Vascular surgery

This chapter on vascular surgery covers diseases of the arterial, venous, and lymphatic systems. The chapter is well structured, describing conditions seen commonly in clinic, in the emergency department, and in theatre. It includes a list of cases to see such as limb ischaemia and varicose veins. It reviews the diagnosis and management of a stable and leaking abdominal aortic aneurysm including repair. It includes a section on amputation which is pertinent to injuries seen due to ischaemic necrosis or malignancy. It reviews the classification of arterial disease and provides pictorial guidance for students. This chapter includes guidance for exam questions on history taking and examination. It is written for both those looking to apply for medicine, and those in medical school.

Over the last three decades, vascular surgery has transformed into a new specialty incorporating endovascular therapies. The field of vascular and endovascular therapy covers an extensive range of conditions and disorders of the arteries and veins such as lower limb ischaemia, abdominal aortic aneurysm, carotid disease, and varicose veins. This chapter covers recent key clinical evidence associated with the above conditions.


Author(s):  
Anil Agarwal ◽  
Neil Borley ◽  
Greg McLatchie

This chapter covers vascular operations. Treatments described for varicose veins are high tie and multiple avulsions, radio-frequency ablation, and foam sclerotherapy. Repair of elective and ruptured abdominal aortic aneurysm and endovascular repair are described. Operations like aortobifemoral bypass, femoral popliteal above- and below-knee bypass graft, and femoro-distal bypass are included. Urgent operations like femoral and brachial embolectomy, lower limb fasciotomy are also described. In addition, above- and below-knee amputations and vascular access are included.


Author(s):  
James Carton

This chapter covers vascular pathology, including common arterial and venous diseases including atherosclerosis and its complications, hypertension, shock, chronic lower limb ischaemia, acute lower limb ischaemia, aortic dissection, abdominal aortic aneurysm, deep vein thrombosis, and varicose veins.


Author(s):  
Matthew D. Gardiner ◽  
Neil R. Borley

This chapter begins by discussing the basic principles of haemostasis and coagulation and atherosclerosis, before focusing on the key areas of knowledge, namely assessment and management of peripheral arterial occlusive disease, acute lower limb ischaemia, extracranial arterial disease, abdominal aortic aneurysm, chronic venous insufficiency, varicose veins, lymphatic conditions, diabetic foot, lower limb ulceration, and miscellaneous vascular conditions. The chapter concludes with relevant case-based discussions.


Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  

This chapter in the Oxford Handbook of Emergency Medicine investigates surgery in the emergency department (ED). It reviews abdominal pain, acute appendicitis, acute pancreatitis, biliary tract problems, peptic ulcer disease, intestinal obstruction, mesenteric ischaemia/infarction, large bowel emergency, anorectal problem, and ruptured abdominal aortic aneurysm. It describes acute limb ischaemia, varicose veins, ureteric colic, and retention of urine, and explores penile problems, prostatitis, and testicular problems. It discusses cellulitis and erysipelas, abscesses, and complications after surgery.


2020 ◽  
Vol 161 (46) ◽  
pp. 1966-1971
Author(s):  
Sándor Bálint ◽  
Zsuzsanna Mihály ◽  
Zoltán Oláh ◽  
Péter Sótonyi

Összefoglaló. A patkóvese a vese leggyakrabban előforduló fejlődési rendellenességeinek egyike. Hasi aortaaneurysmával való együttes előfordulása kifejezetten ritka (a hasi aortaaneurysmás esetek 0,12%-a). Az első esetben egy 64 éves férfi akut alsó végtagi panaszokkal került felvételre. A CT-angiográfia patkóvesét és thrombotizált infrarenalis aortaaneurysmát igazolt. Az akut műtét során a hasi aortaaneurysma resectióját és aortobifemoralis bypassműtétet végeztünk a patkóvese ishmusának megtartásával. A második esetben hasi panaszokat okozó, mindkét arteria iliaca communisra ráterjedő infrarenalis aortaaneurysma esetén végeztünk aortobiiliacalis rekonstrukciót. Az aneurysma előtt elhelyezkedő isthmus tervezetten szétválasztásra került, a poláris veseartériát visszaültettük. A tünetes hasi aortaaneurysma abszolút műtéti indikációt képez. A preoperatív CT- vagy MR-angiográfia kulcsfontosságú mind a műtéti indikáció felállítása, mind pedig a műtét megtervezése szempontjából. A beavatkozás előtt pontos képet kell kapnia az érsebésznek az aorta anatómiája mellett a patkóvese vérellátásáról és a húgyúti rendszerről. Az érsebészeti rekonstrukció esetén a transperitonealis feltárás – főleg akut műtét esetén – több előnnyel rendelkezik, mint a retroperitonealis feltárás. Orv Hetil. 2020; 161(46): 1966–1971. Summary. Horseshoe kidney is one of the most common congenital disorders of the kidney. The simultaneous incidence of horseshoe kidney and abdominal aneurysm is very low (0.12% of all cases of abdominal aortic aneurysm). In the first case, a 64-year-old male patient was admitted with acute lower limb ischaemia. CT-angiography revealed an occluded aortic aneurysm. During the emergency operation, the abdominal aneurysm was resected and an aortobifemoral bypass procedure was performed sparing the kidney’s isthmus. In the second case, the abdominal complaints were caused by an infrarenal abdominal aneurysm that involved both common iliac arteries. Aortobiiliac reconstruction was performed with planned separation of the kidney isthmus and reimplantation of the accessory renal artery. Symptomatic abdominal aortic aneurysm is an urgent indication for reconstruction. The preoperative CT- or MR-angiography play a key role in the indication and planning of the reconstruction. It is highly important for the vascular surgeon to have a clear picture of the blood supply of the horseshoe kidney and the urinary tract along with the anatomy of the aorta before the operation. The transperitoneal approach has several advantages over the retroperitoneal approach during vascular reconstruction surgery. Orv Hetil. 2020; 161(46): 1966–1971.


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