Vascular Surgery

This book was written by a team of vascular, cardiac and neurosurgeons working mainly in the East Slovak Institute of Cardiovascular Diseases, and also Luis Pasteur University Hospital in Kosice, Slovakia. The book is addressed to students of medicine and also as fundamental principles of vascular surgery for residents in different surgical specialisations. Vascular surgery has been rapidly developing in recent decades. Although the first successful arterial reconstructions appeared the beginning of the 20th century, the active management of arterial diseases has developed since the 1950s when new techniques of arterial surgery had been established. The first attempts of vascular reconstructions were performed by Alexis Carrel, a French surgeon who was awarded the Nobel Prize in Medicine in 1912 for inventing modern vascular suture, which is used still today. Significant development of vascular surgery brought the introduction of prosthetic grafts by Vorhees in 1952. That enabled De Backey to resect abdominal aortic aneurysm and replace it with synthetic graft in 1955. The first angiography with the catheter was performed by Seldinger in 1952, and Gruntzig in 1974 was the first who did percutaneous transluminal angioplasty and started the modern era of endovascular treatment. Since this time, an essential development in the treatment of vascular diseases has been observed. Nowadays, vascular surgeons solve the most severe cases of arterial diseases, solve complications of endovascular therapy, or are a part of hybrid procedures, which are a combination of surgical and endovascular treatment. In the first chapter, elementary clinical examinations, imagine methods, and also surgical techniques are described. Aortic disorders that are the most severe vascular diseases are analysed in the second, third, and forth chapters. Open aortic surgery is technically the most difficult part of vascular surgery and is associated with the highest mortality. Open aortic surgery is now being replaced by endovascular procedures due to lesser invasivity and mortality. The fifth chapter is dedicated mainly to surgery of carotid arteries. Stenosis of the internal carotid artery is one of the reasons for stroke. Carotid endarterectomy that removes atherosclerotic plaque from the carotid bifurcations is effective in preventing stroke in patients with stenosis of the internal carotid artery. The sixth chapter analyses the problem of surgery of peripheral arteries as peripheral arterial occlusive disease or acute limb ischemia. Both conditions can lead to major amputations and life long disability. The seventh chapter analyses vascular trauma that may lead to severe bleeding or limb ischemia; both situations require almost immediate diagnosis and treatment. Peripheral artery trauma is treated mainly by open surgery, while the treatment of aortic injury is mostly endovascular. Basic types of vascular access and problems of venous disorders are described in the eighth chapter. Venous diseases are not so life threatening but much more common compared to arterial. The last chapter deals with complications and recovery that is inevitable from an excellent surgical outcome.