Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Home
  • Home
Chapter
  • Print publication year: 2007
  • Online publication date: December 2009

3 - Vascular surgery

Export citation

Summary

In the last five years, vascular surgery has undergone a considerable change in emphasis with respect to the breadth of conditions being treated and in the techniques used in therapy. The evidence base for vascular surgical intervention has broadened considerably, particularly in the fields of carotid intervention and the treatment of abdominal and thoracic aortic aneurysms. This newly gathered evidence base has been used to further define the indications for vascular reconstruction.

The emphasis on the development of new techniques for vascular intervention has continued, with the focus on minimally invasive and endovascular therapy. The application of endovascular therapy for the treatment of aortic and carotid disease is still largely confined to specialist centres but these techniques are likely to represent the future of vascular intervention. The change in direction of traditional vascular surgery has significant implications for anaesthetic practice as most of the newer vascular techniques are amenable to loco-regional anaesthesia. This chapter reviews the most recent advances in vascular practice for the treatment of aortic disease, carotid artery stenosis and varicose veins.

Advances in the treatment of abdominal aortic aneurysms

Aortic aneurysms are responsible for 13 000 deaths in the UK, with abdominal aneurysms causing 8000 of these. The principles that guide aneurysm treatment are to detect aneurysms prior to rupture, to electively repair these aneurysms with the lowest possible mortality and to treat the complications of aneurysmal disease (primarily rupture). Unfortunately, the majority of aneurysms are asymptomatic and many rupture before elective surgical repair can be contemplated.

Related content

Powered by UNSILO
References
Thompson, MM. Infrarenal abdominal aortic aneurysms. Curr Treat Options Cardiovasc Med 2003; 5: 137–46.
Ashton, HA, Buxton, MJ, Day, NE, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 2002; 360: 1531–9.
Kim, LG, Scott, RA, Thompson, SG, et al. Implications of screening for abdominal aortic aneurysms on surgical workload. Br J Surg 2005; 92: 171–6.
Wilson, WR, Fishwick, G, Peter, Sir RFB, Thompson, MM. Suitability of ruptured AAA for endovascular repair. J Endovasc Ther 2004; 11: 635–40.
Boyle, JR, Thompson, MM. Endovascular abdominal aortic aneurysm repair is less invasive: now we must prove its efficacy. J Endovasc Ther 2003; 10: 16–9.
Boyle, JR, Goodall, S, Thompson, JP, Bell, PR, Thompson, MM. Endovascular AAA repair attenuates the inflammatory and renal responses associated with conventional surgery. J Endovasc Ther 2000; 7: 359–71.
Boyle, JR, Thompson, JP, Thompson, MM, et al. Improved respiratory function and analgesia control after endovascular AAA repair. J Endovasc Surg 1997; 4: 62–5.
Bayly, PJ, Matthews, JN, Dobson, PM, Price, ML, Thomas, DG. In-hospital mortality from abdominal aortic surgery in Great Britain and Ireland: Vascular Anaesthesia Society audit. Br J Surg 2001; 88: 687–92.
Biancari, F, Hobo, R, Juvonen, T. Glasgow Aneurysm Score predicts survival after endovascular stenting of abdominal aortic aneurysm in patients from the EUROSTAR registry. Br J Surg 2006; 93: 191–4.
Buth, J, Marrewijk, CJ, Harris, PL, et al. Outcome of endovascular abdominal aortic aneurysm repair in patients with conditions considered unfit for an open procedure: a report on the EUROSTAR experience. J Vasc Surg 2002; 35: 211–21.
Harris, PL, Vallabhaneni, SR, Desgranges, P, et al. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European collaborators on stent/graft techniques for aortic aneurysm repair. J Vasc Surg 2000; 32: 739–49.
EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 2005; 365: 2187–92.
EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005; 365: 2179–86.
Greenhalgh, RM, Brown, LC, Kwong, GP, Powell, JT, Thompson, SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364: 843–8.
Blankensteijn, JD, Jong, SE, Prinssen, M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 2005; 352: 2398–405.
Prinssen, M, Verhoeven, EL, Buth, J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351: 1607–18.
Lippmann, M, Lingam, K, Rubin, S, Julka, I, White, R. Anesthesia for endovascular repair of abdominal and thoracic aortic aneurysms: a review article. J Cardiovasc Surg (Torino) 2003; 44: 443–51.
Parra, JR, Crabtree, T, McLafferty, RB, et al. Anesthesia technique and outcomes of endovascular aneurysm repair. Ann Vasc Surg 2005; 19: 123–9.
Verhoeven, EL, Cina, CS, Tielliu, IF, et al. Local anesthesia for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2005; 42: 402–9.
Veith, FJ, Ohki, T, Lipsitz, EC, Suggs, WD, Cynamon, J. Treatment of ruptured abdominal aneurysms with stent grafts: a new gold standard?Semin Vasc Surg 2003; 16: 171–5.
Huynh, TT, Miller, CC III, Estrera, AL, et al. Correlations of cerebrospinal fluid pressure with hemodynamic parameters during thoracoabdominal aortic aneurysm repair. Ann Vasc Surg 2005; 19: 619–24.
Safi, HJ, Miller, CC III, Huynh, TT, et al. Distal aortic perfusion and cerebrospinal fluid drainage for thoracoabdominal and descending thoracic aortic repair: ten years of organ protection. Ann Surg 2003; 238: 372–80.
Rigberg, DA, McGory, ML, Zingmond, DS, et al. Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: a statewide experience. J Vasc Surg 2006; 43: 217–22.
Leurs, LJ, Bell, R, Degrieck, Y, et al. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg 2004; 40: 670–9.
Sayed, S, Thompson, MM. Endovascular repair of the descending thoracic aorta: evidence for the change in clinical practice. Vascular 2005; 13: 148–57.
Cho, JS, Haider, SE, Makaroun, MS. US multicenter trials of endoprostheses for the endovascular treatment of descending thoracic aneurysms. J Vasc Surg 2006; 43(Suppl. A): 12A–19A.
Makaroun, MS, Dillavou, ED, Kee, ST, et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005; 41: 1–9.
O'Neill, S, Greenberg, RK, Haddad, F, et al. Prospective analysis of fenestrated endovascular grafting: intermediate-term outcomes. Eur J Vasc Endovasc Surg 2006; 32: 115–23.
Rothwell, PM, Eliasziw, M, Gutnikov, SA, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003; 361: 107–16.
Young, B, Moore, WS, Robertson, JT, et al. An analysis of perioperative surgical mortality and morbidity in the asymptomatic carotid atherosclerosis study. ACAS Investigators: Asymptomatic Carotid Artherosclerosis Study. Stroke 1996; 27: 2216–24.
Halliday, A, Mansfield, A, Marro, J, et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet 2004; 363: 1491–502.
Rerkasem, K, Bond, R, Rothwell, PM. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 2004: CD000126; http://www.wchrane.org/reviews/en/ab000126.html.
Yadav, JS, Wholey, MH, Kuntz, RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351: 1493–501.
Yadav, JS, Wholey, MH, Kuntz, RE, et al. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet 2001; 357: 1729–37.
Brooks, WH, McClure, RR, Jones, MR, Coleman, TL, Breathitt, L. Carotid angioplasty and stenting versus carotid endarterectomy for treatment of asymptomatic carotid stenosis: a randomized trial in a community hospital. Neurosurgery 2004; 54: 318–24.
Naylor, AR, Bolia, A, Abbott, RJ, et al. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 1998; 28: 326–34.
Alos, J, Carreno, P, Lopez, JA, et al. Efficacy and safety of sclerotherapy using polidocanol foam: a controlled clinical trial. Eur J Vasc Endovasc Surg 2006; 31: 101–7.
Belcaro, G, Cesarone, MR, Di, RA, et al. Foam-sclerotherapy, surgery, sclerotherapy, and combined treatment for varicose veins: a 10-year, prospective, randomized, controlled, trial (VEDICO trial). Angiology 2003; 54: 307–15.
Guex, JJ, Allaert, FA, Gillet, JL, Chleir, F. Immediate and mid-term complications of sclerotherapy: report of a prospective multicenter registry of 12,173 sclerotherapy sessions. Dermatol Surg 2005; 31: 123–8.
Mundy, L, Merlin, TL, Fitridge, RA, Hiller, JE. Systematic review of endovenous laser treatment for varicose veins. Br J Surg 2005; 92: 1189–94.
Min, RJ, Khilnani, NM. Endovenous laser treatment of saphenous vein reflux. Tech Vasc Interv Radiol 2003; 6: 125–31.
Min, RJ, Khilnani, N, Zimmet, SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol 2003; 14: 991–6.