VASCULAR SURGERY Edited by Dai Yamanouchi Vascular Surgery Edited by Dai Yamanouchi Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Bojan Rafaj Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Vascular Surgery, Edited by Dai Yamanouchi p. cm. ISBN 978-953-51-0328-8 Contents Preface IX Part 1 Open Surgery 1 Chapter 1 Aortoiliac Occlusive Disease 3 Tarek Al-Shafie and Paritosh Suman Chapter 2 Vascular Trauma: New Directions in Screening, Diagnosis and Management 39 Leslie Kobayashi and Raul Coimbra Chapter 3 Eversion Carotid Endarterectomy in Patients with Near-Total Internal Carotid Artery Occlusion – Diagnostic Modalities, Indications and Surgical Technique 73 Đorđe Radak and Slobodan Tanasković Chapter 4 Vascular Complications After Renal Transplantation 85 Taylan Ozgur Sezer and Cuneyt Hoscoskun Chapter 5 Progressive Endolaparoscopic Vascular Training in a Computerized Enhanced Instrumentation Based on Outcome Measurements 97 Bernardo Martinez and George Pradeesh Part 2 Endovascular Surgery 109 Chapter 6 Emergency TEVAR for Complicated Acute Type B Aortic Dissection 111 Y. Kurimoto, Y. Asai and T. Higami Chapter 7 Endovenous Laser Treatment of Incompetent Superficial and Perforator Veins 131 Suat Doganci and Ufuk Demirkilic VI Contents Chapter 8 Iatrogenic Complications Following Laser Ablation of Varicose Veins 151 Carolina Vaz, Arlindo Matos, Maria do Sameiro C. Pereira, Clara Nogueira, Tiago Loureiro, Luís Loureiro, Diogo Silveira and Rui de Almeida Part 3 Preoperative Care, Complications and Others 165 Chapter 9 Preoperative Care, Anesthesia and Early Postoperative Care of Vascular Patients 167 Zsófia Verzár, Endre Arató, Attila Cziráki and Sándor Szabados Chapter 10 Intraoperative Anesthetic Management for Vascular and Endovascular Abdominal Aortic Surgery 189 Maria J. Estruch-Perez, Josep Balaguer-Domenech, Angel Plaza-Martinez and Cristina Solaz-Roldan Chapter 11 Parametric Stochastic Modelling of Uncertainties in the Mechanical Study of the Abdominal Aneurysm Aorta 205 Anissa Eddhahak, Faîza Mohand Kaci and Mustapha Zidi Chapter 12 How to Find New Ways 219 Simon Florian Chapter 13 Ischaemic Postconditioning Reduces Reperfusion Injury After Aortic Revascularization Surgery 237 Gabor Jancso, Endre Arató and Lászlo Sinay Preface Vascular surgery is one of the specialties of surgery focusing on the vascular system of the body, i.e. arteries and veins. The unique feature of this specialty is, unlike other surgical specialty, that vascular surgeons routinely perform not only the conventional open surgery but also the diagnostic and interventional endovascular procedures. For that reason, the field of vascular surgery has evolved rapidly since the introduction of the endovascular aneurysms repair (EVAR) as well as the numerous techniques and devices of endovascular procedures for peripheral artery disease and varicose veins. This book aims to provide a brief overview of conventional open vascular surgery, endovascular surgery and pre- and post-operative management of vascular patients. The first section is focusing on the conventional open vascular surgery with recent consensus and evidence from the literature. The second section addresses the issues of the endovascular surgery. The third section deals with pre- and post-operative management of the vascular patient as well as miscellaneous topics of the vascular surgery. The collections of contributions from outstanding vascular surgeons and scientists from around the world present detailed and precious information about the important topics of the current vascular surgery practice and research. This book covers a wide variety of issues and topics of the vascular surgery. I would like to acknowledge the authors around the world for their excellent contributions to this book. I also would like to express my special thanks to the managing editor of INTECH for providing me numerous supports and advices. I hope this book will be used worldwide by young vascular surgeons and medical students enhancing their knowledge and stimulating the advancement of this field. Dai Yamanouchi, MD, PhD Assistant Professor of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, USA [...]... aortofemoral bypass will expand and become clear 11.10 Endovascular treatment The advent of endovascular surgery has resulted in a dramatic shift in the treatment of patients with aortoiliac occlusive disease It is likely that even patients with more advanced aortoiliac occlusive disease will be candidates for endovascular therapy by means of stent- 26 Vascular Surgery grafts and hybrid open-endovascular... with endovascular techniques to allow a less invasive yet effective femorofemoral bypass when a more invasive procedure would otherwise be required The majority of the studies published have found that iliofemoral bypass yields somewhat better patency than femorofemoral bypass, assuming the presence of an appropriate common iliac artery for inflow to the graft (60-62) Ipsilateral iliofemoral bypass is... endovascular Traditionally aortoiliac occlusive lesions were operated by an open approach Aortobifemoral bypass is the method of choice Increasingly endovascular techniques are being adopted for less severe occlusion when there is no extensive involvement of aorta or common iliac arteries Also for patients with severe comorbidities endovascular methods could be an alternative A significant change has occurred... obtained and if there is no 12 Vascular Surgery significant difference, it should be repeated after induction of vasodilatation in the arteries of the lower extremities by intra-arterial injection of papaverine Alternatively, causing reactive hyperemia by applying a tourniquet to the lower extremity A resting systolic A B 13 Aortoiliac Occlusive Disease C D Fig 6 14 Vascular Surgery gradient of approximately... perioperative mortality associated with femorofemoral bypass is highly dependent on patient selection but should be well under 5% in elective operations Estimated 3-year survival rates of 71% for patients undergoing femorofemoral bypass, versus 35% for those having axillofemoral bypass (67, 68) The primary and secondary patency rates for femorofemoral bypass at 3 to 5 years should be about 60% and 70%,... arterial intervention (70) 11.5 Axillofemoral bypass In high risk patient with a combination of aortic and proximal iliac occlusive disease, those with other co-morbidities such as multiple prior abdominal operations, abdominal stomas, or prior radiation therapy, axillofemoral bypass is a valuable alternative for distal revascularization Axillofemoral bypass is an essential tool for the treatment of... treatment plays a secondary role and revascularization is the essential component for limb salvage 10 Surgical and endovascular treatment The indications for surgery and intervention in symptomatic aortoiliac disease are disabling claudication and ischemia at rest manifested by rest pain in the foot, ischemic ulceration or pre gangrenous skin changes (1) 10.1 Open vs endovascular Traditionally aortoiliac... absorbable Vicryl sutures Confirm adequate distal perfusion and ensure that no distal embolization has occurred Although aortobifemoral bypass is easier and has better long term patency compared to aortobiiliac bypass, in certain circumstances performing an aortobiiliac bypass remains advantageous In patients with hostile groin creases from prior surgery or radiation therapy, or are obese, diabetic patients... rarely done The increasing popularity of endovascular therapy is further decrease the small proportion of patients considered suitable for this reconstructive approach 11.4 Crossover bypass A few patients with only one iliac artery involvement with good aortic and contralateral iliac artery can be offered the choice of supra pubic ilioiliac and femorofemoral bypass graft Hemodynamic studies confirm that... aortoiliac occlusive disease in patients with vascular risk factors with buttock or high thigh claudication and absent femoral pulses is usually straightforward Claudication symptoms however must be distinguished from those of nerve root irritation due to spinal stenosis or disk herniation or arthritis These symptoms are produced by standing as well as by walking and follow sciatic nerve distribution . VASCULAR SURGERY Edited by Dai Yamanouchi Vascular Surgery Edited by Dai Yamanouchi Published by InTech Janeza. hard copies can be obtained from orders@intechopen.com Vascular Surgery, Edited by Dai Yamanouchi p. cm. ISBN 978-953-51-0328-8