Vascular Medicine: A Companion to Braunwald’s Heart Disease

Instructions for online access......Page 3454
Title page......Page 2
Table of Contents......Page 5
Copyright......Page 37
Dedication......Page 40
Contributors......Page 42
Foreword......Page 54
Preface......Page 57
Acknowledgments......Page 61
Series page......Page 62
Part I: Biology of Blood Vessels......Page 66
1: Vascular Embryology and Angiogenesis......Page 67
Abstract......Page 69
Tunica intima: endothelium......Page 72
Tunica media: smooth muscle and extracellular matrix......Page 86
Tunica adventitia......Page 100
Summary......Page 103
2: The Endothelium......Page 121
Abstract......Page 123
Homeostatic functions of the endothelium......Page 125
Endothelial heterogeneity......Page 141
Endothelial dysfunction and vascular disease......Page 144
Functional assessment of the endothelium......Page 148
Conclusions......Page 152
3: Vascular Smooth Muscle......Page 172
Abstract......Page 174
Origins of vascular smooth muscle cells during embryonic development......Page 177
Vascular smooth muscle cell phenotypic modulation......Page 180
Influence of cell-cell and cell-matrix interactions......Page 208
Phenotype-specific vascular smooth muscle cell functions......Page 217
Inflammation and inflammation-related processes......Page 232
Senescence and aging......Page 239
Conclusions......Page 244
4: Normal Mechanisms of Vascular Hemostasis......Page 277
Abstract......Page 279
Endothelial function and platelet activation......Page 280
The coagulation cascade leading to fibrin formation......Page 283
Fibrinolysis......Page 288
Summary......Page 292
5: Vascular Pharmacology......Page 298
Abstract......Page 300
The pharmacological framework of drug action......Page 302
Therapeutic intervention and the endothelium......Page 307
Therapeutic intervention and the autonomic vascular innervation......Page 334
Therapeutic intervention and the vascular media......Page 348
Part II: Pathobiology of Blood Vessels......Page 375
6: Pathobiology of Atherosclerosis......Page 376
Abstract......Page 378
Risk factors for atherosclerosis: traditional, emerging, and on the rise......Page 380
The diversity of atherosclerosis......Page 395
Atherosclerosis: a systemic disease......Page 414
7: Pathobiology of Aortic Aneurysms......Page 430
Abstract......Page 432
Degradation of the medial extracellular matrix......Page 438
Smooth muscle dysregulation......Page 440
Inflammation and oxidative stress......Page 441
Biomechanical stress......Page 443
Risk factors and genetics of aortic aneurysms......Page 445
Epigenetics/micrornas in aortic aneurysms......Page 448
Conclusion......Page 450
8: Pathobiology of Thrombosis......Page 457
Abstract......Page 459
Overview of thrombosis......Page 460
Platelets, thrombosis, and vascular disease......Page 463
Inflammation and thrombosis......Page 472
9: Pathobiology and Assessment of Cardiovascular Fibrosis......Page 481
ABSTRACT......Page 483
Overview of collagen......Page 486
Collagen structure, properties, and relevance to human biology......Page 489
Regulation of collagen synthesis......Page 490
Regulation of collagen metabolism......Page 494
Fibrosis in clinical cardiovascular disease......Page 495
Myocardial fibrosis in specific cardiovascular conditions......Page 499
Biomarkers of myocardial fibrosis......Page 502
Targeting myocardial fibrosis......Page 503
Vascular fibrosis in systemic hypertension......Page 504
Vascular fibrosis in pulmonary arterial hypertension......Page 506
Conclusions......Page 508
10: Pathobiology of Vasculitis......Page 516
Abstract......Page 518
Large-vessel vasculitis......Page 520
Small-vessel vasculitis......Page 526
Medium-vessel vasculitis......Page 531
Summary......Page 533
Part III: Principles of Vascular Examination......Page 537
11: The History and Physical Examination......Page 538
Abstract......Page 540
Vascular history......Page 541
Vascular examination......Page 550
12: Vascular Laboratory Testing......Page 573
Abstract......Page 575
Limb pressure measurement and pulse volume recordings......Page 576
Transcutaneous oximetry......Page 583
Physical principles of ultrasonography......Page 584
Carotid duplex ultrasound......Page 592
Abdominal aorta evaluation......Page 605
Renal artery duplex ultrasonography......Page 610
Peripheral arterial ultrasonography......Page 613
Pseudoaneurysm......Page 621
Arteriovenous fistulae......Page 624
Venous duplex ultrasound......Page 626
Plethysmographic evaluation of venous reflux......Page 635
Vascular laboratory accreditation......Page 636
13: Magnetic Resonance Imaging......Page 642
Abstract......Page 644
Acknowledgment......Page 645
Basic principles......Page 647
Magnetic resonance angiography techniques......Page 649
14: Computed Tomographic Angiography......Page 691
Abstract......Page 693
Fundamentals of computed tomography imaging......Page 695
Radiation exposure and radiation dose reduction......Page 701
Emerging technologies in computed tomography......Page 705
Artifacts and pitfalls of computed tomographic angiography......Page 707
Clinical applications of computed tomographic angiography in vascular disease......Page 708
15: Catheter-Based Peripheral Angiography......Page 748
Abstract......Page 750
Imaging equipment......Page 751
Radiographic contrast......Page 753
Imaging technique......Page 754
Obtaining vascular access......Page 755
Complications of peripheral vascular angiography......Page 787
Part IV: Peripheral Artery Disease......Page 792
16: The Epidemiology of Peripheral Artery Disease......Page 793
Abstract......Page 795
Symptoms and measures of peripheral artery disease in epidemiology......Page 797
Incidence and prevalence of peripheral artery disease......Page 803
Peripheral artery disease risk factors......Page 810
Interaction and risk factor comparisons......Page 824
Progression of peripheral artery disease......Page 825
Co-prevalence of peripheral artery disease and other atherosclerotic disease......Page 828
Peripheral artery disease as a predictor of mortality and morbidity......Page 830
17: Pathophysiology of Peripheral Artery Disease......Page 850
Abstract......Page 852
Clinical expressions of peripheral artery disease......Page 854
Hemodynamics in peripheral artery disease......Page 857
Contributors to limb symptoms in peripheral artery disease: beyond arterial stenosis......Page 861
Altered skeletal muscle structure and function in peripheral artery disease......Page 866
Summary......Page 869
18: Peripheral Artery Disease: Clinical Evaluation......Page 880
Abstract......Page 882
Patient history......Page 883
Critical limb ischemia......Page 888
Physical examination......Page 892
Diagnostic testing......Page 896
Summary......Page 909
19: Medical Treatment of Peripheral Artery Disease......Page 916
Abstract......Page 918
Interventions to reduce cardiovascular risk and adverse limb events......Page 923
Interventions to improve symptoms and function......Page 948
Summary and conclusion......Page 958
20: Endovascular Treatment of Peripheral Artery Disease......Page 979
Abstract......Page 981
Patient and lesion selection criteria......Page 983
Technical and procedural considerations......Page 987
Clinical outcomes......Page 992
Conclusions......Page 1004
21: Reconstructive Surgery for Peripheral Artery Disease......Page 1014
Abstract......Page 1016
Aortoiliac occlusive disease......Page 1018
Infrainguinal Arterial Occlusive Disease......Page 1040
Part V: Renal Artery Disease......Page 1075
22: Pathophysiology of Renal Artery Disease......Page 1076
Abstract......Page 1078
Epidemiology of renal artery disease......Page 1081
Pathophysiologic consequences of renovascular disease......Page 1082
Renal artery disease and mortality......Page 1107
23: Clinical Evaluation of Renal Artery Disease......Page 1113
Abstract......Page 1115
Consequences of renal artery stenosis......Page 1119
Physical examination......Page 1123
Diagnosis of renovascular disease......Page 1124
24: Treatment of Renal Artery Disease......Page 1149
Abstract......Page 1151
Critical functions of the kidney......Page 1152
Medical therapy for renal artery disease......Page 1153
Fibromuscular dysplasia......Page 1154
Atherosclerotic renal artery stenosis......Page 1157
Treatment of unusual causes of renal artery stenosis......Page 1164
Treatment of renal artery aneurysms......Page 1165
Surgical management of atherosclerotic renal artery disease......Page 1166
Part VI: Mesenteric Vascular Disease......Page 1180
25: Epidemiology and Pathophysiology of Mesenteric Vascular Disease......Page 1181
Abstract......Page 1183
Acute arterial occlusive mesenteric ischemia......Page 1184
Mesenteric artery dissection......Page 1190
Nonocclusive mesenteric ischemia......Page 1192
Mesenteric venous thrombosis......Page 1196
Chronic mesenteric ischemia......Page 1199
26: Clinical Evaluation and Treatment of Mesenteric Vascular Disease......Page 1206
Abstract......Page 1208
Chronic mesenteric ischemia......Page 1210
Acute occlusive mesenteric ischemia......Page 1234
Acute nonocclusive mesenteric ischemia......Page 1243
Mesenteric venous thrombosis......Page 1245
Part VII: Vasculogenic Erectile Dysfunction......Page 1254
27: Vasculogenic Erectile Dysfunction......Page 1255
Abstract......Page 1257
Definition and classifications......Page 1258
Epidemiology......Page 1259
Public health and clinical implications......Page 1260
Functional anatomy......Page 1261
Pathophysiology of erectile dysfunction......Page 1268
Evaluation of erectile dysfunction......Page 1270
Treatment......Page 1275
Longitudnal psychological outcomes......Page 1280
Guidelines......Page 1281
Part VIII: Cerebrovascular Ischemia......Page 1291
28: Epidemiology of Cerebrovascular Disease......Page 1292
Abstract......Page 1294
Overview......Page 1295
Stroke risk factors: demographic factors......Page 1300
Stroke risk factors: lifestyle......Page 1302
Medically treatable risk factors......Page 1308
Other risk factors......Page 1315
Awareness of Stroke Warning Signs and Acute Treatment......Page 1319
The future......Page 1320
29: Clinical Presentation and Diagnosis of Cerebrovascular Disease......Page 1344
Abstract......Page 1346
Overview of clinical stroke......Page 1347
Clinical manifestations of stroke and cerebrovascular disease......Page 1348
Clinical assessment tools......Page 1361
Conclusions......Page 1380
30: Prevention and Treatment of Stroke......Page 1393
Abstract......Page 1395
Prehospital and emergency department management of ischemic stroke......Page 1400
Acute stroke therapy......Page 1407
Secondary prevention of ischemic stroke......Page 1425
Primary prevention of ischemic stroke......Page 1429
31: Carotid Artery Revascularization......Page 1452
Abstract......Page 1454
Indications for Carotid Revascularization......Page 1456
Preoperative Management......Page 1458
Carotid Endarterectomy......Page 1460
Carotid Artery Stenting......Page 1464
Postoperative Management......Page 1467
Outcomes for Carotid Endarterectomy and Carotid Artery Stenting......Page 1468
Transcervical Carotid Stenting with Flow Reversal......Page 1471
Management of Postcarotid Endarterectomy Stenosis......Page 1475
Part IX: Aortic Dissection......Page 1481
32: Pathophysiology, Clinical Evaluation, and Medical Management of Aortic Dissection......Page 1482
Abstract......Page 1484
Epidemiology......Page 1485
Classification......Page 1486
Pathogenesis......Page 1489
Predisposing Genetic Factors......Page 1492
Acquired Disorders......Page 1499
Clinical Presentation......Page 1502
Laboratory Testing......Page 1505
Diagnostic Imaging......Page 1507
Differential Diagnosis......Page 1513
Initial Medical Treatment (Fig. 32.9)......Page 1518
Indications For Intervention (Box 32.5)......Page 1522
Prognosis......Page 1532
Long-Term Surveillance......Page 1535
33: Surgical Therapy for Aortic Dissection......Page 1552
Abstract......Page 1554
Type a Aortic Dissection......Page 1559
Acute Type B Aortic Dissection......Page 1578
Chronic Type B Aortic Dissection......Page 1582
Future Therapies......Page 1594
34: Endovascular Therapy for Aortic Dissection......Page 1601
Abstract......Page 1603
Branch Vessel Interventions......Page 1606
Aortic Interventions......Page 1613
Part X: Aortic Aneurysm......Page 1630
35: Epidemiology and Prognosis of Aortic Aneurysms......Page 1631
Abstract......Page 1633
The Normal Aorta......Page 1634
Definition Of Aortic Aneurysm......Page 1637
Epidemiology And Prognosis Of Aortic Aneurysms......Page 1641
Inherited and Developmental Disorders......Page 1651
Other Conditions Associated with Aortic Aneurysm......Page 1654
36: Clinical Evaluation of Aortic Aneurysms......Page 1678
Abstract......Page 1680
Clinical history......Page 1681
Physical examination......Page 1684
Screening of aortic aneurysms......Page 1688
Surveillance of aortic aneurysms......Page 1690
Diagnostic testing......Page 1691
37: Surgical Treatment of Abdominal Aortic Aneurysms......Page 1710
Abstract......Page 1712
Definition......Page 1714
Decision-Making for elective abdominal aortic aneurysm repair......Page 1715
Rupture risk......Page 1717
Expansion rate......Page 1721
Elective operative risk......Page 1723
Life expectancy......Page 1727
Surgical decision-Making......Page 1728
Preoperative assessment......Page 1730
Surgical treatment......Page 1732
Complications of abdominal aortic aneurysm repair......Page 1751
Functional outcome......Page 1757
Long-Term survival......Page 1758
38: Endovascular Therapy for Abdominal Aortic Aneurysm......Page 1782
Abstract......Page 1784
Indications......Page 1786
Anatomic requirements......Page 1787
Endograft design......Page 1795
Graft placement and postoperative management......Page 1800
Problems with endografting and management......Page 1803
Outcomes......Page 1815
Other considerations......Page 1819
Summary......Page 1825
Part XI: Vasculitis......Page 1843
39: Overview of Vasculitis......Page 1844
Abstract......Page 1846
Classification of vasculitis......Page 1850
Large-vessel vasculitis......Page 1852
Medium-vessel vasculitis......Page 1858
Small-vessel vasculitis......Page 1861
VARIABLE-VESSEL VASCULITIS......Page 1868
Evaluation and diagnosis of possible vasculitis......Page 1873
Treatment of vasculitis......Page 1883
40: Large Vessel Vasculitis......Page 1895
Abstract......Page 1897
Acknowledgment......Page 1898
Takayasu arteritis......Page 1899
Giant cell arteritis......Page 1916
Isolated idiopathic aortitis......Page 1936
41: Medium and Small Vessel Vasculitis......Page 1953
Abstract......Page 1955
Medium vessel vasculitis......Page 1956
Small vessel vasculitis......Page 1966
Pauci-immune small vessel vasculitis......Page 1974
Immune complex mediated small vessel vasculitis......Page 1985
42: Thromboangiitis Obliterans (Buerger Disease)......Page 2018
Abstract......Page 2020
Epidemiology......Page 2022
Etiology and pathogenesis......Page 2023
Pathology......Page 2026
Clinical presentation......Page 2031
Differential diagnosis......Page 2035
Diagnosis......Page 2038
Prognosis......Page 2045
Management......Page 2046
Future perspectives......Page 2055
43: Kawasaki Disease......Page 2060
Abstract......Page 2062
Epidemiology......Page 2064
Etiology and pathogenesis......Page 2065
Pathology......Page 2067
Clinical presentation......Page 2070
Cardiac manifestations......Page 2073
Cardiac testing......Page 2075
Clinical course......Page 2078
Treatment......Page 2082
Coronary revascularization for late stenosis......Page 2086
Preventive cardiology......Page 2088
Summary......Page 2089
Part XII: Acute Limb Ischemia......Page 2107
44: Acute Arterial Occlusion......Page 2108
Abstract......Page 2110
Epidemiology of acute limb ischemia......Page 2112
Etiology of acute limb ischemia......Page 2114
Pathophysiology of acute limb ischemia......Page 2121
Diagnosis of acute limb ischemia......Page 2124
Treatment of acute limb ischemia......Page 2127
45: Atheroembolism......Page 2165
Abstract......Page 2167
Pathobiology......Page 2174
Etiology......Page 2175
Atheroembolic syndromes......Page 2186
General treatment measures for atheroembolic disease prevention......Page 2210
Conclusions......Page 2212
Part XIII: Vasospasm and Other Related Vascular Diseases......Page 2227
46: Raynaud Phenomenon......Page 2228
Abstract......Page 2230
Overview of primary raynaud phenomenon......Page 2236
Pathophysiology......Page 2239
Secondary Causes of Raynaud Phenomenon......Page 2247
Diagnostic tests......Page 2257
Treatment......Page 2263
47: Acrocyanosis......Page 2283
Abstract......Page 2285
Epidemiology......Page 2287
Etiology......Page 2288
Pathophysiology......Page 2290
Clinical presentation......Page 2292
Diagnosis......Page 2294
Histopathology......Page 2295
Differential diagnosis......Page 2296
Treatment......Page 2298
Prognosis......Page 2300
48: Erythromelalgia......Page 2304
Abstract......Page 2306
Definition and historical perspective......Page 2307
Nomenclature......Page 2308
Criteria for diagnosis......Page 2309
Clinical controversies......Page 2311
Clinical presentation......Page 2312
Diagnosis......Page 2316
Classification......Page 2317
Incidence......Page 2320
Pathophysiology......Page 2321
Differential diagnosis......Page 2326
Investigations......Page 2327
Natural History and Prognosis......Page 2329
Management......Page 2331
49: Pernio (Chilblains)......Page 2343
Abstract......Page 2345
Epidemiology......Page 2349
Pathophysiology......Page 2350
Histopathology......Page 2353
Clinical features......Page 2355
Diagnosis......Page 2363
Treatment......Page 2365
Part XIV: Venous Thromboembolic Disease......Page 2372
50: Epidemiology of Venous Thromboembolic Disease......Page 2373
Abstract......Page 2375
Incidence and clinical relevance of venous thromboembolism......Page 2376
Secular trends in incidence of venous thromboembolism......Page 2377
Risk factors for venous thromboembolism......Page 2380
Classification of venous thromboembolism......Page 2383
Incidental venous thromboembolism......Page 2385
Conclusion......Page 2386
51: Clinical Evaluation of Venous Thromboembolism......Page 2391
Abstract......Page 2393
Clinical Presentation......Page 2394
Diagnosis......Page 2398
Diagnosis in Pregnancy......Page 2416
Risk Stratification......Page 2418
Adjunctive Clinical Evaluation for Etiology of Venous Thromboembolism......Page 2424
52: Management of Venous Thromboembolism......Page 2436
Abstract......Page 2438
Pathophysiology and Risk Factors for Venous Thromboembolism......Page 2441
Anticoagulation......Page 2446
Recurrent Venous Thromboembolism and Optimal Duration of Anticoagulation......Page 2459
Advanced Management of Venous Thromboembolism: When Anticoagulation Alone May Not or Will Not Suffice......Page 2462
Strategies for Managing Acute Venous Thromboembolism......Page 2471
The Multitude of Challenges in Managing Venous Thrombosis......Page 2475
A Look Into the Future......Page 2477
Part XV: Chronic Venous Disorders......Page 2494
53: Varicose Veins......Page 2495
Abstract......Page 2497
Epidemiology......Page 2498
Anatomy......Page 2499
Pathogenesis......Page 2504
Clinical manifestations......Page 2506
Physical examination......Page 2508
Imaging and physiological testing......Page 2513
Management......Page 2515
Management of incompetent perforator veins......Page 2535
Management of telangiectasia/reticular veins......Page 2538
Follow-up and prognosis......Page 2540
54: Chronic Venous Insufficiency......Page 2552
Abstract......Page 2554
Anatomy......Page 2557
Etiology......Page 2560
Pathophysiology......Page 2561
Diagnosis......Page 2564
Treatment......Page 2577
Conclusions......Page 2595
Part XVI: Pulmonary Hypertension......Page 2614
55: Pulmonary Arterial Hypertension......Page 2615
Abstract......Page 2617
Definition and classification of pulmonary arterial hypertension......Page 2618
Epidemiology......Page 2620
Cellular pathogenesis of pulmonary arterial hypertension......Page 2621
Molecular pathogenesis of pulmonary arterial hypertension......Page 2627
Clinical pathophysiology......Page 2656
Treatment......Page 2668
Conclusions......Page 2682
56: Pulmonary Hypertension in Patients With Nonpulmonary Arterial Hypertension......Page 2709
Abstract......Page 2711
Overview of pulmonary hypertension......Page 2712
Pulmonary venous hypertension......Page 2719
Pulmonary hypertension under conditions of hypoxemia......Page 2726
Pulmonary hypertension secondary to pulmonary thromboembolic disease......Page 2730
Pulmonary hypertension and hemoglobinopathies......Page 2736
Other secondary causes of pulmonary hypertension......Page 2741
Part XVII: Lymphatic Disorders......Page 2756
57: Diseases of the Lymphatic Circulation......Page 2757
Abstract......Page 2759
Anatomy of the lymphatic circulation......Page 2761
Physiology of the lymphatic circulation......Page 2765
Lymphatic insufficiency (Lymphedema)......Page 2768
Diseases of the lymphatic vasculature......Page 2793
Part XVIII: Miscellaneous......Page 2810
58: Fibromuscular Dysplasia......Page 2811
Abstract......Page 2813
Historical perspective......Page 2815
Classification......Page 2816
Epidemiology......Page 2820
Genetics and etiology......Page 2822
Clinical presentation and vascular manifestations......Page 2825
Diagnostic evaluation of fibromuscular dysplasia......Page 2845
Imaging studies for diagnosis of fibromuscular dysplasia......Page 2849
Management of fibromuscular dysplasia......Page 2853
Endovascular therapy for fibromuscular dysplasia......Page 2858
Surgery for fibromuscular dysplasia......Page 2862
Follow-up and prognosis......Page 2863
59: Vascular Infections......Page 2882
Abstract......Page 2884
Primary arterial infections......Page 2886
Secondary arterial infections......Page 2897
Diagnostic Tests to Aid the Diagnosis of Arterial Infections......Page 2906
Management of Primary and Secondary Arterial Infections......Page 2915
Suppurative thrombophlebitis......Page 2933
Septic cavernous sinus thrombosis......Page 2937
Conclusions......Page 2938
60: Dermatological Manifestations of Vascular Disease......Page 2952
Abstract......Page 2954
Peripheral artery disease......Page 2956
Vasomotor diseases......Page 2961
Acrocyanosis......Page 2969
Erythromelalgia......Page 2973
Pernio/chilblains disease......Page 2977
Livedo reticularis......Page 2982
Hybrid vasomotor disease......Page 2986
Chronic venous insufficiency......Page 2989
Lymphedema......Page 3003
61: Lower Extremity Ulceration......Page 3019
Abstract......Page 3021
Biomechanics of walking and ulcer formation......Page 3025
Pathophysiology of ulcer formation......Page 3028
Assessment of the patient with a lower extremity ulcer......Page 3037
Management of ulcers......Page 3045
Summary......Page 3051
62: Vascular Trauma......Page 3061
Abstract......Page 3063
Initial evaluation......Page 3066
Types of vessel injury......Page 3067
Mechanism: Penetrating vs. Blunt trauma......Page 3069
Signs of vascular injury......Page 3070
Neck vascular trauma......Page 3072
Specific NECK VASCULAR injuries......Page 3074
Thoracic vascular trauma......Page 3076
Specific THORACIC VASCULAR injuries......Page 3078
Abdominal vascular trauma......Page 3084
Specific ABDOMINAL VASCULAR injuries......Page 3087
Extremity vascular trauma......Page 3095
Specific EXTREMITY VASCULAR injuries......Page 3096
Ischemia-Reperfusion Injury......Page 3099
Compartment Syndrome......Page 3100
Iatrogenic Vascular Injury......Page 3102
Pediatric Vascular Trauma......Page 3104
63: Vascular Compression Syndromes......Page 3112
Abstract......Page 3114
Thoracic outlet syndrome......Page 3115
Axillary artery compression syndrome......Page 3124
Median arcuate ligament syndrome......Page 3125
Nutcracker syndrome......Page 3129
May-thurner syndrome......Page 3133
Popliteal entrapment syndrome......Page 3136
Cystic adventitial disease......Page 3140
64: Peripheral Vascular Anomalies, Malformations, and Vascular Tumors......Page 3158
Abstract......Page 3160
Proliferative vascular anomalies and tumors......Page 3163
Vascular malformations......Page 3178
Syndromic vascular anomalies......Page 3190
Treatment of vascular malformations (also see Table 64.3)......Page 3195
Prenatal diagnosis of vascular anomalies......Page 3198
Clinical issues (see also Table 64.4)......Page 3199
Index......Page 3222