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Lymphatic Pathophysiology

In a narrow sense, the lymph circulation is a unidirectional vascular system that merely transports surplus tissue fluid back to the bloodstream. In a broader sense, however, this network stabilizes the mobile intercellular liquid and extracellular matrix microenvironment to ensure parenchymal cellular integrity and function. In its entirety, the lymphatic system is composed of vascular conduits: lymphoid organs, including the lymph nodes, spleen, Peyer patches, thymus,…

Venous Pathophysiology

Introduction The veins are complex “organs,” and much like arteries, are well suited to their physiologic purpose. Venous diseases represent a major concern in the general population and are influenced by genetics, environment, and acquired conditions. Understanding the basic physiologic and molecular responses to venous injury is essential for designing effective and safe therapies. Deep venous thrombosis (DVT) refers to the formation of one or more…

Arterial Hemodynamics

Introduction: The Physics of Arterial Flow Haemo : from ancient Greek α α ἱμο -(haimo-). Pertaining to blood. Dynamics : the branch of mechanics concerned with the motion of bodies under the action of forces. It differs from “kinematics”, which is concerned with the motion of bodies without regard to the forces that cause it. This chapter assumes knowledge on anatomy and composition of blood and…

Arteriogenesis and Angiogenesis

Peripheral arterial disease (PAD) of the limbs can progress to critical limb ischemia (CLI), characterized by rest pain and tissue loss, including nonhealing ulceration and gangrene. , The body compensates via neovascularization, either the formation of collateral circulation to bypass the obstructed vessel (arteriogenesis) or increasing capillary density (angiogenesis) to deliver oxygen and nutrients to ischemic tissue. Despite these responses, disease progression can lead to amputation,…

Ischemia-Reperfusion

Ischemia-reperfusion injury (IRI) is the biological equivalent of a well-executed 1-2 punch in boxing. It is best prevented in the first place; the less impactful the first punch, the better. Since the second punch builds on damage of the first punch, limiting ischemia time is mission critical. In IRI, the cells in the affected tissue beds are stunned and then starved by an ischemic state. The…

Intimal Hyperplasia

Intimal hyperplasia represents the healing response to vascular injury as well as the adaptive response to developmental or physiologic events. Injury induces a progressive structural change within the blood vessel lumen that begins with the disruption of endothelial barrier function and damage to the underlying medial smooth muscle cells, initiating platelet deposition and inflammatory changes. These changes begin a cascade of events that lead to smooth…

Atherosclerosis

Vascular surgeons care for a diverse set of clinical manifestations related to atherosclerosis, from transient cerebral ischemic attacks, strokes, aortoiliac occlusions, aortic aneurysms, mesenteric ischemia, to lower extremity arterial occlusive disease. However, despite the wide range of manifestations, culprit lesions are more alike than different. Accumulation of large amounts of cholesterol ester in the arterial wall and formation of complex advanced plaque are common to all…

Vessel Wall Biology

Complex organisms rely on the fluid, nutrient, and waste transport capabilities of the cardiovascular system, whose subdivisions each have unique structure and biology to perform crucial metabolic and mechanical functions. The arterial network reacts to hemodynamic forces through constriction or dilation and also via activation of signaling pathways. Its venous counterpart is an adaptable system, with unique mechanisms for accommodating the hemodynamic stresses of the body.…

Embryology and Developmental Anatomy

The fundamental purpose of the vascular system is to supply the organism with oxygen and nutrients, and to remove metabolic waste products. During the first three weeks of gestation, simple diffusion is sufficient to support the embryo; however, by the fourth week, a functional cardiovascular system must be in place to support the rapidly developing embryo. The cardiovascular system is one of the earliest systems in…

Epidemiology and Research Methodology

The goal of this chapter is to introduce to the vascular surgeon principles that underlie the design, conduct, and interpretation of epidemiology and clinical research. Disease-specific outcomes otherwise detailed in subsequent chapters are not covered here. Rather, this chapter discusses the history of epidemiology in medicine, clinical research methods in vascular care, and techniques in outcome analysis. This chapter serves as a foundation for clinicians to…

Brazil

Introduction For the purposes of this chapter, vascular trauma is considered in the following anatomic distributions, each of which has differing diagnostic and management considerations: (1) cervical or carotid, (2) axillo-subclavian, (3) thoracic, (4) abdominal, and (5) extremity domains. Whereas the majority of vascular injury is managed via an open operative approach, the use of endovascular techniques is common in the metropolitan centers throughout the country.…

South Africa

Region-Specific Epidemiology South Africa is a large country (1,200,000 km 2 ), with a population of about 60 million, of whom half live in the urban environment and half live in the rural environment. There is inevitably a wide difference in the availability of general and specialized medical care as a result. For many years, South Africa has had a background of violence. Some of this…

Israel

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Serbia

Introduction For many centuries a simple ligation was the main treatment option in patients with vascular injury. The first significant series of vascular reconstructions applied for the treatment of vascular injuries was published by Serbian surgeon Vojislav Soubbotich at the beginning of the 20th century. Namely, during the Balkan wars between 1912 and 1913, 60 false traumatic aneurysms and 17 traumatic arteriovenous fistulas were treated by…

Russia

Historical Background Russian surgeons have made significant contributions to vascular surgery. After Nikolai Pirogov, one of the founders of military surgery, investigated vascular trauma and published one of the first atlases on vascular anatomy, many Russian surgeons have contributed to the field of vascular trauma: the portocaval anastomosis by Nikolai Ekk (1877), a lateral arterial suture by Alexander Yassinovsky (1899), blood pressure “sounds” of Nikolai Korotkov…

Sweden

Introduction The management of severe traumatic injury has undergone major changes over the last 20 years, as Advanced Trauma Life Support (ATLS), the concept of damage control, massive transfusion protocols, new technological innovations, and improved intensive care have been implemented across the world. Even in the field of vascular trauma, there have been developments in hemostatic resuscitation and vascular damage control including the use of tourniquets,…

Vascular Trauma in Finland

Introduction Europe covers a land area of 10 million km 2 and has a population of 750 million people in 45 independent countries with a significant variability in the standard of living, culture, religion, ethnics, and politics. Despite a history of wars, the continent has seen long periods of peace and a gradual increase in wealth and stability. The European Union (EU) has 27 member countries…

Sri Lanka

Introduction In 2009 Sri Lanka emerged from a civil war which was mainly fought in the Northern and Eastern parts of the country and spanned 26 years. During this war, soldiers (and to a lesser degree civilians) in the conflict zones sustained injuries due to high-velocity gunshots, artillery, mortars, rocket-propelled grenades, and antipersonnel mines (APMs). Furthermore, people living in villages bordering the conflict zone, Colombo (and…