Emergency Vascular Surgery A Practical Guide

Transcription

1 Emergency Vascular Surgery A Practical Guide

2 Eric Wahlberg Pär Olofsson Jerry Goldstone Emergency Vascular Surgery A Practical Guide With 68 Figures and 39 Tables

3 Eric Wahlberg, MD, PhD Associate Professor Karolinska Institute and University Hospital Department of Vascular Surgery Stockholm Sweden Pär Olofsson, MD, PhD Associate Professor Karolinska Institute and University Hospital Department of Vascular Surgery Stockholm Sweden Professor Jerry Goldstone, MD University Hospital of Cleveland Case Western Reserve Division of Vascular Surgery Cleveland, Ohio USA ISBN Springer Berlin Heidelberg New York Library of Congress Control Number: This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permissions for use must always be obtained from Springer. Violations are liable for prosecution under the German Copyright Law. Springer is a part of Springer Science + Business Media springer.com Springer-Verlag Berlin Heidelberg 2007 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Editor: Gabriele M. Schröder, Heidelberg, Germany Desk Editor: Stephanie Benko, Heidelberg, Germany Production: LE-TeX Jelonek, Schmidt & Vöckler GbR, Leipzig, Germany Drawings: Medical Art, Gudrun and Adrian Cornford, Reinheim, Germany Typesetting: am-productions GmbH, Wiesloch, Germany Cover design: Frido Steinen-Broo, estudio Calamar, Spain Printed on acid-free paper 24/3180 YL

4 Preface Emergency Vascular Surgery A Practical Guide provides a concise guide to managing patients with all kinds of emergent vascular problems. It is not intended 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 practical 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 discussed. 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 pathophysiology. 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 treatment, selection of patients for emergency surgery, and ways to perform common vascular surgical procedures. Technical tips on complicated procedures are also provided. Finally, the chapters end with a brief summary on management after treatment, with some examples of outcome and results. Most chapters also contain illustrations to facilitate the technical description of the surgical 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 information given in the text. The authors would like to acknowledge and thank a number of people involved 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

5 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

6 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