Complications in Endovascular Therapy PDF

Preface

In his well-known oratory ‘‘The Strenuous Life,'' Theodore Roosevelt said, ‘‘Far better it is to dare mighty things, to win glorious triumphs, even though checkered by failure, than to take rank with those poor spirits who neither enjoy much nor suffer much, because they live in the gray twilight that knows not victory nor defeat.''

Roosevelt's thoughts exemplify the successful interventionalist. At a time when the field of percutaneous interventional therapy is exploding, successful clinicians must be innovators-explorers in the area of new technology, not afraid to attempt novel innovations in an effort to enhance the well-being of a patient too old, too frail, or otherwise unwilling to undergo a standard surgical procedure. The interventionalist must sometimes design treatment strategies without the availability or comfort of long-term clinical outcome data. He or she must be willing to risk failure when piecing together bits of anecdotal information to arrive at a rational treatment for a particular patient with a specific clinical problem.

It is easy to achieve acceptable clinical outcome if one limits the scope of procedures to those that are straightforward, well defined, and without technical challenge. At this point in the evolution of interventional therapies, however, few procedures fill this bill. Endovascular complications may occur quickly and without warning. With this in mind, the key to success for any interventionalist centers on an appreciation of the myriad complications that can occur during the course of a procedure. In this manner, the complications can be anticipated, avoided preemptively or, when they do occur, be handled quickly and efficiently.

This book was developed to provide the practicing endovascular practitioner with a compendium that outlines the diagnosis and treatment of complications that occur during the course of interventional procedures. The chapter authors have been chosen for their particular expertise in a given technique or disease. Each author is a high-volume clinical operator, an innovator with vast endovascular experience. And the highest volume, most technically proficient clinicians are also the very same individuals who have experience in the gamut of complications that develop as the result of these interventions. When speaking about his own medical problems, a wise

clinician once stated, ‘‘I never want to be treated by a doctor who hasn't personally experienced every potential complication. This is the doctor who will be the best at avoiding and treating problems when they occur.'' While it is neither desirable nor possible for each of us to experience every potential complication associated with a specific procedure, the study of the experience of others will accelerate our learning process. Careful scrutiny of the chapters of this text will aid in the recognition and avoidance of complications of interventional procedures. Studying the errors of others will allow us to avoid identical errors, to attain a similar level of expertise without traveling the longer and more arduous path of experiential learning.

Roosevelt encouraged us to ‘‘boldly face the life of strife, resolute to do our duty well . . . resolute to be both honest and brave, to serve high ideals, yet to use practical methods.'' We must recognize and analyze our own mistakes and the mistakes of others, carefully evaluating the actions that led to an untoward event. Only then we will be able to avoid these complications in the future. Ultimately, the study of complications will be followed by an improvement in the results of interventional treatment to the point where the long-term outcome of a minimally invasive procedure achieves or exceeds that of traditional open surgery.