دانلود کتاب Current Therapy in Vascular and Endovascular Surgery

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Front Matter Copyright Contributors Preface Cerebrovascular Disease 1 Cerebrovascular Disease Pathology of Carotid Artery Atherosclerosis Geometry of The Carotidbifurcation Hemodynamic Conditions At Thecarotid Bifurcation Carotid Bifurcation Atherosclerosis 2 Carotid and Vertebral Artery Fibrodysplasia Carotid Artery Fibrodysplasia Vertebral Artery Fibrodysplasia 3 Carotid Artery Dissections Clinical Pathophysiology Diagnosis Treatment Outcomes 4 Carotid Artery Kinks and Coils ETIOLOGY EPIDEMIOLOGY IMAGING AND DIAGNOSIS MANAGEMENT AND TREATMENT 5 Giant Cell Arteritis PATHOPHYSIOLOGY CLINICAL FEATURES DIAGNOSIS MEDICAL TREATMENT SURGICAL TREATMENT PROGNOSIS 6 Arteriographic Evaluation of Cerebrovascular Disease INDICATIONS FOR CATHETER-BASED ANGIOGRAPHY Diagnostic Indications Intraoperative Indications Surveillance ANGIOGRAPHIC PROCEDURES Access to the Arterial System Sheath and Catheter Principles Contrast Agents Vessel Selection Catheter Positioning Angiographic Images Angiographic Anatomy Embolic Precautions Injection Rates Sedation and Anesthesia Requirements Postangiography Orders COMPLICATIONS OF CEREBRAL ANGIOGRAPHY Neurologic Complications Nonneurologic Complications 7 Computed Tomography in Cerebrovascular Disease 8 Magnetic Resonance Imaging and Positron Emission Tomography in the Evaluation of Cerebrovascular Disease MAGNETIC RESONANCE IMAGING POSITRON EMISSION TOMOGRAPHY CONCLUSION 9 Duplex Scanning and Spectral Analysis of Carotid Bifurcation Atherosclerotic Disease IMPORTANT CONCEPTS GRADING OF STENOSIS Use of Velocity Criteria Limitations of Duplex Velocity Criteria Other Methods of Grading ICA Stenosiswith Ultrasound DUPLEX SCANNING AND STROKE RISK STRATIFICATION: FUTURE PERSPECTIVES 10 Transcranial Doppler in the Evaluation of Cerebrovascular Disease TECHNIQUE CLINICAL INDICATIONS Cerebral Ischemia Vasomotor Reactivity Cerebral Embolization Subarachnoid Hemorrhage Sickle Cell Disease Cerebral Circulatory Arrest FUNCTIONAL TRANSCRANIAL DOPPLER THERAPEUTIC TRANSCRANIAL DOPPLER SUMMARY 11 Medical Treatment to Prevent Transient Ischemic Attacks and Ischemic Stroke MODIFICATION OF RISK FACTORS Hypertension Tobacco Abuse Diabetes Mellitus Hyperlipidemia Antiplatelet Medication Lifestyle Interventions to Prevent Stroke CARDIOEMBOLIC STROKE PREVENTION Atrial Fibrillation Carotid Artery Stenosis STROKE PREVENTION IN SPECIAL PATIENT POPULATION SECONDARY PREVENTION OF TRANSIENT ISCHEMIC ATTACKAND STROKE SECONDARY PREVENTION OF CARDIOEMBOLIC STROKE Antiplatelet Agents for Secondary Preventionof Stroke or Transient Ischemic Attack CONCLUSION 12 Medical Therapy Including Fibrinolytic Therapy of Acute Ischemic Stroke DIAGNOSIS TREATMENT PREVENTING FUTURE STROKES Strokes of Unknown Onset and Wake-up Strokes INTRAARTERIAL THROMBOLYSIS 13 Diabetes as a Risk Factor in Atherosclerotic Cerebrovascular Disease DIABETES AND CEREBROVASCULAR DISEASE Stroke Characteristics in Diabetes Pathophysiology of Stroke in Diabetes and Hyperglycemia PREVENTION OF STROKE IN PATIENTS WITH DIABETES Glycemic Control Antihypertensive Therapy Lipid-Lowering Therapy Antiplatelet and Anticoagulation Therapy DIABETES AND SURGICAL INTERVENTION FOR CEREBROVASCULAR DISEASES GLYCEMIC CONTROL IN THE SETTING OF ACUTE ISCHEMIC STROKE CONCLUSION 14 Selection of Patients for Carotid Endarterectomy versus Carotid Artery Stenting CAROTID STENTING VERSUS ENDARTERECTOMY: MAJORTRIAL DATA TREATMENT OF ASYMPTOMATIC CAROTID ARTERY STENOSIS TREATMENT OF SYMPTOMATIC CAROTID ARTERY STENOSIS LIMITATIONS OF TRANSFEMORAL CAROTID ARTERY STENTING WITH DISTAL FILTER PROTECTION 15 Technical Aspects of Percutaneous Carotid Angioplasty and Stenting for Arteriosclerotic Disease PREPROCEDURAL EVALUATION ARTERIAL ACCESS CAROTID IMAGING AND SHEATH ACCESS Aortic Arch Angiogram Selective Common Carotid Catheterization Carotid Sheath Access CEREBRAL PROTECTION Technique for Using Distal Filters Proximal Occlusion and Flow-Reversal Devices ANGIOPLASTY AND STENTING COMPLETION ANGIOGRAM MANAGEMENT OF THE ACCESS SITE POSTOPERATIVE CARE ANDFOLLOW-UP 16 Reversal of Cerebral Blood Flow to Prevent Stroke during Percutaneous Carotid Artery Angioplasty and Stenting IMPACT OF EMBOLIZATION PRINCIPLES OF FLOW REVERSAL CLINICAL RESULTS WITH THEFIRST-GENERATION FLOW-REVERSAL SYSTEM SECOND-GENERATION FLOW-REVERSAL SYSTEM AND EMPIRE TRIAL 17 Embolic Protection Devices to Prevent Stroke during Percutaneous Angioplasty and Stenting DEVICE CHARACTERISTICS SELECTION OF DEVICES TECHNIQUE CLINICAL TRIAL RESULTS CONCLUSIONS 18 Blood Pressure Instability after Percutaneous Carotid Angioplasty and Stenting PATHOPHYSIOLOGY OF HEMODYNAMIC INSTABILITY ASSOCIATED WITH CAROTID INTERVENTIONS HEMODYNAMIC INSTABILITY TRIGGERED BY CAROTID ARTERY INTERVENTIONS FACTORS PREDICTING HEMODYNAMIC INSTABILITY DURING CAROTID INTERVENTIONS MANAGEMENT OF HEMODYNAMIC INSTABILITY INDUCED BY CAROTID ANGIOPLASTY AND STENTING 19 Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy and Carotid Stenting PATHOPHYSIOLOGY INCIDENCE RISK FACTORS CLINICAL MANIFESTATIONS DIAGNOSIS TREATMENT 20 Treatment of Recurrent Carotid Artery Stenosis After Percutaneous Angioplasty and Stenting INCIDENCE DIAGNOSIS NATURAL HISTORY CLINICAL SIGNIFICANCE TREATMENT CONCLUSION 21 Technical Aspects of Conventional Carotid Endarterectomy for Atherosclerotic Disease SURGICAL TECHNIQUE POSTOPERATIVE CARE POSTOPERATIVE RESULTS 22 Technical Aspects of Eversion Carotid Endarterectomy for Atherosclerotic Disease METHODS SHUNTING AND EVERSION ENDARTERECTOMY UNUSUAL PROBLEMS AND TROUBLESHOOTING 23 Patch Graft Closure with Carotid Endarterectomy PATCH CLOSURE VERSUS PRIMARY CLOSURE ROLE OF SELECTIVE PATCHING CHOICE OF PATCH MATERIAL CONCLUSIONS 24 Management of the Infected Carotid Artery Patch INFECTING MICROORGANISMS CLINICAL PRESENTATION RELATIONSHIP WITH PERIOPERATIVE INFECTION INVESTIGATION OF PROSTHETIC PATCH INFECTION MANAGEMENT OF PROSTHETIC PATCH INFECTION CONCLUSION 25 Role of Shunting During Carotid Endarterectomy SELECTIVE SHUNTING Awake Carotid Endarterectomy Carotid Back Pressure Measurement Electroencephalographic Monitoring Transcranial Doppler Cerebral Oximetry ROUTINE SHUNTING CONCLUSIONS 26 Intraoperative Assessment of the Technical Adequacy of Carotid Endarterectomy ANGIOGRAPHY DOPPLER STUDIES DUPLEX SCANNING FOLLOW-UP STUDIES CURRENT RECOMMENDATIONS 27 Intraoperative Recognition and Treatment of Cerebral Ischemia During Carotid Endarterectomy REGIONAL ANESTHESIA GENERAL ANESTHESIA INTRAOPERATIVE TREATMENT Hypoperfusion Embolization Fronds Dissection Thrombosis 28 Early Postoperative Recognition and Management of Acute Stroke After Carotid Endarterectomy EVALUATION Portable Duplex Sonography Magnetic Resonance Imaging andComputed Tomography Angiography SURGICAL REEXPLORATION ENDOVASCULAR NEURORESCUE MEDICAL MANAGEMENT CEREBRAL HYPERPERFUSION VERSUS MICROEMBOLIC SHOWERS 29 Regional and Local Anesthesia for Carotid Endarterectomy 30 Carotid Endarterectomy or Stenting for Evolving Stroke Secondary to Carotid Artery Atherosclerosis THROMBOLYSIS AND CAROTID ENDARTERECTOMY IN ACUTE CERVICAL CAROTID OCCLUSION CAROTID ARTERY STENTING IN ACUTE CERVICAL CAROTID OCCLUSION CAROTID ARTERY STENTING FOR EMERGENT REVASCULARIZATION FOR ACUTE ISCHEMIC STROKE CONCLUSION 31 Timing of Carotid Endarterectomy After Fixed Stroke Secondary to Carotid Artery Atherosclerosis 32 Carotid Occlusion and Near-Carotid Occlusion of the Extracranial Internal Carotid Artery INTERNAL CAROTID ARTERY OCCLUSION Acute Occlusion, Asymptomatic Acute Occlusion, Symptomatic Chronic Occlusion, Asymptomatic Chronic Occlusion, Symptomatic CAROTID STRING SIGN SUMMARY 33 Blood Pressure Instability After Carotid Endarterectomy INCIDENCE ETIOLOGY TREATMENT 34 Relevance of External Carotid Artery Disease in Internal Carotid Artery Occlusion ANATOMY OF CEREBRAL COLLATERAL CIRCULATION EVALUATION OF THE PATIENT WITH SYMPTOMATIC OCCLUSION OF THE INTERNAL CAROTID ARTERY CURRENT INDICATIONS AND RESULTS OF SURGICAL TREATMENT TECHNIQUE OF EXTERNAL CAROTID ENDARTERECTOMY RECOMMENDATIONS 35 Intracranial Occlusive Disease and Aneurysms: Influence on Carotid Revascularization Outcomes INTRACRANIAL OCCLUSIVE DISEASE INTRACRANIAL ANEURYSMS 36 Pathology of Carotid Artery Restenosis DESCRIPTIVE PATHOLOGY PATHOGENESIS Cell Proliferation Extracellular Matrix Synthesis Thrombus Organization Artery Wall Remodeling Predictors of Carotid Restenosis after Endarterectomy 37 Treatment of Recurrent Stenosis After Previous Carotid Endarterectomy OPTIMAL IMAGING FOR ASSESSMENT OF CAROTID RESTENOSIS TREATMENT OPTIONS FOR RECURRENT CAROTID ARTERY STENOSIS Repeat CEA for Recurrent Carotid Stenosis Other Surgical Options for RecurrentCarotid Stenosis Endovascular Procedures Carotid Endarterectomy versus Carotid Artery Stenting 38 Management of Concomitant Carotid and Coronary Arterial Disease CARDIAC RISK STRATIFICATION PRIOR TO CAROTID ENDARTERECTOMY CAUSES OF STROKE FOLLOWING CORONARY REVASCULARIZATION RELATIONSHIP OF CAROTID STENOSIS TO PERIOPERATIVE STROKE TIMING OF CAROTID AND CORONARY OPERATIONS CONCOMITANT CAROTID AND CORONARY ARTERY OPERATIONS STAGED VERSUS COMBINED CAROTID AND CORONARY ARTERY OPERATIONS CONCLUSION 39 The Role of Extracranial–Intracranial Bypass in Current Practice HISTORICAL PERSPECTIVE PROCEDURAL CHARACTERISTICS Preoperative Evaluation Procedural Considerations Postprocedural Follow-up and Management CURRENT DATA CONCLUSIONS 40 Open Surgical Treatment of Fibromuscular Dysplasia of the Carotid Artery OPERATIVE TECHNIQUES Open Dilation Resection and Interposition Graft Reconstruction SURGICAL RESULTS 41 Endovascular Treatment of Fibromuscular Dysplasia of the Carotid Artery INDICATIONS TECHNIQUE RESULTS SUMMARY 42 Vertebral Artery Reconstruction for Vertebrobasilar Ischemia PATIENT EVALUATION INDICATIONS FOR OPERATION SURGICAL REPAIR Transposition of the Proximal VA to the Common Carotid Artery Proximal Subclavian–Vertebral Bypass Distal VA Reconstruction (Bypass) Reconstruction and Decompressionof the VA of the C0–C1 Level 43 Endovascular Angioplasty and Stenting for Proximal Subclavian Artery Stenosis CLINICAL EVALUATION AND DIAGNOSIS INDICATIONS FOR TREATMENT TECHNICAL PRINCIPLES OF ENDOVASCULAR THERAPY RESULTS OF SUBCLAVIAN ARTERY ANGIOPLASTY AND STENTING ENDOVASCULAR VERSUS SURGICAL INTERVENTION CONCLUSION 44 Subclavian to Carotid Arterial Transposition 45 Carotid–Subclavian Bypass and Other Nonanatomic Revascularizations for Proximal Subclavian Artery Stenosis ANATOMY CAROTID–SUBCLAVIAN BYPASS OTHER NONANATOMIC SUBCLAVIAN ARTERY RECONSTRUCTIONS 46 Conventional Surgical and Endovascular Treatment of Innominate Artery Atherosclerosis CLINICAL PRESENTATION DIAGNOSIS TREATMENT Surgical Techniques Endovascular Techniques CONCLUSIONS 47 Extracranial Carotid Artery Aneurysms TRUE CAROTID ARTERY ANEURYSMS Incidence Manifestations Treatment TRAUMATIC FALSE ANEURYSMS OF THE CAROTID ARTERY Incidence Treatment FALSE ANEURYSMS FOLLOWING CAROTID ARTERY ENDARTERECTOMY Incidence Treatment 48 Carotid Body Tumors CLINICAL PRESENTATION DIAGNOSIS PREOPERATIVE EMBOLIZATION SURGICAL INDICATIONS SURGICAL APPROACH SURGICAL RESULTS 49 Radiation-Induced Arteritis COMPARISON WITH ARTERIOSCLEROSIS PATHOPHYSIOLOGY CLINICAL MANIFESTATIONS Subclavian–Axillary Lesions Extracranial Cervical Lesions Abdominal Aorta and Its Branches MANAGEMENT Carotid Lesions Subclavian–Axillary Lesions Lesions of the Abdominal Aorta and Its Branches SURVEILLANCE AND PREVENTION 50 Surgical Treatment of Takayasu Arteritis CLINICAL FEATURES MEDICAL TREATMENT SURGICAL TREATMENT Transluminal Angioplasty Arterial Reconstruction Surgical Results Upper Extremity Arterial Disease 51 Pathology of Upper Extremity Arterial Disease VASOSPASM INTRINSIC ARTERIAL DISEASE Atherosclerosis Inflammatory Diseases Connective Tissue Disorders Aneurysms EMBOLISM TRAUMA Iatrogenic Injuries Occupational Trauma Athletic Injuries MEDICAL CONDITIONS 52 Upper Extremity Revascularization DIAGNOSTIC EVALUATION ENDOVASCULAR TREATMENT SURGICAL TREATMENT COMMON APPROACHES TO THE UPPER EXTREMITY VESSELS Subclavian Artery and Proximal Axillary Artery Distal Axillary Artery Brachial, Proximal Radial, and Ulnar Arteries Distal Arteries SURGICAL RESULTS 53 Diagnosis and Treatment of Upper Extremity Vasospastic Disease RAYNAUD’S SYNDROME Primary Raynaud’s Syndrome Secondary Raynaud’s Syndrome Disorders That Mimic Raynaud’s Syndrome TREATMENT Conservative Therapy Pharmacologic Therapy Lumbar Sympathectomy 54 Extremity Causalgia: Reflex Sympathetic Dystrophy DIFFERENTIAL DIAGNOSIS MEDICAL THERAPY SUMMARY 55 Thoracic Sympathectomy ANATOMY OF THE CERVICAL AND THORACIC SYMPATHETIC GANGLIA PHYSIOLOGY OF SYMPATHETIC NERVOUS SYSTEM Indications for Cervicodorsal Sympathectomy THERAPEUTIC OPTIONS Medical Therapy Surgical Therapy Conclusion 56 Etiology and Anatomic Pathology of Thoracic Outlet Syndrome ANATOMY PATHOPHYSIOLOGY Neurogenic Thoracic Outlet Syndrome Venous Thoracic Outlet Syndrome Arterial Thoracic Outlet Syndrome SUMMARY 57 Diagnosis of Thoracic Outlet Syndrome NEUROGENIC THORACIC OUTLET SYNDROME Clinical Presentation Physical Examination VENOUS THORACIC OUTLET SYNDROME Clinical Presentation ARTERIAL THORACIC OUTLET SYNDROME Clinical Presentation Management and Indications for Surgery 58 Conservative Treatment for Thoracic Outlet Syndrome ASSESSMENT FOR PHYSICAL THERAPY COMMENT 59 Transaxillary Operative Management of Thoracic Outlet Syndrome OPERATIVE TECHNIQUE 60 Supraclavicular Operative Approach for Thoracic Outlet Syndrome MANAGEMENT OF NEUROGENIC THORACIC OUTLET SYNDROME Positioning and Initial Exposure Mobilization of the Scalene Fat Pad Anterior Scalenectomy Brachial Plexus Mobilization Middle Scalenectomy Division of the Posterior First Rib Division of the Anterior First Rib Cervical Rib Resection Pectoralis Minor Tenotomy MANAGEMENT OF VENOUS THORACIC OUTLET SYNDROME MANAGEMENT OF ARTERIAL THORACIC OUTLET SYNDROME CLOSURE, POSTOPERATIVE CARE, AND RECOVERY 61 Treatment of Arterial Complications in Thoracic Outlet Syndrome ANATOMIC FEATURES CLINICAL PRESENTATION DIAGNOSIS TREATMENT 62 Subclavian and Axillary Artery Aneurysms SUBCLAVIAN ARTERY ANEURYSMS ABCDABERRANT SUBCLAVIAN ARTERY ANEURYSMS AXILLARY ARTERY ANEURYSMS DIAGNOSIS AND EVALUATION OPERATIVE TREATMENT ENDOVASCULAR REPAIR RESULTS 63 Buerger’s Disease DIAGNOSIS NONOPERATIVE MANAGEMENT Patient Education Smoking Cessation Pharmacologic Therapy Pain Control Local Wound Care OPERATIVE MANAGEMENT Arterial Reconstruction Sympathectomy Amputation 64 Ergotism PHARMACOLOGY CLINICAL PRESENTATION OF ERGOTISM ERGOT ALKALOIDS AND DRUG INTERACTIONS TREATMENT 65 Hypothenar Hammer Syndrome PREVALENCE OF DISEASE ANATOMY AND PATHOPHYSIOLOGY DIAGNOSTIC EVALUATION MANAGEMENT Aortic Aneurysm 66 Pathogenesis of Abdominal Aortic Aneurysms BIOMECHANICAL WALL STRESS ANDSTRUCTURAL PATHOLOGY INTRALUMINAL THROMBUS MATRIX METALLOPROTEINASES AND ENDOGENOUS PROTEASES AORTIC MEDIAL DECOMPENSATION INFLAMMATION AND AUTOIMMUNITY PATHOGEN INVOLVEMENTAND AUTOIMMUNITY OXIDATIVE STRESS ADVENTITIAL MODIFICATION MODELS OF ABDOMINAL AORTIC ANEURYSM AND FUTURE RESEARCH SUMMARY 67 Genetics of Abdominal Aortic Aneurysms THE HERITABILITY OF ABDOMINAL AORTIC ANEURYSMS VERSUS THORACIC AORTIC ANEURYSMS INHERITANCE OF ABDOMINAL AORTIC ANEURYSM IDENTIFYING GENES ASSOCIATED WITH ABDOMINAL AORTIC ANEURYSMS LINKAGE STUDIES GENOME-WIDE ASSOCIATION STUDIES FUTURE RESEARCH CONCLUSION 68 Pathogenesis of Inflammatory Aortic Aneurysms PATHOLOGY ETIOLOGY A Severe Variant of Aortic Aneurysm A Generalized Autoimmune Process An Immunoglobulin G4–Related Systemic Disease CONCLUSION 69 Pathophysiology of Aortic Dissection EARLY ANATOMIC CHANGESIN AORTIC DISSECTION ISCHEMIC COMPLICATIONSOF AORTIC DISSECTION FALSE LUMEN EXPANSION 70 Arteriomegaly and Aneurysmosis ETIOLOGY CLASSIFICATION SURGICAL MANAGEMENT CONCLUSION 71 Vascular Complications of Marfan Syndrome, Ehlers–Danlos Syndrome, and Loeys–Dietz Syndrome MARFAN SYNDROME Affected Organ Systems Treatment EHLERS–DANLOS SYNDROME Affected Organ Systems Treatment Prognosis LOEYS–DIETZ SYNDROME Affected Organ Systems Treatment 72 Ultrasonography in the Evaluation of Abdominal Aortic Aneurysms SCREENING FOR ABDOMINAL AORTIC ANEURYSM ULTRASONOGRAPHIC FOLLOW-UP OF ABDOMINAL AORTIC ANEURYSM Abdominal Aortic and Iliac Artery Aneurysms Follow-up after Endovascular Aneurysm Repair 73 Angiography in the Evaluation of Abdominal Aortic Aneurysm INDICATIONS FOR CATHETER-BASED ARTERIOGRAPHY PLANNING ABDOMINAL AORTIC ANEURYSM REPAIR 74 Magnetic Resonance Imaging in the Evaluation of Abdominal Aortic Aneurysm 75 Computed Tomography and Computed Tomographic Arteriography in the Evaluation of Abdominal Aortic Aneurysms DATA SETS SCAN PARAMETERS RECONSTRUCTION INITIAL AORTIC ASSESSMENT ANALYSIS OF DISEASE EXTENT ANEURYSM SIZE ASSESSMENT OF THE PROXIMAL AND DISTAL NECKS TORTUOSITY AORTIC BRANCH ASSESSMENT RELATIONAL BRANCH VESSEL GEOMETRY AORTIC COMPUTED TOMOGRAPHY AFTER OPEN OR ENDOVASCULAR TREATMENT 76 Selection of Patients with Aortic Aneurysms for Open Surgical or Endovascular Repair OPEN REPAIR OF ABDOMINAL AORTIC ANEURYSM ENDOVASCULAR ANEURYSM REPAIR OPEN VERSUS ENDOVASCULAR ANEURYSM REPAIR: THE DATA Endovascular versus Open Repair of Abdominal Aortic Aneurysm Trial Dutch Randomized Endovascular Aneurysm Management Trial Open Versus Endovascular Repair Trial The Medicare Population INTEGRATION OF TRIAL DATA INTO CLINICAL DECISION MAKING Mortality Rates of Reintervention Cost Quality of Life EVAR VERSUS MEDICAL MANAGEMENT IN PATIENTSAT TOO-HIGH RISK FOR OPEN REPAIR SUMMARY 77 Management of Small Abdominal Aortic Aneurysms RUPTURE RISK LIFE EXPECTANCY OPERATIVE RISK OPERATIVE DECISION MAKING GROWTH AND MEDICAL MANAGEMENT SURVEILLANCE RECOMMENDATIONS 78 Endovascular Treatment of Nonruptured Infrarenal Aortic and Aortoiliac Aneurysms PROCEDURAL PLANNING AND ANATOMIC MEASUREMENTS DEVICE OVERSIZING ENDOVASCULAR STENT DEPLOYMENT TECHNIQUES Imaging Access Anatomic Aims Aortic Neck Contralateral Limb Cannulation Iliac Anatomy LONG-TERM DATA AND FUTURE DIRECTIONS 79 Endovascular Treatment of Pararenal and Suprarenal Abdominal Aortic Aneurysms TECHNIQUE LIMITATIONS PUBLISHED RESULTS EVOLUTION 80 Endovascular Treatment of Inflammatory Abdominal Aortic Aneurysms CLINICAL FEATURES ENDOVASCULAR MANAGEMENT RUPTURED INFLAMMATORY ABDOMINAL AORTIC ANEURYSMS SUMMARY 81 Endovascular Treatment of Ruptured Infrarenal Aortic Aneurysms THEORETICAL CONSIDERATIONS A SINGLE CENTER EXPERIENCE COLLECTED WORLD EXPERIENCE WHY ARE RESULTS VARIABLE? Standard Approach or Protocol Fluid Restriction (Hypotensive Hemostasis) Treatment Site Anesthesia and Catheter-Guidewire Placement Supraceliac Aortic Sheath Placementand Balloon Control Endograft Type and Configuration Abdominal Compartment Syndrome Endovascular Aneurysm Repair for Highest-Risk Patients IS A RANDOMIZED, CONTROLLED COMPARISON OF ENDOVASCULAR AND OPEN REPAIR NEEDED 82 Management of Coexistent Splanchnic and Renal Artery Occlusive Disease SPLANCHNIC OCCLUSIVE DISEASE AND ENDOVASCULAR ANEURYSM REPAIR RENAL ARTERY OCCLUSIVE DISEASE AND ENDOVASCULAR ANEURYSM REPAIR 83 Internal Iliac Artery Embolization as an Adjunct to Endovascular Aneurysm Repair RELEVANT ANATOMY EMBOLIZATION TOOLS Pushable Coils Detachable Coils Vascular Occlusion Plug TECHNIQUE Embolization of Internal Iliac Arteries COMPLICATIONS 84 Endovascular Iliac Branch Devices for Iliac Aneurysms RATIONALE DEVICE DESIGN DEVICE DEPLOYMENT RESULTS DISCUSSION 85 Iliac Artery Conduits for Endovascular Access ILIAC ARTERY ACCESS REMOTE FEMORAL ARTERY ACCESS 86 Conversion to Open Surgical Treatment After Failed Endovascular Aortic Aneurysm Repair INDICATIONS PREOPERATIVE CONSIDERATIONS OPERATIVE TECHNIQUES POSTOPERATIVE CONSIDERATIONS 87 Treatment of Endovascular Leaks After Aortic Endografting TYPE I ENDOLEAK TYPE II ENDOLEAK TYPE III ENDOLEAK TYPE IV ENDOLEAK TYPE V ENDOLEAK CONCLUSIONS 88 Management of Acute Limb Ischemia Complicating Aortic Reconstruction SCOPE OF THE PROBLEM ETIOLOGY PREVENTION DIAGNOSIS MANAGEMENT Medical Interventional Open Surgical 89 Intestinal and Renal Ischemia Complicating Open and Endovascular Abdominal Aortic Reconstructions RENAL COMPLICATIONS Open Repair Endovascular Repair INTESTINAL COMPLICATIONS Open Repair Endovascular Repair 90 Neurologic Complications after Open and Endovascular Aortic Surgery SPINAL CORD INJURY STROKE DIRECT NERVE INJURY Retrograde Ejaculation Peripheral Neuropathy 91 Postoperative Surveillance of Thoracic and Abdominal Aortic Endografts RATIONALE FOR POSTOPERATIVE SURVEILLANCE ELEMENTS OF COMPLETE SURVEILLANCE Computed Tomography Angiography Magnetic Resonance Angiography Multiview Radiographs Duplex Ultrasound with or without Contrast Intravascular Pressure Sensor FOLLOW-UP SCHEDULE 92 Treatment of Aortic Endograft Migration DEFINITION INCIDENCE RISK FACTORS FOR MIGRATION TREATMENT Endovascular Treatment Hybrid Treatment Open Treatment 93 Open Transperitoneal Surgical Treatment of Nonruptured Infrarenal Aortic Aneurysms ANATOMIC PREOPERATIVE PLANNING TECHNIQUE Exposure Clamping Aneurysmorrhaphy Unclamping Closure POSTOPERATIVE CARE Myocardial Infarction Bleeding Acute Pulmonary Decompensation Resulting in Reintubation Deep Vein Thrombosis Kidney Dysfunction Ischemic Colitis Lower Extremity Ischemia EARLY SURVIVAL 94 Open Surgical Treatment of Ruptured Infrarenal Aortic Aneurysms DIAGNOSIS PROCEDURE OUTCOMES 95 Surgical Treatment of Infected Abdominal Aortic Aneurysms DIAGNOSIS MANAGEMENT OUTCOMES 96 Surgical Treatment of Inflammatory Abdominal Aortic Aneurysms CLINICAL PRESENTATION OPERATIVE MANAGEMENT 97 Open Surgical Treatment of Pararenal and Suprarenal Abdominal Aortic Aneurysms PRESENTATION AND DIAGNOSIS OPERATIVE CONSIDERATIONS OUTCOMES 98 Retroperitoneal Approach for Elective Abdominal Aortic Aneurysmectomy INDICATIONS AND CONTRAINDICATIONS SURGICAL TECHNIQUES Left Posterolateral Retroperitoneal Approach Right Retroperitoneal Approach Retroperitoneal Exposure for Failed Endovascular Aneurysm Repair OUTCOMES 99 Autotransfusion in Aortic Reconstruction AUTOLOGOUS PREOPERATIVE DEPOSIT INTRAOPERATIVE AUTOTRANSFUSION IN ELECTIVE AND EMERGENCY AORTIC PROCEDURES INDICATIONS FOR TRANSFUSION 100 Surgical Treatment of Abdominal Aortic Aneurysm–Inferior Vena Cava Fistula CLINICAL PRESENTATION SURGICAL TREATMENT 101 Management of Primary Aortoenteric Fistulas ETIOLOGY DIAGNOSIS TREATMENT 102 Renal Ectopia and Renal Fusion in Patients Requiring Abdominal Aortic Operations EMBRYOLOGY ANATOMIC SUBGROUPS OF RENAL ECTOPIA Ipsilateral Renal Ectopia Horseshoe Kidney Crossed Renal Ectopia PREOPERATIVE IMAGING THERAPEUTIC ALTERNATIVES Open Surgical Approach Open Surgical Technique Endovascular Approaches COMPLICATIONS AND RESULTS 103 Venous Anomalies Encountered During Aortic Reconstruction RETROAORTIC OR CIRCUMAORTIC LEFT RENAL VEIN TRANSPOSED OR DUPLICATE INFERIOR VENA CAVA 104 Open and Endovascular Repair of Abdominal Aortic Aneurysms in Kidney Transplant Patients INDICATIONS RENAL PROTECTION Preoperative Measures Intraoperative Techniques OPEN AORTIC RECONSTRUCTION Technique Complications Follow-up ENDOVASCULAR AORTIC RECONSTRUCTION Technique Complications Follow-up RUPTURED ABDOMINAL AORTIC ANEURYSM IN KIDNEY TRANSPLANT PATIENTS 105 Open Abdominal Aortic Aneurysm Repair and Concurrent Nonvascular Disease SYNCHRONOUS DISEASE GALLBLADDER AND HEPATOBILIARY DISEASE PANCREATIC DISEASE UPPER GASTROINTESTINAL TRACT LOWER GASTROINTESTINAL TRACT GENITOURINARY TRACT GYNECOLOGIC DISEASE RARE TUMORS AND SPINE DISORDERS ABDOMINAL WALL 106 Recognition and Treatment of Abdominal Compartment Syndrome Following Ruptured Abdominal Aortic Aneurysm Repair DETECTION PATHOPHYSIOLOGY Cardiovascular Derangements Pulmonary Derangements Renal Derangements Gastrointestinal Derangements Hepatic Derangements Central Nervous System Derangements Abdominal Wall Derangements RISK FACTORS CLINICAL PRESENTATION CURRENT MANAGEMENT Nonsurgical Management Surgical Management Outcome after Surgical Management 107 Endovascular Treatment of Thoracic Aortic Aneurysms STENT GRAFTS INDICATIONS TECHNIQUE RESULTS 108 Endovascular Graft Completion of Elephant Trunk Thoracic Aneurysm Repair SECOND-STAGE ENDOVASCULAR PROCEDURE RESULTS 109 Thoracic and Abdominal Aortic Debranching in the Endovascular Treatment of Thoracoabdominal Aortic Aneurysms AORTIC ARCH AND PROXIMAL DESCENDING AORTIC ANEURYSM DEBRANCHING ASCENDING, ARCH, AND MORE EXTENSIVE ANEURYSMS DEBRANCHING OF THORACOABDOMINAL ANEURYSMS Thoracoceliac with Thoracomesenteric–Left Renal Bypass (Antegrade Bypass) Iliomesenteric Reconstructions (Retrograde Bypass) Complete Visceral Revascularization (Retrograde) POSTOPERATIVE CONSIDERATIONS 110 Endograft (VORTEC) Reconstruction of Aortic Branches Allowing Endovascular Treatment of Aortic Aneurysms ORIGINAL TECHNIQUE INCISION AND TRANSECTION TECHNIQUES RESULTS DISCUSSION 111 Multibranched Endovascular Repair of Thoracoabdominal Aortic Aneurysm MULTIBRANCHED THORACOABDOMINAL STENT GRAFTS STANDARDIZATION STANDARD STENT GRAFT PLANNING THE REPAIR ADJUNCTIVE PROCEDURES STENT GRAFT IMPLANTATION RADIATION SAFETY RESULTS 112 Open Surgical Treatment of Thoracic Aortic Aneurysms INDICATIONS FOR REPAIR OPERATIVE PLANNING Comorbidity Assessment MEASURES FOR END-ORGAN PROTECTION Extracorporeal Circulation by Atriofemoral Perfusion Hypothermic Arrest Alternative Perfusion Techniques Spinal cord protection SURGICAL TECHNIQUE POSTOPERATIVE MANAGEMENT SURGICAL RESULTS 113 Open Surgical Treatment of Thoracoabdominal Aortic Aneurysms CLASSIFICATION OF THORACOABDOMINAL AORTIC ANEURYSMS CLINICAL MANIFESTATIONS OPEN SURGICAL TECHNIQUE RISK OF IMMEDIATE NEUROLOGIC DEFICIT RISK OF DELAYED NEUROLOGIC DEFICIT RISK OF KIDNEY DYSFUNCTION POSTOPERATIVE GASTROINTESTINAL COMPLICATIONS SURVIVAL AND LONG-TERM OUTCOMES 114 Paraplegia Prevention in Thoracic and Thoracoabdominal Aortic Aneurysm Repair ASSISTED CIRCULATION INTERCOSTAL REIMPLANTATION MOTOR EVOKED POTENTIALS HYPOTHERMIA CEREBROSPINAL FLUID DRAINAGE ENDOGRAFT THORACIC AND THORACOABDOMINAL AORTIC ANEURYSM REPAIR 115 Nonoperative Medical Management of Acute Aortic Dissection EPIDEMIOLOGY CLINICAL SIGNS AND SYMPTOMS INITIAL MEDICAL THERAPY ASCENDING AORTA DESCENDING AORTA LONG-TERM FOLLOW-UP 116 Endovascular Treatment of Aortic Dissection ROLE OF IMAGING VASCULAR ACCESS EXCLUDING THE FALSE LUMEN MALPERFUSION CHRONIC AORTIC DISSECTION 117 Open Surgical Treatment of Aortic Dissection CLASSIFICATION OPERATIVE TREATMENT Surgery for Acute Proximal Aortic Dissection Surgery for Chronic Proximal Aortic Dissection Surgery for Acute Distal Aortic Dissection Surgery for Chronic Distal Aortic Dissection POSTOPERATIVE CARE 118 Natural History and Open Treatment of Isolated Iliac Artery Aneurysms EPIDEMIOLOGY CLINICAL FINDINGS DIAGNOSIS NATURAL HISTORY INDICATIONS FOR TREATMENT TREATMENT POSTOPERATIVE CARE 119 Endovascular Management of Isolated Iliac Artery Aneurysms PREOPERATIVE PLANNING AND IMAGING OPERATIVE TECHNIQUE RESULTS ISOLATED INTERNAL ILIAC ARTERY ANEURYSMS FUTURE THERAPY 120 Long-Term Alterations in Large-Caliber Arterial Prostheses Used for Aortic Repair EARLY HOST RESPONSES TO IMPLANTED MATERIALS Protein Deposition Platelet Deposition and Coagulation Inflammation Mesenchymal Cell Infiltration MID- TO LONG-TERM PROSTHETIC HEALING LONG-TERM PHYSICAL ALTERATIONS Dilatation Other Changes 121 Surgical Treatment of Pediatric Abdominal Aortic Aneurysms ETIOLOGIES SURGICAL OPTIONS Lower Extremity Aneurysm 122 Arteriosclerotic Femoral Artery Aneurysms PATHOGENESIS PATTERN OF DISEASE NATURAL HISTORY CLINICAL PRESENTATION DIAGNOSIS MANAGEMENT RESULTS 123 Infected Femoral Artery False Aneurysms ETIOLOGY PRESENTATION AND DIAGNOSIS TREATMENT Ligation Reconstruction 124 Obturator Foramen Bypass Grafts in Groin Sepsis PATIENT SELECTION OPERATIVE PROCEDURE: ANATOMIC CONSIDERATIONS RESULTS 125 Open Surgical Treatment of Popliteal Artery Aneurysms CLINICAL PRESENTATION DIAGNOSIS AND IMAGING SURGICAL MANAGEMENT SURVEILLANCE 126 Endovascular Treatment of Popliteal Artery Aneurysms PREOPERATIVE EVALUATION CONTRAINDICATIONS FOR ENDOVASCULAR REPAIR STENT GRAFTS ENDOVASCULAR PROCEDURE AND FOLLOW-UP RESULTS OF ENDOVASCULAR REPAIR Aortoiliac Occlusive Disease 127 Conventional Arteriography, Magnetic Resonance Angiography, and Computed Tomographic Arteriography of Aortoiliac Occlusive Disease DIGITAL SUBTRACTIONARTERIOGRAPHY COMPUTED TOMOGRAPHY ANGIOGRAPHY MAGNETIC RESONANCE ANGIOGRAPHY CONCLUSION 128 Physiologic and Noninvasive Studies to Document Severity and Extent of Aortoiliac Occlusive Disease SYMPTOMS AND SIGNS EXTREMITY PRESSURE MEASUREMENTS AND DOPPLER ANALYSIS DUPLEX ULTRASONOGRAPHY 129 Selecting Treatment for Patients with Aortoiliac Occlusive Disease CONSERVATIVE MEDICAL TREATMENT CRITERIA INFLUENCING CHOICE OF REVASCULARIZATION TECHNIQUES Patient Factors Operator and Resource Factors Anatomic and Technical Factors CONCLUSIONS 130 Percutaneous Arterial Angioplasty with and without Stenting for Atherosclerotic Aortic and Iliac Artery Occlusive Disease INDICATIONS TECHNIQUE RESULTS 131 Aortofemoral Bypass for Atherosclerotic Aortoiliac Occlusive Disease PROCEDURE SELECTION OPERATIVE MANAGEMENT Operative Approach Tunnel Construction Proximal Graft Anastomosis Femoral Anastomosis RESULTS OF AORTOFEMORAL BYPASS GRAFTS 132 Endarterectomy for Atherosclerotic Aortoiliac Occlusive Disease OPERATIVE TECHNIQUE RESULTS 133 Management of Juxtarenal Aortic Occlusive Disease by Retroperitoneal and Transperitoneal Exposure of the Pararenal and Suprarenal Aorta TRANSPERITONEAL EXPOSURE OF THE SUPRACELIAC AORTA AND CELIAC ARTERY TRANSPERITONEAL APPROACH TO SUPERIOR MESENTERIC ARTERY AND PARARENAL AORTA LEFT RETROPERITONEAL APPROACH TO THE ABDOMINAL AORTA TRANSPERITONEAL APPROACH TO THE COMPLETE ABDOMINAL AORTA WITH LEFT MEDIAL VISCERAL ROTATION DISCUSSION 134 Acute Aortic Occlusion ETIOLOGY CLINICAL PRESENTATION AND DIAGNOSIS PRINCIPLES OF MANAGEMENT PREOPERATIVE EVALUATION OPERATIVE PLANNING THROMBOEMBOLECTOMY AXILLOBIFEMORAL AND AORTOBIFEMORAL BYPASS PERCUTANEOUS ENDOVASCULAR TREATMENT ADEQUACY OF REVASCULARIZATION AND ADJUNCTIVE PROCEDURES ISCHEMIA AND REPERFUSION INJURY OUTCOME 135 Aortic Graft Limb Occlusion ETIOLOGY CLINICAL PRESENTATION MANAGEMENT Open Surgical Treatment Surgical Technique Interventional Management RESULTS 136 Open and Endovascular Treatment of Anastomotic Aneurysms after Aortoaortic, Aortoiliac, and Aortofemoral Bypass INCIDENCE PATHOPHYSIOLOGY PRESENTATION EVALUATION AND DIAGNOSIS OPEN SURGICAL TREATMENT ENDOVASCULAR TREATMENT RESULTS 137 Combined Laparoscopic and Endovascular Treatment of Aortic Diseases OPERATIVE TECHNIQUE LAPAROSCOPIC REMODELLING OF THE AORTA AFTER ENDOVASCULAR ANEURYSM REPAIR EXCLUSION CRITERIA FOR LAPAROSCOPIC REMODELING AFTER ENDOVASCULAR ANEURYSM REPAIR LAPAROSCOPY-ASSISTED THORACIC ENDOVASCULAR ANEURYSM REPAIR RESULTS OF HYBRID PROCEDURES AND LAPAROSCOPIC TECHNIQUES AFTER ENDOVASCULAR ANEURYSM REPAIR DISCUSSION THE ROLE OF LAPAROSCOPIC AORTIC SURGERY 138 Abdominal Aortic Coarctation and Hypoplasia ETIOLOGY CLINICAL MANIFESTATIONS MANAGEMENT RESULTS 139 Descending Thoracic Aorta to Femoral Bypass INDICATIONS SURGICAL TECHNIQUE RESULTS 140 Axillofemoral Bypass GENERAL PRINCIPLES AND PATIENT SELECTION PREOPERATIVE EVALUATION TECHNIQUE POSTOPERATIVE CARE ANDFOLLOW-UP RESULTS AND INFLUENCE OF PATIENT AND GRAFT FACTORS CONTINUING EVOLUTION OF THE ROLE OF AXILLOFEMORAL BYPASS 141 Unilateral Retroperitoneal Iliofemoral Bypass TREATMENT ALGORITHM FOR ILIAC OCCLUSIVE DISEASE RETROPERITONEAL ILIOFEMORAL BYPASS: SURGICAL TECHNIQUE RESULTS 142 Femorofemoral Bypass for Aortoiliac Occlusive Disease GENERAL PRINCIPLES AND PATIENT SELECTION PREOPERATIVE EVALUATION TECHNIQUE POSTOPERATIVE CARE ANDFOLLOW-UP RESULTS AND INFLUENCE OF PATIENT AND GRAFT FACTORS CONTINUING EVOLUTION OF THE ROLE OF FEMOROFEMORAL BYPASS 143 Diagnosis of Aortic Graft Infection PRESENTATION DIAGNOSISThe diagnosis of aortic graft Computed Tomography Magnetic Resonance Imaging Sinography Endoscopy Other Techniques CONCLUSIONS 144 Treatment of Aortic Graft Infection with Autologous Femoral Vein GRAFT EXCISION OPTIONS FOR RECONSTRUCTION Extraanatomic Reconstruction In-Situ Reconstruction PREOPERATIVE EVALUATION SURGICAL MANAGEMENTAND TECHNIQUE POSTOPERATIVE CARE ANDFOLLOW-UP 145 In-Situ Treatment of Aortic Graft Infection with Prosthetic Grafts and Allografts ANTIBIOTIC OR SILVER-COATED PROSTHETIC GRAFTS CRYOPRESERVED ARTERIAL ALLOGRAFTS PROSTHETIC GRAFT PRESERVATION 146 Aortic Graft–Enteric Fistula PRESENTATION PREOPERATIVE EVALUATION MANAGEMENT The Stable Patient The Unstable Patient 147 Vasculogenic and Postoperative Neurogenic Impotence NORMAL ERECTILE AND EJACULATORY FUNCTION VASCULOGENIC ERECTILE DYSFUNCTION CORRELATION BETWEEN ERECTILE DYSFUNCTION AND CARDIOVASCULAR DISEASE THE METABOLIC SYNDROME AND ERECTILE DYSFUNCTION POSTOPERATIVE NEUROGENIC SEXUAL DYSFUNCTION CONCLUSION 148 Drug Therapy of Erectile Dysfunction BASIC PRINCIPLES PHOSPHODIESTERASE 5 INHIBITORS PENILE INJECTION THERAPY INTRAURETHRAL ALPROSTADIL TESTOSTERONE NONDRUG TREATMENTS FOR ERECTILE DYSFUNCTION Vacuum Constriction Devices Penile Implants THE PRINCETON GUIDELINES 149 Management of Groin Lymphocele and Lymph Fistula INCIDENCE CLINICAL PRESENTATION AND DIAGNOSIS PREVENTION TREATMENT Treatment Options Operative Technique 150 Management of Chyloperitoneum and Chylothorax after Aortic Reconstruction LYMPHATIC ANATOMY IN THE ABDOMEN AND THORAX DIAGNOSIS OF CHYOPERIOTNEUM AND CHYLOTHORAX MANAGEMENT OF CHYLOPERITONEUM AND CHYLOTHORAX SUMMARY 151 Coronary Artery Disease in Patients with Aortoiliac Occlusive Disease and Abdominal Aortic Aneurysm IMPORTANCE OF CORONARY ARTERY DISEASE PREOPERATIVE CARDIAC RISK ASSESSMENT POSTOPERATIVE CARE 152 Pulmonary Risks in Patients Being Treated for Aortic Aneurysms and Occlusive Disease PULMONARY COMPLICATIONS OF OPEN VASCULAR SURGERY IMPACT OF PULMONARY COMPLICATIONS FOLLOWING OPEN ABDOMINAL AORTIC ANEURYSM REPAIR ON PATIENT OUTCOMES APPROACHES TO REDUCE PULMONARY COMPLICATIONS VASCULAR SURGERY Endovascular Repair Anesthesia Technique Administration of Prophylactic Noninvasive Perioperative Ventilation RISK FACTORS FOR PULMONARY COMPLICATIONS MODIFICATION OF RISK FACTORS CONCLUSIONS 153 The Metabolic Syndrome in the Modern World DEFINITION ETIOLOGY Obesity Hypertension: The Role of Adipocytes Atherosclerosis: Disturbed Endothelium andthe Inflammatory Process TREATMENT Hypertension Hyperlipidemia Insulin Resistance 154 Smoking as a Risk Factor in Atherosclerotic Cardiovascular Disease PATHOPHYSIOLOGY Vasomotor Dysregulation Inflammation Thrombosis Metabolism EVIDENCE IN CARDIOVASCULAR DISEASE Coronary Heart Disease Cerebrovascular Disease Aortic Aneurysm Peripheral Arterial Disease SMOKING CESSATION CONCLUSIONS 155 Smoking Cessation IDENTIFYING SMOKERS MOTIVATING PATIENTS TO QUIT HELPING THOSE WHO WISH TO QUIT SUCCESSFUL STRATEGIES 156 Treatment of Dyslipidemia and Hypertriglyceridemia RISK ASSESSMENT AND LDL CHOLESTEROL GOALS GOALS FOR NON-HDL CHOLESTEROL DIET AND EXERCISE GUIDELINES AND RECOMMENDATIONS PHARMACOTHERAPY FOR HIGH LDL CHOLESTEROL PHARMACOTHERAPY FOR LOWNON-HDL CHOLESTEROL ADVERSE EFFECTS OF LIPID TREATMENT 157 Hypertension as a Risk Factor in Atherosclerotic Cardiovascular Disease MEASUREMENT OF BLOOD PRESSURE IN THE OFFICE MEASUREMENT OF BLOOD PRESSURE IN THE HOSPITAL HYPERTENSION AND CARDIOVASCULAR RISK TREATMENT OF HYPERTENSION Initial Treatment Combination Therapies Therapeutic Blood Pressure Targets 158 Homocysteine as a Risk Factor in Atherosclerotic Cardiovascular Disease NOMENCLATURE PATHOPHYSIOLOGY HOMOCYSTEINE AND PERIPHERAL VASCULAR DISEASE EXPRESSION Aortic Disease Cervical Artery Disease Peripheral Artery Occlusive Disease TREATMENT 159 Nitric Oxide and Vascular Disease PHYSIOLOGY OF NITRIC OXIDE IN THE VASCULATURE PATHOPHYSIOLOGY OF NITRIC OXIDE IN THE VASCULATURE Atherosclerosis Restenosis Hypertension Angiogenesis CONCLUSIONS 160 Integrative Therapies in Vascular Disease DIET EXERCISE SMOKING CESSATION MIND–BODY CONNECTION NATURAL PRODUCTS FOR PERIPHERAL ARTERIAL DISEASE Ginkgo biloba Leaf Extract Inositol Nicotinate Propionyl-l-Carnitine Padma 28 Policosanol l-Arginine Mesoglycan Others NATURAL PRODUCTS FOR PERIPHERAL VENOUS DISEASE Hesperidin Horse Chestnut Seed Extract (Aesculus hippocastanum) Grape Seed Extract (Vitis vinifera) Rutin Gotu Kola Extract (Centella asiatica) Pycnogenol (Pinus pinaster) Others SURGICAL ISSUES RELATED TO NATURAL PRODUCTS Coagulation Issues Sedative–Hypnotic Interactions Drug–Herb Interactions CARDIAC EFFECTS OF NONCARDIAC HERBS CONCLUSION Lower Extremity Occlusive Disease 161 Magnetic Resonance Arteriography for Assessment of Infrainguinal Occlusive Disease FUNDAMENTAL PRINCIPLESOF MAGNETIC RESONANCEARTERIOGRAPHY CLINICAL EXPERIENCE WITHMAGNETIC RESONANCEARTERIOGRAPHY 162 Doppler Pressure Evaluation of Infrainguinal Occlusive Disease PHYSIOLOGY OF ARTERIAL OBSTRUCTION TECHNIQUE ANKLE PRESSURE MEASUREMENT SEGMENTAL LIMB PRESSURE MEASUREMENT EXERCISE TESTING TOE PRESSURES LIMITATIONS SUMMARY 163 Duplex Imaging of Infrainguinal Occlusive Disease EQUIPMENT AND TECHNIQUE VELOCITY WAVEFORMS AND CRITERIA DEFINING STENOSES CLINICAL APPLICATIONS Color Flow Duplex Scanning in Preparationfor Endovascular Therapy Arterial Duplex Mapping Instead of Arteriography before Operation Arterial Duplex-Guided Endovascular Therapy 164 Intravascular Ultrasound for Imaging of Diseased Arteries INTRAVASCULAR ULTRASOUND IMAGING CLINICAL UTILITY ANGIOPLASTY ATHERECTOMY STENT DEPLOYMENT ABDOMINAL ENDOLUMINAL GRAFTS THORACIC ENDOLUMINAL GRAFTS 165 Selecting Patients for Open Surgical or Endovascular Treatment of Lower Extremity Occlusive Disease PATIENT SELECTION FOR TREATMENT AND THERAPEUTIC OPTIONS ENDOVASCULAR INTERVENTIONS OPEN SURGICAL PROCEDURES 166 Percutaneous Angioplasty With and Without Stenting for Lower Extremity Occlusive Disease SUPERFICIAL FEMORAL ARTERY Angioplasty Angioplasty with Stenting POPLITEAL ARTERY Angioplasty Stenting INFRAPOPLITEAL ARTERIES Angioplasty Stenting 167 Subintimal Recanalization for Lower Limb Occlusive Disease TECHNIQUE OUTCOMES 168 Endovascular Grafts in the Treatment of Lower Extremity Occlusive Disease INDICATIONS TECHNIQUE RESULTS 169 Percutaneous Cryoplasty and Laser Treatment of Lower Extremity Occlusive Disease LASER PHYSICS LASER EFFECTS ON TARGET TISSUE SPECIFIC LASER SYSTEMS Yttrium–Aluminum–Garnet Laser Argon Laser CO2 Laser Excimer Laser CLINICAL APPLICATION OF LASER ANGIOPLASTY CRYOPLASTY 170 Duplex-Guided Balloon Angioplasty for Infrainguinal Arterial Occlusive and Aneurysmal Disease DUPLEX-GUIDED INFRAINGUINAL ARTERIAL ANGIOPLASTY Preoperative Evaluation Technique Technical Success and Predictors of Technical Failure Thromboembolic Complications Adjunctive Infrapopliteal Balloon Angioplasty Follow-up, Patency, and Limb Salvage DUPLEX-GUIDED ENDOVASCULAR REPAIR OF POPLITEAL ARTERY ANEURYSMS Technique Follow-up, Patency, Morbidity, and Mortality CONCLUSION 171 Reversed and Nonreversed Transposed Autogenous Vein Grafting for Atherosclerotic Lower Extremity Occlusive Disease PATIENT SELECTION AND PREOPERATIVE EVALUATION OPERATIVE TECHNIQUE POSTOPERATIVE CARE RESULTS 172 Short Vein Grafts from the Distal Superficial Femoral, Popliteal, or Infrapopliteal Arteries to More Distal Arteries for Limb Salvage GENERAL CONSIDERATIONS IMPROVED GRAFT PATENCY RATES DECREASED INCIDENCEOF VEIN GRAFT STENOSES INCREASED VEIN UTILIZATION FEWER VEIN HARVEST COMPLICATIONS OTHER ADVANTAGES DISADVANTAGES 173 In-Situ Saphenous Vein Graft for Lower Extremity Occlusive Disease OPERATIVE TECHNIQUE Preparation Equipment Procedure TECHNICAL COMMENTARY POSTOPERATIVE FOLLOW-UP 174 Arm Veins for Lower Extremity Arterial Reconstruction ANATOMY PREOPERATIVE ASSESSMENT INDICATIONS AND CONTRAINDICATIONSFOR ARM VEIN GRAFTS OPERATIVE TECHNIQUE Harvesting of the Vein Implantation RESULTS COMPLICATIONS AND MANAGEMENT COMMENTS 175 Composite Sequential Bypass for Lower Extremity Occlusive Disease INDICATIONS TECHNIQUE RESULTS 176 Expanded Polytetrafluoroethylene and Dacron Grafts for Atherosclerotic Lower Extremity Occlusive Disease INDICATIONS FOR PROSTHETIC BYPASS DATA TECHNICAL CONSIDERATIONS CONCLUSIONS 177 Human Umbilical Vein and Other Biografts for Atherosclerotic Lower Extremity Occlusive Disease HUMAN UMBILICAL VEIN GRAFTS Technical Features Patency Data Comparative Studies Complications CRYOPRESERVED VASCULAR CONDUITS Preparation of the Allograft Immunology Clinical Outcomes Complications Infected Field COLD-PRESERVED VESSELS BOVINE GRAFTS CONCLUSIONS 178 Deep Femoral Patch Angioplasty for Atherosclerotic Occlusive Disease of the Lower Extremity INDICATIONS TECHNIQUES 179 Superficial Femoral Artery Endarterectomy for Atherosclerotic Lower Extremity Occlusive Disease OPEN ENDARTERECTOMY SEMICLOSED ENDARTERECTOMY COMPARISON OF ENDARTERECTOMY TO BYPASS ENDARTERECTOMY IN PERSPECTIVE INDICATIONS 180 Percutaneous Mechanical Thrombectomy and Fibrinolytic Therapy for Acute Thrombosis of Lower Extremity Arteries and Grafts PERCUTANEOUS MECHANICAL THROMBECTOMY DEVICES MECHANISMS OF CLOT FORMATION AND DISSOLUTION FIBRINOLYTIC AGENTS INDICATIONS FOR THROMBOLYTIC THERAPY Patient Selection Lesion Selection TECHNIQUES OF THROMBOLYSIS Initiation of Thrombolytic Therapy RESULTS COMPLICATIONS 181 Operative Thrombectomy for Acute Thrombosis of Lower Extremity Bypass Grafts PREOPERATIVE PLANNING TECHNIQUE 182 Surveillance of Lower Extremity Bypass Grafts MECHANISMS AND HEMODYNAMICS OF GRAFT FAILURE ESSENTIALS OF GRAFT SURVEILLANCE 183 Open Surgery and Endovascular Management of Failing Infrainguinal Bypass Graft PATHOLOGY OF THE FAILING VEIN GRAFT FACTORS INFLUENCING REPAIR CHOICE Time after Graft Implantation Stenosis Length Lesion Location Graft Occlusion TECHNICAL CONSIDERATIONSFOR REPAIR Endovascular Repair Open Operation OUTCOMES CONCLUSIONS 184 Complications and Treatment of Persistent Sciatic Arteries CLINICAL CHARACTERISTICS DIAGNOSTIC CONSIDERATIONS TREATMENT 185 Popliteal Artery Adventitial Cystic Disease ETIOLOGY CLINICAL PRESENTATION DIAGNOSIS TREATMENT 186 Chronic Compartment Syndrome and Functional Popliteal Artery Entrapment EVALUATION TREATMENT Chronic Compartment Syndrome Popliteal Entrapment Recovery RESULTS AND DISCUSSION 187 Exercise in Peripheral Arterial Disease SYSTEMIC DISEASES ALWAYS REQUIRE SYSTEMIC CARE EFFICACY OF EXERCISE TRAINING SCIENCE AND MECHANISMS OF EXERCISE BENEFIT Blood Flow Change in Muscle Metabolism Inflammation and Muscle Injury Changes in Microcirculation and Endothelial Function Hemorheologic Response Walking Economy CLAUDICATION TRAINING TREATMENT PROTOCOL EFFECT OF EXERCISE ON ATHEROSCLEROSIS RISK FACTORS ALL CLAUDICATION THERAPIES ARE EFFECTIVE AND CAN BE USED TOGETHER POTENTIAL OBSTACLES TO THERAPEUTIC SUCCESS CONCLUSIONS 188 Pharmacologic Management of Intermittent Claudication NATURE OF THE PROBLEM CONCOMITANT CORONARY ARTERY DISEASE RHEOLOGIC AGENTS VASODILATOR THERAPY ADDRESSING ENDOTHELIAL DYSFUNCTION CONCLUSION 189 Cutaneous Ulcers in the Neuroischemic Diabetic Foot ETIOLOGY AND PATHOPHYSIOLOGY DISTRIBUTION CLASSIFICATION OF DIABETICFOOT ULCERS REVASCULARIZATION ACHIEVING ULCER CLOSURE 190 Lumbar Sympathectomy for Lower Extremity Ischemic Ulcers ANATOMY AND PHYSIOLOGY CLINICAL RESULTS INDICATIONS AND PATIENT SELECTION SURGICAL TECHNIQUE COMPLICATIONS RECOMMENDATIONS 191 Biologic Therapies for Patients with Critical Limb Ischemia GENE THERAPY TRIALS STEM CELL THERAPY TRIALS SUMMARY 192 Bone Marrow Stem Cell Treatment for Critical Limb Ischemia CELL BIOLOGY OF VASCULOGENESIS PIONEERING WORK CURRENT CLINICAL TRIALS 193 Prothrombotic States and Vascular Thromboses ANTITHROMBIN III DEFICIENCY PROTEIN C AND S DEFICIENCY ANTIPHOSPHOLIPID SYNDROME FACTOR V LEIDEN PROTHROMBIN G20210A MUTATION HEPARIN-INDUCED THROMBOCYTOPENIA AND THROMBOSIS GUIDELINES 194 Role of Antithrombotic Drugs in Maintaining Graft Patency PLATELET INHIBITORS Cilostazol Aspirin Thienopyridines Clopidogrel Glycoprotein IIb/IIIa Antagonists Dextran-like Compounds Bleeding Risks with Antiplatelet Agents ANTICOAGULATION Vitamin K Antagonists Vitamin K Antagonists Plus Aspirin CONCLUSION 195 Complications of Heparin Anticoagulation Therapy NONBLEEDING COMPLICATIONS Heparin-Induced Thrombocytopenia Heparin-Induced Osteoporosis Heparin-Induced Skin Lesions BLEEDING COMPLICATIONS CONCLUSIONS Embolic Diseases of the Extremities 196 Arterial Macroembolism DIAGNOSIS AND ANATOMY PERIOPERATIVE AND POSTOPERATIVE MEDICAL THERAPY OPERATIVE SETTING AND TECHNIQUES POSTOPERATIVE MANAGEMENT AND COMPLICATIONS 197 Paradoxical Embolism PATHOPHYSIOLOGY DIAGNOSIS TREATMENT 198 Atheroembolism PATHOGENESIS CLINICAL SYNDROMES CLINICAL PICTURES EVALUATION TREATMENT 199 Operative Revascularization for Trash Foot CLINICAL PRESENTATIONAND DIAGNOSIS MEDICAL THERAPY AND THROMBOLYSIS PEDAL AND PERIMALLEOLAR THROMBOEMBOLECTOMY PEDAL ARTERY BYPASS 200 Anticoagulant and Lytic Therapy for Arterial Thromboembolism in Extremities PERIOPERATIVE MANAGEMENT THROMBOLYSIS AND RESULTS Pharmacology of Fibrinolytic Agents Outcome Studies of Thrombolysis versusPrimary Operation New-Generation Fibrinolytics THROMBECTOMY DEVICES POSTINTERVENTION TREATMENT CONCLUSIONS 201 Balloon Catheter Embolectomy for Macroembolization in the Extremities PREOPERATIVE DIAGNOSIS AND MANAGEMENT OPERATIVE TECHNIQUE OPERATIVE ADJUNCTS OUTCOMES 202 Noninvasive Methods of Diagnosing Cardiac and Noncardiac Sources of Macroemboli ECHOCARDIOGRAPHY DIAGNOSTIC VASCULAR LABORATORY STUDIES COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING DIAGNOSTIC APPROACH TOA PATIENT WITH PERIPHERAL ARTERIAL EMBOLI Amputation 203 Minor Amputations INDICATIONS SURGICAL TECHNIQUE Transphalangeal Toe Amputation Transmetatarsal (Ray) Toe Amputation Transmetatarsal Foot Amputation POSTOPERATIVE MANAGEMENT COMPLICATIONS OUTCOMES 204 Below-Knee Amputation DETERMINING AMPUTATION LEVEL SURGICAL TECHNIQUE POSTOPERATIVE CARE RESULTS AND COMPLICATIONS 205 Above-Knee Amputation and Hip Disarticulation ABOVE-KNEE AMPUTATION Indications Operative Technique Postoperative Care and Perioperative Outcome Long-Term Outcome HIP DISARTICULATION 206 Upper Extremity Amputations SHOULDER DISARTICULATION TRANSHUMERAL AMPUTATION TRANSRADIAL AMPUTATION KRUKENBERG AMPUTATION WRIST DISARTICULATION 207 Rehabilitation of the Amputee BEFORE AMPUTATION AMPUTATION LEVEL POSTOPERATIVE RESIDUAL LIMB MANAGEMENT AND THERAPY PROSTHETIC RESTORATION Vascular Trauma 208 Conventional and Computed Tomographic Arteriography in Penetrating Vascular Injuries IMAGING FOR PENETRATINGVASCULAR INJURIES OF THE NECK IMAGING FOR PENETRATINGVASCULAR INJURIES OF THE THORAX IMAGING FOR PENETRATINGVASCULAR INJURIES OF THEABDOMEN IMAGING FOR PENETRATING VASCULAR INJURIES OF THE EXTREMITIES 209 Nonarteriographic Diagnosis of Penetrating Vascular Trauma HISTORICAL BACKGROUND ARTERIAL PRESSURE MEASUREMENTS DUPLEX ULTRASONOGRAPHY MINIMAL ARTERIAL INJURY ROLE OF THE SERIAL PHYSICAL EXAMINATION 210 Penetrating and Blunt Injuries of the Carotid Artery PENETRATING CAROTID ARTERY INJURIES Operative Approach Outcomes BLUNT CAROTID ARTERY INJURIES Treatment Outcomes 211 Penetrating and Blunt Injuries ofthe Vertebral Artery ETIOLOGY TREATMENT 212 Blunt Arterial Injuries of the Shoulder: Open and Endovascular Therapy PRESENTATION AND DIAGNOSIS OPEN OPERATIVE MANAGEMENT ENDOVASCULAR MANAGEMENT 213 Penetrating Injuries to the Aortic Arch and Intrathoracic Great Vessels ARTERIAL INJURIES IN THE MEDIASTINUM Epidemiology Clinical Presentation Diagnosis Management Outcomes SPECIFIC ARTERIAL INJURIES Innominate Injury Subclavian Injury Common Carotid Injury 214 Open and Endovascular Management of Blunt and Penetrating Nonaortic Abdominal Vascular Injury ZONES OF INJURY VENA CAVA INJURIES CELIAC ARTERY INJURIES HEPATIC ARTERY INJURIES PORTAL VEIN INJURIES SUPERIOR MESENTERIC ARTERY INJURIES RENAL ARTERY INJURIES 215 Aortic Injury INCIDENCE PATHOPHYSIOLOGY PRESENTATION AND DIAGNOSIS TIMING OF REPAIR OPERATIVE REPAIR Open Thoracic Technique Open Abdominal Technique Endovascular Technique CHANGE IN PARADIGM 216 Complications of Upper and Lower Extremity Percutaneous Arterial Puncture and Catheterization COMPLICATIONS OF LOWER EXTREMITY ARTERIAL PUNCTURES Bleeding Pseudoaneurysm Arteriovenous Fistula Thrombosis, Dissection, and Distal Embolization Femoral Neuropathy Vascular Closure Devices COMPLICATIONS OF UPPER EXTREMITY PUNCTURES 217 Open and Endovascular Treatment of Penetrating Extremity Arterial Injuries RESUSCITATION AND SURGICAL ASSESSMENT OPEN OPERATIVE MANAGEMENT ENDOVASCULAR MANAGEMENT COMPLETION IMAGING POSTOPERATIVE CONSIDERATIONS 218 Blunt Popliteal Artery Injuries DIAGNOSIS Physical Examination Imaging TREATMENT Vascular Repair Fasciotomy Orthopedic and Soft Tissue Injury Postoperative Management OUTCOME 219 Fasciotomy for Compartmental Hypertension and Acute Compartment Syndrome PATHOPHYSIOLOGY CLINICAL PRESENTATION AND DIAGNOSIS OBJECTIVE TESTS IN THE DIAGNOSIS OF COMPARTMENTAL HYPERTENSION FASCIOTOMY Indications Techniques Immediate and Late Effects 220 Ischemia-Induced Muscle Myonecrosis, Myoglobinuria, and Secondary Kidney Failure PATHOPHYSIOLOGY DIAGNOSIS MANAGEMENT 221 Vascular Injury Secondary to Drug Abuse ARTERIAL INJURY Pathophysiology Presentation Evaluation and Diagnosis Treatment VENOUS INJURY Superficial Thrombophlebitis Deep Vein Thrombophebitis Mycotic Venous Aneurysm Chronic Venous Disease 222 Cold Injury HYPOTHERMIA FROSTBITE NONFREEZING INJURIES TREATMENT 223 Pediatric Iatrogenic Vascular Injury LOWER EXTREMITY AND FEMORAL ARTERY UPPER EXTREMITY AND BRACHIAL ARTERY ABDOMINAL AORTA CERVICAL AND CAROTID ARTERY Mesenteric Vascular Disease 224 Arteriography Evaluation of Splanchnic Artery Occlusive Disease VASCULAR ANATOMY Celiac Artery Superior Mesenteric Artery Inferior Mesenteric Artery TECHNIQUE ARTERIOGRAPHY DIAGNOSIS Occlusive Disease at the Origins ofthe Splanchnic Arteries Occlusive Disease of Splanchnic Artery Branches Distal Splanchnic Arterial Occlusive Disease Nonocclusive Mesenteric Ischemia 225 Duplex Scanning in the Diagnosis of Splanchnic Artery Occlusive Disease TECHNIQUE OF MESENTERIC DUPLEX SCANNING FASTING DOPPLER MESENTERIC ARTERY WAVEFORMS FASTING DUPLEX CRITERIA FOR MESENTERIC ARTERY STENOSIS POSTPRANDIAL MESENTERIC DUPLEX SCANNING EVALUATION OF MESENTERIC ARTERY BYPASS GRAFTS EVALUATION OF STENTED SUPERIOR MESENTERIC ARTERIES INTERMITTENT CELIAC AXIS COMPRESSION 226 Acute Embolic and Thrombotic Mesenteric Ischemia CLINICAL PRESENTATION Acute Embolic Mesenteric Ischemia Acute Thrombotic Mesenteric Ischemia DIAGNOSIS TREATMENT Surgical Treatment Endovascular Treatment Surgical versus Endovascular Therapy for Acute Mesenteric Embolus and Thrombosis 227 Endovascular Therapy for Chronic Mesenteric Ischemia DIAGNOSIS TREATMENT Selection Techniques RESULTS Symptom Relief Morbidity and Mortality Restenosis, Symptom Recurrence,and Reintervention Survival 228 Transaortic Splanchnic Endarterectomy for Chronic Mesenteric Ischemia DIAGNOSIS AND EVALUATION OF CHRONIC MESENTERIC ISCHEMIA TECHNIQUE OF TRANSAORTIC SPLANCHNIC ENDARTERECTOMY OUTCOME PATIENT SELECTION 229 Arterial Bypass for Chronic Mesenteric Ischemia TREATMENT OPTIONS ANTEGRADE VERSUS RETROGRADE BYPASS SINGLE- VERSUS MULTI-VESSEL BYPASS TECHNICAL DETAILS SURGICAL RESULTS 230 Operative Treatment of Pediatric Splanchnic Arterial Occlusive Disease CLINICAL PRESENTATION ETIOLOGY OF SPLANCHNIC ARTERIAL OCCLUSIVE LESIONS OPERATIVE THERAPY OUTCOMES 231 Celiac Artery Compression Syndrome CLINICAL MANIFESTATIONS ANATOMIC BASIS OF ARTERIAL ENTRAPMENT PHYSIOLOGIC CONSEQUENCESOF ARTERIAL ENTRAPMENT DIAGNOSTIC EVALUATION OPERATIVE TREATMENT Conventional Open Surgical Approach Laparoscopic and Endoscopic Surgical Approaches Endovascular Management SURGICAL OUTCOMES 232 Nonocclusive Mesenteric Ischemia PATHOPHYSIOLOGY CLINICAL PRESENTATION DIAGNOSIS MANAGEMENT 233 Venous Thrombosis Within the Splanchnic Circulation MESENTERIC VEIN THROMBOSIS Epidemiology Risk Factors Clinical Presentation Diagnosis Medical Management Surgical and Interventional Management Outcomes PORTAL VEIN THROMBOSIS SPLENIC VEIN THROMBOSIS BUDD–CHIARI SYNDROME 234 Celiac, Hepatic, and Splenic Artery Aneurysms CELIAC ARTERY ANEURYSMS Clinical Presentation Management HEPATIC ARTERY ANEURYSMS Clinical Presentation Management SPLENIC ARTERY ANEURYSMS Clinical Presentation Management 235 Mesenteric Artery Aneurysms SUPERIOR MESENTERIC ARTERY ANEURYSMS INFERIOR MESENTERIC ARTERY ANEURYSMS JEJUNAL, ILEAL, AND COLIC ARTERY ANEURYSMS 236 Gastroduodenal and Pancreaticoduodenal Artery Aneurysms PSEUDOANEURYSMS Clinical Manifestations Diagnosis TREATMENT TRUE ANEURYSMS Diagnosis Clinical Manifestations Treatment 237 Vascular Malformations and Arteriovenous Fistulas of the Gastrointestinal Tract ARTERIOVENOUS FISTULAS VASCULAR MALFORMATIONS Renovascular Disease 238 Pathology of Arteriosclerotic, Fibrodysplastic, and Developmental Renal Artery Occlusive Disease RENAL ARTERY FIBRODYSPLASIA Intimal Fibroplasia Medial Fibroplasia Perimedial Dysplasia DEVELOPMENTAL RENAL ARTERY STENOSES RENAL ARTERY ARTERIOSCLEROSIS 239 Conventional Arteriographic and Computed Tomography Arteriographic Diagnosis of Renovascular Hypertension CATHETER ANGIOGRAPHY COMPUTED TOMOGRAPHY ARTERIOGRAPHY 240 Magnetic Resonance Angiographic Diagnosis of Renovascular Disease PATIENT PREPARATION INTERPRETING THE IMAGE 241 Duplex Scanning in the Evaluation of Renal Arterial Occlusive Disease SCANNING TECHNIQUE INTERPRETATION CLINICAL APPLICATIONS 242 Renovascular Hypertension and Renal Artery Occlusive Disease PATHOPHYSIOLOGY OF RENOVASCULAR HYPERTENSION CLINICAL EVIDENCE OF RENIN–ANGIOTENSIN ACTIVATION 243 Renal Insufficiency and Renal Artery Occlusive Disease PATHOPHYSIOLOGY PREVALENCE NATURAL HISTORY DIAGNOSIS MANAGEMENT Selected References 244 Selection of Patients for Open Surgical or Endovascular Treatment of Renal Artery Arteriosclerotic Disease CONDITIONS IN FAVOR OF OPEN RENAL ARTERY REVASCULARIZATION CONDITIONS IN FAVOR OF ENDOVASCULAR RENAL ARTERY REVASCULARIZATION CONCLUSION Selected References 245 Percutaneous Arterial Dilation and Stenting for Arteriosclerotic Renovascular Hypertension and Ischemic Nephropathy PATIENT SELECTION TECHNIQUES OF RENAL ARTERY STENTING ASTRAL AND STAR TRIALS RESULTS OF RETROSPECTIVE OBSERVATIONAL STUDIES OFRENAL ARTERY STENTING Selected References 246 Percutaneous Arterial Dilation for Fibrodysplastic Renovascular Hypertension TREATMENT OUTCOMES 247 Transaortic Renal Artery Endarterectomy for Renal Artery Atherosclerosis OPERATIVE TECHNIQUE Exposure Axial Aortorenal Endarterectomy Transaortic Renal Artery Endarterectomy Direct Renal Artery Endarterectomy POSTOPERATIVE CARE 248 Aortorenal Bypass for Renovascular Hypertension in Adults PREOPERATIVE PREPARATION OPERATIVE MANAGEMENT Surgical Strategy Operative Exposure Renal Artery Bypass Operative Duplex Sonography OUTCOMES 249 Alternative Renal Artery Reconstruction Techniques: Hepatorenal, Splenorenal, Iliorenal, and Mesorenal Bypass Procedures SPLENORENAL BYPASS HEPATORENAL AND GASTRODUODENAL BYPASS ILIORENAL BYPASS MESORENAL BYPASS 250 Ex Vivo Arterial Repair for Renovascular Hypertension Secondary to Fibrodysplasia THERAPY SURGICAL TECHNIQUE Incision Nephrectomy Ex Vivo Reconstruction Autotransplantation of the Kidney RESULTS Complications 251 Operative Evaluation of Renal and Visceral Arterial Reconstructions Using Duplex Sonography 252 Surgical Treatment of Renovascular Hypertension in Children OPERATIVE THERAPY Types of Surgery General Tenets Concomitant Nonrenal Procedures DISCUSSION OUTCOMES 253 Renal Artery Dissection ENDOVASCULAR PROCEDURE-INDUCED DISSECTION BLUNT TRAUMA–RELATED DISSECTION SPONTANEOUS DISSECTION 254 Renal Artery Atheroembolism ETIOLOGY DIAGNOSIS TREATMENT 255 Renal Vein Thrombosis PATHOPHYSIOLOGY CLINICAL PRESENTATION DIAGNOSIS TREATMENT Neonates Adults 256 Treatment of Renal Artery Aneurysms PATHOGENESIS CLINICAL PRESENTATION TREATMENT Indications Surgical Exposure Specific Interventions OUTCOMES 257 Renal Arteriovenous Malformations And Arteriovenous Fistulas CLASSIFICATION INCIDENCE CLINICAL FEATURES ANGIOGRAPHIC DIAGNOSIS MANAGEMENT Congenital Arteriovenous Malformations Arteriovenous Fistula Traumatic Arteriovenous Fistula 258 Endovascular Renal Denervation RESISTANT HYPERTENSION ANDTHE ROLE OF SYMPATHETIC NERVOUS SYSTEM ENDOVASCULAR RENAL DENERVATION CLINICAL EVALUATION OF RENAL DENERVATION ALTERNATIVE APPROACHESTO RENAL DENERVATION EFFECT OF RENAL DENERVATION ON PHYSIOLOGIC PARAMETERS SAFETY OF THE PROCEDURE RENAL DENERVATION FOR OTHER CONDITIONS Arteriovenous Fistulas and Arteriovenous Malformations 259 Classification of Peripheral Arteriovenous and Venous Malformations 260 Imaging of Peripheral Vascular Fistulas and Arteriovenous Malformations IMAGING MODALITIES MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY ULTRASONOGRAPHY COMPUTED TOMOGRAPHY IMAGING FEATURES OF VASCULAR ANOMALIES Capillary Malformations Venous Malformations Lymphatic Malformations Arteriovenous Malformations Mixed Malformations and Syndromes Vascular Tumors Arteriovenous Fistulas 261 Treatment of Congenital Vascular Malformations in Children and Adults TREATMENT GUIDELINES Surgical Treatment Endovascular Treatment 262 Treatment of Traumatic Arteriovenous Fistulas ETIOLOGY AND PATHOPHYSIOLOGY CLINICAL PRESENTATION AND DIAGNOSIS TREATMENT Management Options Treatment at Specific Sites Angioaccess Surgery 263 External Methods of Angioaccess INDICATIONS FOR CENTRAL VENOUSACCESS Chemotherapy Hemodialysis TYPES OF CENTRAL VENOUSCATHETERS Acute-Care Devices Transition Access Devices Tunneled Catheters Implanted Ports TECHNIQUES FOR INSERTION Internal Jugular Approach Subclavian Vein Approach Femoral Vein Approach Other Approaches COMPLICATIONS OF CENTRAL VENOUS CATHETERIZATION Pneumothorax Vascular Injury Arrhythmia Air Embolism Infection Mechanical Complications 264 Direct Arteriovenous Communication Angioaccess PREOPERATIVE EVALUATION LOCATION OF THE FISTULA TECHNIQUE COMPLICATIONS Graft Stenosis Steal Syndrome with Hand Ischemia Central Vein Stenosis MATURATION OF THE FISTULA FOLLOW-UP 265 Bridge Grafts for Angioaccess PREOPERATIVE CONSIDERATIONS BRIDGE GRAFTS SURGERY 266 Role of Surveillance for Hemodialysis Access JUSTIFICATION CLINICAL MONITORING AND SURVEILLANCE TECHNIQUES RECOMMENDATIONS FROM NATIONAL GUIDELINES EVIDENCE TO SUPPORT SURVEILLANCE PRACTICAL RECOMMENDATIONS 267 Thrombotic Complications of Arteriovenous Access RISK FACTORS FOR THROMBOSISOF ARTERIOVENOUS ACCESS Inflow Disease Anastomotic Factors Complications with the Type of Conduit Systemic Factors Intradialytic Factors CLINICAL PRESENTATION MANAGEMENT Patient Selection Contraindications to Thrombectomy TREATMENT TECHNIQUES Standard Percutaneous Technique Standard Open Technique Thrombolysis Mechanical Thrombectomy Balloon Angioplasty Stent and Stent-Graft Placement COMPLICATIONS OF THROMBOLYSIS AND THROMBECTOMY Local Complications Distant Complications Systemic Complications 268 Ambulatory Treatment of Dialysis Access Stenosis TECHNIQUE OF ULTRASOUND-GUIDED FISTULA TREATMENT OFFICE-BASED MANAGEMENT OF ARTERIOVENOUS ACCESS UNDER FLUOROSCOPIC GUIDANCE FOLLOW-UP Venous Disease 269 Coagulation Cascade and Thrombosis BASIC COAGULATION PATHWAYS NATURAL ANTICOAGULANTS BALANCE THROMBOSIS PHYSIOLOGIC THROMBOLYSIS ORGAN HEMOSTASIS: ENDOTHELIUM INFLAMMATION AND THROMBOSIS 863RESOLUTION OF THROMBOSIS INTERPLAY OF ARTERIAL AND VENOUS THROMBOSIS FACTORS THAT INCREASE RISK OF VENOUS THROMBOEMBOLISM BIOMARKERS FOR VENOUS THROMBOEMBOLISM 270 Pathophysiology of Acute Venous Thrombosis RISK FACTORS FOR ACUTE VENOUS THROMBOEMBOLISM PATHOPHYSIOLOGY OF ACUTE VENOUS THROMBOEMBOLISM SUMMARY 271 Ultrasonography for the Diagnosis of Venous Disease EVALUATION OF REFLUX EVALUATION OF OBSTRUCTION EVALUATION OF CONGENITAL MALFORMATION 272 Computed Tomographic Venography and Magnetic Resonance Venography COMPUTED TOMOGRAPHY VENOGRAPHY MAGNETIC RESONANCE VENOGRAPHY 273 Invasive Methods of Diagnosing Acute and Chronic Venous Disease INTRAVASCULAR ULTRASONOGRAPHY CONTRAST VENOGRAPHY IMAGING OF ACUTE AND CHRONIC VENOUS THROMBOSIS 274 Natural History of Acute Venous Thrombosis VENOUS THROMBOGENESIS ANDTHE EARLY NATURAL HISTORY OF DEEP VEIN THROMBOSIS COMPLICATIONS OF ACUTE DEEP VEIN THROMBOSIS CLINICAL IMPLICATIONS OF NATURAL HISTORY STUDIES SUMMARY 275 Nonoperative Treatment of Acute Lower Extremity Venous Thrombosis PATIENTS WITH DEEP VEIN THROMBOSIS PATIENTS WITH THE POST-THROMBOTIC SYNDROME 276 New and Alternative Anticoagulants FONDAPARINUX APIXABAN RIVAROXABAN EDOXABAN DABIGATRAN FUTURE ANTICOAGULANTS 277 Warfarin-Induced Skin Necrosis CLINICAL PRESENTATION LABORATORY PRESENTATION PATHOPHYSIOLOGY PREVENTION AND MANAGEMENT PROGNOSIS 278 Endovascular Thrombolysis and Mechanical Clot Removal for Acute Symptomatic Lower Extremity Deep Vein Thrombosis MECHANISM OF THROMBOLYSIS EVALUATION ENDOVASCULAR STRATEGIESOF THROMBUS REMOVAL QUALITY OF LIFE, VEIN VALVE FUNCTION, AND RECURRENCE CONCLUSION 279 Open Surgical Treatment of Acute Iliofemoral and Inferior Vena Cava Thrombosis INDICATIONS FOR INTERVENTION SURGICAL THROMBECTOMY COMPLICATIONS AND RESULTSOF SURGICAL THROMBECTOMY NEW DEVELOPMENTS TO IMPROVE SURGICAL VENOUS THROMBECTOMY 280 Treatment of Acute Upper Extremity Venous Occlusion CATHETER-ASSOCIATED DEEP VEIN THROMBOSIS OF THE UPPER EXTREMITY TREATMENT COMPLICATIONS 281 Lower Extremity Superficial Vein Thrombophlebitis 282 Pathology and Classification of Chronic Venous Disease IN SEARCH OF COMPLETEAND ACCURATE DIAGNOSIS CLUES TO CHRONIC VENOUS DISEASE SKIN PATHOLOGY AND CLINICAL CLASSIFICATION REFINEMENT IN C, E, A, AND P:2004 CONSENSUS VENOUS CLINICAL SEVERITY SCORING DISABILITY SCORE QUALITY OF LIFE SUMMARY 283 Endovascular Treatment of Chronic Venous Occlusion PATHOPHYSIOLOGY DIAGNOSIS TREATMENT RESULTS 284 Endovascular Laser Treatment of Varicose Veins PATIENT SELECTION TECHNIQUE FOLLOW-UP COMPLICATIONS CLINICAL EXPERIENCE 285 Endovascular Radiofrequency Treatment of Varicose Veins PROCEDURE POST-TREATMENT CARE RESULTS 286 Injection Treatment of Lower Extremity Varicose Veins SCLEROSANTS LIQUID SCLEROTHERAPY FOAM SCLEROTHERAPY SCLEROTHERAPY FOR SUPERFICIAL VARICES AND TELANGIECTASES SAPHENOUS SCLEROTHERAPY RESULTS OF CLINICAL TRIALS SYSTEMIC COMPLICATIONS 287 Excision of Varicose Veins IMPORTANCE OF TREATING TRUNCAL INCOMPETENCE PRINCIPLES OF TREATING VARICOSITIES EXCISION OF VARICOSE VEINS 288 Open Surgical Treatment of Chronic Venous Insufficiency INDICATIONS FOR DETAILED VENOUS EVALUATIONS PRIMARY VENOUS INSUFFICIENCY SECONDARY VENOUS INSUFFICIENCY RESULTS COMPLICATIONS CONCLUSION 289 Nonoperative Management of Chronic Venous Insufficiency COMPRESSION THERAPY Elastic Stockings Paste Boots Compressive Bandages Legging Orthosis Pneumatic Compression Devices PHARMACOLOGIC THERAPIES Diuretics Zinc Fibrinolytic Agents Phlebotrophic Agents Hemorheologic Agents Prostaglandins TOPICAL THERAPIES 290 Pathophysiology of Venous Varicosities and Venous Ulcers MACROSCOPIC ALTERATIONS MICROSCOPIC ALTERATIONS EXTRACELLULAR MATRIX ALTERATIONS CYTOKINE REGULATION AND TISSUE FIBROSIS MATRIX METALLOPROTEINASES AND THEIR INHIBITORS IN VENOUS ULCER HEALING REGULATION OF VENOUS ULCER FORMATION AND HEALING SUMMARY 291 Open Surgical, Endoscopic, and Endovascular Treatment of Perforating Veins ANATOMY AND FUNCTION OF PERFORATORS New Nomenclature Common Sites of Perforating Veins PATHOPHYSIOLOGY DIAGNOSIS OF PERFORATOR INCOMPETENCE CLINICAL OUTCOMES FOLLOWING PERFORATOR ABLATION Determining the Role of and Indication for Ablation Effect of Interrupting ICPVs on Ulcer Healingand Recurrence Effect of Treating GSV Incompetence Aloneon Ulcer Healing and Recurrence NEWER TECHNIQUES FOR ICPV ABLATION Sclerotherapy Endovenous Ablation Radiofrequency Ablation for Venous Ulcer CURRENT APPROACH 292 Nonoperative Treatment of Venous Ulcers COMPRESSION THERAPY AND CHRONIC VENOUS ULCERWOUND THERAPY PHARMACOLOGIC TREATMENT TREATMENT WITH TOPICAL GROWTH FACTORS THERAPEUTIC MODULATION OF MATRIX METALLOPROTEINASE HUMAN SKIN EQUIVALENTS AND BIOLOGIC MATRICES 293 Renal Vein Entrapment: The Nutcracker Syndrome ANATOMIC FEATURES CLINICAL FEATURES DIAGNOSTIC STUDIES TREATMENT Surgical Treatment Endovascular Treatment 294 Pelvic Venous Flow Disorder VENOUS ANATOMY OF THE PELVIS PATHOPHYSIOLOGY SYMPTOMS DIAGNOSIS TREATMENT RESULTS AND OUTCOMES 295 Endovascular Treatment of Vena Cava Occlusion CLINICAL PRESENTATION IMAGING EVALUATION VASCULAR ACCESS FOR ENDOVASCULAR TREATMENT TECHNIQUE OF VENOUS RECANALIZATION TREATMENT ENDPOINTS SPECIAL CASES POSTOPERATIVE FOLLOW-UP AREAS OF UNCERTAINTY AND OPPORTUNITY FOR FUTURE DEVELOPMENT 296 Open Surgical Treatment of Thrombotic Vena Cava Occlusion SUPERIOR VENA CAVA SYNDROME Clinical Presentation Surgical Technique Results INFERIOR VENA CAVA THROMBOSIS Clinical Presentation Open Surgical Treatment Results 297 Primary and Secondary Vena Cava Tumors TUMOR TYPES CLINICAL PRESENTATION EVALUATION TREATMENT OUTCOMES 298 Nonoperative Treatment of Acute Pulmonary Embolism RISK STRATIFICATION TREATMENT STRATEGIES Systemic Fibrinolysis Catheter-Directed Therapy Local Fibrinolytic Therapy Pigtail Fragmentation Rheolytic Thrombectomy Rotational Thrombectomy Ultrasound-Accelerated Thrombolysis PRACTICAL PERSPECTIVE 299 Surgical Treatment of Acute and Chronic Pulmonary Embolism ACUTE PULMONARY EMBOLISM CHRONIC PULMONARY EMBOLISM CONCLUSION 300 Permanent and Temporary Inferior Vena Cava Filters INDICATIONS FOR PLACING FILTERS TYPES OF FILTERS PLACING THE FILTER RETRIEVING THE FILTER COMPLICATIONS OF FILTER PLACEMENT PROPHYLACTIC FILTER PLACEMENT 301 Venous Aneurysms POPLITEAL VENOUS ANEURYSMS ANEURYSMS OF THE SUPERFICIAL VEINS OF THE EXTREMITIES VENOUS ANEURYSMS OF THE DEEP VEINS OF THE EXTREMITIES VENOUS ANEURYSMS OF THE VEINS OF THE NECK AND FACE THORACIC VENOUS ANEURYSMS AZYGOS VEIN ANEURYSMS SUBCLAVIAN AND INNOMINATE VENOUS ANEURYSMS ABDOMINAL VENOUS ANEURYSMS Lymphatic Disease 302 Lymphedema ANATOMY AND PHYSIOLOGY PATHOPHYSIOLOGY CLASSIFICATION EVALUATION AND DIAGNOSIS TREATMENT 303 Lymphedema: Medical and Physical Therapy STRUCTURE AND FUNCTION OF THE LYMPHATIC SYSTEM PATHOPHYSIOLOGY PRIMARY AND SECONDARY LYMPHEDEMA GRADES OF LYMPHEDEMA TREATMENT REHABILITATIVE TREATMENT Elevation Skin Hygiene Exercise Specialized Massage Compression Intermittent Vasopneumatic Compression 304 Surgical Treatment of Lymphedema INDICATIONS FOR SURGICAL TREATMENT EXCISIONAL OPERATIONS MICROSURGICAL LYMPH VESSEL RECONSTRUCTIONS LYMPHATIC GRAFTING CONCLUSION