Laparoscopic surgery has gained popularity in recent time. An essential aspect of this technique is production of a pneumoperitoneum with insufflation for adequate visualization and manipulation of abdominal contents. Various techniques have been developed over the years for optimal access with minimization of complications. Some of these complications include vascular injury, visceral injury, and incisional hernia. Furthermore, considerations with regards to the patient’s physical morphology, and the cardiovascular/respiratory effects of increased abdominal pressure and anesthesia must be accounted for. The guidelines to optimize patient care in these regards are discussed in this review. This review contains 2 videos, 5 figures, 2 tables, and 79 references. Keywords: trocar insertion, port site hernia, Veress needle, optical trocar, trocar related injuries, Hassan cannula, pneumoperitoneum, air embolism, pneumoperitoneum physiology
{"title":"Principles and Techniques of Abdominal Access and Physiology of Pneumoperitoneum","authors":"J. Gould, K. Simon","doi":"10.2310/anes.2203","DOIUrl":"https://doi.org/10.2310/anes.2203","url":null,"abstract":"Laparoscopic surgery has gained popularity in recent time. An essential aspect of this technique is production of a pneumoperitoneum with insufflation for adequate visualization and manipulation of abdominal contents. Various techniques have been developed over the years for optimal access with minimization of complications. Some of these complications include vascular injury, visceral injury, and incisional hernia. Furthermore, considerations with regards to the patient’s physical morphology, and the cardiovascular/respiratory effects of increased abdominal pressure and anesthesia must be accounted for. The guidelines to optimize patient care in these regards are discussed in this review.\u0000\u0000This review contains 2 videos, 5 figures, 2 tables, and 79 references.\u0000Keywords: trocar insertion, port site hernia, Veress needle, optical trocar, trocar related injuries, Hassan cannula, pneumoperitoneum, air embolism, pneumoperitoneum physiology","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131268252","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}
A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform. This review contains 3 tables and 20 references. Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections
{"title":"Health Economics: National Health Expenditures","authors":"B. Hall","doi":"10.2310/surg.2404","DOIUrl":"https://doi.org/10.2310/surg.2404","url":null,"abstract":"A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform.\u0000\u0000This review contains 3 tables and 20 references.\u0000Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125499591","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}
Cardiac arrhythmias and events, such as acute coronary syndrome and acute decompensated heart failure, are becoming increasingly common with an aging population. Much is written regarding the evaluation and management of these conditions in the cardiac and vascular patient populations; however, there is less literature to discuss the management strategies in the critically ill noncardiac postoperative and polytrauma patients. Factors such as physiologic stress, electrolyte imbalances, neurologic derangement, infection, and massive fluid shifts create an environment that promotes cardiopulmonary instability. Appropriate recognition of cardiac arrhythmias, acute coronary syndromes, and heart failure coupled with accurate and timely intervention can reduce morbidity and mortality in these patients. This review discusses the assessment and management of cardiac tachy- and brady-arrhythmias, acute coronary syndromes, and acute decompensated heart failure in the surgical patient. This review contains 4 figures, 5 tables and 45 references Key Words: acute coronary syndrome, angina, arrhythmia, bradycardia, cardiac ischemia, dieresis, fluid overload, heart failure, infarction, tachycardia
{"title":"Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient","authors":"G. Franklin, Amirreza T. Motameni, J. Walker","doi":"10.2310/surg.8003","DOIUrl":"https://doi.org/10.2310/surg.8003","url":null,"abstract":"Cardiac arrhythmias and events, such as acute coronary syndrome and acute decompensated heart failure, are becoming increasingly common with an aging population. Much is written regarding the evaluation and management of these conditions in the cardiac and vascular patient populations; however, there is less literature to discuss the management strategies in the critically ill noncardiac postoperative and polytrauma patients. Factors such as physiologic stress, electrolyte imbalances, neurologic derangement, infection, and massive fluid shifts create an environment that promotes cardiopulmonary instability. Appropriate recognition of cardiac arrhythmias, acute coronary syndromes, and heart failure coupled with accurate and timely intervention can reduce morbidity and mortality in these patients. This review discusses the assessment and management of cardiac tachy- and brady-arrhythmias, acute coronary syndromes, and acute decompensated heart failure in the surgical patient. This review contains 4 figures, 5 tables and 45 references Key Words: acute coronary syndrome, angina, arrhythmia, bradycardia, cardiac ischemia, dieresis, fluid overload, heart failure, infarction, tachycardia","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"110 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134214647","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}
The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details the management of chronic ischemia, acute lower-extremity arterial ischemia, pseudoaneurysms and aneurysms, and arteriovenous malformations. Key words: access closure, access complications, acute limb ischemia, aneurysm endovascular treatment, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, lower limb ischemia, percutaneous transluminal angioplasty, transcollateral access, transpopliteal access
{"title":"Endovascular Procedures For Lower Extremity Vascular Disease: Specifics of Endovascular Treatment","authors":"L. Jayakumar, M. Davies","doi":"10.2310/surg.2388","DOIUrl":"https://doi.org/10.2310/surg.2388","url":null,"abstract":"The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details the management of chronic ischemia, acute lower-extremity arterial ischemia, pseudoaneurysms and aneurysms, and arteriovenous malformations.\u0000Key words: access closure, access complications, acute limb ischemia, aneurysm endovascular treatment, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, lower limb ischemia, percutaneous transluminal angioplasty, transcollateral access, transpopliteal access","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"59 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127380679","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 aortic dissection remains a lethal but uncommon condition. Historically, Stanford type B dissections are managed with best medical therapy whereas Stanford type A dissections are surgically treated. In the last decade, worldwide evidence has been building that has questioned optimal treatment for the former. In this review, we discuss the general features of aortic dissection, the pathophysiology and risk factors, appropriate imaging to make a prompt diagnosis, and current treatment principles and methods. This review contains 82 references, 6 figures and 5 tables. Key words: aortic aneurysm, aortic dissection, intramural hematoma, malperfusion syndrome, penetrating aortic ulcer, thoracoabdominal
{"title":"Aortic Dissection","authors":"K. Orion, James H Black Iii","doi":"10.2310/vasc.3038","DOIUrl":"https://doi.org/10.2310/vasc.3038","url":null,"abstract":"Acute aortic dissection remains a lethal but uncommon condition. Historically, Stanford type B dissections are managed with best medical therapy whereas Stanford type A dissections are surgically treated. In the last decade, worldwide evidence has been building that has questioned optimal treatment for the former. In this review, we discuss the general features of aortic dissection, the pathophysiology and risk factors, appropriate imaging to make a prompt diagnosis, and current treatment principles and methods.\u0000This review contains 82 references, 6 figures and 5 tables.\u0000Key words: aortic aneurysm, aortic dissection, intramural hematoma, malperfusion syndrome, penetrating aortic ulcer, thoracoabdominal","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132056112","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}
Renal artery stenosis (RAS) may present clinically as an incidental radiographic finding in an asymptomatic patient, or it may be the etiology of renovascular hypertension or ischemic nephropathy. Incidental RAS should be treated medically. The available clinical trial data suggest that medical management is the primary treatment for presumed renovascular hypertension. Renal artery stenting should be reserved for patients who fail medical therapy. When renal artery stenting is contemplated for presumed renovascular hypertension or ischemic nephropathy, clinical studies suggest that there are clinical predictors of outcomes that may be useful in identifying patients with a higher probability of a favorable clinical response to stenting. Clinical predictors of a favorable blood pressure response to renal artery stenting include (1) a requirement of four or more antihypertensive medications, (2) preoperative diastolic blood pressure greater than 90 mm Hg, and (3) preoperative clonidine use. The only clinical predictor of improved renal function with stenting is the rate of decline of estimated glomerular filtration rate (eGFR) in the weeks prior to stenting. Patients with a more rapid decline in eGFR have a higher probability of improved renal function after stenting compared with those with relatively stable eGFR prior to stenting. Finally, surgical renal artery revascularization remains a viable option but is usually reserved for younger, fit patients with unfavorable anatomy for stenting. Pediatric renovascular disease responds poorly to endovascular therapy and requires a surgical plan to address both renal artery stenoses and concomitant abdominal aortic coarctation if present. Renal artery stenosis in pediatric patients is best treated with reimplantation of the renal artery or interposition grafting using the autogenous internal iliac artery as a conduit. This review contains 39 references, 15 figures, and 3 tables. Key Words: chronic kidney disease, hypertension, renal artery stenosis, renovascular, stenting
{"title":"Renovascular Hypertension and Stenosis","authors":"J. Modrall","doi":"10.2310/vasc.3042","DOIUrl":"https://doi.org/10.2310/vasc.3042","url":null,"abstract":"Renal artery stenosis (RAS) may present clinically as an incidental radiographic finding in an asymptomatic patient, or it may be the etiology of renovascular hypertension or ischemic nephropathy. Incidental RAS should be treated medically. The available clinical trial data suggest that medical management is the primary treatment for presumed renovascular hypertension. Renal artery stenting should be reserved for patients who fail medical therapy. When renal artery stenting is contemplated for presumed renovascular hypertension or ischemic nephropathy, clinical studies suggest that there are clinical predictors of outcomes that may be useful in identifying patients with a higher probability of a favorable clinical response to stenting. Clinical predictors of a favorable blood pressure response to renal artery stenting include (1) a requirement of four or more antihypertensive medications, (2) preoperative diastolic blood pressure greater than 90 mm Hg, and (3) preoperative clonidine use. The only clinical predictor of improved renal function with stenting is the rate of decline of estimated glomerular filtration rate (eGFR) in the weeks prior to stenting. Patients with a more rapid decline in eGFR have a higher probability of improved renal function after stenting compared with those with relatively stable eGFR prior to stenting. Finally, surgical renal artery revascularization remains a viable option but is usually reserved for younger, fit patients with unfavorable anatomy for stenting. Pediatric renovascular disease responds poorly to endovascular therapy and requires a surgical plan to address both renal artery stenoses and concomitant abdominal aortic coarctation if present. Renal artery stenosis in pediatric patients is best treated with reimplantation of the renal artery or interposition grafting using the autogenous internal iliac artery as a conduit. \u0000This review contains 39 references, 15 figures, and 3 tables.\u0000Key Words: chronic kidney disease, hypertension, renal artery stenosis, renovascular, stenting","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123474055","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}
It is expected that surgeons have detailed and nuanced knowledge of the procedures they perform. It is equally necessary that surgeons have a working knowledge of anesthesia because it is important in patient selection for surgery, and for intraoperative factors including patient positioning and invasive monitoring. Proper care of the operative patient requires excellent communication and coordination between the surgical and anesthetic team. Providing optimal perioperative care for the patient requires the surgeon to understand the risks and benefits of each anesthetic approach and to relay potential portions of the procedure that may have a profound impact on the patient’s physiology so the anesthesiologist can properly prepare for it. With the increasing complexity of patients and the operations being performed, this ensures the best possible outcome. This review contains 6 figures, 13 tables, and 142 references. Key words: Local anesthetic, regional anesthesia, general anesthesia, sedation, cardiovascular risks, preoperative evaluation, difficult airway, perioperative medications, surgical risk calculators
{"title":"Basic Concepts of Anesthesia","authors":"George P. Yang, P. Pandya","doi":"10.2310/vasc.2220","DOIUrl":"https://doi.org/10.2310/vasc.2220","url":null,"abstract":"It is expected that surgeons have detailed and nuanced knowledge of the procedures they perform. It is equally necessary that surgeons have a working knowledge of anesthesia because it is important in patient selection for surgery, and for intraoperative factors including patient positioning and invasive monitoring. Proper care of the operative patient requires excellent communication and coordination between the surgical and anesthetic team. Providing optimal perioperative care for the patient requires the surgeon to understand the risks and benefits of each anesthetic approach and to relay potential portions of the procedure that may have a profound impact on the patient’s physiology so the anesthesiologist can properly prepare for it. With the increasing complexity of patients and the operations being performed, this ensures the best possible outcome.\u0000This review contains 6 figures, 13 tables, and 142 references.\u0000Key words: Local anesthetic, regional anesthesia, general anesthesia, sedation, cardiovascular risks, preoperative evaluation, difficult airway, perioperative medications, surgical risk calculators","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121238403","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}
B. Oommen, K. Kercher, B. T. Heniford, Ian A. Villanueva
{"title":"Splenectomy","authors":"B. Oommen, K. Kercher, B. T. Heniford, Ian A. Villanueva","doi":"10.2310/surg.2082","DOIUrl":"https://doi.org/10.2310/surg.2082","url":null,"abstract":"<jats:p />","PeriodicalId":413935,"journal":{"name":"DeckerMed Vascular and Endovascular Surgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121690922","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}
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