Tomography Esophagogastroduodenoscopy Angiography Other Tests Treatment Urgent Surgical Treatment of Hemorrhage Surgical Treatment in Stable Patients Primary Aortoenteric Fistula Secondary Aortoenteric Fistula Graft Excision Without Replacement In-Situ Aortic Graft Replacement Neo-Aortoiliac System Procedure Extraanatomic Revascularization Endovascular Repair Results and Conclusions Selected Key References References 50 Local Endovascular Complications and Their Management Abstract: Keywords Introduction Groin Hematoma Etiology and Manifestations Management Retroperitoneal Hematoma Manifestations and Diagnosis Management Arteriovenous Fistula Etiology, Manifestations, and Incidence Management Pseudoaneurysm Etiology and Manifestations Management Ultrasound-Guided Thrombin Injection Surgical Management Thrombosis Axillary and Brachial Access Complications Nerve Injury Thrombosis Pedal Access Percutaneous Closure Device Complications Perclose Starclose Exoseal Angio-Seal Mynxgrip (Mynx) Bleeding Complications Ischemic Complications Procedure-Specific Complications Dissection Balloon Angioplasty Dissection Subintimal Angioplasty Embolization Management Wire Perforation Angioplasty Perforation Atherectomy Perforation Endovascular Aneurysm Repair Access Sites Other Complications of Endovascular Procedures Thrombolysis Device Infection Endovascular Stent-Grafts Stents Device Fracture or Embolization Venous Angioplasty and Stenting Inferior Vena Cava Filter Complications Selected Key References References 51 Venous Complications Abstract Keywords Incidence of Venous Complications Direct Venous Injury Diagnostic Evaluation of Direct Venous Injury Management of Direct Venous Injury Arteriovenous Fistulas Venous Thrombosis Endovascular Complications From Venous Interventions Diagnostic Evaluation of Endovascular Complications From Venous Interventions Management of Endovascular Complications From Venous Interventions Inferior Vena Cava Filter Complications Diagnostic Evaluation of Inferior Vena Cava Filter Complications Management of Inferior Vena Cava Filter Complications Conclusions Selected Key References References 52 Local Complications Abstract Keywords Post-Bypass Edema Etiology and Pathogenesis Diagnosis Management Prevention Lymphatic Fistula Etiology Diagnosis Management Lymphocele Groin Lymphocele Retroperitoneal Lymphocele Diagnosis Management Chylous Ascites Diagnosis Management Prevention Thoracic Duct Fistula Chylothorax Diagnosis Management Prevention Selected Key References References SECTION 8 Technique 53 Thoracic and Thoracoabdominal Vascular Exposure Abstract Keywords Exposure of the Ascending Aorta and Aortic Arch Median Sternotomy Position Incisions Dissection Mini-Sternotomy Position Incision Dissection Exposure of the Distal Aortic Arch and Descending Thoracic Aorta Trans-Sternal Bilateral Thoracotomy (Clamshell) Position Incision Dissection Left Posterolateral Thoracotomy Position Incision Exposure of the Thoracoabdominal Aorta Position Incision Thoracic Dissection Abdominal Dissection Exposure of the Distal Descending Thoracic Aorta and Visceral Aorta Transperitoneal Approach Position Incision Dissection Retroperitoneal Approach Position Incision Dissection Selected Key References References 54 Abdominal Vascular Exposures Abstract Keywords Anatomic Considerations Abdominal Incisions Midline Incision Transverse and Subcostal Incisions Oblique Flank Incision Thoracoabdominal Incision (see Chapter 53) Lower Quadrant Incisions Exposure of Infrarenal Abdominal Aorta and Iliac Arteries Transperitoneal Approach Retroperitoneal Approach Exposure of the Proximal Abdominal Aorta (Hiatus to Renals) Transperitoneal Approach Through the Lesser Sac Transperitoneal Approach With Medial Visceral Rotation Left Flank Retroperitoneal/Thoracoretroperitoneal Approach Exposure of Visceral Arteries Celiac Axis Superior Mesenteric Artery Hepatic Artery Splenic Artery Exposure of Renal Arteries Exposure of Major Abdominal Veins Inferior Vena Cava Anatomic Considerations Infrarenal/Suprarenal Inferior Vena Cava Retrohepatic and Suprahepatic Inferior Vena Cava Portal Vein and Branches Anatomic Considerations Portal Vein Superior Mesenteric Vein Splenic Vein Selected Key References References 55 Cerebrovascular Exposure Abstract Keywords General Exposure of the Carotid Artery for Endarterectomy Standard Approach Retrojugular Approach Posterior Approach for Carotid Endarterectomy Proximal Exposure for Carotid Endarterectomy High Exposure Mini-Incisions for Carotid Endarterectomy Short Transverse Incision Longitudinal Mini-Incision of Skin Reoperative Exposure for Carotid Stenosis Exposure for Subclavian Carotid Interventions Transposition Subclavian Bypass Vertebral Artery Exposure Exposure of the V1 Segment of the Vertebral Artery Supraclavicular Approach Anterior Cervical Approach Exposure of the V2 Segment of the Vertebral Artery Exposure of the Atlantoaxial (V3) Segment of the Vertebral Artery Posterior Exposure of the Suboccipital Vertebral Artery (V4) Segment Exposure for Carotid Body Tumors Size of the Tumor Determines Further Dissection Tips 56 Lower Extremity Arterial Exposure Abstract Keywords Introduction Femoral Artery Exposure Common Femoral Artery—Longitudinal Approach Common Femoral Artery—Transverse Approach Deep Femoral Artery—Conventional (Proximal) Approach Deep Femoral Artery—Lateral (Distal) Approach Superficial Femoral Artery Exposure—Proximal Approach Superficial Femoral Artery Exposure—Mid-/Distal Popliteal Artery Exposure Anatomy Suprageniculate Popliteal Medial Exposure Lateral Exposure Midpopliteal Posterior Approach Infrageniculate Popliteal Medial Exposure Lateral Exposure Exposure of the Tibial and Peroneal Arteries Anterior Tibial Artery Exposure Tibioperoneal Trunk and Proximal Posterior Tibial and Peroneal Artery Exposure Posterior Tibial Artery Exposure Peroneal Artery Exposure Medial Exposure Lateral Exposure Exposure of the Arteries of the Foot Exposure of the Dorsalis Pedis Artery Inframalleolar Posterior Tibial and Plantar Artery Exposure Exposure for Obturator Bypass Exposure of the Lower Extremity Veins Great Saphenous Vein Anatomy Exposure of the Great Saphenous Vein Small Saphenous Vein Anatomy Exposure of the Small Saphenous Vein Femoral Vein of the Thigh Anatomy Harvest Technique Selected Key References References 57 Upper Extremity Vascular Exposure Abstract Keywords Introduction Exposure of Arteries Within the Thorax Innominate, Right Subclavian, and Left Common Carotid Arteries, and Proximal Left Subclavian Artery in an Elective Situation Left Subclavian Artery, Emergent Exposure of Veins Within the Thorax Exposure of Vessels Within the Thoracic Outlet Subclavian Arteries Subclavian Veins Exposure of the Arm Vessels Selected Key References References 58 Spinal Operative Exposure Abstract Keywords Clinical Presentation, Diagnostic Evaluation, and Risk Assessment Surgical Treatment Operative Planning and Surgical Exposure Options Thoracic Spine Exposure Lumbosacral Spine Exposure Transperitoneal Exposure Transperitoneal Laparoscopic Exposure Anterior Retroperitoneal Exposure Relevant Surgical Anatomy Thoracic Spine Exposure T12 to L2 Exposure L2 to S1 Exposure L4 to L5 and L5 to S1 Exposures Exposure of More Than One Disk Space Right-Sided Exposure Self-Retaining Retractors Special Considerations Repeat Procedures Calcified Arteries Surgical Results and Complications Postoperative Management and Follow-up Selected Key References References 59 Technique: Open Surgical Basic Principles Vascular Instruments and Retractors Clamps Needle Holders, Forceps, and Scissors Retractor Systems Vascular Sutures and Grafts Sutures Grafts Basic Vascular Techniques Vascular Exposure and Dissection Initial Vessel Exposure “Redo” Vessel Exposure Anticoagulation Blood Vessel Control Vascular Clamping Balloon Occlusion Vessel Loops Pneumatic Tourniquet Other Techniques Thrombectomy and Thromboembolectomy Basic Considerations Thromboembolectomy Catheters Technique Arteriotomy Location and Shape Minimizing Blood Loss Minimizing Vascular Injury Fluoroscopy-Guided Thromboembolectomy Thromboembolectomy in Specific Conditions Endarterectomy Basic Considerations Open Endarterectomy Semiclosed Endarterectomy Eversion Endarterectomy Orificial and Extraction Endarterectomy Endarterectomy in Specific Conditions Arteriotomy Closure Primary Closure Patch Closure Closure of a Transected Vessel Replacement and Bypass Procedures Basic Considerations End-to-Side Anastomosis Anchor Technique Parachute Technique End-to-End Anastomosis Side-to-Side Anastomosis Adjunctive Techniques for Infrainguinal Bypass Anastomosis T-Junction Saphenofemoral Junction Vein Cuff Venous Cuffs and Patches for Prosthetic Grafts Distal Anastomotic Arteriovenous Fistula Selected Key References References Appendix e59.1 Technical Considerations for Thromboembolectomy in Specific Conditions Infrainguinal Thromboembolectomy Aortic Saddle Embolus Occluded Bypass Iliofemoral Venous Thromboembolectomy Appendix e59.2 Technical Considerations for Endarterectomy at Specific Anatomic Locations Carotid Bifurcation Disease Aortic Arch Vessels Abdominal Aorta and Its Branches Visceral Endarterectomy Renal Endarterectomy Aortoiliac Endarterectomy Infrainguinal Vessels 60 Endovascular Diagnostic Technique Introduction Vascular Access Choice of Site Adjuncts to Obtain Access Manual Palpation Fluoroscopy Ultrasound Access Location Options Common Femoral Artery Popliteal Artery Tibial Artery Iliac Artery Axillary Artery Brachial Artery Radial Artery Common Carotid Artery Common Femoral Vein Popliteal Vein Saphenous Vein Cephalic/Basilic Vein Internal Jugular Vein Subclavian Vein Access Technique Access Needles Micropuncture Needle Technique Standard Needle Technique Technique for Catheterization Guidewires Sheaths Diagnostic Catheters Nonselective Catheters Selective Catheters Crossing Catheters Guiding Catheters Closure Devices Applications Abdominal Aortography Extremity Angiography Renal/Mesenteric Angiography Carotid Angiography Fistulography Pelvic Congestion Syndrome Venography Complications Access Site Catheter- or Guidewire–Related Systemic Conclusion Selected Key References References 61 Endovascular Therapeutic Technique Introduction Balloon Angioplasty Balloon Catheter Types Balloon Characteristics Balloon Compliance Profile and Balloon Ability Specialty Balloons Cutting Balloons Cryoplasty Focal Pressure Balloon Drug Coated Balloon Stents Stent Types Balloon-Expanding Stents Self-Expanding Stents Stent Grafts Balloon-Expanding Stent Grafts Self-Expanding Stent Grafts Drug-Eluting Stents Multilayer Stents Bioabsorbable Stents Atherectomy Devices (Debulking Technologies) Directional Rotational Orbital Laser Thromboembolectomy Aspiration Rheolytic Rotational Ultrasound Enhanced Other Devices Intraluminal Devices to Cross Chronic Total Occlusions Crosser TruePath Frontrunner XP Re-Entry Devices Outback LTD Re-Entry System Pioneer Catheter Enteer Catheter OffRoad Catheter Embolization Devices and Agents Vascular Coils Vascular Plugs Liquid Embolic Agents Cyanoacrylate Fibrin Sealant Ethylene Vinyl Alcohol Vascular Closure Devices Extravascular Plug Angio-Seal Exoseal FISH (Femoral Introducer Sheath and Hemostasis) Mynx Suture-Based Devices ProGlide Prostar XL Endovascular Therapeutic Techniques Percutaneous Transluminal Balloon Angioplasty Puncture and Approach to the Lesion Lesion Crossing Balloon Selection Balloon Placement Balloon Inflation and Completion Angiography Double Wire Technique Angiosome Concept Dissection Grade Subintimal Angioplasty CART Stenting Indications Dissection Residual Stenosis Pressure Gradient Acute Occlusion In-Stent Restenosis Stent Fracture Stent Selections Technique of Balloon-Expanding Stents Technique of Self-Expanding Stents Hybrid Therapies Embolization Technique of Coil Embolization Stent-Assisted Coil Embolization Coil Embolization for Type II Endoleak Technique of Vascular Plugs Selected Key References References 62 Laparoscopic and Robotic Aortic Surgery Abstract Keywords Introduction Total Laparoscopic Aortic Surgery Retrocolic Prerenal Transperitoneal Approach for Aortoiliac Occlusive Lesions Retrocolic Retrorenal Transperitoneal Approach Specificity for Abdominal Aortic Aneurysm Combined Transperitoneal and Retroperitoneal Approach Retroperitoneal Approach Hand-Assisted Laparoscopic Aortic Surgery Totally Robotic Aortic and Robot-Assisted Procedures Totally Robotic Aortic Surgery Robot-Assisted Aortic Surgery Published Series Total Laparoscopic Aortic Procedures Hand-Assisted and Laparotomy-Assisted Laparoscopic Surgery Robot-Assisted Laparoscopic Surgery Robot-Assisted Laparoscopy Perioperative Outcomes Operative Time Clamping Time Conversion to Open Surgery Mortality Morbidity Hospital Stay Summary Conclusions Selected Key References References SECTION 9 Grafts and Devices 63 Autogenous Grafts Abstract Keywords Histology Anatomy Lower Extremity Veins Upper Extremity Veins Vein Graft Preparation Preoperative Vein Mapping Vein Handling Considerations Dissection Distention Pressure Irrigating Solution Temperature Pharmacologic Adjuncts Minimally Invasive Vein Harvest Autogenous Vein Graft Configurations Reversed Vein Grafts Nonreversed Vein Grafts In Situ Vein Grafts Proximal and Distal Anastomoses Valve Lysis Side Branch Ligation Arm Vein and Composite Grafts Small Saphenous Vein Grafts Femoral-Popliteal Vein Grafts Superficial Femoral Artery Grafts Hypogastric Artery Grafts Etiology of Vein Graft Failure Technical Factors Intimal Hyperplasia and Pathologic Remodeling Graft Atherosclerosis Autogenous Graft Modifications to Improve Durability Prevention of Vein Graft Failure Intraoperative Evaluation Angiography Flow Rate Measurements Duplex Scanning Angioscopy Postoperative Surveillance Physical Examination and Physiologic Assessment Duplex Scanning Selected Key References References 64 Prosthetic Grafts (Heparin-Bonded and Spiral Grafts) Abstract Keywords Introduction Basic Principles Materials Dacron Expanded Polytetrafluoroethylene Polypropylene and Polyurethane Composite Grafts and Allografts Cryopreserved Vein and Human Umbilical Vein Grafts Clinical Applications Peripheral Bypass Grafts Hemodialysis Access Other Locations Strategies for Improving Prosthetic Graft Patency Vein Patches and Cuffs Heparin-Bonded Grafts Spiral Laminar Flow Grafts Distal Arteriovenous Fistula Adjunct Medical Therapies Graft Surveillance Limitations and Risks Graft Failure Modes The Blood-Material Interface Cellular Interaction and the Coagulation Cascade Graft Complications Graft Thrombosis Graft Infection Future Advances Selected Key References References 65 Biologic Grafts Abstract Keywords Graft Properties Fresh Vascular Allografts Cryopreserved Allografts Methods of Preparation Histology and Physiology Immunology Structurally Modified Biologic Grafts Other Grafts Clinical Use in Peripheral Vascular Surgery Indication Extremity Bypass Arteriovenous Access Replacement of Infected Prosthetic Grafts Biologic Graft Preparation Cryopreserved Allografts Structurally Modified Allografts Clinical Outcomes Cryopreserved Saphenous Vein Allografts Graft Patency Role of Anticoagulation and Immunosuppression Limb Salvage Aneurysmal Degeneration Summary and Indications for Use Cryopreserved Femoral Vein Allografts Cryopreserved Arterial Allografts Human Umbilical Vein Grafts Patency and Limb Salvage Comparison of Human Umbilical Vein With Other Grafts Bovine Carotid Artery Xenografts Bovine Mesenteric Vein Xenografts Tissue-Engineered Vascular Grafts Future Directions Selected Key References References 66 Bioengineered Vascular Grafts Abstract Keywords Basic Principles Initial History Intact Isolated Blood Vessels Artegraft Procol CryoVein Luminal Modification (Biohybrids) Tissue-Engineered Vascular Grafts Grafts Created in vivo (“Bioreactors”) Scaffold Based Biodegradable Scaffolds Xenogeneic Tissue Scaffolds Human Tissue Scaffolds Tissue-Engineered Sheets Clinical Experience Intact Isolated Blood Vessels Biohybrids Tissue-Engineered Vascular Grafts Cytograft—Tissue-Engineered Vascular Grafts for Hemodialysis Vascular Access Olausson—Decellularized Human Donor Vessel Scaffold Humacyte, Inc.—Tissue-Engineered Vascular Grafts for Hemodialysis Vascular Access and Peripheral Arterial Bypass Limitations and Risks Future Advances Selected Key References References 67 Nonaortic Stents and Stent Grafts Abstract Keywords Historical Background Stent-Vessel Interaction Vessel Injury Fluid Dynamics Strut Characteristics Stent Composition Stent Types and Characteristics Important Characteristics Cell Size: Open and Closed Cells Balloon-Expandable Stents Self-Expanding Stents Stent Grafts (Covered Stents) Selection of Stent Plaque Morphology External Forces Anatomic Location Branch Location Failure Modes Drug-Eluting Technology for Neointimal Failure Treatment of in-Stent Restenosis New Developments Absorbable Stents Drug Delivery Without Stenting Future Developments Selected Key References References 68 Novel and Evolving Aortic Endovascular Devices Introduction Thoracic Aorta Current Practice Open Repair Standard Thoracic Endovascular Aneurysm Repair Hybrid Procedure Chimney Technique Fenestrated Technique Branched Endografts Abdominal Aorta Current Practice Standard Endovascular Chimney Endovascular Hybrid Technique Open Repair Fenestrated Endografts Branched Endografts Multilayer Endografts Endovascular Aneurysm Sealing Future Directions Conclusion Selected Key References References SECTION 10 Abdominal Aortic and Iliac Aneurysms 69 Arterial Aneurysms: Etiology, Epidemiology, and Natural History Abstract Keywords General Considerations Historical Perspective Aneurysm Classification Size Definitions Aortic Peripheral True Versus False Aneurysms Location and Extent Morphology Etiology Degenerative Inflammatory Aneurysms Associated With Arterial Dissection Traumatic Developmental and Congenital Anomalies Infectious Specific Arteries Aortic Iliac Femoral Popliteal Visceral Renal Cerebrovascular Upper Extremity Multiple Aneurysms Aortic Peripheral Familial Connective Tissue Disorders Cystic Medial Degeneration Selected Key References References 70 Aortoiliac Aneurysms: Evaluation, Decision Making, and Medical Management History Definitions Epidemiology Associated Aneurysms Rupture Risk Pathophysiology Diagnosis History Physical Examination Ultrasound Computed Tomography Magnetic Resonance Imaging Angiography Screening and Surveillance Recommendations Medical Therapy Medical Management Indications for Intervention Risk Calculator Future Directions Selected Key References References 71 Abdominal Aortic Aneurysms: Open Surgical Treatment Indication for Open Repair Anatomy Endovascular Aneurysm Repair Conversion Infection Additional Circumstances Preoperative Assessment and Planning Preoperative Imaging Computed Tomography Magnetic Resonance Angiography Operative Technique Selecting the Approach Transperitoneal Repair Exposure (See Chapter 54) Pararenal Aorta Supraceliac Aorta Medial Visceral Rotation Arterial Reconstruction Closure Retroperitoneal Repair Exposure Supraceliac Aorta Arterial Reconstruction Closure Anatomic Considerations Management of the Inferior Mesenteric Artery Renal Abnormalities Venous Abnormalities Intraoperative Management Management of Aortic Clamping Renal Protection Postoperative Complications Early Complications Myocardial Ischemia (See Chapter 42) Respiratory Failure (See Chapter 43) Renal Failure (See Chapter 44) Colonic Ischemia Lower Extremity Ischemia Spinal Cord Ischemia Venous Thrombosis Outcomes Early Mortality Postoperative Surveillance Special Circumstances Open Conversion After Endovascular Aneurysm Repair Inflammatory Aneurysms Infected Abdominal Aortic Aneurysms Selected Key References References 72 Aortoiliac Aneurysms: Endovascular Treatment Abstract Keywords Graft Types Percutaneous Technique Randomized Trials of Endovascular Aneurysm Repair Versus Open Repair Perioperative Outcome Long-Term Outcome Population-Based Results Meta-Analysis Endovascular Aneurysm Repair Compared With Medical Management Endovascular Aneurysm Repair in Ruptured Abdominal Aortic Aneurysms Comparison of Different Stent Grafts Complications of Endovascular Aneurysm Repair Endoleak Type I Type II Type III Type IV Type V Endoleak Detection Migration Graft Limb Occlusion Renal Artery Occlusion Neck Dilatation Stent-Graft Infection Pelvic Ischemia Stent-Graft Fatigue Follow-Up Computed Tomography Scans and Ultrasound Sac Pressure Measurement Re-intervention Rates Endovascular Repair of the Juxtarenal Aorta Encroachment Technique Snorkel Technique Results Endovascular Repair of Common Iliac and Internal Iliac Artery Aneurysms Common Iliac Artery Aneurysms Internal Iliac Artery Aneurysms Cost of Endovascular Aneurysm Repair Selected Key References References 73 Endovascular Aneurysm Repair Techniques Abstract Keywords Characteristics of Abdominal Aortic Stent Grafts Fixation Positive Fixation, Column Support, and Friction Infrarenal Versus Suprarenal Fixation Sealing Iliac Limbs Sizing Graft Material Radiopacity Deployment Precision and Ease of Use Graft Selection and Primary Device Characteristics Endograft Configurations Preoperative Sizing and Planning Preoperative Imaging Computed Tomography Arteriography Alternative Imaging Endograft Sizing Aortic Neck Diameter Sizing the Conical Aortic Neck Length Measurements Iliac Diameters Patient Selection Anesthesia, Access, and Imaging Anesthesia Vascular Access Percutaneous Access Open Surgical Access Iliac Occlusive Disease Iliac Conduit Placement Imaging Equipment Gantry Positioning Evar Deployment Wire Placement Delivery of the Main Device Proximal Endograft Deployment Accessory Renal Artery Management Contralateral Gate Cannulation Limb Deployment Completion Arteriography EVAR Troubleshooting Type I and III Endoleaks Aortic Cuffs Giant Palmaz Stent Placement Endo-Anchors Renal Artery Iliac Artery External Iliac Extensions Hypogastric Artery Embolization Preservation Management of Late Type II Endoleaks Indication Diagnosis Treatment Selected Key References 74 Ruptured Aortoiliac Aneurysms and Their Management Terminology and History Definitions History of Ruptured Abdominal Aortic Aneurysm Repair Epidemiology Declining Incidence Overall Mortality of Ruptured Abdominal Aortic Aneurysm Repair Pathophysiology of Aortic Rupture Abdominal Aortic Aneurysm Shape and Finite Element Analysis Role of Aortic Thrombus Clinical Features Signs and Symptoms Differential Diagnosis Diagnostic Evaluation Plain Radiographs Ultrasound Computed Tomography Is There Time for a Computed Tomography Scan in Ruptured Abdominal Aortic Aneurysm? Initial Management Strategies Patient Triage and Transfer to Appropriate Institutions Permissive Hypotension Protocol-Based Approach Anatomic Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Aneurysm Repair Operative Preparation and Setup Operative Strategies: Endovascular Repair Initial Management Technique Arterial Access and Aortic Occlusion Balloon Choice of Anesthesia and Approach Bifurcated Versus Aorto-Uni-Iliac Stent-Grafts for Ruptured Abdominal Aortic Aneurysm Conversion to Open Surgical Repair Operative Strategies: Open Surgical Repair Transperitoneal Approach Retroperitoneal Approach Operative Technique Aortocaval Fistula Autotransfusion Hypothermia Anatomic Abnormalities Venous Abnormalities Renal Abnormalities Abdominal Closure Complications of Ruptured Abdominal Aortic Aneurysm Repair Local Complications Colonic Ischemia Assessment for Abdominal Compartment Syndrome Spinal Ischemia Systemic Complications Cardiac Complications (See Chapter 42) Respiratory Failure (See Chapter 43) Renal Dysfunction (See Chapter 44) Liver Failure Multisystem Organ Failure Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Observational Ruptured Abdominal Aortic Aneurysm Study Outcomes Randomized Ruptured Abdominal Aortic Aneurysm Trials Meta-Analysis of Ruptured Abdominal Aortic Aneurysm Randomized Trials IMPROVE at 3 Years Preoperative Predictors of Mortality Postoperative Estimates of Survival Predictors of Late Survival Late Re-Interventions Rupture After Endovascular Aneurysm Repair Quality of Life Selected Key References References 75 Isolated Iliac Artery Aneurysms and Their Management Introduction Pathogenesis Natural History Presentation Diagnosis Management Operative Approaches and Techniques Endovascular Repair of Common Iliac Artery Aneurysms Endovascular Repair of Internal Iliac Artery Aneurysms Conclusions Selected Key References References SECTION 11 Thoracic and Thoracoabdominal Aortic Aneurysms and Dissections 76 Thoracic and Thoracoabdominal Aortic Aneurysms Introduction The Thoracic Aorta: Anatomy and Epidemiology of TAA and TAAA Definition Normal and Pathologic Aortic Size Incidence/Prevalence Population Affected Risk Factors for Disease and Rupture Pathogenesis Aortic Wall Histology Etiology Anatomic Classification Clinical Findings History and Physical Examination Synchronous Aneurysm Risk Diagnostic Evaluation Imaging Chest X-Ray Computed Tomography Magnetic Resonance Imaging and Magnetic Resonance Angiography Arteriography Laboratory Testing Medical Therapy Antihypertensive Medication Beta Blockers Angiotensin-Converting Enzyme Inhibitors or Receptor Blockers Statins Smoking Cessation Selection of Treatment Size Criteria Preoperative Evaluation Cardiac Pulmonary Renal Functional Status Other Pathologies Associated With the Thoracic Aorta Aberrant Right Subclavian Artery Coarctation of the Aorta Selected Key References References 77 Thoracic and Thoracoabdominal Aneurysms: Open Surgical Treatment Abstract Keywords Pathology Degenerative Inheritable Trauma, Mycotic, Vasculitis Anatomic Classification Indications for Surgical Treatment Patient Evaluation Imaging Informed Consent Surgical Repair Extracorporeal Circulation Other Perfusion Techniques Anesthesia Patient Positioning Surgical Exposure Aneurysm Repair Initial Clamping Proximal Anastomosis Visceral-Renal Reattachment Distal Anastomosis Reimplanting Intercostal Arteries Impact of Endovascular Treatment Postoperative Care Outcomes Spinal Cord Ischemia Physiologic Spinal Protection Expected Paralysis Model Impact of Physiologic Protection Measures Evoked Potential Measurement and Intercostal Reimplantation Descending Thoracic Aneurysms Pulmonary Complications Mortality Renal Function Effect of Surgical Technique on Morbidity Long-Term Survival and Quality of Life Selected Key References References 78 Thoracic and Thoracoabdominal Aneurysms: Endovascular Treatment Abstract Keywords Indications Approved Devices for Thoracic Endovascular Aortic Repair Gore Conformable Thoracic Aortic Graft Device Medtronic Valiant Captivia Device Cook TX2 With Pro-Form Cook Zenith Alpha Bolton Relay PlanningThoracic Endovascular Aortic Repair for Thoracic Aneurysms Relevant Anatomy Aorto-Iliac Anatomy Aortic Sealing Zones Operative Planning and Options Imaging Sizing Identification of Landing Zones Debranching of the Arch Vessels Management of the Celiac Artery Adjunctive Measures for Neuroprotection Operative Technique Postoperative Management Follow-Up Results Technical Results Perioperative Outcomes Late Results Complications Vascular Complications Neurologic Complications Endoleaks Sac Enlargement Migration, Device Integrity, and Rupture Re-Interventions Hybrid Endovascular Repair for Thoracoabdominal Aneurysms Investigational Devices for Thoracoabdominal Aortic Aneurysms Investigational Devices for Aortic Arch Selected Key References References 79 Thoracic and Thoracoabdominal Aneurysms: Aortic Stent Grafts and Techniques of Thoracic Endovascular Aortic Repair Abstract Keywords Introduction Indications Guidelines Thoracic Endovascular Aortic Repair Versus Open Repair Devices History First Generation Modern Devices Technique Training Sizing Access Management of Proximal or Distal Short Neck Perioperative Consideration Preoperative Cardiac Workup Antibiotic Prophylaxis Implantation Procedure Optimal C-Arm Angulation Staged Procedure Fusion Imaging Radiation Exposure to Staff and Patient Complications Intraoperative Complications Iliac Rupture Failure to Deliver the Device Device Distal or Proximal Device Migration Perioperative Complications Postimplantation Syndrome Spinal Cord Ischemia Pathophysiology Neuroprotective Strategies Increasing Tolerance to Ischemia Pharmacologic Neuroprotection Ischemic Preconditioning by Staged Repair Intraoperative Hypothermia (34°C) Augmenting Spinal Cord Perfusion Deliberate Hypertension Cerebrospinal Fluid Drainage Preservation of the Collateral Network Supplying the Spinal Cord Maximize Oxygen Delivery Complications Related to Cerebrospinal Fluid Drainage Cerebral Infarction/Stroke Retrograde Type A Aortic Dissection Acute Kidney Injury Cardiovascular Complications Thoracic Endovascular Aortic Repair Collapse Late Complications Endoleak Device Migration, Component Separation, and Device Integrity Failure Stent Graft Infections Aorto-Esophageal/-Bronchial Fistulae Imaging Surveillance Outcomes Short- and Long-term Results After Thoracic Endovascular Aortic Repair (see Table 79.1) Risk Stratification Scores Ruptured Descending Thoracic Aortic Aneurysm Connective Tissue Disorders Methods for Failure to Rescue Endovascular Rescue Open Conversion Selected Key References References 80 Fenestrated and Branched Endograft Treatment of Juxtarenal, Paravisceral, Thoracoabdominal, and Aortic Arch Aneurysms Abstract Keywords History of Fenestrated and Branched Endovascular Aortic Aneurysm Repair Definitions Techniques for Incorporating Branch Vessels Device Availability Physician Modified Endografts Company-Manufactured Custom-Made Devices Company-Manufactured Off-the-Shelf Devices Overview of Current Devices Based on Aneurysm Location and Extent Juxtarenal Abdominal Aortic Aneurysm Pararenal Abdominal Aortic Aneurysm Thoracoabdominal Aortic Aneurysms Custom Made Devices Thoracic Branch or “t-Branch” (Cook Medical) Gore Excluder Thoracoabdominal Multibranch Endoprosthesis (W.L. Gore and Associates) Aortic Arch Cook Arch Branch Device Relay NBS Plus for Aortic Arch (Bolton Medical, Barcelona, Spain) Valiant Mona LSA Stent Graft System (Medtronic, Inc., Minneapolis, Minnesota) TAG Thoracic Branch Endoprosthesis (W.L. Gore and Associates) Case Planning and Sizing Preoperative Imaging Anatomic Considerations for Fenestrated and Branched Repair Proximal Seal Zone Aortic Angulation, Calcification, and Mural Thrombus Branch Vessel Characteristics Access Vessels Sequence of Intraoperative Steps and Staging of Repair Patient Selection and Preoperative Evaluation Patient Longevity Preoperative Evaluation Renal Evaluation Cardiac Evaluation Pulmonary Evaluation Evaluation of Spinal Cord Circulation Operative Technique Anesthesia Intraoperative Imaging Technical Skills and Resources Device Delivery and Deployment Nonpreloaded Devices Preloaded Fenestrations Preloaded Branches Aortic Arch Branched Devices Outcomes of Fenestrated and Branched Repair Juxtarenal, Pararenal, and Type IV Thoracoabdominal Aortic Aneurysm Early Outcomes Midterm Outcomes and Branch Durability Thoracoabdominal Aortic Aneurysms Early Outcomes Midterm Outcomes and Branch Durability Aortic Arch Aneurysms Surveillance Recommendations After Fenestrated and Branched Repair Practice and Regulatory Issues Selected Key References References 81 Aortic Dissection: Epidemiology, Pathophysiology, Clinical Presentation, and Medical and Surgical Management Classification Temporal Anatomic Epidemiology Risk Factors for Dissection Cardiovascular Conditions Pregnancy Cocaine Abuse Pathologic Anatomy of Acute Aortic Dissection Intimal Tear Cystic Medial Necrosis Pathogenesis of Malperfusion Syndromes Mechanism Clinical Presentation Pain Hypertension Syncope/Neurologic Symptoms Peripheral Vascular Complications Diagnostic Evaluation Imaging Plain Radiography Computed Tomographic Angiography Echocardiography Magnetic Resonance Imaging Treatment of Type B Dissection Medical Treatment Open Surgical Repair of Descending Aortic Dissection Endovascular Treatment of Aortic Dissection Goals of Treatment False Lumen Thrombosis Technical Details Outcomes Treatment of Malperfusion Syndrome Endovascular Treatment Percutaneous Fenestration Open Surgical Treatment Natural History and Follow-Up Long-Term Survival Late Therapy Selected References References 82 Penetrating Aortic Ulcers Abstract Keywords Introduction Pathophysiology Incidence Clinical Presentation Other Aortic Pathologies Associated With Penetrating Aortic Ulcer Diagnostic Imaging Treatment Operative Repair Endovascular Repair Complications Associated With Repair Summary Selected Key References References SECTION 12 Peripheral and Splanchnic Aneurysms 83 Lower Extremity Aneurysms Femoral Artery Aneurysms True Aneurysms Epidemiology Clinical Presentation and Diagnosis Indications for Treatment Surgical Treatment Endovascular Treatment Pseudoaneurysms Clinical Findings and Natural History Diagnosis Treatment Ultrasound-Guided Compression Ultrasound-Guided Thrombin Injection Open Surgical Repair Superficial Femoral Artery Aneurysms Profunda Femoral Artery Aneurysms Persistent Sciatic Artery Aneurysm Popliteal Artery Aneurysms Epidemiology Pathogenesis Natural History Clinical Findings Diagnosis Imaging Indications for Treatment Elective Treatment Endovascular and Hybrid Treatment Procedure Open Treatment Medial Approach Posterior Approach Urgent/Emergent Repair Open Approach Endovascular Treatment—Thrombolysis Results Hybrid Approach Results: Open Versus Endovascular Repair Conclusion Tibial Artery and Pedal Artery Aneurysms Selected Key References References 84 Upper Extremity Aneurysms Abstract Keywords Arch Vessel Aneurysms Epidemiology and Etiology Subclavian Artery Aneurysms Innominate Artery Aneurysms Common Carotid Artery Aneurysms Clinical Presentation Symptoms Signs Imaging Open Surgical Repair Innominate Artery Aneurysms Subclavian Artery Aneurysms Results Endovascular Repair Anatomic Considerations Technique Hybrid Operations Results Aneurysm of Aberrant Subclavian Artery and Kommerell Diverticulum Anatomy Aberrant Subclavian Artery Aberrant Subclavian Artery Aneurysm Kommerell Diverticulum Clinical Presentation Aberrant Right Subclavian Artery Aberrant Subclavian Artery Aneurysm Treatment Surgical Treatment Aberrant Right Subclavian Artery Aberrant Subclavian Artery Aneurysm Endovascular-Hybrid Treatment Hybrid Approach Endovascular Approach Axillary Artery Aneurysms Etiology and Pathology Pseudoaneurysms Treatment Open Surgery Endovascular Treatment Brachial Artery Aneurysms Etiology Clinical Evaluation Treatment Open Surgical Treatment Endovascular Treatment Iatrogenic Injury Presentation Treatment Selected Key References References 85 Splanchnic Artery Aneurysms Abstract Keywords Incidence and Etiology Special Considerations for Associated Conditions General Treatment Principles Elective Repair Emergent Repair Observation Surgical and Endovascular Techniques Open Repair Endovascular Therapy Embolization Covered Stents Flow-Diverting Stents Specific Splanchnic Aneurysms Splenic Artery Aneurysms Epidemiology Etiology Clinical Presentation Treatment Open Surgical Repair Endovascular Therapy Hepatic Artery Aneurysms Epidemiology Etiology Clinical Presentation Treatment Open Surgical Repair Endovascular Repair Superior Mesenteric Artery Aneurysms Epidemiology Etiology Clinical Presentation Treatment Celiac Artery Aneurysms Epidemiology Etiology Clinical Presentation Treatment Other Rare Splanchnic Aneurysms Gastric/Gastroepiploic Aneurysms Etiology Clinical Presentation Treatment Pancreaticoduodenal and Gastroduodenal Artery Aneurysms Etiology Clinical Presentation Treatment Inferior Mesenteric, Jejunal, Ileal, and Colic Artery Aneurysms Etiology Clinical Presentation Treatment Visceral Venous Aneurysms Selected Key References References SECTION 13 Cerebrovascular Diseases 86 Cerebrovascular Disease: Epidemiology and Natural History Abstract Keywords Background Stroke—Background/Introduction Stroke Cost of Caring for Stroke Patients Treatment of Acute Stroke Stroke—Prevalence/Incidence Stroke Prevalence Stroke Incidence Declining Prevalence/Incidence of Stroke Possible Decreasing Prevalence and Incidence of Stroke Effect of Improved Medical Therapy on the Reduced Incidence of Stroke Ischemic Stroke—Epidemiology Risk Factors for Stroke Ischemic Stroke—Natural History Outcome of Stroke Recurrent Stroke Following an Initial Event Stroke Mortality Transient Ischemic Attack—Background/Introduction Transient Ischemic Attack—Prevalence Transient Ischemic Attack—Natural History Extracranial Carotid Artery Atherosclerosis—Background Pathophysiology The Vulnerable Plaque and Patients at Increased Risk for Ischemic Stroke Transcranial Doppler Detection of Microembolization Types of Strokes and Relationship of Stroke to Carotid Artery Atherosclerosis Extracranial Carotid Artery Atherosclerosis—Epidemiology Prevalence of Carotid Artery Disease Extracranial Carotid Artery Atherosclerosis—Natural History Additional Topics Vertebrobasilar Insufficiency Global Cerebral Ischemia Lacunar Infarcts Cognitive Decline Selected Key References References 87 Cerebrovascular Disease: The Unstable Carotid Plaque Abstract Keywords Mechanism of Stroke in Carotid Atherosclerosis Stable Versus Unstable Carotid Plaques Histomorphology of the Unstable Carotid Plaque Biomechanics of the Unstable Carotid Plaque Noninvasive Identification of the Unstable Carotid Plaque Two-Dimensional B-Mode Imaging Ultrasonographic Virtual Histology Three-Dimensional Ultrasonography Contrast Enhanced Ultrasonography Plaque Strain Measurement Intravascular Ultrasound Magnetic Resonance Imaging for Histomorphology Combined Magnetic Resonance Imaging and Ultrasonography for Biomechanics Summary Selected Key References References 88 Cerebrovascular Disease: Diagnostic Evaluation Duplex Ultrasound Indications Carotid Artery Disease Vertebrobasilar Disease Role in Screening Role in Trauma Evaluation of Carotid Body/Glomus Vagale Tumors (See Chapter 95) Role in the Planning of Carotid Endarterectomy and Carotid Artery Stenting Evaluating Plaque Morphology Perioperative Roles Postoperative Roles Contraindications Accuracy and Limitations Magnetic Resonance Imaging/Magnetic Resonance Angiography Indications Carotid Disease Role in Vertebrobasilar Disease Role in Screening Role in the Evaluation of Trauma Role in the Evaluation of Carotid Body/Glomus Tumors Role in the Planning of Carotid Endarterectomy and Carotid Artery Stenting Role in Evaluating Plaque Morphology Perioperative Roles Postoperative Roles Contraindications Accuracy and Limitations in Clinical Practice Positron Emission Tomography-Computed Tomography (See Chapter 29) Indications Carotid Artery Disease Role in Evaluating Plaque Morphology Other Roles Accuracy and Limitations in Clinical Practice Computed Tomography Angiography Indications Carotid Artery Disease Vertebrobasilar Disease Role in Screening Role in the Evaluation of Trauma Role in the Evaluation of Carotid Body/Glomus Tumors Role in the Planning of Carotid Endarterectomy and Carotid Artery Stenting Role in Evaluating Plaque Morphology Perioperative Roles Postoperative Roles Contraindications Limitations in Practice Digital Subtraction Angiography Indications Carotid Artery Disease Vertebrobasilar Disease Role in Screening Role in Trauma Role in the Evaluation of Carotid Body/Glomus Vagale Tumors Role in the Planning of Carotid Endarterectomy/Carotid Artery Stenting Role in Evaluating Plaque Morphology Perioperative Roles Postoperative Roles Contraindications Accuracy and Limitations in Clinical Practice Transcranial Doppler Indications Carotid Artery Disease Vertebrobasilar Disease Role in the Evaluation of Trauma Intraoperative Monitoring Role in Evaluating Postoperative Strokes Selected Key References References 89 Cerebrovascular Disease: Decision Making Including Medical Therapy Introduction Clinical Implications of Carotid Stenosis and Goals of Therapy Treatment Options When Carotid Bifurcation Stenosis Is Identified Best Medical Therapy Risk-Factor Reduction and Medical Management Blood Pressure Control Diabetes Mellitus Lipid Management Behavioral Modification Metabolic Syndrome Antiplatelet Therapy Estimating the Stroke Risk in A Particular Clinical Scenario Patient Characteristics Prior Neurologic Symptoms Contralateral Carotid Occlusion Evidence of Clinically Silent Emboli Plaque Characteristics Degree of Stenosis Plaque Progression Plaque Character Factors Influencing the Decision to Recommend Intervention Life Expectancy Age Gender Functional Status Cardiac Status Pulmonary Disease Renal Insufficiency Contralateral Carotid Occlusion Patient-Specific Factors That Influence the Choice of Therapy Presence of Neurologic Symptoms Hostile Neck Lesions Outside the Area of the Cervical Carotid Artery Vessel Tortuosity Lesion Character Evidence-Based Selection of Therapy Best Medical Therapy Alone Versus Carotid Endarterectomy Plus Best Medical Therapy Interventional Strategies: Carotid Angioplasty and Stenting Versus Carotid Endarterectomy Societal Guidelines Regarding Carotid Revascularization and Stroke Prevention Selecting the Appropriate Therapy for the Appropriate Patient Patients With Carotid Bifurcation Stenosis of Less Than 50% Asymptomatic Patients With Carotid Bifurcation Stenosis of 70% to 99% Symptomatic Patients With Carotid Bifurcation Stenosis 50% to 99% Contralateral Carotid Occlusion Timing of Intervention After Acute Stroke Unstable Neurologic Syndromes Recurrent Carotid Stenosis Radiation-Induced Stenosis Select Key References References 90 Nonatherosclerotic Carotid Artery Disease and Its Management Abstract Keywords Carotid Stenosis After Radiotherapy Epidemiology Pathogenesis Clinical Findings History and Physical Examination Diagnostic Evaluation Treatment General Considerations Carotid Stenting (See Chapter 92) Carotid Endarterectomy (See Chapter 91) Medical Management Open Surgical Approach Endovascular Approach Results Follow-Up Recurrent Carotid Stenosis Epidemiology Pathogenesis Clinical Findings History and Physical Diagnostic Evaluation Treatment General Considerations Carotid Stenting Redo Carotid Endarterectomy Medical Management Reoperative Surgical Revascularization Endovascular Management of Post-Endarterectomy Stenosis Stenting Versus Endarterectomy for Restenosis After Carotid Endarterectomy Surgical Revascularization for In-Stent Restenosis Endovascular Management of In-Stent Restenosis Follow-Up Selected Key References References 91 Carotid Endarterectomy Abstract Keywords Epidemiology Incidence Etiology Indications for Carotid Endarterectomy Preoperative Imaging Perioperative Medical Management Beta-Blockers Antiplatelet Therapy Heparin Protamine Administration Dextran Statins Operative Technique Anesthesia Patient Positioning Skin Incision Carotid Exposure (see Chapter 55) Conventional Endarterectomy Eversion Endarterectomy Comparison of Conventional and Eversion Carotid Endarterectomy Exposure for High Lesions Nasotracheal Intubation Division of the Digastric Muscle Resection of the Styloid Process Anterior Subluxation of the Mandible Cerebral Protection and Monitoring Shunting Stump Pressure Electroencephalographic and Somatosensory Evoked Potential Monitoring Transcranial Doppler Awake Carotid Endarterectomy With Regional or Local Anesthesia Routine Shunting Arteriotomy Closure Patch Material Saphenous Vein Patches Synthetic Patches Comparative Analyses Selective Patching Completion Studies Results of Completion Studies Perioperative Stroke Management Intraoperative Postoperative Surgical Results Randomized Trials Symptomatic Disease Asymptomatic Disease Institutional Experience Population-Based Experience Complications Cardiac Cranial Nerve Injury Incidence Anatomic and Clinical Considerations Hypoglossal Nerve Vagus Nerve Superior Laryngeal Nerve Facial Nerve: Marginal Mandibular Branch Glossopharyngeal and Spinal Accessory Nerves Cutaneous Sensory Nerves Hemodynamic Instability Incidence and Etiology Treatment Cerebral Hyperperfusion Syndrome Other Complications Infections Bleeding Recurrent Carotid Stenosis Repeat Carotid Endarterectomy Carotid Artery Stenting Versus Repeat Carotid Endarterectomy Special Considerations Combined Carotid Artery and Cardiac Disease Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting Carotid Artery Stenting Before Coronary Artery Bypass Grafting Advanced Age Gender Race Symptomatic Disease With Less Than 50% Carotid Stenosis External Carotid Endarterectomy Impact of Radiation Therapy Hospital/Surgeon Volume Selected Key References References 92 Cerebrovascular Disease: Carotid Artery Stenting Abstract Keywords Background Landmark Clinical Trials SAPPHIRE EVA-3S SPACE ICSS CREST ACT-I Current Guidelines Symptomatic Carotid Artery Stenosis Asymptomatic Carotid Artery Stenosis Patient Selection Age Sex Hostile Neck Combined Carotid and Coronary Artery Disease Restenosis Contraindications Anatomic Considerations Aortic Arch Morphology Carotid Artery Morphology Plaque Morphology Contralateral Carotid Artery Occlusion Preoperative Considerations Preoperative Imaging Timing of Surgery Technique General Principles of Stenting Periprocedural Monitoring Arterial Access Target Lesion Access Angiography Embolic Protection Devices Predilation Stent Selection and Delivery Postdilation Completion Angiography and Retrieval of Embolic Protection Device Access Hemostasis Perioperative Medications Anticoagulation Atropine Vasodilators Beta Blockers Antiplatelet Therapy Antithrombotic Therapy Statins Complications Technical Complications Neurologic Complications Cardiovascular Complications Renal Dysfunction Access Complications Stent Fracture Restenosis Postoperative Surveillance Long-Term Outcomes Randomized Controlled Trials Ongoing Trials Conclusions Selected Key References References 93 Cerebrovascular Disease: Carotid Artery Dissection Abstract Keywords Carotid Artery Dissection Spontaneous Carotid Artery Dissection Epidemiology Pathogenesis Clinical Findings Traumatic Carotid Artery Dissection Epidemiology Pathogenesis Clinical Findings Diagnostic Evaluation Natural History Treatment Medical Therapy Surgical Treatment Endovascular Therapy Selection of Treatment Selected Key References References 94 Carotid Artery Aneurysms Abstract Keywords Definition Historical Review Epidemiology Population Affected Incidence Pathogenesis Etiology Degenerative/Atherosclerotic Posttraumatic Causes Post-Endarterectomy Aneurysms Arterial Dysplasia Pathology Clinical Findings Physical Features/Symptoms Pulsatile Mass Neurologic Symptoms Cranial Nerve Dysfunction Dysphagia Hemorrhage and Rupture Differential Diagnosis Diagnostic Evaluation Natural History Treatment Open Surgical Approaches Ligation Adjunctive Measures Resection and Reconstruction Reconstruction Options Pseudoaneurysm Repair After Previous Carotid Endarterectomy Open Surgical Technique Endovascular Therapy Trans-Stent Coil Embolization Stent-Graft Coverage Selection of Treatment Treatment Outcome Open Surgical Repair Endovascular Therapy Treatment of Carotid Blowout Medical Management Mycotic Aneurysms Special Considerations Pediatric Patients Selected Key References References 95 Carotid Body Tumors Abstract Keywords Introduction Epidemiology and Etiology Anatomy and Physiology Pathology Clinical Presentation Diagnosis Treatment Preoperative Preparation Surgical Technique Positioning and Exposure Resection of Tumor Postoperative Care Results Conclusions Selected Key References 96 Unusual Carotid Artery Conditions Abstract Keywords Background Carotid Sinus Syndrome/Carotid Sinus Hypersensitivity Background and Epidemiology Epidemiology Classification Physiology and Pathophysiology Presentation and Risk Factors Diagnosis and Workup Treatment Moyamoya Disease Background and Epidemiology Presentation and Risk Factors Pathology and Genetics Pathophysiology Diagnosis and Workup Treatment Management and Prognosis Carotid Artery Kinks and Coils Background Epidemiology Etiology and Clinical Presentation Treatment Management and Prognosis Intracranial Vascular Stenosis Background and Epidemiology Pathophysiology and Risk Factors Diagnosis Treatment Intracranial Aneurysm With Extracranial Carotid Stenosis Background and Epidemiology Treatment and Management Cerebral Vasculitis Background and Epidemiology Presentation and Diagnosis Treatment Lacunar Infarcts Background Pathophysiology Diagnosis Treatment Selected Key References References 97 Vertebral Artery Dissection and Other Conditions Abstract Keywords Pathogenesis and Anatomy Ischemic Mechanisms Low Flow Embolic Disease Distribution V1 Segment V2 Segment V3 Segment V4 Segment Patient Selection for Vertebral Artery Reconstruction Anatomic Considerations Etiologic Considerations Low Flow Embolic Differential Diagnosis Diagnostic Testing Duplex Ultrasonography Computed Tomography and Magnetic Resonance Imaging Arteriography Vertebral Artery Reconstructive Procedures Disease Location V1 Segment V2 Segment V3 Segment Suboccipital Segment Transposition of the Proximal Vertebral Artery Into the Common Carotid Artery Distal Vertebral Artery Reconstruction Common Carotid–Vertebral Artery Bypass Alternative Options for V3 Reconstruction Posterior Suboccipital Vertebral Artery Bypass Operative Results Perioperative Outcomes Proximal Reconstructions Distal Reconstructions Long-Term Outcomes Endovascular Therapy Endovascular Treatment Conclusion Selected Key References References 98 Brachiocephalic Artery Disease and Its Surgical Treatment Abstract Keywords Introduction Anatomic Variants Indications for Intervention in Occlusive Disease Other Indications for Intervention Infection Trauma Dissection Arterial Thoracic Outlet Syndrome Aneurysm Diagnostic Evaluation Revascularization Transthoracic Revascularization Endarterectomy Bypass Grafts Total Aortic Arch Replacement Transthoracic Operative Results Postoperative Management Extraanatomic Revascularization Subclavian-Carotid Transposition Carotid-Subclavian Bypass Carotid-Carotid Bypass Axilloaxillary and Subclavian-Subclavian Bypass Carotid-Contralateral Subclavian Bypass Operative Results Postoperative Management Acknowledgments Selected Key References References 99 Brachiocephalic Artery Disease and Its Endovascular Management Procedure Planning Imaging Studies Duplex Ultrasound Computed Tomography and Magnetic Resonance Angiography Arteriography Transesophageal Echocardiography Anatomic Considerations Disease Distribution Options for Endovascular Therapy Angioplasty Stents Covered Stents Perioperative Medical Management Antiplatelet Agent Intraprocedural Heparin Technical Details Left Subclavian Artery Intervention Vertebral Artery Protection Brachial Access Radial Access Innominate Artery Interventions Access Carotid Protection Innominate Branches Left Common Carotid Artery Interventions Innominate and Left Common Carotid Interventions in Combination With Carotid Endarterectomy Technique Results Results Patency Arch Intervention in Inflammatory Conditions Long-Term Management Medical Therapy Surveillance Protocol Selected Key References References SECTION 14 Acute Limb Ischemia 100 Acute Limb Ischemia: Evaluation and Decision Making Etiology and Pathology Embolism Cardiac Embolism Atrial and Ventricular Paradoxical Endocarditis Cardiac Tumor Noncardiac Embolism Atheroembolism Aortic Mural Thrombi Thrombosis Atherosclerotic Obstruction Hypercoagulable States Vasospasm Aortic Dissection Bypass Graft Occlusion Clinical Presentation Clinical Assessment History Physical Findings Classification of Acute Limb Ischemia Diagnosis Aortic Occlusion Iliac Occlusion Femoropopliteal Occlusion Popliteal and Infrapopliteal Occlusion Investigation Computed Tomographic Angiography Ultrasound Transfemoral Arteriography Magnetic Resonance Angiography Echocardiography Initial Management Anticoagulation Ancillary Supportive Measures Treatment Options Anticoagulation Operative Intervention Endovascular Intervention Selection Acute Critical Ischemia Acute Subcritical Ischemia Prognosis Upper Limb Ischemia Selected Key References References 101 Acute Ischemia: Treatment Abstract Keywords Initial Management Anticoagulation and Supportive Measures Treatment Selection Endovascular Treatment Catheter-Directed Thrombolysis Technique Results Complications Pharmacomechanical Thrombectomy EKOS EkoSonic Endovascular System AngioJet Thrombectomy System Percutaneous Mechanical Thrombectomy Without Thrombolysis Hydrodynamic Devices Rotational/Mechanical Devices Thrombus Aspiration Devices Results Complications Surgical Revascularization Techniques Balloon Catheter Thrombectomy or Embolectomy Bypass Procedures Endarterectomy Results Special Considerations Myoglobinuria Fasciotomy Pediatric Population Upper Limb Ischemia Selected Key References References 102 Compartment Syndrome and Its Management Abstract Keywords Introduction Pathogenesis of Compartment Syndrome Local Hemodynamics of Compartment Syndrome Compartment Pressures Critical Closing Pressure Absolute Intracompartmental Pressure Threshold Dynamic Intracompartmental Pressure Threshold Clinical Etiologies Vascular Causes Ischemia-Reperfusion Trauma Venous Outflow Obstruction Hemorrhage Nonvascular Etiologies Fracture Crush Injury Iatrogenic Secondary Compartment Syndrome Clinical Presentation History and Examination Measurement of Compartment Pressures Technique Unusual Presentations for Compartment Syndrome Adjunctive Measures Prevention of Compartment Syndrome Prevention of Systemic Sequelae Hyperkalemia Myoglobinuria Fasciotomy Criteria for Fasciotomy Clinical Criteria Intracompartmental Pressure Measurements Contraindications to Fasciotomy Technique of Fasciotomy Lower Extremity Technique Lower Leg Anatomic Considerations Skin Incisions Double-Incision Technique Single-Incision Technique Thigh Buttock Foot Upper Extremity Forearm Hand Fasciotomy Wound Management Outcomes Early Outcomes Late Outcomes Sequelae of Missed Compartment Syndrome Chronic Exertional Compartment Syndrome Clinical Presentation and Diagnosis Fasciotomy for Chronic Exertional Compartment Syndrome Outcomes Selected Key References References 103 Atheromatous Embolization and Its Management Incidence Pathogenesis Risk Factors Endovascular Procedures for Coronary and Peripheral Arterial Occlusive Disease Cardiac Surgery Vascular Surgery Anticoagulation Thrombolysis Clinical Features Cutaneous Manifestations Livedo Reticularis Blue Toe Syndrome Other Skin Manifestations Renal Involvement Gastrointestinal Involvement Central Nervous System and Eye Involvement Retinal Cerebral Other Areas Diagnosis Laboratory Tests Imaging Modalities Histologic Findings Differential Diagnosis Treatment Preventive Strategies Medical Therapy Surgical and Endovascular Therapy Surgical Therapy Endovascular Therapy Pain Control Summary Selected Key References References SECTION 15 Lower Extremity Chronic Arterial Disease 104 Lower Extremity Arterial Occlusive Disease: Epidemiology and Natural History Abstract Keywords Epidemiology of Peripheral Arterial Disease Incidence and Prevalence Risk Factors Demographics Smoking Diabetes Hypertension Dyslipidemia Obesity Inflammation Homocysteine Socioeconomic Status Anatomic Distribution of Disease and Clinical Correlations Clinical Syndromes of Peripheral Arterial Disease, Staging and Natural History Asymptomatic Disease Intermittent Claudication Limb-Threatening Ischemia Screening for Peripheral Arterial Disease Surveillance of Peripheral Arterial Disease Patients With Established Disease Selected Key References References 105 Lower Extremity Arterial Disease: Medical Management and Decision Making Abstract Keywords Medical Management Risk Factor Modification Exercise Therapy for Claudication Pharmacologic Treatment of Claudication Cilostazol Decision Making for Revascularization Defining Treatment Success Limb- and Patient-Centered Outcomes Claudication Chronic Limb-Threatening Ischemia Treatment Guidelines According to Anatomic Disease Classification Trans-Atlantic Inter-Society Consensus Classification Runoff Score Treatment Guidelines According to Presentation Claudication Medical Therapy Versus Revascularization Endovascular Treatment Versus Open Surgery (see Chapters 106 through 110) Chronic Limb-Threatening Ischemia Medical Therapy Versus Revascularization Limb Amputation Versus Revascularization Endovascular Treatment Versus Open Surgery (see Chapters 106 to 110) Situational Perfusion Enhancement BASIL Trial Ongoing Trials Threatened Limbs, With or Without Peripheral Arterial Disease Impact of Conduit Availability, Preoperative Functional Status, and Comorbid Disease Conduit Availability Influence of Comorbid Conditions and Preoperative Functional Status Risk Prediction Models Angiogenesis for Peripheral Arterial Disease Future Developments Future Trends Decision Analysis Cost Considerations Unmet Needs Selected Key References References 106 Aortoiliac Disease: Direct Reconstruction Abstract Keywords Pathology and Clinical Presentation Pathology Collateral Circulation Epidemiology Presenting Symptoms Diagnosis History and Physical Examination Noninvasive Hemodynamic Assessment Indications for Surgical Intervention Impact of Endovascular Treatment Claudication Chronic Limb-Threatening Ischemia Surgical Treatment Preoperative Preparation Coronary Artery Disease Aortoiliac Endarterectomy Patient Selection Technique Aortobifemoral Bypass Exposure Clamp Placement Graft Selection Anastomoses End to End End to Side Technique Closure Adjunctive Profundaplasty Technique Other Operative Considerations External Iliac Anastomosis Multilevel Occlusive Disease Associated Renal or Mesenteric Artery Occlusive Disease Coexistent Abdominal Aortic Aneurysms Retroperitoneal Approach Minimally Invasive Approaches Results Early Complications Hemorrhage Intestinal Ischemia Late Complications Graft Thrombosis False Aneurysm Graft Infection Aortoenteric Fistula Isolated Profundaplasty Selected Key References References 107 Aortoiliac Disease: Open Extraanatomic Bypass Femorofemoral Bypass Axillofemoral Bypass Obturator Bypass Summary Selected Key References References 108 Aortoiliac Disease: Endovascular Treatment Abstract Keywords Background Indications Limb Ischemia Younger Patients Embolization Improving Inflow for Concomitant Procedures Contraindications Relevant Anatomy: Trans-Atlantic Inter-Society Consensus Classification Patient Evaluation and Operative Planning Primary Evaluation Noninvasive Imaging Duplex Arterial Mapping Magnetic Resonance Angiography Computed Tomographic Angiography Evaluation for Common Femoral Artery Disease Concomitant Aortic Disease Technique Pretreatment Considerations Avoiding Contrast Nephropathy Determination of Approach Determination of Hemodynamically Significant Lesion Techniques to Recanalize Chronic Totally Occluded Iliac Arteries Contralateral Approach Brachial Approach Reentry Wires and Catheters Aortic Bifurcation Lesions Technical Approach Aortic Bifurcation Advancement Concomitant Femoral Endarterectomy Stent Sizing Stent Selection Results Percutaneous Angioplasty Versus Selective Stenting Primary Stenting Versus Selective Stenting Long-Term Results Patency Based on Trans-Atlantic Inter-Society Consensus Classification Trans-Atlantic Inter-Society Consensus Types A and B Lesions Trans-Atlantic Inter-Society Consensus Types C and D Lesions Patency With Concomitant Common Femoral Artery Disease Predictors of Failure Stent Grafting Stent-Graft Patency Predictors of Failure for Stent Grafting Mortality Complications Contrast Related Sheath Site Related Remote Arterial Rupture Arterial Dissection Embolization Postoperative Management Criteria for Reporting Significant Change in Clinical Status Criteria for Patency Quality of Life Outcomes Selected Key References References 109 Infrainguinal Disease: Surgical Treatment Abstract Keywords Indications Claudication Critical Limb Ischemia and Chronic Limb-Threatening Ischemia Preoperative Assessment Preoperative Imaging Defining Bypass Target Arteries Autogenous Vein Assessment Operative Planning Concomitant Inflow Disease Proximal Anastomotic Site Associated Femoral Endarterectomy Distal Anastomotic Site Isolated Popliteal Target Tibial, Peroneal, and Pedal Targets Operative Exposures Standard Anterior Approach to the Common Femoral and Profunda Femoris Arteries Alternative Approaches to the Profunda Femoris Artery Exposures of the Popliteal and Tibioperoneal Arteries Choice of Conduit Autogenous Grafts Prosthetic Grafts Vein Cuffs Human Umbilical Vein and Adjunctive Arteriovenous Fistula Heparin-Bonded Polytetrafluoroethylene Graft Comparison Bypass Technique Reversed Vein Bypass Arm Vein Harvest and Vein Splicing In situ Vein Bypass Intraoperative Completion Studies Doppler Flow Assessment Arteriography Duplex Ultrasound Angioscopy Results Objective Endpoints Graft Patency Patency Definitions Comparison of Graft Types Subjective Endpoints Durability Functional Outcomes Cost-Effectiveness and Risk Stratification Quality of Life Postoperative Management Antiplatelet Therapy Anticoagulation Wound Care Complications Early Graft Occlusion Late Graft Occlusion Graft Surveillance Treatment of Graft and Anastomotic Stenoses Acknowledgment Selected Key References References 110 Infrainguinal Disease: Endovascular Therapy Abstract Keywords Introduction Intermittent Claudication Chronic Limb Threatening Ischemia Bypass Versus Angioplasty in Severe Ischemia of the Leg Trials Best Endovascular Versus the Best Surgical Therapy in Patients With Critical Limb Ischemia Global Vascular Guidelines on Chronic Limb Threatening Ischemia Factors Affecting Outcomes Smoking Best Medical Therapy Diabetes Mellitus Gender Residual and Recurrent Disease End-Stage Renal Disease (Dialysis) Vessel Calcification Body Mass Index Race and Ethnicity Re-admissions Inflow Considerations Common Femoral Artery Deep Femoral Artery Hybrid Procedures Outflow Considerations Angiosome Targeted Endovascular Treatment Treatment of Multiple Outflow Vessels Pedal Intervention Atherectomy Stent Graft Conclusions Selected Key References References 111 Lower Extremity Amputations: Epidemiology, Procedure Selection, and Rehabilitation Outcomes Abstract Keywords Epidemiology Variation in Amputation Rates Effects of Ethnicity, Economic, and Social Factors Effect of Revascularization Rates Indications for Amputation Impact of Diabetes Impact of Tissue Loss and Anatomy Impact of Delay in Presentation Primary Amputation Versus Revascularization Groups Benefiting From Primary Amputation Perioperative Evaluation Perioperative Stages Reducing Perioperative Risk Managing Infection Planning Rehabilitation Amputation Level Selection Objective Testing and Clinical Judgment Physical Findings Skin Temperature Measurements Ankle and Toe Pressure Measurements Arteriography Radioisotope Scans, Scintigraphy, and Skin Perfusion Pressure Transcutaneous Oxygen Measurements Technique Selection Rehabilitation Considerations Amputation Wound Dressings Prosthesis Selection and Training Functional Outcome Impact of Amputation Level and Comorbidities Impact of Age Fate of the Contralateral Limb After Amputation Depression After Amputation Selected Key References References 112 Lower Extremity Amputations: Operative Techniques and Results Abstract Keywords General Principles Amputation Types Toe and Ray Amputation Anatomy Technique: Toe Amputation Technique: Ray Amputation Transmetatarsal Amputation Anatomy Technique Midfoot and Hindfoot Amputations Anatomy Lisfranc and Chopart Amputations Lisfranc Chopart Postoperative Considerations Syme Amputation Postoperative Considerations Transtibial (Below-Knee) Amputation Anatomy Technique Posterior Flap Sagittal Flap Skew Flap Fish-Mouth Flap Medial Flap Ertl Procedure Guillotine Amputation Cryoamputation Postoperative Considerations Through-Knee Amputation Anatomy Technique Transfemoral (Above-Knee) Amputation Anatomy Technique Postoperative Considerations Hip Disarticulation Anatomy Technique Postoperative Considerations Principles of Postoperative Care Operative Mortality Long-Term Survival Functional Outcome Reamputation Complications Local Bleeding Infection Contracture Systemic Cardiac Pulmonary Venous Thromboembolism Renal Failure Stroke Psychiatric Pain Selected Key References References SECTION 16 Diabetic Foot and Its Management 113 General Considerations of Diabetic Foot Ulcers Abstract Keywords Introduction Epidemiology Pathophysiology Diabetic Neuropathy Peripheral Arterial Disease Soft Tissue Infection Muscle and Bone Abnormalities Presentation and Diagnosis Patient History Physical Examination Diabetic Ulcer Evaluation and Classification Radiologic Investigations Management General Principles Wound Débridement Offloading Patient Education Advanced Wound Treatment Modalities Soft Tissue Surgery for the Diabetic Foot Local Tissue Flaps Free (Microvascular Transfer) Flaps Prevention of Recurrent Soft Tissue Defects Amputation Peripheral Arterial Disease and the Diabetic Foot Vascular Lab Workup Endovascular Interventions in the Diabetic Patient Surgical Bypass in the Diabetic Patient Endovascular Versus Bypass for Diabetic Revascularization Multidisciplinary Limb Preservation Programs Selected Key References References 114 Diabetic Foot Abnormalities and Their Management Abstract Keywords Introduction Peripheral Neuropathy Biomechanics Ischemia Infection The Diabetic Foot Ulcer Charcot Neuroarthropathy Other Important Considerations Conclusions Selected Key References References 115 Wound Care Abstract Keywords Normal Wound Healing Inflammatory Phase Proliferative Phase Epithelialization and Remodeling Mechanisms of Abnormal Wound Healing in Chronic Wounds Inflammation Cytokines Cell Senescence Therapeutic Targets Etiology of Ulceration Venous Leg Ulcers Diabetic Foot Ulcers Limb Ulcers Associated With Arterial Insufficiency Other Causes of Limb Ulceration Clinical Presentation and Initial Evaluation Wound Classification Systems Wound Size Measurement Wound Bed Assessment and Preparation Débridement Chemical Larval Ultrasound Bacterial Colonization Properties and Categories of Wound Dressings Venous Leg Ulcers Compression Pharmacologic Treatment Pentoxifylline Flavonoids Anticoagulants Indications for Intervention Adjunctive Therapies to Accelerate Healing Skin Grafting Human Skin Equivalents Diabetic Foot Ulcers Adjunctive Therapies to Accelerate Healing Vitamin D Growth Factors Living Tissue Substitutes Apligraf Dermagraft Acellular Dermal Matrix Products Integra Dermal Regeneration Template Ulcers Associated With Arterial Insufficiency Local Wound Management Pharmacologic Treatment Pentoxifylline and Cilostazol Prostaglandins Angiogenesis for Critical Limb Ischemia and Ischemic Wounds Intermittent Pneumatic Compression Wound Management After Intervention Specialized Techniques Negative-Pressure Wound Therapy Hyperbaric Oxygen Other Tissue/Matrix Products Selected Key References References 116 Podiatric Care Abstract Keywords The Specialty of Podiatry Education and Training Scope of Practice Diabetes-Related Amputations Epidemiology Etiology and Natural History Preventive Strategies Podiatric Care Team Approach Primary Amputation Prevention Neuropathy Pressure Reduction Secondary Amputation Prevention Infection Vascular Care Wound Care Mechanical Off-Loading Surgical Off-Loading Class I: Elective Class II: Prophylactic Class III: Curative Class IV: Emergency The Charcot Foot Metabolic Control Post–Secondary Amputation Prevention: Diabetic Foot Remission Summary Selected Key References References SECTION 17 Upper Extremity Arterial Disease 117 Upper Extremity Arterial Disease: Epidemiology, Etiology, and Diagnostic Evaluation Abstract Keywords Introduction Epidemiology Etiology and Pathogenesis Small Vessel Arteriopathies Scleroderma Systemic Lupus Erythematosus Rheumatoid Arthritis Sjögren’s Syndrome Mixed Connective Tissue Disease Buerger’s Disease Hand-Arm Vibration Syndrome Fibromuscular Disease Hypersensitivity Angiitis Malignancy Frostbite Large Vessel Arteriopathies Clinical Findings Acute Ischemia Chronic Ischemia Diagnostic Evaluation Clinical Evaluation Vascular Laboratory Evaluation Other Imaging Treatment Medical Surgical Summary Selected Key References References 118 Upper Extremity Arterial Disease: Medical, Endovascular, and Open Surgical Management Abstract Keywords Clinical Findings Acute Arm Ischemia Chronic Arm Ischemia Treatment Conservative Therapy Endovascular Treatment Surgical Treatment Arterial Exposure Axillary Artery Brachial Artery Radial Artery Ulnar Artery Interosseous Artery Palmar Arteries Bypass Conduit and Tunneling Transbrachial Embolectomy Postoperative Management and Follow-Up Alternative Therapy Trauma Iatrogenic Trauma Brachial Artery Radial Artery Noniatrogenic Trauma Penetrating Trauma Delayed Recognition Blunt Trauma Pediatric Supracondylar Fractures Complications Compartment Syndrome Selected Key References References 119 Upper Extremity Arterial Disease: Amputation Epidemiology Etiology Trauma and Military Injuries Nontraumatic Disease General Operative Considerations Initial Management Arterial Assessment Preservation of Length Soft Tissue Coverage Nerves Bone and Cartilage Tendons Specific Amputations Fingertip Amputation Technique Skin Grafts Local Flap Closure Digit-Level Amputations Midfinger Amputation Proximal Phalanx Ray Amputation Thumb Amputation Hand-Wrist Amputations Forearm Amputations Elbow Disarticulation Upper Arm Amputations Shoulder Disarticulation and Forequarter Amputations Postoperative Management and Complications Wound Treatment Revision Phantom Pain Psychosocial Rehabilitation Physical Rehabilitation Prostheses Hand Transplantation Long-Term Outcomes Selected Key References References SECTION 18 Thoracic Outlet Syndrome 120 Thoracic Outlet Syndrome: Pathophysiology and Diagnostic Evaluation Introduction Relevant Anatomy Nerves Brachial Plexus Phrenic Nerve Long Thoracic Nerve Dorsal Scapular Nerve Cervical Sympathetic Chain Variations and Anomalies of the Scalene Muscle Skeletal Abnormalities Contribution of the Pectoralis Minor Neurogenic Thoracic Outlet Syndrome Pathogenesis Pathology Pathophysiology History Physical Examination Anterior Scalene Muscle Block Venous Thoracic Outlet Syndrome Pathogenesis Pathology Pathophysiology Clinical Findings Physical Examination Diagnostic Evaluation Arterial Thoracic Outlet Syndrome Pathogenesis History Physical Examination Diagnostic Evaluation Coexisting Thoracic Outlet Syndromes Challenges in Diagnosis Emerging Diagnostic Studies Selected Key References References 121 Thoracic Outlet Syndrome: Neurogenic Anatomy Nerves in the Thoracic Outlet Musculofascial Variations Bony Anomalies Histopathology Etiology Predisposing Anatomic Factors Neck Trauma and Repetitive Strain Injury Clinical Findings Symptoms Demographics Pain and Paresthesia Headache Weakness and Muscle Atrophy Disability Vascular Symptoms and Complex Regional Pain Syndrome Physical Examination Vascular Examination Diagnostic Tests Radiography Cross-Sectional Imaging Neurophysiologic Testing Scalene Muscle Blocks Angiography and Vascular Laboratory Studies Making the Diagnosis Conservative Management Physical Therapy Evaluation Treatment Results Surgical Treatment Historical Background Transaxillary Approach Supraclavicular Approach Pectoralis Minor Tenotomy Postoperative Management Surgical Complications Nerve Injuries Lymph Leakage Results of Surgery Outcome Measures Operative Results Anterior Scalenotomy/Scalenectomy Transaxillary First Rib Resection Supraclavicular First Rib Resection With Anterior and Middle Scalenectomy Comparison of Surgical Approaches Predicting the Outcomes of Surgery Ongoing Symptoms Persistent Neurogenic Thoracic Outlet Syndrome Recurrent Neurogenic Thoracic Outlet Syndrome Selected Key References References 122 Thoracic Outlet Syndrome: Arterial Pathophysiology Epidemiology Clinical Presentation Signs and Symptoms Clinical Assessment Diagnostic Evaluation Compression Maneuvers Noninvasive Vascular Laboratory Studies Duplex Ultrasonography Pulse Volume or Segmental Pressure Recording Radiographic Studies Radiography Computed Tomography Magnetic Resonance Angiography Catheter-Based Angiography Laboratory Testing Differential Diagnosis Screening Treatment Medical Treatment Surgical Treatment Principles Treatment Selection Scher Classification Surgical Treatment Relevant Anatomy Operative Planning and Strategy Description of Technique Endovascular Options Distal Revascularization Postoperative Management Definition of Success and Determinants of Outcome Results Complications Selected Key References References 123 Thoracic Outlet Syndrome: Venous Abstract keywords Epidemiology and Etiology Primary Subclavian-Axillary Vein Thrombosis McCleery Syndrome Secondary Subclavian-Axillary Vein Thrombosis Clinical Presentation Diagnostic Evaluation Duplex Ultrasound Magnetic Resonance and Computed Tomographic Venography Venography Treatment Anticoagulation Alone Thrombolytic Therapy Post-Thrombolysis Management Surgical Decompression of the Thoracic Outlet Vein Treatment After First Rib Resection Postoperative Care Recurrence Results Selected Key References References 124 Thoracic Outlet Syndrome: Surgical Decompression of the Thoracic Outlet Indications Preoperative Planning Selection of Arterial Conduit Surgical Techniques Supraclavicular Approach Transaxillary Approach Infraclavicular Approach Postoperative Care and Rehabilitation Pain Management Physical Therapy Follow-Up Pitfalls and Complications General Specific Surgical Complications Selected Key References References SECTION 19 Renovascular Disease 125 Renovascular Disease: Pathophysiology, Epidemiology, Clinical Presentation, and Medical Management Historical Perspective Pathogenesis of Renovascular Disease Etiology of Renal Artery Lesions Pathophysiology of Renovascular Hypertension Pathophysiology of Ischemic Nephropathy Epidemiology Prevalence of Renovascular Disease Natural History of Renal Artery Stenosis Anatomic Progression Functional Progression Associated Morbidity Clinical Presentation History and Physical Examination Laboratory Findings Diagnostic Imaging Renal Duplex Ultrasonography Computed Tomographic Angiography and Magnetic Resonance Angiography Digital Subtraction Angiography Functional Studies Radionuclide Renography Renal Vein Renin Assays Treatment of Renovascular Hypertension Medical Management of Atherosclerotic Renovascular Disease Renal Revascularization Selected Key References References 126 Renovascular Disease: Open Surgical Treatment Indications for Surgical Repair Open Operative Strategy Management Options Mobilization and Dissection (see Chapter 58) Midline Exposure Flank Exposure Direct Surgical Techniques Aortorenal Bypass Thromboendarterectomy Reimplantation Indirect Surgical Techniques Splanchnic-Renal Bypass Hepatorenal Bypass Splenorenal Bypass Ex Vivo Reconstruction Intraoperative Assessment Intraoperative Duplex Sonography Results of Open Operative Management Anatomic Results Operative Morbidity and Mortality Blood Pressure Response Renal Function Response Hypertension and Renal Function Benefit: Clinical Outcome Consequence of Failed Open Renal Artery Repair Selected Key References References 127 Renovascular Disease: Endovascular Treatment Indications and Contraindications Indications Contraindications Results Definitions of Success Early Outcomes Late Outcomes Hypertension Response Renal Function Response Renal Artery Restenosis After Intervention Survival Description of Technique Relevant Anatomy Operative Planning and Options Contrast Considerations Medical Management Primary Angioplasty Versus Angioplasty and Stenting Bilateral Atherosclerotic Renovascular Disease Access Angioplasty and Stenting Embolic Protection Postoperative Management Complications Selected Key References References 128 Renovascular Disease: Aneurysms and Arteriovenous Fistulae Abstract Keywords Renal Artery Aneurysms Epidemiology Pathogenesis True Aneurysms False Aneurysms (Pseudoaneurysms) Dissections Intrarenal Aneurysms Clinical Manifestations and Diagnosis Indications for Intervention Rupture and Prevention of Rupture Hypertension Dissection Other Clinical Manifestations Treatment: Medical, Endovascular, Surgical Repair of a Ruptured Renal Artery Aneurysm Elective Repair of Renal Artery Aneurysm Fibromuscular Dysplasia Intrarenal Aneurysms Renal Arteriovenous Malformations and Fistulae Epidemiology and Pathogenesis Congenital Arteriovenous Malformations Acquired Arteriovenous Fistulae Clinical Presentation Diagnosis Treatment: Medical, Surgical, Endovascular Selected Key References References 129 Renovascular Disease: Acute Occlusive and Ischemic Events Pathophysiology Duration of Ischemia Gradual Versus Acute Renal Occlusion Renal Vein Thrombosis Clinical Presentation Diagnostic Evaluation Laboratory Tests Imaging Tests Computed Tomography Angiography Magnetic Resonance Angiography Ultrasound Nuclear Renal Scan Angiography Renal Artery Embolism Epidemiology Treatment Endovascular Treatment Open Surgery Renal Artery Thrombosis Epidemiology Treatment Endovascular Treatment Open Surgery Renovascular Trauma Epidemiology Treatment Results Renal Vein Thrombosis Epidemiology Treatment Anticoagulation Thrombectomy Selected Key References References 130 Renovascular and Aortic Developmental Disorders Abstract Keywords Developmental Abdominal Aortic Coarctation and Hypoplasia Classification Etiology and Pathogenesis Embryology Associated Genetic Syndromes and Infectious-Inflammatory Disorders Developmental Renal and Splanchnic Arterial Stenoses Clinical Manifestations Definition of Hypertension in Children Diagnostic Evaluation Medical Management Antihypertensive Drug Treatment Surgical Treatment Patch Aortoplasty Thoracoabdominal Bypass Renal Artery Repair Splanchnic Artery Repair Endovascular Treatment Selected Key References References SECTION 20 Mesenteric Vascular Disease 131 Mesenteric Arterial Disease: Epidemiology, Pathophysiology, and Clinical Evaluation Abstract Keywords Anatomy of the Visceral Arteries Physiology of Splanchnic Blood Flow Epidemiology Pathophysiology Chronic Mesenteric Ischemia Acute Mesenteric Ischemia Arterial Embolism Arterial Thrombosis Nonocclusive Mesenteric Ischemia Mesenteric Venous Thrombosis Clinical Presentation Acute Mesenteric Ischemia Chronic Mesenteric Ischemia Diagnostic Evaluation Noninvasive Evaluation Invasive Evaluation Treatment of Acute and Chronic Mesenteric Ischemia Medical Treatment Endovascular Treatment Surgical Treatment Treatment of Nonocclusive Mesenteric Ischemia Treatment of Mesenteric Venous Thrombosis Selected Key References References 132 Chronic Mesenteric Arterial Disease: Clinical Evaluation, Open Surgical and Endovascular Treatment Background Pathophysiology Etiology Natural History Diagnostic Evaluation Clinical Presentation Diagnostic Imaging Mesenteric Duplex Ultrasound Multidetector Computed Tomography Magnetic Resonance Angiography Contrast Arteriography Other Ancillary Studies Treatment Strategies Indications for Revascularization Choice of Open Versus Endovascular Revascularization Preprocedure Evaluation Endovascular Revascularization Diagnostic Angiography Angioplasty and Stenting Recanalization of Mesenteric Occlusions Adjunctive Techniques Complications Postprocedure Management Open Revascularization Choice of Open Surgical Revascularization Antegrade Mesenteric Bypass Retrograde Mesenteric Bypass Retrograde Open Mesenteric Stenting Transaortic Mesenteric Endarterectomy Intraoperative Duplex Ultrasound Monitoring Complications Postoperative Management Results Morbidity and Mortality Symptom Relief Restenosis, Symptom Recurrence, and Reintervention Patient Survival Selected Key References References 133 Acute Mesenteric Arterial Disease Abstract Keywords Incidence and Risk Factors Pathophysiologic Classification Arterial Embolism Arterial Thrombosis Nonocclusive Mesenteric Ischemia Final Common Pathway of Bowel Ischemia Diagnostic Evaluation Clinical Presentation Laboratory Evaluation Diagnostic Imaging Abdominal Plain Radiographs Duplex Ultrasonography Computed Tomography Arteriography Magnetic Resonance Angiography Diagnostic Laparoscopy Treatment Initial Resuscitation and Critical Care Treatment of Nonocclusive Mesenteric Ischemia Surgical Treatment Superior Mesenteric Artery Embolectomy Superior Mesenteric Artery Bypass Assessment of Bowel Viability Endovascular Treatment Superior Mesenteric Artery Embolization Superior Mesenteric Artery Thrombosis Hybrid Procedure: Retrograde Open Mesenteric Stenting Other Considerations Spontaneous Visceral Dissection Second-Look Surgery Intraoperative Vasodilators Duplex Follow-Up Selected Key References References 134 Mesenteric Arterial Dissection Abstract Keywords Incidence Etiology Clinical Presentation Diagnosis Classification System Treatment Asymptomatic Patients Symptomatic Patients Surgical Treatment Endovascular Treatment Thrombolysis Embolization Stenting Other Considerations Segmental Arterial Mediolysis Surveillance Remodeling Summary Selected Key References References 135 Median Arcuate Ligament Syndrome: Pathophysiology, Diagnosis, and Management Keywords Introduction Anatomy Pathophysiology Diagnosis History and Physical Exam Radiologic Studies Management Laparoscopic Technique Results Conclusion Selected Key References References 136 Mesenteric Vascular Disease: Venous Thrombosis Abstract Keywords Epidemiology Pathogenesis Etiology Risk Factors Natural History Pathology and Manifestations Diagnosis Recognition by History and Physical Examination Laboratory Testing Noninvasive and Invasive Testing Treatment and Results Medical Treatment Endovascular Treatment Surgical Treatment Selected Key References References SECTION 21 Nonatherosclerotic Arterial Diseases 137 Vasculitis and Other Uncommon Arteriopathies Vasculitis Presentation Histologic Characteristics of Vasculitis Angiography Noninvasive Vascular Imaging Large-Vessel Vasculitis Takayasu’s Arteritis Giant Cell Arteritis (Temporal Arteritis) Epidemiology Pathogenesis Clinical Characteristics Diagnostic Criteria Medical Treatment of Giant Cell Arteritis Role for Vascular Surgical Intervention in Giant Cell Arteritis Idiopathic Aortitis Idiopathic Retroperitoneal Fibrosis (Ormond Disease) IgG4-Related Systemic Disease Erdheim-Chester Disease Medium-Sized Vessel Vasculitis Polyarteritis Nodosa Pathogenesis Histology Laboratory Testing Clinical Features Treatment Prognosis Other Diseases Showing Aneurysms on Abdominal Visceral Angiography Thromboangiitis Obliterans (Buerger’s Disease) Epidemiology Clinical Presentation Diagnostic Testing Pathologic Findings Treatment Kawasaki Disease Small-Vessel Vasculitis Antineutrophil Cytoplasmic Antibody-Associated Vasculitides Granulomatosis With Polyangiitis (Previously Known as Wegener’s Granulomatosis) Epidemiology Clinical Presentation Laboratory Testing Treatment Microscopic Polyangiitis Epidemiology Clinical Presentation Laboratory Testing Renal Histopathology Treatment Eosinophilic Granulomatosis With Polyangiitis (Previously Known as Churg-Strauss Syndrome) Epidemiology Pathophysiology Clinical Presentation Laboratory Findings Treatment Vasculitis Secondary to Connective Tissue Diseases Vascular Manifestations of Behçet’s Disease Epidemiology Treatment Systemic Lupus Erythematosus Rheumatoid Vasculitis Relapsing Polychondritis Cogan’s Syndrome Pseudoxanthoma Elasticum Exercise-Related External Iliac Arteriopathy Vasculitis Mimics Fibromuscular Dysplasia Radiation Arteritis Epidemiology Pathogenesis Clinical Presentation Diagnostic Evaluation Treatment Neurofibromatosis Type-1 Drug-Induced Vasculitis Selected Key References References 138 Thromboangiitis Obliterans (Buerger Disease) Abstract Keywords Introduction Definition Brief Historical Review Epidemiology Population Affected Risk Factors Etiology Immune-Mediated Injury Genetic Predisposition Hypercoagulability Oral Infection-Inflammatory Pathway Vascular Endothelium and Circulating Progenitor Cells Pathology Clinical Presentation Diagnosis Vascular Evaluation Noninvasive Testing Laboratory Testing Angiography Biopsy Differential Diagnosis Natural History Treatment Lifestyle Changes Smoking Cessation Exercise Training Foot, Hand, and Dental Care Pharmacologic Treatment Calcium Channel Blockers Prostacyclin Analogs Iloprost Infusion Oral Iloprost Prostaglandin E1 Analogs Phosphodiesterase Inhibitors Phosphodiesterase 3 Inhibitors (Cilastazol) Phosphodiesterase 5 Inhibitors (Sildenafil, Tadalafil) Endothelin Receptor Antagonists Thrombolytics Folate Supplementation Statins Analgesia Regional Sympathetic Blockade Spinal Cord Stimulation Surgery Lumbar or Thoracic Sympathectomy Distal Surgical Revascularization Pedicled Omental Graft Distal Venous Arterialization Local Wound Care Endovascular Treatment Other Interventional Procedures Immunoadsorption Growth Factors Stem Cell-Based Therapeutic Angiogenesis Acknowledgments Selected Key References References 139 Takayasu Disease Abstract Keywords Introduction Epidemiology Pathogenesis Etiology Pathology Clinical Presentation Diagnostic Evaluation Diagnostic Criteria Laboratory Markers Radiologic Evaluation Classification Medical Treatment Refractory Therapy Indications for and Results of Revascularization Procedures Endovascular Treatment Open Surgical Treatment Direct Comparison of Endovascular and Open Surgical Treatment Special Considerations Pregnant Patients Pediatric Patients Quality of Life Prognosis Selected Key References References 140 Aneurysms Caused by Connective Tissue Abnormalities Abstract Keywords Marfan Syndrome Epidemiology and Natural History Pathogenesis Role of Fibrillin Interaction With Transforming Growth Factor Clinical Manifestations and Diagnostic Evaluation Diagnostic Criteria Ghent Criteria Differential Diagnosis Surveillance Aortic Disease Prevention Medical Treatment Surgical Treatment Descending Thoracic and Thoracoabdominal Aorta Endovascular Treatment Vascular-Type Ehlers-Danlos Syndrome Epidemiology and Natural History Pathogenesis Clinical Evaluation Common Manifestations Differential Diagnosis Selection of Treatment True Aneurysms Vascular Complications Nonvascular Complications Medical Treatment Surgical Treatment Endovascular Treatment Pregnancy in Patients With Type IV Ehlers-Danlos Syndrome Loeys-Dietz Syndrome Epidemiology Clinical Evaluation Common Manifestations Differential Diagnosis Selection of Treatment Medical Treatment Surgical Treatment Familial Thoracic Aortic Aneurysm and Dissection Pathogenesis Clinical Manifestations Selection of Treatment Selected Key References References 141 Raynaud Phenomenon Epidemiology Normal Arterial Flow to the Hand Regulation of Blood Flow in the Digits Pathogenesis Vascular Impaired Vasodilatation Increased Vasoconstriction Neural Factors Humoral Factors Risk Factors Associated Diseases Clinical Findings Diagnosis Physical Examination Vascular Laboratory Evaluation Segmental Pressure Measurements and Duplex Ultrasonography Finger Systolic Blood Pressure Cold Challenge Testing Nail Fold Capillary Microscopy Serologic Evaluation Treatment Preventive Measures Behavioral Therapies and Maneuvers Pharmacologic Therapy Calcium-Channel Blockers Alpha Adrenergic Blockers Prostaglandins and Analogues Phosphodiesterase Inhibitors Endothelin Inhibitors Other Medications Surgical Therapy Sympathectomy Nerve Stimulation Alternative Therapies Selected Key References References 142 Fibromuscular Dysplasia Abstract Keywords Introduction Pathogenesis of Fibromuscular Dysplasia Etiology Differential Diagnosis Classification Renal Artery Fibromuscular Dysplasia Epidemiology Pathophysiology Natural History Clinical Presentation History and Physical Examination Screening for Secondary Hypertension Diagnostic Evaluation Treatment Selection Medical Treatment Endovascular Treatment in Adults Technical Considerations Stenting Procedure-Related Complications Early and Late Outcomes Surgical Management Patient Selection Techniques Aortorenal Bypass Autotransplantation Results of Open Surgery Complications of Open Surgery Fibromuscular Dysplasia and Aneurysm Pediatric Renal Artery Stenosis and Arterial Dysplasia Endovascular Treatment in Children Open Surgery for Pediatric Renovascular Hypertension Extracranial Cerebrovascular Fibromuscular Dysplasia Epidemiology Pathophysiology Concurrent Pathology Natural History Clinical Presentation Diagnostic Evaluation Treatment Selection Therapeutic Challenges Clinical Considerations Anatomic Considerations Cerebral Protection Stents Medical Management Mechanical Repair Open Surgical Dilation Open-Access Balloon Dilation Percutaneous Transluminal Angioplasty Fibromuscular Dysplasia in Other Arterial Beds Selected Key References References 143 Nonatheromatous Popliteal Artery Disease Introduction Popliteal Artery Entrapment Syndrome Epidemiology Pathogenesis Etiology Classification Type I Type II Type III Type IV Type V Type VI Pathology Clinical Presentation Diagnostic Evaluation Noninvasive Testing Angiography Computed Tomography and Magnetic Resonance Imaging Treatment Type I to V, Normal Popliteal Artery Types I to V, Abnormal Popliteal Artery Type VI, Symptomatic Type VI, Asymptomatic Treatment Outcomes Adventitial Cystic Disease Epidemiology Pathogenesis Etiology Repetitive Trauma Theory Ganglion Theory Systemic Disorder Theory Developmental Theory Articular (Synovial) Theory Pathology Clinical Presentation Arterial Venous Diagnostic Evaluation Noninvasive Testing Angiography Computed Tomography and Magnetic Resonance Imaging Treatment Nonresectional Methods Transluminal Angioplasty Cyst Aspiration Cyst Excision and Evacuation Resectional Methods Treatment Outcomes Selected Key References References 144 Infected Arterial Aneurysms History and Epidemiology Pathogenesis and Etiology Microbial Arteritis Post-Traumatic Infected Pseudoaneurysms Infection of Preexisting Aneurysms Infected Aneurysms Due to Endocarditis Microorganisms Specific Organisms Diagnosis Clinical Findings Laboratory Studies Imaging Management Antibiotics Operative Treatment Aorta Thoracic Aorta Abdominal Aorta Cryopreserved Arterial Allografts Antibiotic Soaked Dacron Grafts Neo-Aorta-Iliac System Extra-Anatomic Abdominal Aortic Reconstruction Endovascular Aortic Repair Femoral Artery Popliteal Artery Carotid Artery Upper Extremity Arteries Visceral Arteries Selected Key References References SECTION 22 Acute Venous Thromboembolic Disease 145 Acute Deep Venous Thrombosis: Epidemiology and Natural History Abstract Keywords Epidemiology Incidence Populations Affected Risk Factors Age Immobilization Travel History of Venous Thromboembolism Malignancy Surgery Trauma Pregnancy Oral Contraceptives and Hormonal Therapy Blood Group Geography and Ethnicity Inflammatory Bowel Disease Systemic Lupus Erythematosus Varicose Veins Iliac Vein Compression Popliteal Vein Entrapment Other Risk Factors Natural History Recanalization Recurrent Venous Thrombosis Mortality Selected Key References References 146 Venous Thromboembolic Disease: Mechanical and Pharmacologic Prophylaxis Abstract Keywords Rationale for Risk Stratification and Prophylaxis Risk-Assessment Models Methods of Prophylaxis General Measures Mechanical Methods of Prophylaxis Elastic Compression Stockings Intermittent Pneumatic Compression of the Legs Foot Compression Devices Pharmacologic Methods of Prophylaxis Aspirin Warfarin Heparins Fondaparinux Direct Oral Anticoagulants Combination of Mechanical and Pharmacologic Methods Specific Surgical Groups Cancer Vascular Surgery Cardiac Surgery Bariatric Surgery Neurosurgery Trauma Evidence-Based Guidelines Versus Real Clinical Practice Summary of Recommendations for Venous Thromboembolism Prophylaxis in Surgical Patients Selected Key References References 147 Acute Lower Extremity Deep Venous Thrombosis: Presentation, Diagnosis, and Medical Treatment Clinical Assessment Diagnostic Tests D-Dimer Duplex Ultrasonography Venography Computed Tomographic Venography Magnetic Resonance Venography 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Diagnostic Strategies Risk Assessment Diagnostic Strategies for Symptomatic Deep Venous Thrombosis Diagnosis of Deep Venous Thrombosis in Emergency Departments Thrombus Age and Diagnosis Medical Treatment of Acute Lower Extremity Deep Venous Thrombosis Medical Treatment of Calf Deep Vein Thrombosis Medical Treatment of Femoropopliteal Deep Vein Thrombosis Medical Treatment of Iliofemoral Deep Vein Thrombosis Anticoagulation (see Chapter 39) Unfractionated Heparin Low-Molecular-Weight Heparin Parenteral Direct Thrombin Inhibitors Vitamin K Antagonists Direct-Acting Oral Anticoagulants Adjunctive Measures for Acute Deep Venous Thrombosis Management Longitudinal Treatment of Deep Venous Thrombosis Selected Key References References 148 Acute Lower Extremity Deep Venous Thrombosis: Surgical and Interventional Treatment Abstract Keywords Postthrombotic Syndrome Morbidity Etiology Rationale for Thrombus Removal Recurrence Valve Function Randomized Trials of Catheter-Directed Thrombolysis Strategies for Thrombus Removal Thrombolytic Therapy Intrathrombus Catheter-Directed Thrombolysis Outcomes From the National Venous Registry Pharmacomechanical Thrombolysis Endovascular Mechanical Thrombectomy Ultrasound-Accelerated Thrombolysis Isolated Segmental Pharmacomechanical Thrombolysis Endovascular Aspiration Thrombectomy Operative Venous Thrombectomy Technique of Contemporary Venous Thrombectomy Preoperative Care Operative Care Postoperative Care Choosing the Appropriate Treatment Option Risk Assessment Patient Selection Pretreatment Evaluation Importance of Imaging Published Guidelines Selected Key References References 149 Acute Upper Extremity and Catheter-Related Venous Thrombosis Abstract Keywords Introduction Clinical Findings Diagnostic Strategies Risk Factors and Prevention Biomarkers Role of Thromboprophylaxis Catheter/Patient-Related Causes Treatment Conclusion Selected Key References References 150 Superficial Thrombophlebitis and Its Management Epidemiology and Pathogenesis Clinical Presentation Superficial Thrombophlebitis With Varicose Veins Traumatic Thrombophlebitis Septic and Suppurative Thrombophlebitis Migratory Thrombophlebitis Mondor Disease Small Saphenous Vein Superficial Thrombophlebitis Upper Extremity Superficial Thrombophlebitis Superficial Thrombophlebitis After Endovascular Venous Obliteration Diagnosis Treatment LMWH Nonsteroidal Antiinflammatory Medications Surgery Topical Therapy Selected Key References References 151 Pulmonary Embolism: Presentation, Natural History, and Treatment Abstract Keywords Introduction Clinical Presentation Diagnosis Laboratory Tests Electrocardiogram Chest X-ray Computed Tomographic Pulmonary Arteriography Echocardiogram Other Imaging Modalities Probability Algorithms and Diagnostic Strategies Risk Stratification Treatment Initial Supportive Therapies Anticoagulation Inferior Vena Cava Filter Thrombolysis Systemic Thrombolysis Catheter-Directed Interventions Technical Considerations for Catheter-Directed Interventions Surgical Thrombectomy Extracorporeal Membrane Oxygenation Early Discharge and Home Treatment Treatment Algorithm Special Populations Incidental Subsegmental Pulmonary Embolism Thrombus in Transit Pregnancy Cancer Nonthrombotic Pulmonary Embolism Prognosis Selected Key References References 152 Vena Cava Interruption Abstract Keywords Filter Design Design Considerations Filter Types Clinical Indications Permanent Versus Optional Retrievable Filter Specific Patient Groups Trauma Patients Bariatric Patients Orthopedic Patients Cancer Patients High-Risk General Surgical Patients Pregnant Patients Inferior Vena Cava Filters Anatomic Considerations Technical Considerations Venographically Guided Filter Placement Transabdominal Duplex Ultrasound–Guided Filter Placement Intravascular Ultrasound–Guided Filter Placement Filter Retrieval Superior Vena Cava Filters Selected Key References References 153 Compartment Syndrome and Venous Gangrene Introduction Phlegmasia Cerulea Dolens Venous Gangrene Heparin-Induced Thrombocytopenia Cancer-Associated Disseminated Intravascular Coagulation With Venous Limb Gangrene Disseminated Intravascular Coagulation Symmetric Peripheral Gangrene (Purpura Fulminans) Fasciotomy for Venous Disease Fasciotomy for Acute Venous Thrombosis (Phlegmasia Cerulea Dolens) Fasciotomy for Chronic Venous Disease Selected Key References References SECTION 23 Chronic Venous Disorders 154 Varicose Veins: Surgical Treatment Abstract Keywords Decision Making Pathophysiology and Natural History Treatment Options Patient Risk Assessment Anatomic Considerations Great Saphenous Vein Small Saphenous Vein Gastrocnemius Veins Intersaphenous Vein Neurovascular Relationships in the Popliteal Fossa Perforating Veins Surgical Techniques High Ligation of the Great Saphenous Vein Great Saphenous Vein Stripping Adjunctive Considerations for Stripping Procedures Ultrasound Guidance Tumescent Anesthesia Minimization of Accumulation of Blood in the Stripping Tunnel Leg Elevation Before and During Stripping Proximal Tourniquet Surgery on the Small Saphenous Vein and Veins of the Popliteal Fossa Operative Technique for Small Saphenous Vein Procedures Excision of Local Varicosities (Ambulatory Phlebectomy) Transilluminated Powered Phlebectomy Saphenous-Sparing Operations Conservatrice et Hémodynamique de l’Insuffisance veineuse en Ambulatoire Ambulatory Selective Varices Ablation Endovenous Ablation Results Results of Surgery on the Great Saphenous Vein Versus Conservative/Nonoperative Treatment Comparison of Results of Endovenous Ablation Versus Ligation and Stripping of the Great Saphenous Vein Results of Surgical Treatment of Veins of the Popliteal Fossa Multimodality and Individualized Care Patient Management and Reimbursement Considerations Indications for Ligation and Stripping of the Great Saphenous Vein in the Current Climate Favoring Endovenous Ablation Selected Key References References 155 Varicose Veins: Endovenous Ablation and Sclerotherapy Abstract Keywords Background Relevant Anatomy Great Saphenous, Small Saphenous, and Perforating Veins Reticular Veins Telangiectasias Diagnostic Evaluation Clinical Scoring Systems Imaging Treatment Selection Thermal Ablation Techniques Radiofrequency Ablation Preoperative Planning Radiofrequency Ablation Procedure Discharge and Follow-Up Clinical Results: Complications Clinical Results: Outcomes Endovenous Laser Ablation Laser Wavelength and Fiber Type Preoperative Planning Endovenous Laser Ablation Procedure Procedural Variations Discharge and Follow-Up Clinical Results: Complications Clinical Results: Outcomes Sclerotherapy Sclerosing Agents Osmotic Agents Alcohol Agents Detergent Agents Preoperative Planning Sclerotherapy Procedure Liquid Sclerotherapy Ultrasound-Guided Foam Sclerotherapy Catheter-Directed Sclerotherapy Discharge and Follow-Up Complications Clinical Results Comparison of Outcomes of Radiofrequency Ablation, Endovenous Laser Ablation, Sclerotherapy, and Surgery Mechanicochemical Ablation Adhesive Closure Selected Key References References 156 Chronic Venous Disorders: Postthrombotic Syndrome, Natural History, Pathophysiology, and Etiology Abstract Keywords Introduction Postphlebitic (Thrombotic) Syndrome: Etiology and Epidemiology Postphlebitic (Thrombotic) Syndrome: Cellular and Molecular Mechanisms Postphlebitic (Thrombotic) Syndrome: Natural History and Pathophysiology Postphlebitic (Thrombotic) Syndrome: Clinical Summary Points of Natural History, Epidemiology, and Pathophysiology Selected Key References References 157 Chronic Venous Disorders: Nonoperative Management Abstract Keywords Treatment of Chronic Venous Disorders Nonoperative Treatment of Chronic Venous Disease Lifestyle Modification Exercise Leg Elevation Compression Therapy Gradient Elastic Stockings Gradient Compression Stockings in C1-C2 Disease. Surgery Versus Compression in C2-C3 Disease. Gradient Compression Stockings in C4-C6 Disease. Gradient Compression Stockings and Prevention of Postthrombotic Syndrome in Acute Deep Vein Thrombosis. CircAid Garment Unna Boot Layered Elastic and Nonelastic Compression Bandages Intermittent Pneumatic Compression Adaptive Pressure Multichamber System. Surgery Versus Compression in C6 Disease. Pharmacologic Therapies Diuretics Zinc Fibrinolytic Agents Pentoxifylline Phlebotropic Agents Prostaglandins Other Medications Conclusion Selected Key References References 158 Chronic Venous Insufficiency: Treatment of Perforator Vein Incompetence Abstract Keywords Pathophysiology Normal Perforating Veins Hemodynamic Impact of Perforating Vein Incompetence Clinical Correlations of Perforating Vein Incompetence Anatomy Diagnostic Evaluation Clinical Investigation (CEAP Level 1) Noninvasive Vascular Investigation (CEAP Level 2) Indications for Interruption Operative Planning Options Open Surgery Subfascial Endoscopic Perforator Surgery Results and Complications Percutaneous Ablation of Perforating Veins Techniques Laser Ablation Radiofrequency Ablation Sclerotherapy New Treatment Modalities Results and Complications Postoperative Management Selected Key References References 159 Chronic Venous Insufficiency: Deep Vein Valve Reconstruction Pathogenesis Etiology Hemodynamics Diagnostic Evaluation History and Physical Examination Noninvasive Evaluation Invasive Evaluation Treatment Selection Natural History and Patient Risk Assessment Treatment Options Surgical Treatment Relevant Anatomy Operative Planning Techniques Overall Exposure Internal Valvuloplasty External Valvuloplasty External Banding Valve Transplantation Valve Transposition Venous Valve Substitutes (Neovalve) Endovascular Valve Replacements Postoperative Management Results Complications and Initial Results Late Results Internal Valvuloplasty External Valvuloplasty External Banding Valve Transplantation Valve Transposition Multilevel Valve Reconstruction Venous Valve Substitutes Overview Follow-Up Monitoring and Management Selected Key References References 160 Iliocaval Venous Obstruction: Surgical Treatment Abstract Keywords Surgical Treatment of Iliocaval Venous Obstruction Etiology Preoperative Evaluation History and Physical Examination Imaging Indications for Surgical Treatment Grafts in the Venous System Venous Graft Materials Use of Arteriovenous Fistulae Anticoagulation Graft Surveillance Surgical Procedures Cross-Pubic Venous Bypass (Palma Procedure) Technique Results Prosthetic Femorocaval, Iliocaval, and Inferior Vena Caval Bypasses Technique Results Combined Endovascular and Open Reconstructions Iliac Vein Decompression Technique Results Suprarenal Inferior Vena Cava Reconstruction Technique Results Summary Pelvic Congestion Syndrome Incidence Anatomy of the Pelvic Venous System Pathophysiology Clinical Findings Diagnosis Noninvasive Investigations Duplex Scanning Computed Tomographic and Magnetic Resonance Venography Contrast Phlebography Differential Diagnosis Treatment Medical Treatment Conventional and Laparoscopic Surgery Endovascular Treatment Techniques Selected Key References References 161 Iliocaval Venous Obstruction: Endovascular Treatment Abstract Keywords Introduction Pathology Indications and Patient Selection for Iliocaval Venous Stenting Diagnosis Treatment Technique Recanalization of Chronic Total Occlusions Inferior Vena Cava Filters Anticoagulation Reinterventions Chronic Stent Malfunction Stent Surveillance Outcomes Morbidity and Mortality Patency Clinical Results Geriatric Group Obese Patients Lymphedema Iliac Vein Stenosis With Tandem Femoral Vein Occlusions Thrombosed Inferior Vena Cava Filter Selected Key References References SECTION 24 Miscellaneous Venous Conditions 162 Superior Vena Cava Occlusion and Management Abstract Keywords Etiology Clinical Presentation Diagnostic Evaluation Radiography Ultrasonography Radionuclide Imaging Computed Tomographic Angiography Contrast Venography Magnetic Resonance Venography Initial Treatments Indications for Interventional Treatment Endovenous Treatment Surgical Treatment Graft Materials Great Saphenous Vein Graft Femoral Vein Graft Spiral Saphenous Vein Graft Expanded Polytetrafluoroethylene Graft Other Grafts Surgical Technique Results Results of Endovenous Treatment in Patients With Malignancy Results of Endovenous Treatment in Patients With Benign Superior Vena Cava Syndrome Complications, Restenosis, and Outcomes Results of Surgical Treatment Graft Surveillance Conclusions Selected Key References References 163 Congenital Occlusion/Absence of Inferior Vena Cava Abstract Keywords Association With Deep Venous Thrombosis Embryogenesis Presentation Clinical Diagnosis Imaging Modalities Duplex Scan of the Lower Extremities and Pelvis Axial Imaging (Computed Tomography Venography and Magnetic Resonance Venography) Venography Management Acute Deep Venous Thrombosis With Mild Symptoms Acute Deep Venous Thrombosis With Severe Symptoms (Leg Swelling, Venous Congestion) Severe Symptoms Refractory to Thrombolysis and Compression or Severe Chronic Sequelae (Venous Ulceration) Summary Selected Key References References 164 Portal Hypertension Abstract Keywords Introduction Pathophysiology Classification Extrahepatic Presinusoidal Obstruction Intrahepatic Presinusoidal Obstruction Intrahepatic Sinusoidal and Postsinusoidal Portal Hypertension Extrahepatic Postsinusoidal Obstruction Arteriovenous Fistulae Clinical Presentation Complications of Portal Hypertension Variceal Formation and Hemorrhage Ascites Encephalopathy Hepatorenal Syndrome Hepatopulmonary/Portopulmonary Syndromes Diagnosis Laboratory Evaluation Upper Gastrointestinal Endoscopy Liver Biopsy Duplex Scanning Computed Tomography Angiography Percutaneous Angiography Nonsurgical Treatment of Portal Hypertension and Its Complications Prevention and Treatment of Variceal Bleeding Primary Prophylaxis Nonselective Beta Blockade Endoscopic Variceal Band Ligation Endoscopic Sclerotherapy Acute Variceal Hemorrhage Vasopressin Somatostatin/Octreotide Balloon Tamponade Balloon-Occluded Antegrade and Retrograde Transvenous Obliteration Transjugular Intrahepatic Portosystemic Shunt Secondary Prophylaxis Treatment of Ascites Treatment of Encephalopathy Hepatic and Portal Vein Recanalization Surgical Treatment of Portal Hypertension Liver Transplantation Selected Key References References 165 Nutcracker Syndrome Abstract Keywords Introduction Background Demographics and Risk Factors Anatomy Diagnosis Clinical Presentation Imaging Management Open Surgery for Anterior Nutcracker Syndrome Open Surgery for Posterior Nutcracker Syndrome Endovascular Treatment of Nutcracker Syndrome Summary Selected Key References References 166 Venous Aneurysms and Their Management Abstract Keywords Introduction Lower Extremity Venous Aneurysms Lower Extremity Superficial Venous Aneurysms Lower Extremity Deep Venous Aneurysms Abdominal Venous Aneurysms Inferior Vena Cava Visceral Venous Aneurysms Upper Extremity and Internal Jugular Venous Aneurysms Upper Extremity Superficial Venous Aneurysms Upper Extremity Deep Venous Aneurysms Jugular Venous Aneurysms Conclusion Selected References References 167 Venous Reconstruction in Nonvascular Surgical Oncologic Procedures Abstract Keywords Introduction and Definitions Portal and Superior Mesenteric Vein Reconstruction Tumor Types Clinical Presentation, Evaluation, and Patient Selection Surgical Approach to Pancreatectomy and Portal Vein and Superior Mesenteric Vein Resection Methods of Portal Vein and Superior Mesenteric Vein Reconstruction Perioperative Outcomes Long-Term Outcomes Inferior Vena Cava Reconstruction Tumor Types Clinical Presentation and Evaluation Surgical Approach Methods of Inferior Vena Cava Reconstruction Adjunctive Extracorporeal Bypass Techniques Perioperative Outcomes Long-Term Outcomes Summary and Conclusions Selected Key References References SECTION 25 Lymphedema 168 Lymphedema: Evaluation and Decision Making Pathophysiology Classification and Staging Primary Lymphedema Classification by Age at Onset and Inheritance Classification by Morphology Classification by Anatomy Classification by Clinical Setting Secondary Lymphedema Cancer Filariasis Other Causes Clinical Staging Clinical Presentation History Signs and Symptoms Edema Skin Changes Pain Complications Infection Malnutrition and Immunodeficiency Malignant Tumors Diagnosis Physical Examination Testing Lymphoscintigraphy Computed Tomography and Magnetic Resonance Imaging Direct Contrast Lymphangiography Differential Diagnosis Systemic Causes Venous Insufficiency Vascular Malformation Lipedema Other Causes Decision Making Prospects for Molecular Therapy Selected Key References References 169 Lymphedema: Nonoperative Treatment Abstract Keywords Introduction Epidemiology Etiology Diagnosis, Classification, and Clinical Features Preventive Medicine Patients at Risk Edema Preventive Measures Mechanical Reduction of Limb Swelling Complex Decongestive Therapy Manual Lymphatic Drainage Compression Bandaging Compression Garments Nonelastic Compression Sequential Pneumatic Compression Pressure Level Exercise Skin Care and Nail Care Therapeutic Approach Based on Clinical Stages Level of Evidence Other Treatment Supporting Evidence Complications Skin Infections Malignancy Psychological Impairment Insurance Role Ideal Outpatient Lymphedema Clinic Helpful Resources Selected Key References References 170 Lymphedema: Surgical Treatment Basis of Surgical Treatment Historical Perspective Excisional Operations Surgical Excision Liposuction Functional Procedures Early Techniques Modern Techniques Preoperative Planning Visualizing Lymphatic Vessels Lymphography Magnetic Resonance Imaging Lymphoscintigraphy Dye Injection Lymphatic Donor Site Assessment Patient Risk Assessment Surgery Autologous Lymphatic Grafting Indications Surgical Technique Arm and Neck Leg Postoperative Treatment Results Other Direct Reconstructive Methods Lymphovenous Anastomosis Indications Preoperative Evaluation Surgical Technique Leg Arm Postoperative Treatment Results Resection Liposuction Surgical Technique Results Staged Subcutaneous Excision Beneath Flaps Surgical Technique Results Primary Chylous Disorders Lower Extremity and Genitalia Surgical Treatment Results Chylous Ascites Surgical Treatment Results Chylothorax Surgical Treatment Thoracic Duct Reconstruction Selected Key References References SECTION 26 Vascular Malformations 171 Congenital Vascular Malformations: General Considerations Abstract Keywords Definitions Nomenclature and Classification Hamburg Classification ISSVA/Mulliken Classification Incidence Etiology Embryology Extratruncular Lesions Truncular Lesions Pathophysiology Extratruncular Lesions Truncular Lesions Secondary Organ Impact Clinical Presentation Capillary Malformations Venous Malformations Lymphatic Malformations Arteriovenous Malformations Combined Vascular Malformations (Hemolymphatic Malformations) Diagnosis General Principles Physical Examination Imaging Minimally Invasive Studies Invasive Studies Evaluation of Affected Systems Differentiating Congenital Vascular Malformations From Infantile or Neonatal Hemangioma Treatment General Principles Arteriovenous and Venous Malformations Order of Treatment Nonsurgical/Endovascular Therapy Sclerotherapy and Embolotherapy Surgical Therapy Specific Vascular Malformations and Conditions Congenital Vascular Bone Syndrome: Angio-Osteodystrophy Klippel-Trénaunay Syndrome Parkes Weber Syndrome Coagulopathy: Thrombosis and Fibrinolysis Long-Term Follow-Up Assessment Selected Key References References 172 Congenital Vascular Malformations: Surgical Management Abstract Keywords Introduction Surgical Treatment of Low-Flow Malformations Capillary Malformations Lymphatic Malformations Operative Treatment Postoperative Management Venous Malformations Operative Treatment Postoperative Management Surgical Treatment of High-Flow Malformations Arteriovenous Malformations Operative Treatment Postoperative Management Surgical Treatment of Combined Vascular Malformations Operative Management Postoperative Management Selected Key References References 173 Congenital Vascular Malformations: Endovascular Management Abstract: Keywords Introduction Diagnosis of Vascular Malformations Treatment of Low-Flow Vascular Malformations Introduction Imaging Therapy Overview Sclerotherapy Preintervention Assessment Technical Details Postintervention Care and Complications Additional Endovascular Techniques and Other Therapies Magnetic Resonance Imaging– Guided Sclerotherapy Coil and Glue Embolization Laser Therapy Sirolimus Treatment of High-Flow Vascular Malformations Introduction Imaging Treatment of Arteriovenous Malformations Treatment of Arteriovenous Fistulas Syndromes Associated With Vascular Malformations Klippel-Trénaunay Syndrome Parkes-Weber Syndrome Hereditary Hemorrhagic Telangiectasia Conclusion Selected Key References References 174 Acquired Arteriovenous Fistulas Keywords Etiology and Incidence Traumatic Arteriovenous Fistulas Iatrogenic Arteriovenous Fistulas Spontaneous Arteriovenous Fistulas Arteriovenous Fistulas in Specific Locations Carotid Artery Arteriovenous Fistulas Vertebral Artery Arteriovenous Fistulas Axillary and Subclavian Arteriovenous Fistulas Brachial, Radial, and Ulnar Arteriovenous Fistulas Femoral Arteriovenous Fistulas Popliteal Arteriovenous Fistulas Tibial and Peroneal Arteriovenous Fistulas Aorto-iliac Arteriovenous Fistulas Renal Arteriovenous Fistulas Splenic, Hepatic, and Mesenteric Arteriovenous Fistulas Pathophysiology Fistula Size and Flow Chronic Changes Cardiac Effects Clinical Presentation History Physical Examination Neck and Upper Extremities Lower Extremities Chest and Abdomen Diagnostic Evaluation Color-Flow Duplex Ultrasound Imaging Computed Tomography Angiography Magnetic Resonance Imaging and Angiography Digital Subtraction Angiography Principles of Management Conservative Treatment Compression Therapy Endovascular Therapy Embolization Covered Stent-Grafts Abdominal Endografts Operative Repair Carotid and Vertebral Arteriovenous Fistulas Axillary and Subclavian Arteriovenous Fistulas Lower Extremity Arteriovenous Fistulas Aortocaval and Iliac Arteriovenous Fistulas Aortorenal Arteriovenous Fistulas Visceral Arteriovenous Fistulas Treatment Outcomes Operative Repair Endovascular Therapy Operative Repair Versus Endovascular Therapy Selected Key References References SECTION 27 Hemodialysis Access 175 Hemodialysis Access: General Considerations and Strategies to Optimize Access Placement Abstract Keywords Initiatives and Guidelines Timing of Referral Preoperative Evaluation History and Physical Examination Medical Assessment Age Diabetes Mellitus Smoking Medications Arterial Assessment Venous Assessment Selection of Access Location Forearm Access Cephalic Vein Basilic Vein Alternate Vein Prosthetic Graft Upper Arm Access Cephalic Vein Basilic Vein Alternate Vein Prosthetic Graft Technique for Permanent Access Autogenous Access One-Stage Versus Two-Stage Transposed Access Prosthetic Access Choice of Prosthetic Material Postoperative Follow-Up Long-Term Follow-Up Results Selected Key References References 176 Hemodialysis Access: Complex Abstract Keywords General Principles Avoiding Complex Access Selection of a Complex Access Site Autogenous Arteriovenous Access Translocation Procedures Saphenous Vein–Forearm Translocation Femoropopliteal Vein–Arm Translocation Results Technique Transposition Procedures Brachial Vein Transposition Results Technique Saphenous Vein Transposition Results Technique Femoral Vein Transposition Results Technique Ankle Fistula. Prosthetic Arteriovenous Access Prosthetic Chest Wall and Cervical Arteriovenous Access Results Necklace Access Brachial to Jugular Access Ipsilateral Axillary-Axillary Chest Wall Loop Access Technique Hemodialysis Reliable Outflow Vascular Access Device Results Technique Prosthetic Lower Extremity Arteriovenous Access Results Technique Cryopreserved Vein Allografts Unconventional Vascular Access Procedures Unconventional Chest or Abdominal Wall Access Procedures Arterial–Arterial Access Procedures Unconventional Sites for Placement of a Tunneled Dialysis Catheter Transthoracic Superior Vena Cava Catheters Translumbar Inferior Vena Cava Catheters Transhepatic Inferior Vena Cava Catheters Pediatric Vascular Access Kidney Disease Outcomes Quality Initiative Recommendations and Recent Trends Autogenous Arteriovenous Access Technique Selected Key References References 177 Hemodialysis Access: Dialysis Catheters Abstract Keywords Indications Types of Catheters Design Characteristics Design Categories Split Tip Step Tip Dual Catheter Symmetric Tip Preoperative Evaluation History and Physical Examination Central Venous Imaging Color-Flow Venous Duplex Imaging Magnetic Resonance Venography Computed Tomographic Venography Catheter-Based Contrast Venography Catheter Insertion Site Selection Technique Antegrade Placement Retrograde Placement Unconventional Catheter Sites Perioperative Care and Complications Pneumothorax Hemothorax Wire Embolism Cardiac Arrhythmia Cardiac Perforation Thoracic Duct Laceration Nerve Injuries Catheter Misplacement Venous Arterial Long-Term Care and Complications Air Embolism Catheter Embolism Catheter Occlusion Prevention Treatment Central Venous Thrombosis Central Venous Stenosis Presentation Treatment Catheter-Related Infection Treatment Selected Key References References 178 Hemodialysis Access: Failing and Thrombosed Measuring Access Function Mechanisms of Access Failure Flow Limitation Venous Outflow Stenosis Arterial Inflow Stenosis Cannulation Location Conduit Access Limitation Causes of Access Failure Detection of Access Failure Clinical Evaluation Collateral Veins or Edema Access Bleeding Failure to Mature Assessment During Dialysis Venous Pressure Measurement Flow Measurement Duplex Ultrasound Access Surveillance Catheter-Based Contrast Imaging Interventions for Failing Access Open Surgical Techniques Revision for Stenoses Revision for Other Problems Percutaneous Techniques Balloon Angioplasty Stenting Hybrid Approach Interventions for Thrombosed Access Autogenous Arteriovenous Access Prosthetic Arteriovenous Access Open Surgical Techniques Percutaneous Techniques Thrombolysis Stenosis Treatment Hybrid Techniques Treatment Outcome Selected Key References References 179 Hemodialysis Access: Nonthrombotic Complications Abstract Keywords Bleeding Etiology Treatment Active Bleeding and Emergent Surgery Elective Surgery Postoperative Bleeding Infection Treatment Pseudoaneurysm and Aneurysm Pseudoaneurysm Treatment True Aneurysm Aneurysmal Degeneration of Inflow Artery Seroma Pathophysiology and Risk Factors Diagnosis Treatment Reduction of Access Flow Direct Augmentation of Peripheral Flow Venous Hypertension Diagnosis Treatment Neuropathy Types of Neuropathy and Management Systemic Disease Neuropathy Compressive Mononeuropathies Ischemic Monomelic Neuropathy Cardiopulmonary Complications Coronary Steal Syndrome Embolization of Stents to Heart and Pulmonary Arteries Pulmonary Hypertension Selected Key References References SECTION 28 Vascular Trauma 180 Epidemiology and Natural History of Vascular Trauma Introduction The Origins of Vascular Injury Management Evolution Through Military Conflict Data Repositories and Registries Vascular Injury Classification and Scoring Contemporary Civilian Vascular Injury Violence in Society Epidemiologic Patterns and Trends Factors Influencing the Natural History of Vascular Injury Impact of Age and Gender on Vascular Injury Ethnicity and Socioeconomic Factors Mechanisms of Injury, Ballistics, and Biomechanics Epidemiology and Natural History of Specific Vascular Injuries Neck Truncal Injury Noncompressible Truncal Hemorrhage Thorax Thoracic Aorta Great Vessels Axillosubclavian Vessels Abdomen Abdominal Aorta (Zone 1) Inferior Vena Cava (Zone 1) Celiac and Mesenteric Vessels (Zone 1) Renal Vessels (Zone 2) Iliac Vessels (Zone 3) Hepatoportal Vessels (Zone 4) Extremity Upper Extremity Lower Extremity Femoropopliteal Vessels Tibioperoneal Vessels Summary Selected Key References References 181 Vascular Trauma: Head and Neck Abstract Keywords Carotid Arteries Penetrating Injury Clinical Presentation Diagnostic Evaluation Medical Treatment (Nonoperative Management) Endovascular Treatment Surgical Treatment Proximal and Distal Control in the Neck Surgical Repair of Cervical Vessels Blunt Cerebrovascular Injuries Clinical Presentation Mechanism of Blunt Cerebrovascular Injury Signs and Symptoms of Blunt Cerebrovascular Injury Screening for Blunt Cerebrovascular Injury Diagnostic Evaluation Duplex Ultrasound Digital Subtraction Angiography Computed Tomographic Angiography Magnetic Resonance Angiography Medical Treatment Endovascular Treatment Surgical Treatment Vertebral Arteries Clinical Presentation Diagnostic Evaluation Medical Treatment Endovascular Treatment Surgical Treatment Subclavian Artery Clinical Presentation Diagnostic Evaluation Medical Treatment Endovascular Treatment Surgical Treatment Cervical Venous Injuries Clinical Presentation Diagnostic Evaluation Endovascular Treatment Surgical Treatment Selected Key References References 182 Thoracic Vascular Trauma Abstract Keywords Introduction Presentation and Evaluation Imaging Indications for Emergent Operation Open Surgical Exposure/Incisions Operative Techniques Management of Specific Thoracic Vascular Injuries Blunt Thoracic Aortic Injury Diagnosis Classification/Grading Blunt Thoracic Aortic Injury Treatment—Medical Therapy Blunt Thoracic Aortic Injury Repair Postoperative Management Potential Complications of Thoracic Endovascular Aortic Repair Outcomes After Blunt Thoracic Aortic Injury Management Remaining Controversies and Future Directions Vascular Injuries to the Aortic Arch Vessels and Thoracic Outlet Vasculature Ascending Aorta and Transverse Arch Innominate Artery Left Common Carotid Artery Subclavian Vessels Conclusion Selected Key References References 183 Vascular Trauma: Abdominal Abstract Keywords Surgical Anatomy Epidemiology Clinical Presentation Diagnostic Evaluation Treatment Prehospital Treatment Emergency Department Treatment Surgical Treatment General Principles Retroperitoneal Hematoma Damage Control Procedures Endovascular Techniques Abdominal Compartment Syndrome Specific Vascular Injuries Abdominal Aorta Injuries Anatomy Mechanism of Injury Clinical Presentation Management Endovascular Treatment Surgical Treatment Mortality Celiac Artery Injuries Anatomy Mechanism of Injury Surgical Treatment Mortality Superior Mesenteric Artery Injuries Anatomy Mechanism of Injury Clinical Presentation Surgical Treatment Exposure Operative Management Postoperative Considerations Mortality Renovascular Injuries Anatomy Mechanism of Injury Clinical Presentation Endovascular Treatment Surgical Treatment Revascularization Surgical Reconstruction Venous Injuries Mortality Inferior Mesenteric Artery Injuries Anatomy Mechanism of Injury Surgical Treatment Iliac Vascular Injuries Anatomy Mechanism of Injury Clinical Presentation Endovascular Treatment Surgical Treatment Exposure Arterial Injuries Venous Injuries Compartment Syndrome Mortality Inferior Vena Cava Injuries Anatomy Mechanism of Injury Clinical Presentation Surgical Exposure Hepatic Vascular Isolation Atriocaval Shunt Division of the Liver Surgical Options Mortality Portal Venous System Injuries Anatomy Mechanism of Injury Clinical Presentation Surgical Treatment Mortality Advances in the Management of Abdominal Vascular Injuries Selected Key References References 184 Vascular Trauma: Extremity Abstract Keywords Epidemiology and Pattern of Injury Mortality Amputation Location of Injury Associated Tissue Injuries Diagnosis and Workup Physical Examination and Doppler Indices Computed Tomographic Angiography Duplex Ultrasonography Treatment Principles Nonoperative Management Endovascular Therapy Open Surgical Management Temporary Shunting Venous Repair Versus Ligation Specific Arterial Injuries Axillary Artery Mechanism and Pattern Diagnostic Considerations Surgical Considerations Brachial Artery Diagnostic Considerations Surgical Considerations Radial and Ulnar Arteries Diagnostic Considerations Surgical Considerations Femoral Arteries Diagnostic Considerations Surgical Considerations Popliteal Artery Diagnostic Considerations Surgical Considerations Tibial Arteries Diagnostic Considerations Surgical Considerations Other Considerations Compartment Syndrome and Fasciotomy Vascular Injury in the Mangled Extremity Intra-arterial Drug Injection Extremity Frostbite Selected Key References References 185 Conditions Arising From Repetitive Trauma and Occupational Vascular Problems Abstract Occupational Vascular Problems Abstract Keywords Manual Labor Injuries Hand-Arm Vibration Syndrome Clinical Findings and Risk Factors Diagnosis Treatment and Prevention Hypothenar Hammer Syndrome Etiology and Incidence Clinical Findings and Diagnosis Treatment Exposure Injuries Occupational Acro-Osteolysis Electrical Burns Extreme Thermal Injuries Athletic Injuries Hand Ischemia Clinical Findings and Risk Factors Treatment Quadrilateral Space Syndrome Humeral Head Compression of the Axillary Artery Thoracic Outlet Syndrome Clinical Findings and Risk Factors Treatment Selected Key References References SECTION 29 Special Issues in Pediatric Vascular Surgery 186 Special Techniques in Pediatric Vascular Surgery Introduction Historical Background Basic Principles Timing of Surgery Anticoagulant and Antiplatelet Agents Pediatric Anesthesia and Perioperative Care Basic Vascular Techniques Vascular Instruments and Retractors Vascular Exposure and Clamping Arteriotomy Closure Arterial Replacement and Bypass Procedures Endovascular Selected Key References References 187 Aortic and Arterial Aneurysms in the Pediatric Population Abstract Aortic Aneurysms Nonaortic Arterial Aneurysms Summary Selected Key References References 188 Pediatric Vascular Tumors Abstract Keywords Introduction Clinical Features Infantile Hemangioma Congenital Hemangioma Kaposiform Hemangioendothelioma Pyogenic Granuloma Diagnosis Management Infantile Hemangioma Congenital Hemangiomas Kaposiform Hemangioendothelioma Pyogenic Granuloma Secondary Tumors Selected Key References References 189 Vascular Trauma in the Pediatric Population Introduction Epidemiology Anatomic and Physiologic Considerations Diagnostic Evaluation Management of Pediatric Vascular Injuries Lower Extremity Arterial Injuries Management of Iatrogenic Vascular Injuries Management of Noniatrogenic Injuries Special Case of Noniatrogenic Arterial Injuries—Blunt Brachial Artery Injury Truncal Vascular Injuries Role of Endovascular Techniques in Pediatric Patients Postoperative Management and Outcomes Conclusions and Future Directions Selected Key References References 190 Placement of AV Dialysis Accesses and Central Catheters in the Pediatric Patient Background Incidence Etiology Morbidity and Mortality Patient Selection Treatment With Hemodialysis Central Venous Catheters General Considerations Central Venous Catheters Technical Considerations AV Access General Considerations AV Access Technical Considerations Conclusion Selected Key References References SECTION 30 Miscellaneous Conditions 191 Erectile Dysfunction Abstract Definition Epidemiology Physiology of Penile Erection Pathophysiology of Erectile Dysfunction Psychogenic Erectile Dysfunction Neurogenic Erectile Dysfunction Endocrinologic Erectile Dysfunction Vasculogenic Erectile Dysfunction Drug-Induced Erectile Dysfunction Assessment of Erectile Dysfunction History and Physical Examination Laboratory Evaluation and Adjunctive Testing Vascular Evaluation Penile Brachial Pressure Index Office Injection Testing Duplex Ultrasonography of the Penis Dynamic Infusion Cavernosometry and Cavernosography Selective Internal Pudendal Angiography/ Penile Angiography Treatment of Erectile Dysfunction Phosphodiesterase Type 5 Inhibitors Mechanism of Action and Means of Use Outcomes Adverse Events and Contraindications Intracavernosal Injection Therapy Mechanism of Action and Means of Use Outcomes Adverse Events and Contraindications Intraurethral PGE1 Suppository Vacuum Constriction Devices Penile Implant Surgery Technical Considerations Outcomes and Adverse Events Penile Revascularization Surgery Technical Considerations Outcomes and Complications Surgery for Veno-Occlusive Dysfunction Future Therapeutic Strategies Endovascular Stenting—ZEN Trial Stem Cell Therapy Erectile Dysfunction in Men Undergoing Vascular Surgery Prevalence of Erectile Dysfunction in the Vascular Surgery Population Erectile Function Outcomes Following Definitive Therapy Conclusions Acknowledgments Selected Key References References 192 Complex Regional Pain Syndrome Abstract Keywords Epidemiology/Etiology Traumatic Nontraumatic Idiopathic Classification and Terminology Summary of Key Features Syndrome Types Diagnostic Criteria Pathogenesis Theories and Components Exaggerated Local Inflammatory Response Theory/Neurogenic Inflammation Complex Regional Pain Syndrome as a Sympathetically Mediated Syndrome Complex Regional Pain Syndrome as the Result of Limb Ischemia/Reperfusion Injury Central Sensitization Theory Complex Regional Pain Syndrome Secondary to Nerve Damage Complex Regional Pain Syndrome as an Autoimmune Disorder Cortical Reorganization Theory Clinical Presentation Symptoms and Signs Budapest Consensus Criteria Comprehensive Adjunctive Clinical Tests Diagnostic Evaluation Radiographic Findings Diagnostic Sympathetic Blockade Differential Diagnosis Nonsurgical Treatment Physical Therapy Pharmacologic Therapy Sympathetic Blockade Lumbar Sympathetic Blockade Technique Epidural and Intrathecal Drug Therapy Neuromodulation Psychotherapy Sympathectomy Indications Lumbar Sympathectomy Anatomic Considerations Chemical Sympathectomy Open Technique Laparoscopic Technique Results of Sympathectomy/Complex Regional Pain Syndrome Complications Summary of Treatment Guidelines Overall Results of Treatment Selected Key References References 193 Current Role of Sympathectomy (Upper and Lower) Abstract Keywords Anatomy Sympathetic Ganglia Sympathetic Innervation of the Upper Limbs Sympathetic Innervation of the Lower Limbs Sympathetic Innervation of the Ocular Structures Sympathetic Innervation of the Cephalic Segment Sympathetic Innervation of the Heart Physiology Indications for Cervicothoracic Sympathectomy Indications for Lumbar Sympathectomy Idiopathic Hyperhidrosis Ischemia of the Hand Complex Regional Pain Syndrome Long QT Syndrome Raynaud Syndrome Surgical Techniques Open Surgery for Cervicothoracic Sympathectomy Video-Assisted Thoracoscopic Sympathectomy Instrumentation Anesthesia Positioning Technique Lumbar Sympathectomy Technical Difficulties in Video-Assisted Thoracoscopic Sympathectomy Technical Alternatives for Video-Assisted Thoracoscopic Sympathectomy Contraindications to Video-Assisted Thoracoscopic Sympathectomy Target Ganglia Palmar Hyperhidrosis Axillary Hyperhidrosis Craniofacial Hyperhidrosis or Facial Rubor Complex Regional Pain Syndrome, Vascular Disease, and Raynaud Syndrome Long QT Syndrome Results Hyperhidrosis Vascular Diseases Complex Regional Pain Syndrome Long QT Syndrome Raynaud Syndrome Complications of Video-Assisted Thoracoscopic Sympathectomy Pneumothorax Hemorrhage Chylothorax Cardiac Complications Neurologic Complications Causes of Failure Incomplete Denervation Regeneration Functional Reorganization (Collateral Nerve Sprouting) Reversal of Sympathectomy Selected Key References References 194 Vascular Tumors and Their Management Abstract Keywords Introduction Tumor Types Clinical Presentation and Evaluation Treatment Replacement of the Inferior Vena Cava Outcomes Selected Key References References 195 Vascular Reconstruction in Oncologic Surgery Abstract Keywords Pancreatic Malignancies Pancreaticoduodenectomy Venous Resection and Reconstruction Tangential Superior Mesenteric Vein/Portal Vein Resection With Saphenous Vein Patch Segmental Resection and Primary Anastomosis Segmental Resection and Interposition Grafting Left Renal Vein Graft Internal Jugular Vein Graft Splenic Vein Preservation Versus Ligation Arterial Resection Postoperative Considerations and Oncologic Outcomes Celiac Axis Resection/Appleby Procedure Hepatic and Biliary Malignancies General Considerations and Surgical Principles Portal Vein Reconstruction Hepatic Artery Resection Inferior Vena Cava Resection Soft Tissue Sarcoma General Considerations and Surgical Principles Extremity Soft Tissue Sarcoma Retroperitoneal Soft Tissue Sarcoma Selected Key References References 196 Chronic Exertional Compartment Syndrome Abstract Keywords History Etiology Epidemiology Differential Diagnosis Anatomy Clinical Presentation and Diagnosis Management Nonsurgical Surgical Anterior and Lateral Compartment Fasciotomy Posterior Compartments Release Endoscopic Compartmental Release Postoperative Management and Complications Outcomes Selected Key References References SECTION 31 The Business of Vascular Surgery 197 Development and Operation of Multispecialty Cardiovascular Centers Abstract Keywords Introduction Early Examples of Multispecialty Cardiovascular Centers Forces Shaping the Evolution of Contemporary Multispecialty Cardiovascular Centers Changes in Demographics and Care Delivery Competition Reimbursement and Quality of Care Development of a Multispecialty Cardiovascular Center Finances and Compensation Operational Issues The Current State of Multispecialty Cardiovascular Centers Future Directions Conclusion Selected Key References References 198 Development and Successful Operation of an Outpatient Vascular Center Abstract Key Words Introduction Regulations Anesthesia Radiology Occupation Safety and Health Administration Components for Success Office for Patients Noninvasive Vascular Lab Endovascular Lab Types of Procedures Hemodialysis Access–Related Procedures (See Chapter 177) Peripheral Arterial Procedures Arterial Intervention Venous Procedures Port Insertions Venous Center Additional Services Vascular Medicine Wound Care Center Screening Program Building a Center Business Plan Building Equipment Supplies and Medications Staffing Electronic Health Record, Picture Archiving, and Communication System (PACS) Biomedical and Electrical Accreditation Running a Center Medical Records Policies and Procedures Coding Compliance Billing Data Management Quality Control Outcome Measurement Management of Complications Marketing Avenues for Marketing Radiation Patient Satisfaction Evaluation of the Center by Physicians Future Acknowledgment Selected Key References References 199 Essentials and Value of a Vascular Registry to the Practice Abstract Keywords Introduction What Is the Definition of a Medical Registry? Why Do Registries Exist? What Determines the Value of a Registry? Where Do Registries Fit as Medical Evidence? Existing Vascular Surgery Registries (Table 199.2) Vascular Quality Initiative American College of Surgeons National Surgical Quality Improvement Program National Veterans Administration Surgical Quality Improvement Program Vascunet National Cardiovascular Data Registry Role of Medical Registries in Quality Improvement Public Reporting of Registry Data The Future of Medical Registries Selected Key References References 200 Marketing a Vascular Surgery Practice Abstract Keywords Discovery Strategy and Solutions Internal Marketing External Marketing Implementation Review Summary Selected Key References
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