Emergency Vascular Surgery A Practical Guide
Eric Wahlberg Pär Olofsson Jerry Goldstone
Emergency
Vascular Surgery
A Practical Guide
With 68 Figures and 39 Tables
Eric Wahlberg, MD, PhD Associate Professor
Karolinska Institute and University Hospital Department of Vascular Surgery
17176 Stockholm Sweden
Pär Olofsson, MD, PhD Associate Professor
Karolinska Institute and University Hospital Department of Vascular Surgery
17176 Stockholm Sweden
Professor Jerry Goldstone, MD University Hospital of Cleveland Case Western Reserve
Division of Vascular Surgery Cleveland, Ohio 44106 USA
ISBN 978-3-540-44393-3 Springer Berlin Heidelberg New York Library of Congress Control Number: 2006936731
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Preface
Emergency Vascular Surgery – A Practical Guide provides a concise guide to managing patients with all kinds of emergent vascular problems. It is not in- tended to be a “classic” textbook, so the background information given is very concise. The focus is instead on management and treatment, especially open surgical strategies.
The text is written for newcomers to the vascular surgical field, for surgical trainees, and for all doctors who treat emergent vascular surgical patients in the emergency department. We believe the hands-on approach and the practi- cal tips will be appreciated by these readers in the clinical situation, and we hope the book may also serve as a quick review before a physician takes care of a case. Medical students during surgical clerkships might find parts of the book valuable, as will experienced vascular surgeons.
The book is organized into two sections: specific body areas and general concepts. The former covers the body from head to toe and includes separate chapters for injuries and for nontraumatic disease. In the second part, some general principles related to emergency vascular surgical practice are dis- cussed. Management of complications is difficult to cover in a book of this scope, so the principles given in the chapter pertaining to this area are not very detailed. The final chapter gives general vascular surgical guidelines for the inexperienced surgeon.
All chapters are organized the same way. They start with a brief background that aims to motivate the reader and give an idea of incidence and pathophysi- ology. The rest of the chapter follows the patient’s course through the hospital:
The clinical presentation is followed by suggestions for work-up and diagnosis, and the next part concerns management and treatment – emergency treat- ment, selection of patients for emergency surgery, and ways to perform com- mon vascular surgical procedures. Technical tips on complicated procedures are also provided. Finally, the chapters end with a brief summary on manage- ment after treatment, with some examples of outcome and results. Most chap- ters also contain illustrations to facilitate the technical description of the surgi- cal procedures and notes to highlight particularly important aspects. A few references for further reading are also suggested; they have been selected to give a better understanding of the issues and do not necessarily refer to infor- mation given in the text.
The authors would like to acknowledge and thank a number of people in- volved in the writing of this book. First, we are grateful to the initial authors of the Swedish book from 1998 that gave us the idea to expand its contents and write an English version of it. Thank you all for letting us continue in this direction. We are also very grateful to all the residents, vascular trainees, and vascular surgeons who have read chapters and given us valuable suggestions on
how to improve the content and structure. Last but not least, we acknowledge the secretaries Annika Johansson and Synnove Nordstrom for all of their help with this project.
Eric Wahlberg Pär Olofsson Jerry Goldstone Stockholm and Cleveland 2007
Contents
Part A Specific Body Areas
Chapter 1 Vascular Injuries to the Neck 1
Chapter 2 Vascular Injuries to the Thoracic Outlet Area 15 Chapter 3 Vascular Injuries in the Arm 31
Chapter 4 Acute Upper Extremity Ischemia 41 Chapter 5 Abdominal Vascular Injuries 45 Chapter 6 Acute Intestinal Ischemia 65 Chapter 7 Abdominal Aortic Aneurysms 75 Chapter 8 Aortic Dissection 91
Chapter 9 Vascular Injuries in the Leg 101 Chapter 10 Acute Leg Ischemia 119
Part B General Concepts
Chapter 11 Vascular Access in Trauma 135
Chapter 12 Complications in Vascular Surgery 141 Chapter 13 Acute Venous Problems 159
Chapter 14 Acute Problems with Vascular Dialysis Access 167 Chapter 15 General Principles of Vascular Surgical Technique 179
Subject Index 191
