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“CONTEMPORARY MANAGEMENT OF VASCULAR TRAUMA”
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David V. Feliciano, MD, FACS, MAMSE
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Clinical Professor of Surgery, University of Maryland School of Medicine
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Attending Surgeon Emeritus, Shock Trauma Center/Department of Surgery
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University of Maryland Medical Center
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As noted in the first chapter of this new book, the expressions “vascular trauma” and “control of hemorrhage” only were synonymous from antiquity till 1759 (arterial repair of brachial artery by Hallowell). Since then, it has taken over 250 years to reach the current state of vascular trauma—namely, the revivification of tourniquets to control hemorrhage from the extremities, advanced techniques of imaging for diagnosis, and multiple options for management after or simultaneous with control of hemorrhage (nonoperative, operative, endovascular, angioembolization).
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General surgeons who did their residency training in the last four decades of the 20th century and/or served as military surgeons during the Vietnam War had significant exposure to open vascular surgery prior to fellowship training or a career in trauma. Therefore, open repairs of vascular injuries were routinely performed by general and trauma surgeons through the first decade of the 21st century.
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There have been two events that have had a major impact on the management of vascular trauma since that time. The first is the decreased volume of open elective vascular operations available to residents in general surgery training programs. The second is the introduction of endovascular approaches to manage vascular trauma as first described in 1991 and 1993. These events have resulted in the following changes: (1) trauma surgeons (even those with additional training in Acute Care Surgery) still have a strong interest in the open management of vascular trauma, but do not feel that they have the experience to expose and repair major injuries; and (2) vascular surgeons with expertise in endovascular techniques are now managing 15% of all patients with vascular trauma, and this rate is increasing by approximately 2% per year.
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These changes have prompted Drs. DuBose, Teixiera, and Rajani to develop and edit CONTEMPORARY MANAGEMENT OF VASCULAR TRAUMA. This much-needed new textbook includes a broad overview of vascular trauma with special emphasis on traditional open and newer endovascular techniques of repair. It will be a welcome addition to the libraries of general trauma surgeons and vascular surgeons in addition to their trainees.