Preface

Vascular surgery goes back to the days of medicine giants Hinter brothers and Astley Cooper; however, most of the advancements in the diagnosis and management of vascular disease took place in the last few decades. The recognition of vascular surgery as a specialty occurred in the twentieth century with the explosion of technology and advancement of interventions in vascular disease. The modern field of vascular surgery was led by innovations in the field of endovascular interventions that were influenced by the involvement of both interventional radiology and interventional cardiology which added to the complexity and diversity of vascular interventions. This book was written to guide learners and clinicians in the diagnosis and management of vascular disease including medical therapy, endovascular interventions, and open surgery that transformed vascular disease management and continuously modified treatment guidelines.

The evolution in vascular disease management was complemented by advances in the noninvasive diagnosis of vascular disease. Noninvasive evaluation of vascular disease was revolutionized by advances and improvements in ultrasound and Duplex technology that helped early detection and tried to prevent complications of vascular disease. Other advances in noninvasive vascular diagnosis discussed in this book include magnetic resonance imaging, computed tomography, positron emission tomography and scintigraphy, optical coherence tomography, and intravascular ultrasound.

Vascular disease is a manifestation of systemic disease that has the potential to be treated and modified by lifestyle changes such as smoking cessation and optimal medical therapy. However, in patients who have advanced disease, a more advanced therapy is needed which includes endovascular and open surgery. The pendulum shifts between open and endovascular interventions based on technological innovations and experience of the interventionalists. Endovascular interventions were embraced by a wider variety of health providers including radiologists, cardiologists, and vascular surgeons. The real breakthrough in the diagnostic and later endovascular intervention happened after the introduction of selective arteriography and selective evaluation of vascular beds by Sven-Ivar Selinger of Sweden and later Dotter’s accidental recanalization of the iliac artery. Since then, there has been exponential growth in endovascular innovations for arterial and venous occlusive diseases. Endovascular treatment of aneurysmal disease started later with Juan Parodi’s conception in 1976 that made clinical application possible using a Palmaz stent in the first patient in Argentina in 1990. Endovascular management of aortic aneurysm changed the direction of surgical interventions in aortic disease. Since their initial introduction, dramatic technological advances in both occlusive and aneurysmal disease, including balloon angioplasty, stents of different types, drug-coated balloons and stents, atherectomy, vena cava filters, embolization, thrombolytic therapy, and mechanical thrombectomy devices for both arterial and venous disease, have transformed vascular disease treatment. Such advances are applied to a different extent in different vascular beds with variable degrees of success, and sometimes without class 1 evidence, but lead by convenience to the patient and operator. Although technology changes continuously, we have tried to include many of the latest treatment options in this book.

The chapters of Vascular and Endovascular Surgery: Clinical Diagnosis and Management follow a format that covers all aspects of disease diagnosis and management. Each chapter starts with an overview of the disease process followed by symptoms and signs of disease, then diagnosis and therapy that includes both endovascular and open surgery with comparison between both, when appropriate. A unique part of the clinical chapters is a flowchart to summarize the management of the clinical problem. A set of multiple-choice questions with answers are included in each chapter to augment the learning process.

The book is divided into four sections. Section I: General Vascular contains chapters on vascular biology, hemodynamics, thrombosis and hemostasis, cardiac evaluation, radiation safety, noninvasive evaluation of arterial and venous disease, and surgical techniques in vascular surgery. Section II: Venous Disease covers a continuum of venous disease topics. Section III: Arterial Disease deals with arterial diseases including acute ischemia and chronic occlusive diseases of lower extremities, mesenteric, renal arteries, aneurysmal disease, and cerebrovascular disease. The last section, Section IV: Special Vascular Conditions, contains miscellaneous subjects such as vasculitis, thoracic outlet syndrome, hemodialysis access, portal hypertension, lower extremity ulcers, vascular infections, and vascular disease in pediatric patients in addition to newer subjects of interest to the vascular specialists such as the business of the vascular centers, leadership in medicine, artificial intelligence.

We are dedicating this book to all those who are interested in vascular disease in an easy format to read by the whole continuum of learners from medical students, general surgery residents, vascular surgery residents/fellows, vascular surgeons, general surgeons in addition to nurses, nurse practitioners, and physicians assistants. The efforts of the editors and contributors are complemented by the professional support of the staff at McGraw Hill to ensure a final product that is accurate, of high quality, and follows the intended format.

Finally, we hope that this first edition will gain the satisfaction of the readers and learners. Their support by criticism and suggestions for future editions is greatly appreciated.