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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3710_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Preface
- •Contents
- •List of Invited Discussants
- •History
- •Physical Examination
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Procedure
- •Discussion
- •References
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Discussion
- •Reference
- •9: Secondary Aortoduodenal Fistula Following Abdominal Aortic Aneurysm Repair
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •12: Large Symptomatic Abdominal Aortic Aneurysm
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •History
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •History
- •Procedure
- •Discussion
- •References
- •History
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Procedure
- •Discussion
- •Reference
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •Reference
- •34: Infected Dacron Patch Following Carotid Endarterectomy
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •38: Intracerebral Hemorrhage Following Carotid Endarterectomy
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •40: Nonconvulsive Status Epilepticus Following Carotid Endarterectomy
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •45: Redo Aorto-bifemoral Graft
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •48: Infected Aorto-bifemoral Graft
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •50: Aorto-Bifemoral Grafting for Infrarenal Aortic Occlusion
- •Procedure
- •Discussion
- •Reference
- •51: Exposed Femoral Graft Following Multiple Arterial Reconstruction
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Patient A: Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •58: Repeat Femoral Posterior Tibial Bypass Using Spliced Cephalic Vein
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •Reference
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •The Ruptured Kommerell’s Diverticulum
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •Discussion
- •References
- •History
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •90: Iliac Stenting Complicated by Iliac Artery Rupture
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •96: Superior Mesenteric Artery In-stent Restenosis
- •Physical Examination
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •References
- •Procedure
- •Discussion
- •Reference
- •Procedure
- •Discussion
- •References
- •101: 100 Multiple Choice Questions
- •Part X Carotid Endarterectomy
- •Part XI Aortofemoral Grafting
- •Part XII Aortomesenteric Bypass
- •Part XIII Infrainguinal Arterial Bypass Graft
- •Part XX Thoracic Endovascular Aneurysm Repair
- •Part XXIII Carotid Stenting
- •Part XXIV Iliac Stenting
- •Part XXV Aortoiliac Stenting
- •Part XXVIII Renal Artery Stenting
- •Part XXIX Subclavian Artery Stenting
- •Part XXX Acquired Arteriovenous Fistula
- •Index

Challenging Arterial
Reconstructions
100 Clinical Cases
Sachinder Singh Hans
123

Challenging Arterial Reconstructions

SachinderSinghHans
Challenging Arterial
Reconstructions
100 Clinical Cases

SachinderSinghHans
Medical Director of Vascular and Endovascular Services
Henry Ford Macomb Hospital
Clinical Assistant Professor at Wayne State
University School of Medicine
Clinton Township
MI, USA
ISBN 978-3-030-44134-0 ISBN 978-3-030-44135-7 (eBook)
https://doi.org/10.1007/978-3-030-44135-7
© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
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neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword
The ultimate measure of a man is not where he stands
in moments of comfort and convenience, but where
he stands at times of challenge and controversy.
Challenging surgical cases test skills and judgment of the surgeon and put
limbs, organs, or the life of the patient in great danger. The true challenge for
the surgeon is to establish correct diagnosis, recognize potential problems in
advance, plan with care, and perform a successful operation with the least
risk and maximum benet to the patient, using hospital resources prudently
to achieve durable result. No matter how complex the situation looks, the
surgeon must stay calm, think with a clear mind, and nd the safest, simplest,
most effective way to solve the problem and proceed as planned.
Challenging Arterial Reconstructions: 100 Clinical Cases written by
Sachinder Hans reects the lifetime experience of a master surgeon. All 100
cases, just 6 with participation of colleagues, were performed by the author,
an exceptionally well-trained vascular and endovascular surgeon of a solo
vascular practice. A graduate of the renowned fellowship program of the
Beaumont Hospital in Royal Oak, MI, Dr. Hans currently works as the
Medical Director of Vascular and Endovascular Services, Henry Ford
Macomb Hospital, Clinton Township MI, formerly Chief of Vascular Surgery
at Ascension Macomb, Oakland Hospital (Macomb Campus), Warren, MI.
This book is a gold mine of interesting cases of a rich and exciting vascular surgery practice and reects expertise in almost the full spectrum of vascular and endovascular surgery. The chapters include difcult surgical
problems of patients with aortic, visceral, and peripheral arterial aneurysms,
with expert management of mycotic, inammatory, and ruptured aneurysms
and major complications like aortoduodenal stula, graft infection, or inferior vena cava injury. Open aortoiliac and extra anatomic reconstructions are
amply covered. The volume presents difcult cases of carotid artery surgery,
discusses management of carotid body tumors, and describes the rarely used
but helpful maneuver of mandibular subluxation.
There is ample evidence of an excellent surgical practice in this volume,
with 30-year follow-up of aortofemoral grafts, with description of tips and
techniques for lower extremity distal revascularization using spliced vein
grafts or tourniquet occlusions. The reader will nd information on how to
manage rare cases of popliteal adventitial cystic disease, popliteal arteriovenous stula, or venous aneurysm. More than a third of the chapters are
—Martin Luther King, Jr.
v

vi
dedicated to endovascular interventions, including stent-graft repair of elective, symptomatic, and ruptured aortic and iliac aneurysms, thoracic endovascular repairs, and stent grafting for popliteal artery aneurysms. Interventionists
will enjoy reading about carotid artery stenting in challenging patients, like in
those after radiation, with contralateral occlusion or following previous open
surgery. This book concludes with cases of infrainguinal endovascular reconstructions and visceral and renal stenting and the expert management of a
patient with arteriovenous stula of the axillary artery.
Some of the chapters are followed by insightful expert commentaries of
Dr. Charles W.Acher, Professor of Surgery at the University of Wisconsin
School of Medicine and Public Health. This book is nicely illustrated with
black and white and colored photographs of the procedures, with imaging
studies and drawings. The text is easy to read and is especially suitable for
short review, before embarking in a surgical or endovascular intervention of
a similar challenging case.
It is easy for me to recommend this book to all who just learn or regularly
perform open surgical or endovascular interventions. Keep in mind, however,
that your patient with a challenging problem relies on your judgment and
competence. If you feel you can treat your patient, proceed. If you need consultation of your colleagues or of other specialties, do not delay. If you feel
this challenge is beyond your expertise, refer the patient for appropriate care.
Remember what you signed up for as a physician: you are committed to take
care of your patient like you would want someone treat a member of your
family.
This collection of cases is testimony that there are many situations when
competent vascular specialists can appropriately handle even rare and challenging patients. In some cases, referral is not even an option because of
intraoperative problems requiring instant care, local issues, or long-distance
travel. For appropriate management of all these cases, this book will be
invaluable.
Peter Gloviczki, MD, FACS
Roberts Professor and Chair (Emeritus)
Division of Vascular and Endovascular Surgery
Mayo Clinic, Rochester, MN, USA
Editor in Chief, Journal of Vascular Surgery
Foreword

Preface
Lessons Learned from100 Challenging Arterial
Reconstructions
The unpredictability of vascular reconstructions is such that a very small
error in judgment in patient selection, or a technical error during execution of
open or an endovascular reconstruction, can lead to poor outcome. With that
in mind, 100 challenging cases encountered by the author since January 1980
through December 2019 are presented in this book. These cases have been
selected from the author’s vascular registry of 7000 vascular reconstructions
(endovascular and open). These reconstructions were primarily performed at
2 mid-sized (approximately 350 beds each) suburban teaching hospitals,
which are representative of the “real-world” experience of vascular surgery in
the United States. The selection of cases in this book was based on either difculty with case selection or complex operative or an endovascular technique. The natural history of vascular reconstructions often leads to secondary
reconstructions, which are far more complex and therefore are included in
signicant numbers in this text.
I am keenly aware that certain cases in this book may not appear to be of
a sufcient complexity to an experienced vascular surgeon, but to many
recent vascular surgery trainees, these challenging arterial reconstructions
will hopefully be valuable in their clinical practices. In this book, both and
good and unsatisfactory results have been included, and the lessons learned
from the poor outcomes are emphasized. Certain advanced vascular reconstructions (branched aortic endografts, open repair of Type II and Type III
thoracoabdominal aneurysm repair) were not within the purview of my
practice.
In order to keep uniformity in patient selection, technique, and postintervention care, the cases presented in this book were selected only from
my own vascular registry. Other treatment options selected by an experienced
vascular surgeon may have worked equally as well, and I do not profess that
my methods are the only way to have provided care for these patients. I am
thankful to many physicians who also participated in some aspects of the
patient’s care (Chaps. 1, 20, 41, 72, 80, 100).
Invited commentaries from leading experts in the eld have been added to
a few chapters offering an alternate viewpoint in the management of patients
with complex pathology. I am grateful to the contributors of the invited
vii

viii
commentary for submitting their comments in a timely manner and being
objective in their evaluation of the case management. Dr. Mary Lee, our Chief
Surgery Resident (starting vascular fellowship in 2020), was involved in
helping with multiple-choice questions (n100), and her contributions are
appreciated.
I am extremely grateful to my patients and their families for their patience
and understanding during some of the most trying times in their lives. I also
owe a sense of gratitude to the house staff, nursing personnel, and our vascular intervention lab for their immense contributions in care of our patients.
My special thanks to Connie Walsh, Lillie Gaurano, and Richard Hruska
(Springer) for their tireless help and support. My special thanks to Shagufta
Din for her strong work in getting the chapters transcribed timely and efciently. My wife, Dr. Bijaya Hans, an interventional radiologist, has been of
great help and inspiration during the completion of this book as it was taking
time away from the family.
I sincerely hope that this book will help vascular surgeons to learn from
my successes as well as my failures.
Clinton Township, MI, USA SachinderSinghHans
Preface

Contents
Part I Open Repair of Intact Abdominal Aortic Aneurysm
1 Symptomatic Proximal Anastomotic Pseudoaneurysm
of Suprarenal Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Invited Commentary from Charles W. Acher, MD . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 Repair of Juxtarenal Abdominal Aortic Aneurysm
with Aortorenal Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Invited Commentary from Timothy J. Nypaver, MD . . . . . . . . . . 12
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Abdominal Aortic Aneurysm Repair in a Patient with Celiac
Artery Occlusion and a Large Inferior Mesenteric Artery . . . 15
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Invited Commentary from Mitchell Ross Weaver, MD . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4 Abdominal Aortic Aneurysm Repair in a Patient
with a Pelvic Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Invited Commentary from Mitchell Ross Weaver, MD . . . . . . . . 21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
5 Open Repair of Abdominal Aortic Aneurysm in a Patient
with Double Inferior Vena Cava . . . . . . . . . . . . . . . . . . . . . . . . 23
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ix

x
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Invited Commentary from Graham W. Long, MD . . . . . . . . . . . . 25
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
6 Mycotic Aneurysm of the Abdominal Aorta . . . . . . . . . . . . . . . 27
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
7 Open Abdominal Aortic and Iliac Aneurysm Repair
in a Patient with Cirrhosis of the Liver . . . . . . . . . . . . . . . . . . . 31
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
8 Major Venous Injury During Repair of Abdominal Aortic
and Iliac Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
History and Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
9 Secondary Aortoduodenal Fistula Following Abdominal
Aortic Aneurysm Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 35
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Contents
10 Open Repair of an Inflammatory Abdominal Aortic
Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 39
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
11 Right Subhepatic Approach for Inflammatory Aortic
Aneurysm in a Patient with Scoliosis . . . . . . . . . . . . . . . . . . . . 43
History and Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . 43
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
12 Large Symptomatic Abdominal Aortic Aneurysm . . . . . . . . . . 47
Physical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
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