Emergency Vascular and Endovascular Surgical Practice PDF

Preface

Patients presenting with emergency vascular problems, often during antisocial hours, form a substantial percentage of the caseload of a vascular surgeon. Ruptured aortic aneurysms, acute limb ischaemia and stroke represent the core of that emergency practice but the spectrum varies from one country to another. In some populations, as has been true of Northern Ireland for at least a quarter of a century of terrorist violence, vascular surgeons have also had to deal with life-threatening penetrating injuries. In other societies they have had to cope with grave vascular emergencies generated by substance abuse, HIV/AIDS or cold injury.

Between the covers of this book is to be found a comprehensive range of vascular emergencies affecting the entire body, if one excludes those of intracranial and cardiac origin. Full consideration is given to current practice, evidence- based or otherwise, as well as to anticipated developments particularly in the field of minimally invasive intervention. Endovascular interventions for some emergency vascular conditions seem to offer, long-term trial results pending, speedy resolution, shortened hospital stay and rapid return to an active life. In most centres in the UK a collaborative team approach, with vascular surgeons and radiologists sharing specialist skills, has proved effective and has largely averted the turf wars with cardiologists and neurologists reputedly plaguing those across the Atlantic.

Each chapter begins by defining the nature and extent of ‘the problem' when confronted with a particular emergency, emphasising clinical presentation and prudence in resorting to time-consuming investigations. In terms of treatment, ‘hands-on' practical advice is imparted based on fundamental principles, identifying pitfalls, offering guidelines and giving helpful tips assisted by algorithms on available management strategies. The reader will find ‘boxed' key points within the text where appropriate, and from the extensive bibliography of all chapters, selected references are recommended for further reading.

The text is divided conveniently into nine broad sections, the first on ‘General Considerations' leading off with introductory chapters outlining the provision of vascular services in different countries. Focused chapters on the pathophysiology of acute limb ischaemia and colonic ischaemia, and the systemic sequelae to these insults, precede others on critical care, risk assessment and current imaging techniques in refining diagnosis. Indicators of ‘best practice' being absolutely central to modern management of vascular emergencies, this section ends with chapters on outcomes of treatment gleaned from the three prestigious Scandinavian registries and a more recent UK database, followed by an important review of relevant medico-legal considerations.

Three further clinical sections follow under the headings of acute cerebrovascular syndromes, the acutely swollen limb and acute lower limb ischaemic states, the latter including a superb chapter on the diabetic foot from a well recognised centre. The sheer wealth of topics within the section on thoracoabdominal catastrophes is exemplified by an authoritative contribution on stenting in acute aortic dissection, a modality of treatment positioned to virtually displace both the relatively ineffectual conservative medical approach as well as the more perilous surgical option. Further important sections cover acute complications of endovascular aortic repair (EVAR), regional vascular trauma and iatrogenic injuries, the last section including first rate chapters on catheterisation and peripheral endovascular injuries. Fresh chapters by recognised world experts on substance abuse, HIV/AIDS and cold injury give added weight to the concluding section on special acute vascular challenges.

With a book such as this devoted solely to the management of vascular emergencies, the vascular specialist looking for information is spared the laborious exercise of delving through burgeoning tomes on vascular surgery in general. For the vascular trainee this book represents essential reading; for the established vascular surgeon, radiologist and angiologist it is a source to be consulted profitably from time to time; for general surgeons, traumatologists, emergency physicians and other specialists it contains pertinent chapters of interest.

Distinguished vascular surgeons, radiologists and other specialists around the world have enriched this book with their personal expertise and enthusiasm tempered by sound evidence and mature reflection. I am grateful to them for generously taking time in the course of their busy professional lives to contribute invaluably to this book. I must thank Tony Chant, co-editor to the first edition, for staying on board and for his assistance with the preliminary editing of a few chapters. I would like to register my appreciation to the publishers for encouraging a second edition, in particular Jo Koster, Director of Health Sciences Subdivision of Hodder Arnold, for moving the project forward. I am indebted most of all to Sarah Burrows, Senior Development Editor and latterly Commissioning Editor, for her unfailing kindness, diligent support and professional expertise during every phase of preparation of the book. I also thank Naomi Wilkinson, current Project Editor, for ensuring that the production of this book is of the highest quality. To that end the superb artwork by Simon Lindo, Oxford Designers and Illustrators, and the meticulous scrutiny by Lotika Singha, copy editor, and Andy Anderson, proofreader, are acknowledged.