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Minimally Invasive Diaphragmatic Plication

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Paralysis or eventration of the diaphragm is a relatively uncommon problem in infants and children, but one that can cause significant respiratory distress. Eventration may be congenital in origin, or it may result from iatrogenic injury, either from birth trauma or from injury to the phrenic nerves during cardiac surgery. When there is significant…

Laparoscopic Operation for Choledochal Cyst

Access the accompanying videos for this chapter online. Available on ExpertConsult.com . Choledochal cyst is a traditional term representing a congenital dilatation of the biliary tract. Choledochal cysts are classified into five types: Type I Ia. Cystic dilatation of the choledochus Ib. Fusiform dilatation of the choledochus Type II: Diverticulum of choledochus Type III: Choledochocele Type IV IVa: Multiple cysts of the extra- and intrahepatic ducts…

The Rise of Modern Surgery:: An Overview

“If there were no past, science would be a myth; the human mind a desert. Evil would preponderate over good, and darkness would overspread the face of the moral and scientific world.” Samuel D. Gross (Louisville Review 1:26–27, 1856) The Beginnings From earliest recorded history through late in the 19th century, the manner of surgery changed little. During those thousands of years, surgical operations were always…

The Quality and Fidelity of Vascular Information on the Internet

Role of the Internet in Medicine The internet has become an essential medium of communication and a popular disseminator of verifiable and non-verifiable information. In recent times, it has replaced many in-person contacts within the healthcare sector. With the volume of information now freely published and available and topics easily searchable, patients are increasingly using the internet to locate providers, to seek to reduce costs, to…

Social Media in Vascular Surgery

Background History of Social Media Social media is defined as “forms of electronic communication through which users create online communities to share information, ideas, personal messages, and other content.” Early social networking websites can be traced back to the end of the 20th century with sites such as Classmates and SixDegrees, with expanding popularity in the early 2000s with Friendster and Myspace. However, the social media…

Internet-Based Surveillance of Vascular Disease and Reconstructions

Introduction Technology has transformed the delivery of healthcare, both in-person and remotely, over the past 30 years. The World Health Organization (WHO) defines telemedicine (TM) or telehealth (TH) as “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries,…

Telemedicine in Vascular Surgery Practice

Introduction Telehealth technologies offer opportunities to improve the access to vascular care and enhance continuity of care. Many vascular surgeons are already using store-and-send options to review CT images generated at distant hospitals to triage symptomatic aortic pathology. This capability allows referring physicians to access expeditiously the expertise of larger aortic centers. Recently, the COVID-19 pandemic forced all medical and surgical practices to adapt to telehealth…

Online Branding and Marketing a Vascular Surgery Practice

Introduction Marketing has shifted from being frowned upon and avoided, to being acceptable for building and maintaining a vascular surgery practice, to now becoming an essential. Increasing competition amongst vascular surgeons as well as physicians in other specialties, patient consumerism, growth of elective/ambulatory procedures, and presence of business entrepreneurs in healthcare services are all factors that necessitate marketing. Vascular surgery practices largely rely on patient referrals…

Health and Wellness for the Vascular Surgeon

Introduction The epidemic of physician burnout has been declared a public health crisis, and a growing focus for occupational intervention. Symptoms of burnout are particularly problematic among surgeons and surgical trainees in comparison to the general population (53% vs. 26%). Burnout is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and arises from a chronic disparity between people and their work setting.…

Improving Quality and the Value of a Vascular Registry to the Practice

Introduction Registries contain large bodies of information, generally collected in the course of routine clinical practice. The usefulness or value of that information depends on many issues but primarily whether it is used for a purpose consistent with the intent of the registry and whether the registry data are regarded as valid. This chapter summarizes the characteristics of registries, and examines how they might – or…

Alternative Payment Models in Vascular Surgery

Introduction Alternative payment models were introduced with the Quality Payment Program, which was established with the Medicare Access and Children’s Health Insurance Plan (CHIP) Reauthorization Act of 2015 (MACRA). Prior to MACRA, payments for Medicare services were set by the Sustainable Growth Rate (SGR). Under the SGR law, spending increases were capped in accordance with growth in the Medicare population with a modest allowance for inflation.…

Development and Operation of Outpatient Dialysis Access Centers

Introduction Hemodialysis is the perfect example of bioengineering being applied to medicine to preserve the life of the patient with an otherwise fatal disease. Unfortunately, the interface between the biomechanical mechanism in the patient, i.e., the vascular access, is defective. Problems related to the vascular access are a major cause of hospitalization of the dialysis patient, contribute approximately 20% of the cost of caring for these…

Development and Successful Operation of an Outpatient Vascular Center

Introduction Endovascular procedures have traditionally been performed in the hospital where the patient was observed overnight following the procedure; this gradually transitioned to the patient being discharged on the same day. Once the safety and efficacy of these procedures was established in the hospital-based setting, studies were conducted by multiple investigators that documented the safety, cost efficiency, and clinical efficacy of conducting endovascular procedures in a…

Development of a Multispecialty Practice and Operation of Multispecialty Cardiovascular Centers

Introduction A service line strategy has long been used by medical centers to counter inefficiency in provision of multidisciplinary care, improve quality, and capitalize on high-frequency diseases with well-reimbursed treatments. Common examples are neuroscience, cancer, and wound care services. The concept of a vascular service line has existed since World War II, and organized cardiovascular (CV) centers have existed in civilian hospitals since the 1980s. However,…

Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) is a nonatherosclerotic cause of claudication that is often referred to a vascular surgeon. As the name implies, it is exercise-induced leg pain that usually presents in young, active patients such as athletes and military personnel. Symptoms are generally confined to the compartment of the leg that is affected and are reproducible to timing, distance, and the intensity of exercise. History…

Vascular Reconstruction in Oncologic Surgery

Pancreatic Malignancies Pancreatic cancer is currently the fourth leading cause of cancer death within the United States with 56,770 new cases and 45,750 deaths estimated for 2019. Five-year survival remains poor at an estimated 10%. Improving long-term survival is therefore the goal of care, with surgery as a pivotal portion of multidisciplinary care. Preoperative surgical resectability can be classified as follows: unresectable (metastatic disease, encasement of…

Abdominal Vascular Tumors and their Management

Introduction Over the past 20 years, surgical treatment of primary and secondary malignancies involving the arteries and veins has become more aggressive. This is due in part to careful patient selection, improvement in surgical techniques and critical care, and the lack of curative adjuvant therapies. Diagnosis is rarely made at an early stage in which surgical resection would be broadly applicable. This chapter reviews patient selection,…

Current Role of Sympathectomy (Upper and Lower)

Introduction Cervical sympathectomy was first performed to treat a patient with hyperhidrosis by Kotzareff in 1920. Subsequently, Diez performed the first lumbar sympathetic chain ganglia resection to treat a patient with thromboangiitis obliterans (TAO) in 1924, and reported 100% success in treating 150 cases of upper limb TAO. Leriche in 1924 performed this procedure to treat Raynaud disease. Subsequently, open surgery evolved with a number of…

Complex Regional Pain Syndrome

Introduction Complex regional pain syndrome (CRPS) is a chronic pain condition, usually affecting an extremity and associated with inflammatory and autonomous changes. Pain can be spontaneous or induced by a specific stimulus, usually out of proportion to the inciting event, and associated with skin and soft tissue changes. CRPS is also commonly associated with motor and sensory changes leading to significant disability. Historically, the syndrome has…

Erectile Dysfunction

Acknowledgments We would like to gratefully acknowledge the assistance of Irwin Goldstein, MD, Director of Sexual Medicine at San Diego Sexual Medicine, Alvarado Hospital, San Diego, California, in providing us with images from selective internal pudendal arteriography and intraoperative photographs from his extensive experience with penile revascularization. Erectile dysfunction (ED) is defined as the recurrent or consistent inability to develop and/or maintain a penile erection sufficient…