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Atherosclerosis is a generalized disease [2,4,9,11,21,22,41]. Therefore, it is of no surprise that simultaneous ath- erosclerotic lesions may exist in the carotid arteries, the coronary arteries, the aorta and the peripheral arteries in the form of unifocal, bifocal and multifocal occlusive or aneurysmal disease [1,14,15,18,26,38,39]. Coexis- tence of severe coronary artery disease with carotid artery stenosis, aortic aneurysm and critical limb ischaemia is a frequent event and the management of these patients is still unclear and in some cases controversial [12,16, 17,24,27,31,32,36,37]. Therefore,multifocal athero- sclerosis remains a challenge for the cardiothoracic and vascular surgeon who has,nowadays, the therapeutic al- ternative of open or endovascular repair. [ABSTRACT FROM AUTHOR]

Carter and Eban [1] were the first to report bilateral abnormality of the popliteal artery and gastrocnemius muscles, in 1962.The term popliteal entrapment was then coined in 1965 by Love and Whelan [6], the same year that Hamming and Vink [3] published their clinical report of popliteal artery obstruction at an early age.Popliteal artery entrapment is characterized by extrin- sic compression of the popliteal artery, while in adven- titial cystic disease the artery is compressed by a cyst located in the adventitia of the artery. [ABSTRACT FROM AUTHOR]

Aortic aneurysm formation is a well-documented complication in patients with coarctation of the aorta, whether untreated or treated.Patients not undergoing surgical or interventional treatment may develop aneurysms of the ascending aorta, possibly involving the aortic arch. This is prob- ably the manifestation of inherent aortic wall abnor- malities.A bicuspid aortic valve (present in 85% of these pa- tients) is well known to be associated with aorticpa- thology and has been confirmed as an independent predictor of ascending aortic aneurysm in this patient population.Moreover, coarctation patients typically have proximal arterial hypertension, which causes increased haemo- dynamic stress on the aortic wall and predisposes to aneurysm formation, rupture and aortic dissection.As a result, approximately 20% of adults with coarcta- tion will die from spontaneous rupture of the aorta if left untreated.Close supervision of patients with bicuspid aortic valves and ascending aortic dilatation is mandatory to prevent such catastrophic complications.Patients who have undergone surgical repair may also develop postoperative aneurysms in the region of the aortic isthmus.These aneurysms are usually asymp- tomatic but are associated with a 36%mortality rate if left untreated.They can be true or false and may in- volve the distal aortic arch.Their incidence varies and depends on a number of factors, i.e. the time of operation, age at the time of surgery, the postoperative interval and the surgical technique employed.Although all types of surgical repair have the risk of aneurysm formation, prosthetic Dacron patch aorto- plasty has been historically associated with the highest incidence (up to 39%) of this complication.In the initial descriptions of the procedure, the posteri- or coarctation membrane or fibrous shelf was excised. This manoeuvre was later found to be a significant predisposing factor for development of true aneu- rysms and it is now discouraged. It also appears that the risk of aneurysm formation is higher for patients operated on at >13.5 years of age, for patch aortoplasty of recoarctation following resection with end-to-end anastomosis, and for patients with coarctation associ- ated with transverse arch hypoplasia.Recent series using PTFE for the patch have not re- ported any aneurysm in a short follow-up period.Aneurysm formation also complicates balloon angio- plasty. Disruption of the intima and morphologically distorted elastic media in the precoarctation and post- coarctation aortic segments are probably causally con- nected with this complication.Dilatation of native adult coarctation is particularly associated with aneurysm formation, the reported incidence varying from 4% to 42%. As a result, most centres do not routinely utilize angioplasty in the management of native coarctation. Aneurysms may develop either immediately after angioplasty or after several months, hence close follow-up is essential. On the other hand, balloon angioplasty may be the pre- ferred approach for recurrent coarctation following surgical repair.Due to the apparent protective effect of the fibrous perivascular surgical scar, aneurysm formation is a rather infrequent complication (0-5%)in this setting. [ABSTRACT FROM AUTHOR]

There are various situations in which the orthopaedic surgeon may be faced with vascular injuries. The most common of these are complete or incomplete nonviable amputations and open injuries/fractures of the upper or lower extremities. In addition, injuries to major vessels during trauma or reconstructive orthopaedic procedures are known to occur and need to be addressed immedi- ately by the operating team. [ABSTRACT FROM AUTHOR]

Urological surgery has evolved over time and now in- cludes many major operations, sometimes with consid- erable morbidity. Procedures that were performed only in specialized centres are now considered the standard of care for many institutions all over the world. The manage- ment of renal cell carcinoma involving the inferior vena cava remains a technically challenging surgical condition, while radical pelvic surgery for bladder cancer is some- times complicated with vascular injuries. In the last few decades we have also witnessed the evolution of laparos- copy from a diagnostic tool to a sophisticated therapeutic procedure which, in several centres, is used for advanced ablative and complex reconstructive urological proce- dures. However, this evolution has been accompanied by the occurrence of new types of vascular complications during laparoscopic urological surgery. [ABSTRACT FROM AUTHOR]

Acute leg/limb/lower extremity ischaemiaAcute peripheral arterial occlusion. [ABSTRACT FROM AUTHOR]

Technical advances in vascular surgery in recent years have enhanced our ability to care for patients with car- diovascular diseases. Theextensive use of medical devices and prosthetic materials has resulted in longer survival of such patients and has also improved their quality of life. However, infection remains the most serious com- plication of prosthetic grafts and devices, because it dra- matically alters the patient's outcome. Infections are often severe and in some cases life-threatening, while their cure may be problematic if removal of the infected material is not feasible. The incidence of infection varies with the indication of implantation and the site of the implant, be- ing more common after emergency procedures, when the prosthesis is anastomosed with the femoral artery and when placed subcutaneously. The true incidence may be higher than that reported, because many graft infections are not apparent until several years after implantation. [ABSTRACT FROM AUTHOR]

•Patients who are in the final stage of chronic renal fail- ure should,in order to remain alive,undergo dialysis -which may be either peritoneal dialysis or haemodialysis.•Haemodialysis may be urgent or chronic and requires venous access. [ABSTRACT FROM AUTHOR]

Arteriovenous malformationsVascular malformationsArteriovenous fistulasAngiodysplasias. [ABSTRACT FROM AUTHOR]

The lymphatic system is a significant pathway for the drainage of fluid,large protein molecules and white blood cells from the interstitial spaces within capillary beds. Lymphatic capillaries lie in the dermis and subcu- taneous fat, in the fascial planes between muscles and in perivascular tissues. Lymphatic vessels transport lymph from these areas through regional lymph nodes towards the thoracic duct. Lymph returns to the venous circula- tion via the termination of the thoracic duct at the left internal jugular vein close to its junction with the left subclavian vein. The system plays a major immunologi- cal role,with the regional lymph nodes processing anti- gens presented to them by white blood cells from the pe- ripheries. Antigen-specific lymphocytes proliferate in the lymph nodes and are then released into the circulation via the main lymph ducts and also through small lym- phovenous connections within the lymph nodes them- selves. Impaired drainage of lymph from a limb, usually due to obstruction of the system, leads to the accumu- lation of fluid and protein in the subcutaneous tissues with eventual irreversible fibrosis and swelling, known as lymphoedema [8]. [ABSTRACT FROM AUTHOR]

The following three factors, primarily postulated by Virchow, are most important in the pathophysiology of deep venous thrombosis (DVT)[10]: Injury of vessel wallAbnormalities of blood (coagulation disorders)Abnormalities of blood flow (stasis).There are multiple risk factors for DVT, but the inde- pendence and magnitude of each are unclear [10,11, 12,34 ]: Increasing ageCancerCoagulation disorderSmokingObesityOestrogen substitutionSurgery (hip or knee arthroplasty,cancer surgery in the abdominopelvic area, neurosurgery)TraumaImmobilization (air-related DVT)Previous DVT.Calf veins are the most common site of thrombus [20]. Acute DVT is more frequently left-sided, and this phenomenon can be noted more clearly in proximal DVTs. Acute DVT affects vein segments from calf to iliac level in 5%of cases (iliofemoral DVT). Postoperative DVT is restricted to calf veins in 80% [21]. Propagation into more proximal veins may occur in 5-15% [16].The annual incidence of DVT is 5 per 10,000 in the general population. The 5-year cumulative incidence of recurrent DVT is approximately 20%. Prevalence of DVT is 0.5% at age 50 years and 4.5% at age 75 years. Therisk of DVT increases twofold during each 10-year increase in age [9,11].Without prophylaxis, the incidence of postoperative cDVT is 40-80%in patients undergoing large ortho- cpaedic surgery. The corresponding numbers in general csurgery are 20-40%. In vascular surgery, several Du- cplex or venography-based studies have shown that the crate of DVT is 18-32%after abdominal or lower limb creconstructions. Postoperative DVT has been noted in c12%of the legs after abdominal vascular surgery de- cspite medical prophylaxis [10].Superficial thrombophlebitis may be associated with DVT. In legs with large-scale thrombophlebitis involv- ing the saphenofemoral or saphenopopliteal junction, DVT may be present in as much as 40%of cases [10]. [ABSTRACT FROM AUTHOR]

Nearly every second adult in Europe suffers from ve- nous disorders.In only 15% are they considered to be venous diseases threatening the patient.The spectrum ranges from spider telangiectasia to chronic states and acute, potentially lethal, pulmonary embolism — generally described as chronic venous in- sufficiency (CVI).In vascular surgery,varicosities of the greater saphe- nous vein in particular are important.In principle,every varicose disorder leading to symp- toms such as oedema and lower leg ulcer should be treated surgically [1,4,16,21]. [ABSTRACT FROM AUTHOR]

The main goal of all vascular surgeons in the field of arterial iseases or trauma in the extremities is arterial reconstruction in order to save vitality and function. However, despite substantial improvement of limb-salvage rates in patients with peripheral vascular disease, extremity amputation can be, in some cases, the only possible treatment for a limb severely affected by trauma, infection, tumour, or at the last stage of ischaemia [8]. [ABSTRACT FROM AUTHOR]

According to the World Health Organization and to the International Working Group on the Diabetic Foot [32], diabetic foot is defined as the foot of diabetic pa- tients with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnor- malities and various degrees of peripheral vascular disease in the lower limb. [ABSTRACT FROM AUTHOR]

Whilst many problems affecting the vascular system may be managed by vascular surgical procedures or alterna- tively by minimally invasive catheter-directed interven- tions, the treatment of vascular injury and definitive care thereof are unquestionably the unchallenged fiefdom and responsibility of the well-trained vascular surgeon,whose clinical and diagnostic acumen,expediency and opera- tive skill are in demand. It is important to recognize vascular injury because of the danger of limb-threatening ischaemia if arteries are involved.Venous injury is also of significance at anatomical sites where venous flow passes through a bottleneck, such as the popliteal or the external iliac vein.Disturbance or disruption of venous return can give rise to venous hypertension, compartment syndrome and necrosis of striated muscle and nerve tissue. [ABSTRACT FROM AUTHOR]

Thromboangiitis obliterans (TAO). [ABSTRACT FROM AUTHOR]

An artery is considered to be aneurismal when it pres- ents a dilatation above 50%as compared to the proxi- mal diameter of the artery itself.The following locations can be clearly differentiated according to their anatomy.The list below is made in order of decreasing importance:Popliteal artery aneurysmCommon femoral artery aneurysms and its bifurcationSuperficial femoral artery aneurysmsDistal arterial branches aneurysms. [ABSTRACT FROM AUTHOR]

Disorders of the vascular system are the leading causes of death and disability in the western world. One of the most debilitating forms of vascular disease is peripheral arterial occlusive disease when it is manifested as critical limb ischaemia. Patients with limbs threatened by distal tibioperoneal occlusive disease present an ongoing chal- lenge to the vascular surgeon. [ABSTRACT FROM AUTHOR]

Lower limb arterial recanalization is a term that encom- passes various therapeutic manoeuvres with the goal of re-opening or dilating occluded and stenotic arteries. This chapter deals primarily with the treatment of chronic infra-inguinal occlusive disease. Percutaneous transluminal angioplasty (PTA) and stents are,at present, accepted as effective treatment in a substantial portion of iliac artery lesions [52]. The role of endovascular repair in the femoro-popliteo-crural system is still the subject of debate [37,55]. Percutaneous revascularization of femo- ro-popliteal arteries has shown high restenosis rates and stents should be confined to flow-limiting dissections or where there have been inadequate results from balloon angioplasty alone [27]. [ABSTRACT FROM AUTHOR]

Acute intestinal or mesenteric ischaemia may have sev- eral causes: Nonocclusive ischaemia (NOMI)Occlusive ischaemia:Arterial embolismArterial thrombosisVenous thrombosisAfter aortoiliac surgery [ABSTRACT FROM AUTHOR]

Aneurysms of the renal and intestinal arteries are rela- tively rare. In 1970, Stanley et al. [17] and Deterling [6] published a review of the compiled clinical experience of the prevalence, diagnosis and treatment of 1500 aneurysms of the intestinal arteries as published in the literature [17]. Since then,in an additional 50 articles, "case reports" have often been published [9]. Recently, an overview of demographic data concerning the prevalence,diagnosis and treatment has been presented [16]. [ABSTRACT FROM AUTHOR]

Since the recent publication of EVAR Trial I [23] and DREAM [29], endovascular aneurysm repair (EVAR) has proven superior results versus open surgical repair con- cerning 30-day mortality and morbidity. It is now well enough established that EVAR is feasible, efficacious and has proven considerable benefits over conventional open surgery in many aspects; namely, duration of operation, blood loss, length of hospital and intensive care unit stay, quality of life (QOL) and 30-day mortality and morbid- ity [11,14,21,23,29,30]. Moreover, midterm results of EVAR are sufficiently encouraging to justify the proce- dure, especially in high-risk patients [6,11,15,17,30,40, 51,63]. However, some publications have raised concerns about the long-term results of the procedure [4,24,26,43] [ABSTRACT FROM AUTHOR]

Splanchnic vascular diseases encompass a spectrum of acute and chronic occlusive and aneurysmal disorders affecting the vessels of the abdominal entrails.Of these relatively uncommon disorders,splanchnic ischaemia occurs most frequently.Chronic splanchnic disease is characterized by symp- tomless but significant stenosis in the coeliac artery, the superior mesenteric artery and/or the inferior mesenteric artery [45].It is important to distinguish chronic splanchnic dis- ease from chronic splanchnic ischaemia or syndrome, which is the combination of splanchnic disease and symptoms of ischaemia.In this respect,there is a close analogy between chron- ic splanchnic disease and renovascular disease.A complete overview has been published recently [54]. [ABSTRACT FROM AUTHOR]

The infrarenal aorta and its branches supply a very large anatomical area which includes the walls of the inferior part of the abdomen, the walls of the pelvis, the descend- ing colon, the viscera of the pelvis, the reproductive or- gans and the inferior limbs. For this reason, acute infra- renal aortic occlusion is a catastrophic event. In contrast, chronic obstructive aortoiliac disease can be asymptom- atic. It depends on how quickly the disease develops, its extent and the development of collateral circulation. In- deed, the branches of the aortoiliac artery develop a large anastomotic, parietal, visceral and parieto-visceral circu- lation. This is fundamental in the context of the physiopa- thology of aortoiliac obstructive disease. mesenteric arteries. [ABSTRACT FROM AUTHOR]

The use of minimally invasive laparoscopic techniques has expanded in recent years. As in other specialties, these techniques are becoming increasingly prevalent in vascular surgery. For aortic repair best results in terms of long-term patency are obtained by conventional sur- gery but its associated short-term morbidity and mortal- ity have not changed in the last 10 years. This situation created an opening for endovascular techniques that are much less invasive but with less reliable long-term results. In addition to endovascular surgery, video-endoscopic aortic surgery has been proposed as an alternative to con- ventional open surgery and is considered by some as a veritable third solution. The advantages of minimally in- vasive surgery are shorter intensive care and hospital stay, quicker resumption of intestinal transit, requirement for less analgesic and fewer abdominal wall complications. But specialized training is required to master the pro- cedure and to become acquainted with the coelioscopic practice necessary for laparoscopic suture. [ABSTRACT FROM AUTHOR]

Aortic aneurysms and treatment thereof continue to challenge the vascular surgeon. The natural history of aneurysms has been well documented, and the indica- tion for treatment extensively discussed [56]. The goal of treatment is to prevent aneurysm rupture and distal embolization. It is well known that aneurysm size is the most important criterion determining the main risk, namely rupture. Arterial hypertension is the second most important parameter that influences this risk, according to Laplace's law (tension on the wall is produced by the product of pressure and radius). As experience has accu- mulated, the durability of open surgical therapy, which was introduced over 50 years ago, has also been well doc- umented [29]. In contrast, there are very few data on the long-term durability of endovascular aneurysm repair (EVAR), which was introduced as a new approach about 15 years ago [45]. [ABSTRACT FROM AUTHOR]

The indications of abdominal aortic aneurysm repair have been well defined in the UK Small Aneurysm Trial [52 ].Elective reconstruction can be offered with an accept- able morbidity and mortality rate.Occasionally however, the vascular surgeon is con- fronted with certain pathological or anatomical vari- ants, which may increase the risk of the operation.In this chapter a distinct pathological and anatomical entity is described, namely the inflammatory aneu- rysm of the abdominal aorta, which is characterized by a very thick wall and a dense fibrotic reaction envel- oping the aneurysm and the surrounding structures, leading to ureteral and even caval vein obstruction in a significant percentage of the cases. [ABSTRACT FROM AUTHOR]

This chapter will focus on how to deal with AAA from a practical point of view and also give hints on how to cor- rect some of the complications that may occur. The two principal options to treat AAA are by: (1) open repair or (2) endovascular aneurysm repair (EVAR). Both can be used irrespective of whether the AAA is ruptured or treat- ed electively, although the experience on EVAR in the case of rupture so far is limited. A third option, laparoscopic repair, can still be considered as non-established, and its role remains to be seen. It will not be further discussed in this chapter. Today there are no pharmacological means to treat AAA or reduce expansions, although α-blockade and antibiotics have been tried. A better understanding of the cause of AAA may, however, lead to other treatment options in the future. [ABSTRACT FROM AUTHOR]

Although problems and complications of aneurysm management have been recognized for nearly 4000 years, abdominal aortic aneurysm (AAA) was inaccessible to treatment until, in 1817, Sir Astley Cooper (1768-1841) made the first attempt to ligate the infrarenal aorta in a man with a leaking iliac aneurysm. The patient, however, succumbed 40 h after the operation. [ABSTRACT FROM AUTHOR]

Thoracic aortic trauma is a relatively rare but cata- strophic event.It may be secondary to several mechanisms: it can be seen after penetrating or iatrogenic trauma.The most frequent cause however is blunt trauma and this chapter will focus on this specific aetiological mechanism.Most of the patients have suffered automobile-related trauma and the associated mortality remains enor- mous.Therefore, thoracic aortic trauma is identified in the advanced trauma life support (ATLS) franchise as one of the eight "life-threatening chest injuries" in the so- called secondary survey.Diagnosis is based on clinical suspicion and techni- cal examinations such as spiral computed tomography, angiography and transoesophageal echocardiography.Classic treatment consists of open surgery, but endo- vascular stent-grafting is becoming more and more popular. [ABSTRACT FROM AUTHOR]

Aortic/arterial dissection means intramural haemor- rhage arising in most cases through an intimal lesion.It leads to the separation of wall components and false lumen formation.In certain cases multiple formations of false lumen may develop. [ABSTRACT FROM AUTHOR]

A thoracoabdominal aortic aneurysm is defined as a dilatation of the aorta involving the origins of the co- eliac, superior mesenteric or renal arteries.Crawford's classification system is universally accepted (Fig.4.1.1).Aneurysms arising proximal to the left subclavian or ending proximal to the level of the diaphragm should be classified as arch or descending thoracic aneurysms and are outside of the scope of this chapter.It is important to differentiate operations performed electively from those performed for acute dissection and free rupture, as mortality in these latter patients is higher. [ABSTRACT FROM AUTHOR]

The incidence of vascular trauma in general, and of upper extremity artery and vein lesions in particular, is unknown.Possible reasons for lack of data are: (1)death of indi- viduals before arriving at the hospital, or before ini- tiation of vascular repair; (2) failed diagnosis of blood vessel injury; (3) inadequate nationwide data collec- tion; and (4) national vascular registries based on data about procedures instead of underlying diagnosis.In a retrospective analysis, 3.3% of patients with upper extremity injuries admitted to a level I trauma centre in the USA were diagnosed to have concomitant arte- rial trauma [34].In patients with shoulder and elbow dislocations, symptomatic arterial injuries were present in 0.97% (axillary artery) and 0.47% (brachial artery), respec- tively [43].The anatomical distribution of vascular injuries from published European studies or vascular registries was recently summarized: the relative frequency of up- per extremity arterial injuries was 33%, almost half of them being located in the brachial artery [13]. penetrating traumas due to associated fractures and dislocations,and concomitant injuries to nerves and muscles, as well as delayed therapy because of initial misinterpretation of the injury. [ABSTRACT FROM AUTHOR]

Thoracic outlet syndrome (TOS) describes a variety of symptoms caused by compression of the brachial plexus or subclavian vessels at the thoracic outlet.In the majority of cases, symptoms are neurological with pain and weakness resulting from C8 or T1 root compression.Arterial or venous symptoms resulting from compres- sion are uncommon accounting for 5% of cases in a large published series [13]. [ABSTRACT FROM AUTHOR]

Raynaud's syndrome is named after Maurice Raynaud, who first identified it in 1862 [12].It is characterized by recurrent episodes of digital numbness, tingling and a skin tricolour sequence:pal- lor, cyanosis and rubor.Formerly subcategorized into Raynaud's disease and Raynaud's phenomenonRaynaud's disease is a benign form with no underlying diseaseRaynaud's phenomenon is an aggressive form, associ- ated with vascular collagen diseases or other concomitant processes.Nowadays patients tend to be currently diagnosed simply with Raynaud's syndrome, since long periods of time may elapse between the vasospastic episodes and any underlying first identifiable features of this condition. [ABSTRACT FROM AUTHOR]

Unlike the lower extremity, the upper extremity is less likely to be affected with occlusive disease (10%) [17]. Di- agnosis and treatment of upper limb occlusive disease is often difficult for the following reasons: Most of the lesions are asymptomatic until the appear- ance of trophic lesions.Only 2.8%of all vascular reconstructive techniques are applied to the upper extremity.One-third of the lesions are proximal and accessible to reconstructive or endovascular techniques while two- thirds are distal lesions, where treatment is considered to be a therapeutic challenge [18].Ischaemic problems in the upper extremity have many causes.Local,regional and systemic causes have been recognized.A precise aetiology is often difficult to es- tablish. [ABSTRACT FROM AUTHOR]

Carotid body tumour (CBT)ChemodectomaParagangliomas. [ABSTRACT FROM AUTHOR]

Endovascular treatment of carotid stenosis using carotid angioplasty and stenting (CAS) was first implemented ex- perimentally on dogs in 1977 [33]. Since the early 1980s there have been reports of its implementation, mainly on patients suffering from fibromuscular dysplasia [18] and, later on, on patients with atherosclerosis and post-endar- terectomy restenosis [34, 41,57]. Stenting was performed electively in order to treat possible dissection or residual stenosis after the angioplasty procedure. Later this tech- nique was abandoned to a routine stenting procedure. In 1986 Theron introduced a cerebral protection device using an occlusion balloon in the internal carotid artery (ICA) with simultaneous aspiration of possible microem- boli [54-56]. [ABSTRACT FROM AUTHOR]

Carotid artery aneurysm can be defined as a more than 50% localized increase of carotid calibre diameter when compared to reference values: Internal carotid: 0.55±0.06 in men and 0.49±0.07 in womenCarotid bulb: 0.99±0.10 in men and 0.92±0.0 in women.Unlike occlusive or ulcerated atherosclerotic lesions carotid aneurysms are quite uncommon, with very few cases reported in the literature, which influences the correct knowledge of the natural history of this entity.In 1808 Sir Ashley Cooper made history when he per- formed, at Guy's Hospital in London, the first success- ful treatment of a carotid aneurysm. The operation consisted of ligation of the common carotid artery, and the patient, a 50-year-old man, left the hospital after a 3-month period of recovery (because of a "smoulder- ing wound infection")[4,5].The patient died 14 years later from a cerebral haemorrhage.Through autopsy, Sir Ashley Cooper noticed that the haemorrhage was on the same side as the previous ca- rotid ligation, and there was a large posterior commu- nicating artery supplying collateral circulation to the ipsilateral middle cerebral artery.In 1936 Nathan Winslow and colleagues reported an exhaustive review of 124 cases published in the litera- ture. Surgical ligation of the carotid was the main ther- apeutical option (82 patients) with cure or improve- ment in 71%, and a mortality rate of 28%, while the conservative approach (42 patients) carried a mortal- ity of 71% with 12% cure or improvement [16].Ligation remained the main therapeutical option until the late 1960s, when direct arterial reconstruction and/ or autogenous vein grafting had definitely become the best surgical option irrespective of the aetiology.Since then several series have been published, such as those of McCollum and deBakey with 37 cases oper- ated in 20 years, representing 0.5% of all aneurysms performed in the same period [3].More recently El Sabrout and Cooley [2] published, in 2000, the largest single centre series of 67 carotid an- eurysms operated between 1960 and 1995.Nowadays endovascular techniques are being used particularly for lesions that are inaccessible to sur- gery. [ABSTRACT FROM AUTHOR]

Arterial fibromuscular disease encompasses a heteroge- neous group of nonatherosclerotic vascular occlusive and aneurysmal diseases. A principal forum of fibrodysplastic stenoses includes: Intimal fibroplasiaMedial hyperplasiaMedial fibroplasiaPerimedial dysplasia [2, 11, 17]. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy (CEA) is well established as a stroke-preventing treatment. Since the 1960s, two differ- ent techniques have evolved, namely conventional and eversion carotid endarterectomy, which is a modified ver- sion of the original method. 1.Conventional endarterectomy is the most common option for carotid bifurcation endarterectomy. It in- volves a longitudinal arteriotomy extending to the internal carotid distal to the lesion, and arteriotomy closure, which is made either using a patch or with pri- mary closure.2.The second technique is eversion endarterectomy, which was initially reported by De Bakey and later described by Etheredge, while a modification of the technique was presented by Kasprzak and Raithel in 1989 [4]. [ABSTRACT FROM AUTHOR]

Ischaemic stroke represents a major health problem and an important cause of morbidity and mortality in several western countries [12]. Mortality from stroke ranges be- tween 10% and 30% [61] and its survivors remain at a high annual risk of recurrent ischaemic events and mor- tality both from myocardial infarct and repeated stroke [76]. Atherosclerosis from supra-aortic vessels, especially from the common carotid bifurcation, is the major single aetiology of ischaemic stroke in developed countries as opposed to intracranial occlusive disease and cardioem- bolization. [ABSTRACT FROM AUTHOR]

The brain's ability to keep cerebral blood flow (CBF) rela- tively constant despite changes in systemic blood pressure (BP) is due to cerebrovascular autoregulation. The actual cerebral perfusion pressure (CPP) depends on the BP and the intracranial pressure (ICP). [ABSTRACT FROM AUTHOR]

Intraoperative assessment of technical adequacy is a nec- essary part of all arterial reconstructions. Detection of any technical imperfection in the operating room allows the surgeon to provide immediate correction of the abnor- malities that may lead to early thrombosis. Technical im- perfection accounts for about 2.4-26% of all failures ac- cording to different studies [6]. In the past most surgeons used to check the reconstruction through the palpation of a pulse in the vessel distal to the anastomosis; only later was continuous wave (CW) Doppler adopted, providing data on the physiology of the reconstruction (flow veloc- ity). Intraoperative angiography was introduced in the 1970s, thus providing information on the morphology of the by-pass. In recent years duplex scan and colour du- plex scan have been widely used, thus permitting us to check the reconstruction for its physiological and mor- phological parameters (vessel wall and lumen). [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) affects more than 10 million people in the United States. The risk factors as- sociated with PAD are similar to those for coronary heart disease (CHD) and cerebrovascular disease (CVD )[4,7]. Medical therapy of PAD must include modification of vascular risk factors with application of strict secondary prevention guidelines [7]. [ABSTRACT FROM AUTHOR]

In the last two decades the most crucial event in the evo- lution of vascular surgery has been the advent of endo- vascular techniques. [ABSTRACT FROM AUTHOR]

The vascular patient is at high risk of complications in the peri-operative period,due to the generalized nature of the atherosclerotic disease and other concomitant dis- eases.The aim of peri-operative care for the vascular pa- tient is to minimize the risk of complications by: careful pretreatmentperi-and postoperative monitoringoptimized anaesthesiapostoperative pain treatment. [ABSTRACT FROM AUTHOR]

The purpose of preoperative evaluation is to identify and, if necessary, implement measures to prepare higher risk patients for surgery. Preoperative evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries [4]. With the high likelihood of un- derlying coronary artery disease and the high degree of haemodynamic cardiac stress with profound alteration in heart rate, blood pressure, vascular volume, bleeding and clotting tendencies, vascular surgery represents an inter- mediate (1-5%)to high (>5%)mortality risk. [ABSTRACT FROM AUTHOR]

To diagnose vascular disease,physicians usually base their decision on clinical history and physical examina- tion of the patient, as well as visual inspection of medi- cal images. In some cases, confirmation of the diagnosis is particularly difficult because it requires specialization and experience, or even the application of interventional methodologies (e.g. arteriography). While advances in medical imaging technology have greatly contributed to early detection and diagnosis of vascular disease, the selection of patients to whom surgery is offered remains one of the most challenging tasks in the management of vascular disease. [ABSTRACT FROM AUTHOR]

Angiography is the most used invasive technique to study vascular disorders. It consists of the introduction of iodinated contrast material into the vascular system, through percutaneous direct injection or catheterization of the vessels, allowing its visualization by X-rays. It fol- lowed the discovery by Roentgen of the capability of us- ing radiation to visualize the bodily structures. [ABSTRACT FROM AUTHOR]