Vascular surgery
From Wikipedia, the free encyclopedia
Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery. Dr Robert Paton, one of the first Australian vascular surgeons, was a pioneer of the field, pushing for it to become a speciality. Edwin Wylie of San Francisco was one of the early American pioneers in the specialty who developed and fostered advanced training in vascular surgery and pushed for its recognition as a specialty in the United States in the 1970s. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system except that of the heart and brain. Cardiothoracic surgeons manage surgical disease of the heart and its vessels. Neurosurgeons manage surgical disease of the vessels in the brain (eg intracranial aneurysms).
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[edit] Breadth of discipline
- Arterial diseases ( especially in Diabetics )
- Aneurysms
- Ischemia
- Limb ischemia
- Acute limb ischemia
- Thrombectomies
- Embolectomies
- Anti-coagulation and Thrombolysis
- Chronic limb ischemia
- see intermittent claudication and peripheral artery occlusive disease
- Diabetic foot ulcers
- Acute limb ischemia
- Mesenteric ischemia
- Renal ischemia
- Limb ischemia
- Extracranial cerebrovascular disease
- Carotid Endarterectomy and other carotid surgery
- Surgery of the vertebral system
- Venous disease
- Lymphatic disease
- Vascular Medicine
- Medical disorders with a significant vascular components, for example:
[edit] Training
Previously considered a field within general surgery, it is now considered a specialty in its own right. As a result, there are two pathways for training in the United States. Traditionally, a five year general surgery residency is followed by a 1-2 year (typically 2 years) vascular surgery fellowship. An alternative path is to perform a five or six year vascular surgery residency.
Programs of training are slightly different depending on the region of the world one is in.
| Country | Standards body | Professional representation | Minimum Length of training (post intern) |
|---|---|---|---|
| Australia and New Zealand | Royal Australasian College of Surgeons | Australian & New Zealand Society of Vascular Surgery (ANZSVS) | 6 years |
| United Kingdom | Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh | Vascular Society of Great Britain and Ireland http://www.vascularsociety.org.uk/ | 8 years |
| USA | Accreditation Council for Graduate Medical Education (ACGME), American Board of Surgery | American College of Surgeons
Multiple vascular societies |
5 years ( 4 via 5-year integrated Vascular Surgery Residency)[1] |
[edit] Surgical procedures
By no means exhaustive, but below are a number of common procedures and indications for vascular surgeons.
| Indication/disease | Procedure |
|---|---|
| Abdominal aortic aneurysm | Open AAA repair
Endoluminal AAA repair (EVAR) |
| Carotid stenosis | Carotid endarterectomy |
| Varicose veins | Vein stripping
Sclerotherapy and Foam sclerotherapy or Laser and radiofrequency vein ablation |
| Peripheral arterial occlusive disease | Angioplasty with/out Stenting |
| Acute limb ischaemia | Balloon embolectomy |
| Aortic dissection | Open repair |
[edit] Major Trials in Vascular Surgery
- Edinburgh Artery Study. *Highwire results for Edinburgh Artery Study
- Netherland Vascular Study.[2]
- Framingham heart study. Highwire results for Framingham heart Study
- MASS Trial. – the Multicentre Aneurysm Screening Study (MASS) trial. Four centres (about 7000 men); screening (and treatment) vs. control group. AAA-related mortality in the screening arm reduced by about 40%; emergency ruptured AAA reducted by about 70%; disruption to elective work was reduced; and better management of risk factors and ITU/HDU beds. The overall survival benefits remain difficult to estimate, nevertheless, screening for AAA is recommended [level of recommendation: B].[3][4][5]
- UK Small Aneurysm Trial: 1090 patients; AAA 4-5.5 cm; Immediate surgery vs. ultrasound surveillence (and treatment for rapid expansion or AAA >5.5); 30-day mortality after elective AAA repair is 5.8%. No difference in survival.[6]
- ADAM VA Cooperative Group Trial. 32697 patients screened; Age 50-79; AAA 4.0-5.4 cm; similar conclusion to Uk Small Aneurysm Trial.[7]
- Joint Vascular Research Group Trial. 284 patients; Study the relationship between intraoperative intravenous heparinisation, blood loss during surgery and thrombotic complications. Conclusion: Intraoperative heparin, given before aortic cross clamping, is an important prophylaxic against perioperative MI in aortic aneurysm surgery.[8]
- HOPE (Heart Outcomes Prevention Evaluation) study - 4046 patients with PAD. In this subgroup, there was a 22% risk reduction in patients randomized to ramipril compared with placebo,which was independent of lowering of blood pressure.[9]
[edit] References
- ^ VascularWeb: New Vascular Surgery Training Paradigms
- ^ Hooi JD, Kester AD, Stoffers HE, Overdijk MM, van Ree JW, Knottnerus JA (Apr 2001). "Incidence of and risk factors for asymptomatic peripheral arterial occlusive disease: a longitudinal study". Am J Epidemiol. 153 (7): 666–72. doi:. PMID 11282794. http://aje.oxfordjournals.org/cgi/content/abstract/153/7/666.
- ^ VSGBI. Position statement for AAA screening 2004
- ^ Ashton HA, Buxton MJ, Day NE, et al. (Nov 2002). "The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial". Lancet 360 (9345): 1531–9. doi:. PMID 12443589. http://linkinghub.elsevier.com/retrieve/pii/S0140673602115224.
- ^ Fleming C, Whitlock EP, Beil TL, Lederle FA (01 Feb 2005). "Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force". Ann Intern Med. 142 (3): 203–11. PMID 15684209. http://www.annals.org/cgi/content/abstract/142/3/203.
- ^ "Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. The UK Small Aneurysm Trial Participants". Lancet 352 (9141): 1649–55. Nov 1998. doi:. PMID 9853436. http://linkinghub.elsevier.com/retrieve/pii/S014067369810137X.
- ^ Lederle FA, Wilson SE, Johnson GR, et al. (Aug 1994). "Design of the abdominal aortic Aneurysm Detection and Management Study. ADAM VA Cooperative Study Group". J Vasc Surg. 20 (2): 296–303. PMID 8040955.
- ^ Thompson JF, Mullee MA, Bell PR, et al. (Jul 1996). "Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: a Joint Vascular Research Group study". Eur J Vasc Endovasc Surg 12 (1): 86–90. doi:. PMID 8696904.
- ^ Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (Jan 2000). "Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators". N Engl J Med. 342 (3): 145–53. doi:. PMID 10639539. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=10639539&promo=ONFLNS19.
[edit] External links
- University of Illinois at Chicago, Division of Vascular Surgery
- Society for Vascular Surgery (U.S.)
- European Journal of Vascular and Endovascular Surgery: the official journal of the European Society for Vascular Surgery.
- Division of Vascular Surgery and Endovascular Therapy at the Baylor College of Medicine
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