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Primary and
Repeat Arterial
Reconstructions
Sachinder SinghHans
MitchellR.Weaver
TimothyJ.Nypaver
Editors
123
Primary and Repeat Arterial Reconstructions
Sachinder Singh Hans • Mitchell R. Weaver
Timothy J. Nypaver
Editors
Primary and Repeat Arterial
Reconstructions
Editors
Sachinder Singh Hans
Vascular and Endovascular Services
Henry Ford Macomb Hospital
Clinton Township, MI, USA
Timothy J. Nypaver
Henry Ford Hospital
Detroit, MI, USA
Mitchell R. Weaver
Henry Ford Hospital
Detroit, MI, USA
ISBN 978-3-031-13896-6 ISBN 978-3-031-13897-3 (eBook)
https://doi.org/10.1007/978-3-031-13897-3
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
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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 contained herein or for any
errors or omissions that may have been made. The publisher remains 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
There is no excuse today for the surgeon to learn on the patient.—Dr. William J.Mayo
During the last two decades, the endovascular revolution has transformed treatment of patients with vascular disease. Today, most vascular reconstructions are
performed percutaneously, using catheters, guidewires, balloons, stents, and stentgrafts. Open surgery, however, is here to stay, both as a primary and as a redo intervention, performed following failed open or endovascular procedures. Complications
of endovascular interventions are frequently dealt with open repair, and there is an
increasing number of hybrid procedures where open surgery is combined with an
endovascular intervention. Teaching open arterial reconstructions, however, has
been challenging, since they are less frequently performed today than just a few
years ago and some vascular surgeons who serve as mentors have inadequate experience with complex open surgical operations.
Arterial reconstructions require thorough planning and preparation, knowledge
of surgical anatomy and pathology, proper training, appropriate indication, highquality preoperative imaging studies, perfect surgical technique, and correct postoperative care. To achieve success, this book of Sachinder Singh Hans and colleagues
from the Henry Ford Hospital and the University of Michigan offers invaluable help
to both a novice and an experienced vascular surgeon.
The 38 chapters of this well-constructed volume cover all major primary and
redo open arterial reconstructions performed from the base of the skull to the dorsum of the foot. It focuses on surgical techniques and uses beautiful color illustrations to explain details of the interventions, including dissections, vascular clamping,
performance of endarterectomy, placement of grafts, vascular closures and anastomoses, and closure of the wound. Each chapter lists the surgical instruments, suture
materials, and vascular grafts or patches used during the procedure.
Read and reread these chapters, keeping in mind that reading is an integral part
of the learning process. But also remember what Dr. Will Mayo once said, “see
things for yourself; reading alone is not enough.” Seize any opportunity to assist or
watch your mentor or an experienced surgeon perform these operations and consult
collections of the Journal of Vascular Surgery or of your society looking for
v
vi
Foreword
peer-reviewed surgical videos. In addition, practice your technique at home or in a
simulation lab, and learn how to cut tissues, tie knots, and best suture blood vessels.
Denton Cooley, one of the most dexterous cardiovascular surgeons, recommended
to “get a scalpel and practice just, say, cutting a piece of meat” and “learn how you
want to hold your ngers” and “try to become graceful when you operate.” The end
result will fully justify the time you spent with the learning process.
Few interventions provide a satisfaction that surpasses a beautifully performed
and well-functioning arterial reconstruction. With the expert descriptions and
detailed illustrations, this practical atlas guides you from the basic to the most
sophisticated primary and redo open arterial reconstructions. Use this volume to
learn or refresh your memory before an operation and remember what Will Mayo
once said: “There is no excuse today for the surgeon to learn on the patient.”
Division of Vascular and Endovascular Surgery PeterGloviczki
Mayo Clinic
Rochester, MN, USA
Preface
Over the last three decades, the rapid growth of endovascular techniques used in
managing patients with both aneurysmal and arterial occlusive disease has led to a
signicant decline in the number of open arterial reconstructions performed in the
United States. Even as endovascular options supplant open arterial procedures, it
seems unlikely that open arterial reconstructions will ever disappear. Open arterial
reconstructions and operations remain condently within the domain of the practicing vascular surgeon, and the ability to offer an open therapeutic solution to the
patient’s problem, often in the setting of failed or complicated prior endovascular
procedures, is what sets the vascular surgeon apart from other interventional colleagues. New graduates of vascular surgery training programs may have limited
case volume exposure to some open operations and will hopefully nd the operative
steps detailed in this book essential prior to undertaking a potentially technically
challenging open arterial procedure.
We have chosen to highlight the technical steps involved in what we considered
as standard open arterial procedures, focusing on the indications for the operation as
well as the surgical anatomy, the operative steps, and the recognition and management of potential intraoperative complications. There is purposeful limited discussion involving historical aspects of disease management, disease presentation,
methods of diagnosis, results, or alternative surgical or endovascular therapies. This
practical and illustrated guide emphasizes the technical steps and potential operative missteps not only for primary arterial reconstructions, but also for those associated with more complex repeat or redo procedures. To preserve uniformity in the
approach of patient management, most authors were drawn from Henry Ford
Hospital’s vascular surgery program. We wish to thank all the contributors for their
help in the timely completion of the manuscript. We are also indebted to the publishing staff at Springer—Richard Hruska, Lillie Gaurano, Vijayasankra Gomathy
Rajagopal, and Dhanapal Palanisamy—for seeing through to the book’s completion.
Bloomeld Hills, MI, USA SachinderSinghHans
Detroit, MI, USA MitchellR.Weaver
Detroit, MI, USA TimothyJ.Nypaver
vii
Contents
1 Basic Arterial Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Sachinder Singh Hans
Part I Open Repair of Aneurysmal Disease
2 Open Repair of Descending Thoracic Aortic Aneurysm . . . . . . . . . . . 23
Pieter A. J. van Bakel, Yunus Ahmed, and Himanshu J. Patel
3 Open Repair of Juxtarenal and Infrarenal Abdominal Aortic
Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Sachinder Singh Hans
4 Paravisceral Abdominal Aortic Aneurysm Repair . . . . . . . . . . . . . . . 51
Alexander D. Shepard
5 Open Thoracoabdominal Aortic Aneurysm Repair . . . . . . . . . . . . . . . 61
Mark F. Conrad and Srihari K. Lella
6 Inflammatory Abdominal Aortic Aneurysm . . . . . . . . . . . . . . . . . . . . 81
Sachinder Singh Hans
7 Repair of Aortoenteric Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Timothy J. Nypaver
8 Open Repair of Ruptured Abdominal Aortic Aneurysm . . . . . . . . . . 97
Sachinder Singh Hans
9 Endovascular Aortic Stent Graft Explantation . . . . . . . . . . . . . . . . . . 107
Loay Kabbani, Khalil Masabni, and Timothy J. Nypaver
10 Open Repair of Splanchnic Artery Aneurysms . . . . . . . . . . . . . . . . . . 117
Sachinder Singh Hans
11 Renal Aneurysm Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Abdul Kader Natour and Alexander D. Shepard
ix
x
Contents
12 Femoral and Femoral Anastomotic Aneurysms . . . . . . . . . . . . . . . . . . 141
Sachinder Singh Hans
13 Popliteal Artery Aneurysm Repair Primary and Recurrent . . . . . . . 153
Mitchell R. Weaver
14 Extracranial Carotid Artery Aneurysms . . . . . . . . . . . . . . . . . . . . . . . 163
Sachinder Singh Hans
15 Subclavian Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Mitchell R. Weaver
16 Axillary and Brachial Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Farah Hanif Ali Mohammad
Part II Open Arterial Reconstructions for Arterial Occlusive Disease
17 Carotid Endarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Sachinder Singh Hans
18 Carotid Endarterectomy for High Plaque . . . . . . . . . . . . . . . . . . . . . . 203
Sachinder Singh Hans
19 Carotid Interposition Graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Sachinder Singh Hans
20 Redo Carotid Endarterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Sachinder Singh Hans
21 Vertebral Artery Reimplantation into the Common
Carotid Artery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Sachinder Singh Hans
22 Carotid Subclavian Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Timothy J. Nypaver
23 De-branching Operations on Supra-aortic Trunk . . . . . . . . . . . . . . . . 237
Timothy J. Nypaver
24 Brachiocephalic Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Mitchell R. Weaver
25 Aortofemoral Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Alexander D. Shepard
26 Thoraco Femoral Bypass for Aorto Iliac Occlusive Disease . . . . . . . . 271
Iraklis I. Pipinos and Sachinder Singh Hans
27 Mesenteric Artery Bypass and Reconstruction . . . . . . . . . . . . . . . . . . 279
Timothy J. Nypaver
28 Aortorenal Bypass and Renal Artery Reconstruction . . . . . . . . . . . . . 291
Kaitlyn Dobesh and Timothy J. Nypaver
Contents
29 Crossover Femoral-Femoral Bypass Graft and Iliofemoral
Bypass Graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Alice Lee
30 Axillo-Femoral Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Alice Lee
31 Iliac and Femoral Artery Endarterectomy . . . . . . . . . . . . . . . . . . . . . . 313
Farah Hanif Ali Mohammad
32 Femoral-Popliteal Bypass Graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Abdul Kader Natour and Loay Kabbani
33 Femoral-Infrapopliteal (Crural and Paramalleolar)
Bypass Graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Sachinder Singh Hans
34 Upper Extremity Artery Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Farah Hanif Ali Mohammad
35 Arterial Reconstructions in Patients with Hostile Groin . . . . . . . . . . 353
Sachinder Singh Hans
Part III Amputations
36 Lower Extremity Major Amputations . . . . . . . . . . . . . . . . . . . . . . . . . 365
Chinmayee Potti and Andi Peshkepija
xi
Part IV Misscelanous
37 Carotid Body Tumor Resection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Mitchell R. Weaver
38 Multiple-Choice Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Sachinder Singh Hans and Alexander D. Shepard
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
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