By Alain Branchereau, Michael Jacobs
Nearly forty% of vascular surgical practices are decided by means of vascular emergencies, for that reason a tremendous quantity in this topic is a useful addition to the literature. As a multi-contributor undertaking, this article is ready to draw at the services of a large variety of across the world popular practitioners, offering a entire compilation of pressing and emergency vascular difficulties, nearly all of on the way to be acceptable to each vascular surgical perform.
The textual content offers wide insurance of the extra universal vascular pathologies reminiscent of acute limb ischemia, venous emergencies and arterial occlusion, whereas additionally devoting enormous house to much less widespread, but both demanding events, resembling blunt trauma of the carotid artery and stab wounds to the bottom of the neck. a couple of new insights are supplied, for instance, the application of endovascular techniques to the rupture of the stomach aorta instead of the conventional surgical intervention. Authors additionally discover the contribution of underlying pathologies equivalent to peripheral aneurysms and diabetes to emergency occasions. a number surgical, endovascular and thrombolytic remedies are lined, along an appreciation of the broader bioethical issues proper to vascular emergencies.
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Additional info for Vascular Emergency
Mechanisms of injury and arterial lesions The mechanism for disruption of the extracranial carotid artery can be a direct blow, either external (Figs. 1A and IB) or transoral, hyperextension or hyper-rotation of the neck with stretching of the artery over the transverse process of Cl (Fig. 2), direct contusion by a fragment of frac- tured mandible, and proximity involvement of the internal carotid artery in a fracture of the temporal bone. An object striking the neck from the outside can exert a direct blow to the common or internal carotid arteries (this includes the mechanism of safety belt injury).
Cerebrovasc Dis 1999; 9: 270-281. 26 Greenhalgh RM, Cuming R, Perkin GD, McCollum CN. Urgent carotid surgery for high risk patients. Eur J Vase Surg 1993; 7SupplA:25-32. 27 Brandl R, Brauer RB, Maurer PC. Urgent carotid endarterectomy for stroke in evolution. Vasa 2001; 30:115-121. 28 Stork JL, Levi CR, Chambers BR et al. Possible determinants of early microembolism after carotid endarterectomy. Stroke 2002; 33:2082-2085. 29 Pelz DM, Buchan A, Fox AJ et al. Intraluminal thrombus of the internal carotid arteries: angiographic demonstration of resolution with anticoagulant therapy alone.
11 A - This false aneurysm of the vertebral artery (C3 level) was stented but its false lumen did not thrombose. B - Coils were introduced into the false lumen through the mesh of the stent and eventually obliterated the false lumen. BLUNT INJURY TO THE CAROTID AND VERTEBRAL ARTERIES R E F E R E N C E S 1 Miller PR, Fabian TC, Croce MA et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Swrg-2002; 236: 386-395. 2 McKevitt EC, Kirkpatrick AW, Vertesi L et al.
Vascular Emergency by Alain Branchereau, Michael Jacobs