Development Of Vascular Surgery Research Articles

Ближайшие и отдаленные результаты хирургического лечения синдрома диабетической стопы и оценка качества жизни больных (обзор литературы)

В настоящее время при многих хронических заболеваниях все большее значение придается исследованию качества жизни (КЖ). Сахарный диабет (СД) в силу сложного режима контроля и лечения, а также многочисленных соматических проявлений (острых и хронических осложнений) оказывает выраженное воздействие на КЖ. КЖ, в свою очередь, оказывает значительное влияние на прогноз заболевания. В данном обзоре рассмотрены ближайшие и отдаленные результаты хирургического лечения синдрома диабетической стопы, определения КЖ и сходных понятий, освещены основные подходы к исследованию КЖ при СД, приведен перечень наиболее часто использующихся инструментов для оценки КЖ. Анализ публикаций показал, что до сих пор недостаточно проводилась системная проработка данной проблемы, не реализованы возможности современного уровня развития техники и информационных технологий для ее решения. Таким образом, несмотря на дальнейшее развитие сосудистой хирургии, многие вопросы, связанные с диагностикой и методами лечения больных с язвенно-некротическими поражениями нижних конечностей, остаются нерешенными. Качество диагностических и лечебных мероприятий по-прежнему зависит от профиля лечебного учреждения, наличия в нем отделения хирургии сосудов, субъективного отношения врачей к тем или иным методам лечения, их знаний и опыта в этой области. Наиболее эффективно решить данные проблемы и повысить качество диагностики, лечения и последующей жизни пациентов позволяет создание алгоритма, определяющего последовательность действий врачей при поступлении в стационар такого больного. Анализ литературы показал, что для более точной оценки ближайших и отдаленных результатов реконструктивных сосудистых операций у больных с диабетической ангиопатией необходимо использовать определение показателя КЖ и его параметров, что в дальнейшем позволяет выбрать наилучший способ оперативного лечения в каждом конкретном случае, а также выявить влияние хирургической операции или других видов лечения на психику пациента. По мнению некоторых авторов, имеющиеся классификации синдрома диабетической стопы неполно отражают клиническую картину осложнений, а следовательно, в большинстве случаев не определяют тактику лечения больных. Существуют различные мнения в отношении оперативно-хирургических приемов. Недостаточно полно и не всегда обоснованно описаны способы снижения послеоперационных осложнений, частота которых во многих клиниках превышает 30 %.

Compression of the сeliac trunk syndrome. History of the problem

The article presents the main stages of the development of ideas about a fairly rare pathology in clinical practice the syndrome of compression of the ventral trunk. Until the mid-nineteenth century, reports of the clinical picture of chronic abdominal ischemia were more descriptive. Serial pathoanatomic studies, comparison of anatomical features revealed at autopsy with clinical manifestations accompanying these changes, contributed to the isolation of chronic ischemic disease of the digestive system in a separate nosological form. The discovery of angiography contributed to the significant development of vascular surgery and the isolation of the ventral trunk compression syndrome as an independent disease, since it allowed for a lifetime comparison of the detected changes in blood vessels with the clinical manifestations of the disease. The term ventral trunk compression syndrome was first introduced by P. Harjola when describing a case of abdominal pain in a patient with compression of the ventral trunk by the neuroganglionic tissue of the ventral plexus. Later, J. Dunbar confirmed the Association of clinical manifestations of chronic abdominal pain with compression of the ventral trunk by the median arched ligament of the diaphragm. In English-language literature, the disease was named Dunbar syndrome. The effectiveness of eliminating the symptoms of this disease by surgical dissection of compression structures has been proven. Further study of this problem developed in parallel with the development of surgery in General in accordance with the emergence and introduction of new surgical technologies. The purpose of numerous studies was to study the etiopathogenetic mechanisms of the occurrence of a variety of clinical manifestations of this syndrome and improve the results of its treatment by improving known surgical techniques and introducing new ones.

Catheter-directed thrombolysis for thrombi in right atrium and upper extremity caused by peripherally inserted central catheters

Introduction: Peripherally inserted central catheters (PICC) are widely applied in clinical practice. One of the foremost complications is the potential risk for thrombosis associated with their use. Especially the thrombi within the cardiac chambers are rarely observed in clinical practice, but they are potentially deadly to patients for pulmonary embolism. There are no evidencebased guidelines for their treatment, and the optimal treatment is controversial (conservative or positive). Case Report: We report the case of a 52-year-old female, who presented with both a right atrial thrombus and upper extremity deep vein thrombi on three days following PICC insertion. After an elaborate surgery with two catheters for thrombolysis and one filter for prevention of pulmonary embolism, the thrombi were dissolved effectively without occurrence of any complications. Conclusion: In summary, regarding the treatment choice of complex thrombi in both right atrium and upper extremity, with the development of vascular surgery and interventional equipment, interventional treatment might be a well-tolerated therapeutic option. The ingenious surgical design of two catheters for thrombolysis and one filter for prevention of pulmonary embolism highlights a safe and feasible treatment for this kind of thrombi with minimal trauma.

ВЫБОР ТАКТИКИ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ С ПОРАЖЕНИЕМ АРТЕРИЙ БЕДРЕННО-ПОДКОЛЕННОГО СЕГМЕНТА

Ummary: In all periods of development of vascular surgery, the problem of choosing the optimal method for surgical treatment of occlusal-stenotic lesions of the arteries of the lower extremities (OSPANK) has been and remains one of the most urgent.The most common occlusal-stenotic lesion of the arteries of the lower extremities, according to most modern sources, is the lesion of the femoropopliteal segment, which occurs in approximately 65% of cases. This pathology is more common among patients of the older age group (more than 60 years). According to the data of modern authors, the need for surgical treatment for atherosclerotic lesions of arteries of the lower extremities is about 600 people per 1 million population per year. At the same time, despite the dynamic development of reconstructive methods of treatment, approximately 500 patients per 1 million population a year perform an amputation of the lower limb. Characteristically, according to modern data, the five-year survival after amputation of the lower extremity for atherosclerotic arterial lesion in most cases does not exceed 54%, which can not be called a satisfactory result [6,7]

Current status in the field of vascular surgery in the era of innovation and scientific technology

Vascular surgery largely benefits from the innovation foundation of the 19th century surgical flight development period. Now, a new round of science and technology and industrial revolution promote the development of vascular surgery. The key areas related to vascular surgery medical innovation, including individualized treatment, new materials, biological medicine, high-performance medical apparatus and instruments, and the field of artificial intelligence research make quick progress, which provides support for the development of the discipline. In general, the development of vascular surgery is still growing and improving. With the progress of population aging, the incidence of diseases required for vascular surgery is increasing year by year. The rapid development of imaging technology has greatly increased the detection rate of diseases required for vascular surgery and promoted the vigorous development of intracavitary technology. And the innovation technology and informatization provide the opportunity and challenge for the research of vascular surgery diseases. Understanding new technology and new information has a great impact on the development of this profession. Regardless of medical research, the ultimate goal is to serve the health of mankind. Key words: Vascular surgery; Innovation; Disease; Treatment

The development of vascular surgery in Brisbane: some reminiscences.

The development of vascular surgery in Brisbane: some reminiscences.

PC92. Have General Surgery Trainees Kept Pace with the Evolution of Vascular Surgery?

PC92. Have General Surgery Trainees Kept Pace with the Evolution of Vascular Surgery?

Conversion des abords vasculaires d’urgence pour hémodialyse en fistules natives au Rwanda : à propos de 37 cas

Chronic hemodialysis in Rwanda is relatively recent and most of patients are treated with catheters. SummaryThirty-seven patients who require chronic hemodialysis with catheters were evaluated during a 3-years period in order to facilitate the creation of a permanent vascular access for hemodialysis (AVF). Patient selection were made during a multi-disciplinary consultation. The sex-ratio was 1.5 and the main cause of the nephropathy was arterial hypertension. ResultsThirty-one patients benefited from the creation of an arterioveinous fistula. All of the interventions were performed using local or loco-regional anesthesia. Sixty percent of these AVF were radio-cephalic, 35.4% were humero-cephalic. Sixty-four percent of the operations were performed on ambulatory patients, with a primary function for 90% of them. ConclusionThis work proves the feasibility of the creation of AVF in Rwanda, thus allowing to preclude the various complications that arise with the prolonged use of a catheter. This experience was made possible by the pooling of the resources of 4 of Rwanda's leading hospitals. In an early future, the development of vascular surgery will assure the permanence of this care.

Debate: Whether venous perforator surgery reduces recurrences

Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive procedures. Despite this, there remains much discussion (as well as overt disagreement) about whether perforator vein surgery is actually appropriate and beneficial in the first place. Surgeons have no level I evidence from randomized controlled studies to determine whether perforator vein surgery does or does not reduce the chances of recurrence of superficial venous varicosities, so we must rely on the evidence as it currently is. Perhaps not surprisingly, our two experts have assembled divergent opinions on the role of perforator venous surgery in contemporary practice.

Vascular training in Scotland and Northern Ireland: The trainee perspective prior to introduction of the new vascular curriculum

BackgroundThe last decade has seen the evolution of vascular surgery from a sub-specialty of general surgery to that of an independent, stand-alone specialty. The introduction of a vascular-only curriculum is anticipated to require significant change from the current provision for vascular surgical training to allow vascular trainees to acquire the specialist skills in elective, emergency, and endovascular surgery to provide endovascular services in the future. AimTo provide an insight into current vascular training in Scotland and Northern Ireland. MethodSpecialty trainees in general surgery, with a sub-specialty interest in vascular in Scotland and Northern Ireland were asked to carry out a voluntary online survey between May 2012 and July 2012. Results22 specialty trainees/specialist registrars who have declared a sub-specialty interest in vascular surgery were identified and polled. 20 trainees completed the survey. 13 trainees still participated in general surgical on-call rotas. Formal teaching opportunities were readily available but only 10 trainees could attend regularly. All trainees worked in units offering endovascular treatment for aneurysm and occlusive disease, but few had dedicated training sessions in endovascular skills. All endovascular simulation-based training was industry sponsored. The majority of trainees report a good overall training experience and are keen to see the implementation of a vascular-specific curriculum. 15 trainees had undertaken a dedicated period of research towards a higher degree, with only 50% based on a vascular topic. ConclusionThe majority of trainees reported a positive training experience with Scotland and Northern Ireland having great potential as vascular training deaneries. The survey identifies specific areas that could be improved by the development of the new curriculum in vascular surgery to provide excellent vascular training in Scotland and Northern Ireland.

Remodelling of Vascular (Surgical) Services in the UK

The last few years have seen major changes in the delivery of vascular services in the UK. An increasingly elderly population with greater expectations from their medical services has challenged established methods. It also became apparent that outcomes for low volume, high risk index vascular interventions such as abdominal aortic aneurysm repair were poor in the UK compared to the rest of Europe. Other ongoing challenges were the introduction of a national aortic aneurysm screening programme and the development of vascular surgery as a separate speciality. This article details the approach taken to modernise vascular services in the UK, using a quality framework agreed by vascular specialists, which drove the structural change to move vascular interventions into fewer, higher volume centres. The introduction of modern networks is designed to maintain services in surrounding hospitals without on site vascular inpatient services. The initial effects of this service remodelling are positive, with elective aortic aneurysm mortality rates falling nationally from 7.5 to 2.4 per cent.

Die „Akiurgischen Abbildungen“ von Ernst Blasius (1802–1875)

The work ”Akiurgische Abbildungen” (surgical illustrations) by the surgeon Ernst Blasius from Halle compiles the surgical equipment of the nineteenth century in a unique guide. Not only does it illustrate the enormous number of more than 3,000 instruments, it also impresses with its accuracy. Additionally, each instrument is explained in detail by indications and function.During the 33 years in his position as the Chair of surgery at the Friedrichs University in Halle, Blasius left behind an amazing life’s work and also trained many subsequently famous doctors. He collected the surgical and ophthalmological knowledge of his time in several textbooks. Especially their aspects concerning vascular surgery are emphasized in part II of this article.Derived from the ligature of arteries, operations on blood vessels as described by Blasius were performed in almost all topographies of the human body. However, they were carried out more or less close to the body surface. Established in France and England these operations had been utilized for almost 100 years before Blasius’ time and hence originate from a period prior to narcosis. It is thus surprising that Blasius delivers no more information about the development of vascular surgery after the introduction of narcosis.

Comments regarding ‘Endovascular Stent-graft Treatment for Stanford Type A Aortic Dissection’

It was only a matter of time before vascular surgeons attempted to treat type A aortic dissections using endovascular techniques. There is a clear need for a different approach to reduce mortality of standard surgical techniques. Only a proportion of patients with acute Type A dissection are offered surgery and for the fittest that are, recovery to pre-morbid health status is far from assured.1Rampoldi V. Trimarchi S. Eagle K.A. Nienaber C.A. Oh J.K. Bossone E. International Registry of Acute Aortic Dissection (IRAD) Investigators et al.Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score.Ann Thorac Surg. 2007 Jan; 83: 55-61Google Scholar The current series incorporates a mixed bag of patients with different pathologies, some of whom have classic acute type A dissection with an entry tear in the ascending aorta. Others had tears in the descending or arch of the aorta with retrograde extension. The study builds on previous sporadic cases of endovascular repair of type A dissection and the more commonly stent-grafted type B dissection.2Zimpfer D. Czerny M. Kettenbach J. Schoder M. Wolner E. Lammer J. Treatment of acute type a dissection by percutaneous endovascular stent-graft placement.Ann Thorac Surg. 2006; 82: 747e9Google Scholar Outcomes in the study were encouraging but significant challenges remain. Current classifications (Stanford, DeBakey) are helpful in the prognostication and management of dissections confined to the ascending and/or descending aorta. Confusion and uncertainty exists in the arch where these standard classification systems are less helpful. The advent of endovascular techniques are likely to further challenge the relevance of traditional classifications. Ultimately more appropriate schemes are required to help define management of dissections in the arch and the indications and timing of endovascular repair. As the authors have acknowledged imaging of the ascending and arch of the aorta is particularly important to define the location of the primary entry tear. Standard CT imaging is insufficient. Transoesophageal echocardiography or multidetector and cardiac gated CT improve visualization of the entry tear and their relationship to the coronary arteries and supra-aortic trunks. Preliminary European data suggest that half of patients undergoing open surgical repair would have been morphologically suitable for an endovascular repair.3Sobocinski J. O’Brien N. Maurel B. Bartoli M. Goueffic Y. Sassard T. et al.Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study.Eur J Vasc Endovasc Surg. 2011; 42: 442-447Google Scholar The length and diameter of the proximal landing zones and competency of the aortic valve are key in assessing suitability. To increase this proportion further it is likely that either a hybrid approach will be required or stent-grafts manufactured which incorporate a new aortic valve or permit flow in to the coronary arteries and supra-aortic trunks. Total endovascular solutions are likely to be some years off yet. Questions remain regarding the most appropriate technique to deliver and deploy stent-grafts in the aortic arch. Femoral access is more convenient but supra-aortic trunks offer a more direct approach. Stroke is a significant risk with either approach. In contrast to the present authors, many find pacing the heart a more reliable solution to permit accurate stent-graft deployment rather than simply lowering the blood pressure. Aortic stent-grafts in current use were designed with aneurysms and the abdominal aorta in mind. They are generally rigid with high radial strength and poor conformability, characteristics which are not particularly suited to acute dissections with fragile membranes. Located in the arch, where forces and movement are considerable, these stent-grafts are going to have issues regarding durability. At present endovascular management of type A dissection must be regarded as experimental until the current limitations of technology can be surmounted and surgeons gain a better grasp of the indications, limitations and complications of the technique. It should only be employed in those patients turned down for conventional surgery as part of a properly conducted clinical trial or registry. Nevertheless, this technique represents a new and exciting chapter in the evolution of vascular surgery. Endovascular Stent-graft Treatment for Stanford Type A Aortic DissectionEuropean Journal of Vascular and Endovascular SurgeryVol. 42Issue 6PreviewThe aim of the study is to summarise our experience of endovascular stent grafting for Stanford type A aortic dissection. Full-Text PDF Open Archive

Champ Lyons, Holt McDowell, and the Evolution of Vascular Surgery at the University of Alabama at Birmingham: A Personal Perspective

The history of medical centers, hospitals, clinics, and their evolution are important contributions and resources to medical history. Likewise, evolution of specialties within these healthcare centers frequently parallels their growth and development. This contribution depicts the evolution of a specialty, vascular surgery, within a major medical center, the University of Alabama at Birmingham. It recounts the major participants involved and their contributions and pioneering efforts, some of which have received little attention or were overshadowed by other events. Perspectives from participants--a patient and a trainee--provide insight into this process that has supported the growth and development of a major world-class medical center.

Running with the Hares and Hunting with the Hounds: An Impossibility?

Vascular surgery has emerged as an independent speciality in India. The growth and development of vascular surgery in India has been slow, yet steady. It is a matter of concern that almost a quarter century down the line this speciality is faced with several problems. This article examines the issue of whether it is feasible for vascular surgery to exist as an independent subspeciality. Does one follow a conciliatory or a confrontational approach with the ‘competing specialities’?

Langenbeck’s archives and the early development of vascular surgery in Germany

Langenbeck's Archives of Surgery and its predecessor Archiv für Klinische Chirurgie have addressed vascular surgical problems from the early beginning. In 1860, Bernhard von Langenbeck published a review on venous injuries during tumor surgery, and in 1907, Erich Lexer heralded the era of vascular reconstructive therapy in Germany when he treated an axillary aneurysm by use of a segment of the longer saphenous vein. The Archiv für Klinische Chirurgie has significantly promoted the development of vascular surgery in Germany especially at the end of the nineteenth and first decades of the twentieth century.

150. Declining Interest in Vascular Surgery Among General Surgery Residents

The evolution of vascular surgery over the past ten years has changed the traditional manner in which vascular surgeons practice. Several studies have investigated the impact on residency training and case volumes. To our knowledge, no study has looked into the interest level of general surgery residents in vascular surgery. Our training program is based in a private urban tertiary care hospital where 17 surgical residents function on four general surgical teams. The program has no fellows or dedicated vascular service.

Endovascular Stent Graft for Aortic Diseases

Endovascular aortic stent grafting remained one of the most signifi cant developments in vascular surgery in the last decade since its fi rst introduction in 1991. Today at least a dozen commercial devices are available for treating a wide spectrum of diseases in the thoracic and abdominal aorta. The minimally invasive concept of transfemoral

In situ Femoral to Popliteal Bypass Graft Using Superficial Femoral Vein to Popliteal Vein

During the evolution of vascular surgery as a specialty, many conduits have been used to revascularize the lower extremities. Superficial veins and prosthetic materials make up the majority of materials used to bypass diseased segments of native artery. The deep veins of the thigh have also been reported as alternatives for arterial bypass. However, the use of the in situ superficial femoral and popliteal vein bypass has not been reported to our knowledge in current literature. We report a 79-year-old white female with lower extremity rest pain who underwent an in situ femoral popliteal bypass graft for limb salvage.

Evolution of Vascular Surgery and Its Consequences: The Need for an Independent American Board of Vascular Surgery

Evolution of Vascular Surgery and Its Consequences: The Need for an Independent American Board of Vascular Surgery