Megan J. Lanigan, Matthew Culling, Robert G. Gould, M. Wall, Joss J. Thomas
An estimated 92.1 million Americans have at least one type of cardiovascular disease (CAD).1 Even though death rates due to CAD have declined, at least 2200 Americans die each day of CAD. 2 In the U.S. at least 50 million operations occur every year and up to 4% are associated with adverse cardiac events. 3There are many identifiable risk factors for cardiac disease such as diabetes, hypertension, obesity, smoking, and high cholesterol. 1In addition, there are non-modifiable risks for cardiac disease; these include age, gender, family history, and homocysteine levels. 4 Hypotension and tachycardia are the most common causes of ischemic cardiac events in the intra-operative phase. The failure to detect myocardial injury early on may contribute to complications as long as 30 days post-operatively. Typically, ischemic findings on electrocardiography and elevated troponin measurements have been used as potential indicators of ischemia or myocardial injury after non-cardiac surgery in the peri-operative setting. In the treatment of ischemic cardiac events, intensified medical therapy (antiplatelet, beta-blocker, ACE inhibitor, or a statin) in patients who suffered from a troponin elevation in the postoperative period reduces the risk of having a major cardiac event within a year. This review contains 1 figure, 2 tables, and 74 references. Keywords: Myocardial Injury after Non Cardiac Surgery (MINS), Perioperative ischemia, Troponin assay, VISION study, Coronary artery disease
{"title":"Ischemic Cardiac Event","authors":"Megan J. Lanigan, Matthew Culling, Robert G. Gould, M. Wall, Joss J. Thomas","doi":"10.2310/surg.8004","DOIUrl":"https://doi.org/10.2310/surg.8004","url":null,"abstract":"An estimated 92.1 million Americans have at least one type of cardiovascular disease (CAD).1 Even though death rates due to CAD have declined, at least 2200 Americans die each day of CAD. 2 In the U.S. at least 50 million operations occur every year and up to 4% are associated with adverse cardiac events. 3There are many identifiable risk factors for cardiac disease such as diabetes, hypertension, obesity, smoking, and high cholesterol. 1In addition, there are non-modifiable risks for cardiac disease; these include age, gender, family history, and homocysteine levels. 4 Hypotension and tachycardia are the most common causes of ischemic cardiac events in the intra-operative phase. The failure to detect myocardial injury early on may contribute to complications as long as 30 days post-operatively. Typically, ischemic findings on electrocardiography and elevated troponin measurements have been used as potential indicators of ischemia or myocardial injury after non-cardiac surgery in the peri-operative setting. In the treatment of ischemic cardiac events, intensified medical therapy (antiplatelet, beta-blocker, ACE inhibitor, or a statin) in patients who suffered from a troponin elevation in the postoperative period reduces the risk of having a major cardiac event within a year. \u0000This review contains 1 figure, 2 tables, and 74 references. \u0000Keywords: Myocardial Injury after Non Cardiac Surgery (MINS), Perioperative ischemia, Troponin assay, VISION study, Coronary artery disease","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121225145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blunt thoracic trauma comprises approximately 8% of all traumatic admissions in the United States. While chest wall injuries comprise much of this burden, mediastinal injuries, including cardiac and great vessel injuries, are being recognized more frequently given the diagnostic capabilities of modern CT imaging. In penetrating trauma, close proximity of structures in the mediastinal space, comes with a higher incidence of injury to multiple structures. Further, cardiac injury is estimated to comprise 10% of the mortality of gunshot wound victims, while more than 90% of great vessel injury is associated with penetrating injury, representing a significant burden of disease. Management and care of these injuries requires consideration of multiple details and exposure techniques. This article will address diagnosis, management and repair of esophageal, thoracic duct, cardiac, and great vessel injuries. This review contains 4 figures, 2 tables, and 49 references. Keywords: Mediastinal structures, esophageal injury, esophageal repair, thoracic duct injury, thoracic duct ligation, blunt cardiac injury, penetrating cardiac injury, blunt aortic injury, great vessel injury, endovascular stenting
{"title":"Injuries to the Chest Part 2 : Mediastinal Injuries","authors":"Matthew D. Painter, A. Hildreth, J. J. Hoth","doi":"10.2310/surg.2419","DOIUrl":"https://doi.org/10.2310/surg.2419","url":null,"abstract":"Blunt thoracic trauma comprises approximately 8% of all traumatic admissions in the United States. While chest wall injuries comprise much of this burden, mediastinal injuries, including cardiac and great vessel injuries, are being recognized more frequently given the diagnostic capabilities of modern CT imaging. In penetrating trauma, close proximity of structures in the mediastinal space, comes with a higher incidence of injury to multiple structures. Further, cardiac injury is estimated to comprise 10% of the mortality of gunshot wound victims, while more than 90% of great vessel injury is associated with penetrating injury, representing a significant burden of disease. Management and care of these injuries requires consideration of multiple details and exposure techniques. This article will address diagnosis, management and repair of esophageal, thoracic duct, cardiac, and great vessel injuries.\u0000This review contains 4 figures, 2 tables, and 49 references.\u0000Keywords: Mediastinal structures, esophageal injury, esophageal repair, thoracic duct injury, thoracic duct ligation, blunt cardiac injury, penetrating cardiac injury, blunt aortic injury, great vessel injury, endovascular stenting","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134585161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nearly 800,000 strokes are reported in the United States annually, with an economic impact upward of $33 billion. Carotid artery disease, familiar to all vascular surgeons, accounts for just over one fifth of these strokes. However, these cases reflect an opportunity for the surgeon to intervene and mitigate the substantial burden of stroke. This review includes the epidemiology of stroke in the United States and the carotid artery and noncarotid etiologies of stroke, including atherosclerotic disease, fibromuscular dysplasia, carotid artery dissection, and cardioembolism. The clinical presentations of ischemic and hemorrhagic stroke and transient ischemia attacks are examined, as are the major findings expected in the patient history and physical examination. Strategies for further evaluation of the patient are discussed, including the use of sonographic imaging of the carotid artery and the relative advantages and disadvantages among the dominant modes of brain imaging. New updates to the review include interventional approaches toward the treatment of acute ischemic stroke, as well as the latest strategies regarding the timing of carotid endarterectomy after stroke and the utility of carotid artery stenting in these patients, with active areas of current research highlighted. Figures show a computed tomographic (CT) angiogram of fibromuscular dysplasia of an internal carotid artery, a CT angiogram of an internal carotid artery dissection showing a defect in the dissection, a CT scan demonstrating hemorrhagic conversion of cardioembolic stroke, a CT scan of acute thalamic hemorrhage, a CT scan of evolving ischemic stroke, a T2-weighted image demonstrating acute left frontal stroke and remote right frontal stroke, T1- and T2-weighted images of right parietal ischemic stroke, and M1 occlusion of a middle cerebral artery treated successfully with transcatheter thrombectomy. Tables list Society of Radiologists in Ultrasound and University of Washington criteria for duplex ultrasound diagnosis of carotid artery stenosis. This review contains 8 figures, 8 tables, and 68 references. Keywords: Carotid stenosis, ischemic stroke, transient ischemic attack, endovascular therapy, thrombolysis, infarct, hemorrhagic stroke, atherosclerosis, embolism
{"title":"Symptomatic Carotid Stenosis: Stroke and Transient Ischemic Attack","authors":"Kenneth R Ziegler, T. Naslund","doi":"10.2310/surg.2096","DOIUrl":"https://doi.org/10.2310/surg.2096","url":null,"abstract":"Nearly 800,000 strokes are reported in the United States annually, with an economic impact upward of $33 billion. Carotid artery disease, familiar to all vascular surgeons, accounts for just over one fifth of these strokes. However, these cases reflect an opportunity for the surgeon to intervene and mitigate the substantial burden of stroke. This review includes the epidemiology of stroke in the United States and the carotid artery and noncarotid etiologies of stroke, including atherosclerotic disease, fibromuscular dysplasia, carotid artery dissection, and cardioembolism. The clinical presentations of ischemic and hemorrhagic stroke and transient ischemia attacks are examined, as are the major findings expected in the patient history and physical examination. Strategies for further evaluation of the patient are discussed, including the use of sonographic imaging of the carotid artery and the relative advantages and disadvantages among the dominant modes of brain imaging. New updates to the review include interventional approaches toward the treatment of acute ischemic stroke, as well as the latest strategies regarding the timing of carotid endarterectomy after stroke and the utility of carotid artery stenting in these patients, with active areas of current research highlighted. Figures show a computed tomographic (CT) angiogram of fibromuscular dysplasia of an internal carotid artery, a CT angiogram of an internal carotid artery dissection showing a defect in the dissection, a CT scan demonstrating hemorrhagic conversion of cardioembolic stroke, a CT scan of acute thalamic hemorrhage, a CT scan of evolving ischemic stroke, a T2-weighted image demonstrating acute left frontal stroke and remote right frontal stroke, T1- and T2-weighted images of right parietal ischemic stroke, and M1 occlusion of a middle cerebral artery treated successfully with transcatheter thrombectomy. Tables list Society of Radiologists in Ultrasound and University of Washington criteria for duplex ultrasound diagnosis of carotid artery stenosis.\u0000 \u0000This review contains 8 figures, 8 tables, and 68 references.\u0000Keywords: Carotid stenosis, ischemic stroke, transient ischemic attack, endovascular therapy, thrombolysis, infarct, hemorrhagic stroke, atherosclerosis, embolism","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133277540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postoperative pneumonia is currently the third most common complication seen in surgical patients and is associated with an increase in both patient morbidity and hospital costs. The incidence of postoperative pneumonia varies among the different surgical subspecialties. A number of evidence-based strategies exist regarding the prevention and management of pneumonia. However, the majority of studies on ventilator-associated pneumonia (VAP) do not specifically focus on surgical patients but rather are based on mixed medical-surgical ICU patients. The aim of this review is to define the incidence, pathogenesis, and risk factors of both postoperative and VAP; determine what pathogens are commonly encountered; discuss treatment methods; and introduce measures that can be implemented in both the surgical wards and the ICU aimed at preventing this complication. This review contains 5 figures, 7 tables, and 64 references. Key Words: antimicrobial therapy, disease prevention, postoperative pneumonia, surgical critical care; ventilator associated pneumonia, culture, prevention, management, bundles, diagnosis
{"title":"Postoperative and Ventilator-Associated Pneumonia","authors":"C. Coopersmith, Caitlin A. Fitzgerald","doi":"10.2310/surg.2164","DOIUrl":"https://doi.org/10.2310/surg.2164","url":null,"abstract":"Postoperative pneumonia is currently the third most common complication seen in surgical patients and is associated with an increase in both patient morbidity and hospital costs. The incidence of postoperative pneumonia varies among the different surgical subspecialties. A number of evidence-based strategies exist regarding the prevention and management of pneumonia. However, the majority of studies on ventilator-associated pneumonia (VAP) do not specifically focus on surgical patients but rather are based on mixed medical-surgical ICU patients. The aim of this review is to define the incidence, pathogenesis, and risk factors of both postoperative and VAP; determine what pathogens are commonly encountered; discuss treatment methods; and introduce measures that can be implemented in both the surgical wards and the ICU aimed at preventing this complication.\u0000This review contains 5 figures, 7 tables, and 64 references. \u0000Key Words: antimicrobial therapy, disease prevention, postoperative pneumonia, surgical critical care; ventilator associated pneumonia, culture, prevention, management, bundles, diagnosis","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130315912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute liver failure (ALF) is a rare but highly morbid condition that is optimally managed by a multidisciplinary team of surgeons, hepatologists, and intensivists at a tertiary care center that specializes in liver disorders. ALF is caused by four primary mechanisms, including viral infections (most commonly Hepatitis A and B); toxicity from acetaminophen overdose or other substances; postoperative hepatic failure ; and miscellaneous causes such as autoimmune hepatitis, genetic disorders, or idiopathic etiologies. Unlike chronic liver failure in which the body develops compensatory, protective mechanisms, ALF may be associated with severe multisystem organ involvement, including respiratory distress syndrome, renal failure, and cerebral edema. Fulminant hepatic failure represents a rapidly progressive form of ALF that portends worse prognosis. Prompt diagnosis and management of multisystem organ dysfunction in an intensive care setting is paramount to survival. However, a subset of patients will fail to improve with medical management alone. Early identification of these individuals for emergent transplant listing has been shown to improve outcomes. Multiple predictive models for ALF survival have been developed, which are based on weighted evaluation of clinical and laboratory parameters. These models may be used to facilitate treatment, predict prognosis, and guide transplant listing. In this chapter, we provide an in-depth review these concepts, focusing on the classification, epidemiology, diagnosis, and management of ALF. This review contains 5 tables and 69 references. Key Words: acute liver failure, acute respiratory distress syndrome, coagulopathy, cerebral edema, fulminant hepatic failure, hepatic necrosis, liver transplantation, metabolic disarray, multidisciplinary intensive care, prognostication
{"title":"Acute Hepatic Failure","authors":"Derek J. Erstad, M. Qadan","doi":"10.2310/surg.2412","DOIUrl":"https://doi.org/10.2310/surg.2412","url":null,"abstract":"Acute liver failure (ALF) is a rare but highly morbid condition that is optimally managed by a multidisciplinary team of surgeons, hepatologists, and intensivists at a tertiary care center that specializes in liver disorders. ALF is caused by four primary mechanisms, including viral infections (most commonly Hepatitis A and B); toxicity from acetaminophen overdose or other substances; postoperative hepatic failure ; and miscellaneous causes such as autoimmune hepatitis, genetic disorders, or idiopathic etiologies. Unlike chronic liver failure in which the body develops compensatory, protective mechanisms, ALF may be associated with severe multisystem organ involvement, including respiratory distress syndrome, renal failure, and cerebral edema. Fulminant hepatic failure represents a rapidly progressive form of ALF that portends worse prognosis. Prompt diagnosis and management of multisystem organ dysfunction in an intensive care setting is paramount to survival. However, a subset of patients will fail to improve with medical management alone. Early identification of these individuals for emergent transplant listing has been shown to improve outcomes. Multiple predictive models for ALF survival have been developed, which are based on weighted evaluation of clinical and laboratory parameters. These models may be used to facilitate treatment, predict prognosis, and guide transplant listing. In this chapter, we provide an in-depth review these concepts, focusing on the classification, epidemiology, diagnosis, and management of ALF.\u0000This review contains 5 tables and 69 references.\u0000Key Words: acute liver failure, acute respiratory distress syndrome, coagulopathy, cerebral edema, fulminant hepatic failure, hepatic necrosis, liver transplantation, metabolic disarray, multidisciplinary intensive care, prognostication","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132024971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review describes the clinical presentation, disease biology, and treatment (both medical and surgical) of genetically predisposed vascular diseases including Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, neurofibromatosis, and pseudoxanthoma elasticum. This study briefly evaluates the progress in understanding the genetic causes of nonsyndromic thoracic aortic aneurysms and dissections and recommendations for working up these patients and their family members. This study then discusses the historical context, current efforts, and future direction of understanding the genetic underpinnings of peripheral arterial disease and abdominal aortic aneurysms through linkage gene studies, candidate gene studies, genome-wide association studies, and epigenetics. This review contains 4 figures, 6 tables, and 68 references. Key Words: candidate genes, complex traits, Ehlers-Danlos syndrome (EDS), geneme-wide association studies (GWASs), inherited nonsyndromic arteriopathies, linkage studies, Loeys-Dietz syndrome (LDS), Marfan syndrome (MFS), syndromic arteriopathies
{"title":"Genetic Vascular Disorders","authors":"A. Fairman, S. Damrauer","doi":"10.2310/vasc.3081","DOIUrl":"https://doi.org/10.2310/vasc.3081","url":null,"abstract":"This review describes the clinical presentation, disease biology, and treatment (both medical and surgical) of genetically predisposed vascular diseases including Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome, neurofibromatosis, and pseudoxanthoma elasticum. This study briefly evaluates the progress in understanding the genetic causes of nonsyndromic thoracic aortic aneurysms and dissections and recommendations for working up these patients and their family members. This study then discusses the historical context, current efforts, and future direction of understanding the genetic underpinnings of peripheral arterial disease and abdominal aortic aneurysms through linkage gene studies, candidate gene studies, genome-wide association studies, and epigenetics.\u0000This review contains 4 figures, 6 tables, and 68 references. \u0000Key Words: candidate genes, complex traits, Ehlers-Danlos syndrome (EDS), geneme-wide association studies (GWASs), inherited nonsyndromic arteriopathies, linkage studies, Loeys-Dietz syndrome (LDS), Marfan syndrome (MFS), syndromic arteriopathies","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133040134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Madden, K. Calligaro, M. Dougherty, Douglas A. Troutman
Prosthetic graft infections remain one of the most significant complications encountered by vascular surgeons given the high rate of morbidity and limb loss. Graft infections involving the lower extremity have a reported incidence of 2 to 6%. Presentation can include an indolent infection, septic shock, or frank hemorrhage. The goals of therapy are minimizing morbidity and mortality, preventing recurrent infection, and limb salvage. The gold standard in management is complete graft excision; however, this may not always be feasible or necessary. Various techniques such as partial preservation with concomitant revascularization may be appropriate in selected circumstances. A thorough understanding of the pathophysiology, extent of infection, and the patient’s overall clinical picture are necessary so that a patient-specific approach can be implemented. This review contains 4 figures, 1 table, and 31 references. Keywords: cryopreserved cadaveric graft, extracavitary graft, graft excision, graft infection, graft preservation, lower-extremity bypass graft, lateral femoral bypass, prosthetic vascular graft
{"title":"Surgical Principles for the Management of Peripheral Graft Infections","authors":"N. Madden, K. Calligaro, M. Dougherty, Douglas A. Troutman","doi":"10.2310/vasc.3080","DOIUrl":"https://doi.org/10.2310/vasc.3080","url":null,"abstract":"Prosthetic graft infections remain one of the most significant complications encountered by vascular surgeons given the high rate of morbidity and limb loss. Graft infections involving the lower extremity have a reported incidence of 2 to 6%. Presentation can include an indolent infection, septic shock, or frank hemorrhage. The goals of therapy are minimizing morbidity and mortality, preventing recurrent infection, and limb salvage. The gold standard in management is complete graft excision; however, this may not always be feasible or necessary. Various techniques such as partial preservation with concomitant revascularization may be appropriate in selected circumstances. A thorough understanding of the pathophysiology, extent of infection, and the patient’s overall clinical picture are necessary so that a patient-specific approach can be implemented.\u0000This review contains 4 figures, 1 table, and 31 references.\u0000Keywords: cryopreserved cadaveric graft, extracavitary graft, graft excision, graft infection, graft preservation, lower-extremity bypass graft, lateral femoral bypass, prosthetic vascular graft","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131619896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arterial, venous, and lymphatic vessel walls are organized in three concentric layers that are composed of specialized cells and matrix components, allowing a vessel to function both as a conduit for fluid flow and regulate tone, control passage of cells and molecules to the interstitium and have the capacity to remodel after injury. The arrangement and proportions of these components vary depending on the location of a particular vessel within the circulation; variations allow specialization to accommodate pulsatile flow, regulate peripheral resistance, facilitate immune surveillance, or transport nutrients and metabolic waste. In addition to understanding the biology of the vessel wall and its role in pathology, a knowledge of the development of the vascular system and the various consequences of deviation from normal development will aid in identifying and treating a diverse range of vascular diseases. This review contains 5 figures, 1 table, and 44 references. keywords: artery, adventitia, angiogenesis, arteriogenesis, arteriole, intima, media, physiology, vasculogenesis
{"title":"Physiology of the Arterial Wall","authors":"Shirley Liu, A. Dardik","doi":"10.2310/vasc.3001","DOIUrl":"https://doi.org/10.2310/vasc.3001","url":null,"abstract":"Arterial, venous, and lymphatic vessel walls are organized in three concentric layers that are composed of specialized cells and matrix components, allowing a vessel to function both as a conduit for fluid flow and regulate tone, control passage of cells and molecules to the interstitium and have the capacity to remodel after injury. The arrangement and proportions of these components vary depending on the location of a particular vessel within the circulation; variations allow specialization to accommodate pulsatile flow, regulate peripheral resistance, facilitate immune surveillance, or transport nutrients and metabolic waste. In addition to understanding the biology of the vessel wall and its role in pathology, a knowledge of the development of the vascular system and the various consequences of deviation from normal development will aid in identifying and treating a diverse range of vascular diseases.\u0000This review contains 5 figures, 1 table, and 44 references. \u0000keywords: artery, adventitia, angiogenesis, arteriogenesis, arteriole, intima, media, physiology, vasculogenesis","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126143049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：