Peripheral and Cerebrovascular Intervention draws upon experts from diverse fields to provide readers with a comprehensive foundation for understanding and performing endovascular procedures-from the basic steps to the most current and advanced techniques. Individual chapters focus on primary intervention sites, including lower extremity, renal/mesenteric, subclavian/upper extremity, carotid/vertebral, intracranial and venous interventions. Additionally, chapters covering critical limb ischemia and abdominal and thoracic aortic aneurysms are included. By incorporating valuable clinical information, such as indications, contraindications, complications and discussions of surgical techniques and procedures, this book is a valuable resource for the busy practitioner and will be of interest to all interventional and general cardiologists, radiologists and neurologists; vascular surgeons; internists and residents and fellows.

This new edition of Vascular Interventional Radiology: Current Evidence in Endovascular Surgery provides a thorough yet succinct and accessible review of the latest knowledge in the field of endovascular surgery. All chapters have been updated to reflect the advances that have occurred during the past five years, and new chapters are included on carotid artery stenting and day case intervention. The chapter on lower limb veno-occlusive disease has been expanded to include management of deep venous thrombosis. Among the other topics considered are the endovascular treatment options in different arterial territories, aneurysm repair techniques, and the management of venous stenosis and venous insufficiency. The aim throughout is to tackle issues of evidence-based practice in order to assist trainees and experienced practitioners in making and implementing treatment decisions. This book will be an invaluable source of information for both interventional radiologists and vascular surgeons with an interest in endovascular techniques.

Cardiovascular fluid mechanics is now used as a tool in determining diagnosis, treatment, and prognosis by physicians and surgeons working in the fields of cardiology and angiology. The text is based on a considerable amount of clinical and experimental data on blood flow in the heart and large vessels obtained using various methods such as ultrasound pulsed Doppler velocimetry (including Doppler color flow imaging), catheter-tip electromagnetic velocimetry, hot-film anemometry, and laser Doppler velocimetry. The book will introduce medical researchers and clinicians to this rapidly developing field and allow them to apply the knowledge and the methods of fluid mechanics to practical medicine.

The current textbooks for specialists are too detailed. This book will be a handy pocket guide for trainee vascular radiologists, and will serve as an aide-memoire for senior vascular radiologists. Each procedure will be shown in its entirety. Rather than being a library purchase, this book will be a handy and accessible guide for quick reference aimed at clinical interventional radiologists in multidisciplinary staff rooms and angiography suites.

Membrane Receptors, Channels and Transporters in Pulmonary Circulation is a proceeding of the 2008 Grover Conference (Lost Valley Ranch and Conference Center, Sedalia, Colorado; September 3-7, 2008), which provided a forum for experts in the fields of those receptors, channels and transporters that have been identified as playing key roles in the physiology and pathophysiology of the pulmonary circulation. The book rigorously addresses: i) recent advances in our knowledge of receptors, channels and transporters and their role in regulation of pulmonary vascular function; ii) how modulation of expression and function of receptors, channels and transporters and their interrelationships contribute to the pathogenesis of pulmonary vascular disease; and iii) the therapeutic opportunities that may be revealed by enhancing our understanding of this area. The overall goal was to explore the mechanisms by which specific receptors, channels and transporters contribute to pulmonary vascular function in both health and disease, and how this knowledge may lead to novel interventions in lung dysplasia, pulmonary edema, lung injury, and pulmonary and systemic hypertension to reduce and prevent death from lung disease. Membrane Receptors, Channels and Transporters in Pulmonary Circulation is divided into six parts. Part 1 (Ion Channels in the Pulmonary Vasculature: Basics and New Findings) is designated for basic knowledge and recent findings in the research field of ion channels in pulmonary circulation. There are five chapters in Part I discussing the function, expression, distribution and regulation of various ion channels present in pulmonary vascular smooth muscle cells and how these channels are integrated to regulate intracellular Ca2+ and cell functions. Part II (TRP Channels in the Pulmonary Vasculature: Basics and New Findings) is composed of five chapters that are exclusively designed to discuss the role of a recently identified family of cation channels, transient receptor potential (TRP) channels, in the regulation of pulmonary vascular tone and arterial structure. Part III (Pathogenic Role of Ion Channels in Pulmonary Vascular Disease) includes four chapters that discuss how abnormal function and expression of various ion channels contribute to changes in cell functions and the development of pulmonary hypertension. Part IV (Receptors and Signaling Cascades in Pulmonary Arterial Hypertension) consists of five chapters devoted to the role of bone morphogenetic protein receptors, Notch receptors, serotonin receptors, Rho kinase and vascular endothelial growth factor receptors in the development of pulmonary arterial hypertension. Part V (Receptors and Transporters: Role in Cell Function and Hypoxic Pulmonary Vasoconstriction) includes four chapters designed to illustrate the potential mechanisms involved in oxygen sensing and hypoxia-induced pulmonary vasoconstriction and hypertension. Part VI (Targeting Ion Channels and Membrane Receptors in Developing Novel Therapeutic Approaches for Pulmonary Vascular Disease) consists five chapters which discuss the translational research involving on membrane receptors, channels and transporters, including their potential as novel drug targets. We hope that Membrane Receptors, Channels and Transporters in Pulmonary Circulation will allow readers to foster new concepts and new collaborations and cooperations among investigators so as to further understand the role of receptors, channels and transporters in lung pathophysiology. The ultimate goal is to identify new mechanisms of disease, as well as new therapeutic targets for pulmonary vascular diseases. An additional outcome should be enhanced understanding of the role of these entities in systemic vascular pathophysiology, since the conference will include researchers and clinicians with interests in both pulmonary and systemic circulations.

One of the most outstanding achievements in contemporary surgery has been the development ofmicrosurgery and its c1inical application. Early in 1960s, the Shanghai Sixth People's Hospital began to research and practise the replant- ation of severed limbs and has hence been acc1aimed as the cradle of replant- ation surgery in China. Succeeding Dr. Chen Zhong-wei, Dr. Yu Zhong-jia has led the Department of Orthopaedic Surgery to continue ploughing and weeding diligently in the field of microsurgery of the extremities and has made, in both reconstructive and reparative microsurgery, great advances that have attracted world attention. I used to be the scientific advisor of this hospital and have therefore followed c1ose1y what has been achieved there. A well-known orthopaedist and microsurgeon, Dr. Yu Zhong-jia is adept in using the present advanced techniques to solve difficult problems which re- mained unsettled in spite of predecessors' repeated earlier attempts, and his own scientific research is always directed by the imperative needs of his patients. The results of his research thus not only attain a high technical standard, but are also rich in practical value. Dr. Yu was the the first surgeon in the world to trans plan ted autogenous toes to the amputated forearm stump, with a metallic artificial metacarpus as the connection, reconstructing a new hand with sensibil- ity and movability afterwards eulogized by foreign friends as the "China Hand".

The aim of this book is to focus on the important relationships between the heart and the brain in health and disease. The brain and nervous system may cause or influence heart disease, e. g. , by causing arrhythmias or modi- fying the response to ischemia. Disorders of the heart and circulation may cause brain damage, e. g. , by releasing emboli resulting in cerebral infarc- tion. Furthermore, both the brain and the heart are frequently targets of the same disease process. The heart and brain have electrophysiologically active cells, which may respond in similar ways to diseases and various interventions. Finally, many drugs affect both the brain and the heart, and drugs used for heart diseases usually have side effects on the brain and vice versa. With today's increasing subspecialization in medicine, we feel the time has come to present a book that integrates basic and clinical aspects of cardiology, neurology, cardiovascular surgery, and neurosurgery. We hope this cross fertilization will broaden horizons and advance both understand- ing and practice. This book is based on a symposium held at the University of TromS!/l, Norway, 24-27 June 1987, organized by Ilmar A. Sulg, Knut Rasmussen, Svein Ivar Mellgren, Dag S!/lrlie, and Helge Refsum of the Departments of Clinical Neurophysiology, Medicine, Neurology, Surgery, and Physiology, respectively. Weare grateful to the distinguished group of contributors for not only outlining their pioneering studies, but also describing their recent work and indicating important possibilities for the future.

Abdominal Wall Hernias is the most up-to-date, comprehensive reference available on all aspects of hernia repair. It includes state-of-the-art approaches to conventional open repairs using tissue-to-tissue techniques, the use of prosthetic mesh, minimally invasive approaches, the repair of recurrent and massive hernias, pertinent anatomy, basic science, and emerging biomaterials. The authors present a full spectrum of procedures to enable readers to gain a broad knowledge of the multifaceted repair of hernias. Richly illustrated, this book is a vital resource for all general surgeons and surgeons-in-training.

Occult atherosclerotic diseases impose great challenges in the cardiovascular practice. Although their pathology is not much different from that of the overt group of diseases, the clinical approach to their diagnoses remains a puzzle. This has mainly emerged as a result of the problems faced in trying to pick up the vulnerable subjects from among the general public. More definitive candidates to be evaluated are those belonging to one of the high risk groups. There are no statistical figures available on the incidence of occult atherosclerotic disease in the "non risky" general public and this is definitely an area that needs further investigation. Atherosclerotic disease whether they are in the cerebral, coronary, renal or lower limb arteries are theoretically interrelated because the basic patho logical changes are usually similar. However there still remain some differ ences which are mainly due to variation in the flow pattern in the arteries. Thus it will be important clinically and from the management point of view to investigate for the presence of occult disease in other arteries if an atherosclerotic disease in a certain artery has been discovered. This approach is of a great significance especially from the preventive point of view in order to avoid catastrophic events which may have resulted from pathology in the other region."

From the Foreword by Eric J. Topol In the past five years, interventional cardiology has entered a new era of evaluating percutaneous transcatheter technologies to treat coronary artery disease and prevent restenosis. Cardiologists attempting to follow this new and exciting field may easily be confused by the growth and expansion of new devices, the technical details relevant to each device and enthusiastic claims of success. This monograph is a comprehensive and objective assessment of restenosis from the perspective of these new technologies including stenting, atherectomy, rotational abrasion and lasers, written by innovators and pioneers. The international breadth of experience is reflected in the summary of experiences from both sides of the Atlantic, at times with conflicting observations and results which in itself is valuable, given the diverse experience to date. In addition to the lucid summaries of the early and late results of these new devices, important issues in the methodology of restenosis research are addressed, including limitations of quantitative coronary arteriography in evaluating the new devices and important advances in alternatives to arteriography such as intravascular imaging. As a whole, this monograph is exceptionally worthwhile owing to its complete, up-to-date, balanced and visionary elements. There is no question that the new coronary device era has ushered in some excitement, and some despair. This book serves a pivotal purpose by weaving so many new concepts together, establishing the groundwork for further development of mechanical approaches to limit restenosis. I heartily recommend this text to all interventional cardiologists interested in practical and research aspects of restenosis.

Leading heart surgeons (including the President of the Royal College of Surgeons) bridge the ever-widening gap between the "student" (both pre- and post-graduate) and an increas- ingly remote group of medical and surgical specialists in this , the only book devoted entirely to the established principles of cardiac diagnosis.

A number of exciting new developments have occurred during the last few years concerning the platelet-vessel wall interaction. Although they may be obvious and clear to the specialist in the field, for the clinician the area has become rather confusing. Time has come to review current knowledge on the pathophysiology of the platelet-vessel wall interaction and show how this knowledge can constitute the rationale for pharmacotherapeutic interventions. A symposium was organized in Antwerp during which a number of outstanding speakers gave an overview of what is new on a particular topic and how this information can be translated to possible clinical applications. The proceedings of the symposium are not only of interest to the practising physician, but contain enough new fundamental data to be of use for all those who are interested in the role of platelets in the etiopathogenes ofcardiovascular diseases. Arnold G. Herman Antwerp, July 1-991 vii ListofContributors A.G. Herman DepartmentofPharmaceutical Sciences M.R. Buchanan University Hospital DepartmentofPathology Universiteitsplein I McMaster Clinic B-261O ANTWERP (Wilrijk) Hamilton General Hospital Belgium 237 Barton Street East HAMILTON, Ontario G. Homstra Canada L8L 2X2 DepartmentofHuman Biology UniversityofLimburg Co-author: SJ. Brister P.O. Box 616 6200MD MAASTRICHT J.-P. Cazenave The Netherlands Regional Centre ofBlood Transfusion 10, Rue Spielmann J.F. Martin F-67085 STRASBOURG Cedex Department ofMedicine France King's College School ofMedicine and Dentistry Co-authors: C. Gachet and F. Lanza LONDON SE5 9PE U.K.

The efficiency of carotid surgery on an asymptomatic carotid artery stenosis and its superiority to conservative treatment was clearly demonstrated in the ACAS study. The stroke risk over a five year follow-up period could be reduced by 55 % and the combined stroke and mortality rate was shown to be a mere 2. 3 %. The efficacy of surgical treatment in also reducing stroke rates in the case of a symptomatic carotid stenosis was proven in the NASCET and ECTS prospective randomized studies. Of extreme importance in these procedures is, however, precise quality control and quality assessment. This is presently a topic of tremendous interest in reconstructive vascular surgery and is constantly being discussed in specialist circles and beyond. Documentation and the possibility of accurate reconstruction of the intraoperative situation are in high demand. Perioperative monitoring of neurological function, particularly the monitoring during carotid surgery, are the aspects underlying constant revision and reassessment to ensure quality control and assurance of a negligeable mortality and morbidity rate. The aim of this book is to discuss the presently available perioperative control methods, examinations, and quality assessments, and the critical consideration of these. We would like to express our thanks to all authors who helped achieve the sense and aim of this book. A special word of thanks to Dr. Kerstin Simons (assistant surgeon) for assisting in the editing of the numerous presentations in this book. Particularly we thank Dr.

This book discusses contemporary features of ject, creating, therefore, a lacuna the could be diagnosis of endocrine diseases using the filled by this project. radiologic technique of percutaneous venous This book is intended to be a practical guide blood sampling for hormone assay. A compre- for vascular and interventional radiologists, in- hensive survey of the field is provided by the ternists, surgeons, endocrinologists, and other contributing authors, who have considerable physicians who care for patients with endocrine expertise in the subject. Some have published diseases. The intention is to provide a practical several articles in the literature; others have text covering anatomical data, clinical prob- extensive clinical experience. lems related to the diagnosis of the endocrine The approach to many of the endocrine dis- diseases, patient preparation for the sampling, eases has been markedly improved ~uring the blood sampling techniques, sample manipula- last two decades because of selective venous tion and storage, laboratory data, and clinical blood sampling, not only in the diagnosis of the significance of the hormone sampling and condition but especially in the precise localiza- assay. tion of the hormone-producing lesion and its clinical significance. Scattered informationbn venous blood sam- pling is available in the literature, but there is Renan Uftacker no comprehensive text dealing with the sub- Reingard Sorensen Contents Preface v Contributors xi 1 Selective Venous Sampling for the Differential Diagnosis of Female Hyperandrogenemia 1 Lathar Moltz and Reingard Sorensen Introduction ...1 Diagnostic Procedures ...2 Indications ...4 Anatomy and Anatomical Variations...

This must-have manual for surgical residents and vascular surgery trainees is copiously illustrated with more than 250 original line drawings. The author presents in a step-by-step fashion the techniques for all common vascular reconstructions, basics of exposure and access, as well as invaluable technical pearls and tips. The text provides the surgical trainee with the opportunity to review and practice the necessary vascular reconstructions before entering the operating room. The illustrations and clear instructions make this a manual that is referred to again and again throughout the surgical residency.

Cardiac surgery has developed dramatically since the first open-he art operations were performed in the mid 1950s. Although the improvement of surgical technique, extracorporeal circulation, and postoperative management has contributed to a marked reduction of morbidity and mortality, the development of cardiac surgery to its present state would not have been possible without blood substitution by homologous donor blood. Only 20 years ago, open-heart operations required an average of 8 units of blood preserves. The excessive need of donor blood in those early days was mainly due to premature surgical technique, insecure control of anticoagulation, severe blood trauma by extracorporeal circulation, and the lack of retransfusion technologies that would have allowed the reuse of shed mediastinal blood. The introduction of new technologies, such as normovolemic hemodilution, in traoperative autotransfusion, postoperative return of shed mediastinal blood, and predonation of autologous blood has greatly reduced donor blood requirements. At present the majority of routine coronary artery surgical procedures can be performed without any blood transfusion. Blood loss, however, may be considerable in patients undergoing complex valve surgery or reoperations, as they often require several units of transfused blood. Blood conservation has now become an area of major interest for the cardiac surgeon. This increased concern is caused by infectious complications of blood transfusion, in particular hepatitis and, more recently, AIDS."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was first discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbiihl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume.

The International Symposium on Ischemic Mitral Incompetence was held December2-4,1988 at the Intercontinental Hotel, Berlin . It wasorganized bythe German Heart Center Berlin with the primary aim to bring together experts interested in the subject of ischemic mitral regurgitation. Our intention was to face the problems associated with diagnosis and treatment of mitral incompetence resulting from coronary artery disease. A "work-up" of the whole topic from its basic, diagnostic, and surgical aspects wasinitiated. In the first section weconcentrate on the basic anatomical and pathophysiological knowledge, as well as on experimental work. In the second section cardiologists report on inci- dence of ischemic mitral incompetence, diagnostic methods that include esophageal echocardiography, follow-up studies of medical- and surgical-treated patients. This section considers interventional therapy in acute myocardial infarc- tion, as well. The third section includes contributions by cardiac surgeons with many years' experience in operative treatment of ischemic mitral incompetence including the decision-making criteria for non-mitral valve surgery, and for valve reconstruction or replacement.

Professor George Fegan is a world authority on the use of sclerotherapy for the treatment of varicose veins. His technique for injecting varicose veins is regarded by many to be the best method for achieving success with sclerotherapy. Professor Fegan first published his method in 1963. This book is an update to his previous work and describes his method step by step as well as relevant information on the anatomy, physiology, pathology and investigations of varicose veins. Sclerotherapy is finding its place as an effective weapon in the phlebologist's armamentarium, and its indications are becoming clearer. All involved in the care of patients with venous disease will find this an invaluable read.

A pioneering group of authors describes in this book, for the first time, the state of the art of spinal cord stimulation for chronic critical limb ischemia. This method, a progeny of pacemaking in cardiac rhythm disorders, is a promising, innovative procedure; it presents a modern challenge in treatment of endstage peripheral vascular disease or neuropathic pains. Spinal cord stimulation may have a tremendous future if it further develops to become a standard treatment in special indications.

Posttraumatic stump formation and replantation of the severed limb are both reconstructive plastic operations which may lead to the improvement or destruction of a patient's lifestyle. For the primary attending surgeon, the decision whether to undertake such an operation depends on the patient's clinical condition, the operational circumstances, the psychological and social aspects and, last but not least, on the surgeon's own abilities. This monograph is designed as a synopsis of the great number of patho-physiological parameters and surgical and rehabilitational aspects which must be considered in the analysis of complications in major limb replantation. In addition, basic information about the key role of ischemic myopathy and microangiopathy is supplied to encourage further experimental investigations.

Despite a worldwide reduction in its incidence, stroke remains one of the most common diseases generally and the most important cause of premature and persistent disability in the industrialized countries. The most frequent cause of stroke is a localized disturbance of cerebral circulation, i.e., cerebral ischemia. Less common are spon taneous intracerebral and subarachnoid hemorrhages and sinus ve nous thromboses. The introduction of new diagnostic procedures such as cranial computed tomography, magnetic resonance imaging, digi tal subtraction radiologic techniques, and various ultrasound tech niques has led to impressive advances in the diagnosis of stroke. Through the planned application of these techniques, it is even possible to identify the pathogenetic mechanisms underlying focal cerebral ischemia in humans. However, these diagnostic advances have made the gap between diagnostic accuracy and therapeutic implications even greater than before. This fact can be easily explained. In the past, therapeutic studies had to be based on the symptoms and temporal aspects of stroke; it was impossible for early investigations to consider the various pathogeneses of cerebral ischemia. Inevitably, stroke patients were treated as suffering from a uniform disease.

Direct surgery on arteries was born at the turn of the nineteenth and twentieth century. However, it was only during the last twenty-four years, that this new chapter of clinical surgery could be weil established, owing to diverse kinds of minds and hands. The result is that limbs, organs, functions, and lives have since then been saved in increasing numbers. We may now consider that the main impulse of this new phase is over. But the material of wh ich the chapter was built is still defective, incomplete, or inadequate, and therefore surgeons and many other men will still have to spend a lot of sagacity and vigour to give this chapter its proper arrangement. Principles evolve, methods are modified as a result of technical progress, surgeons' solid opinions on a particular matter give way to other distinct but equally solid opinions on the same matter. These are the reasons why the moment we are living in is a wonderful one. As always in Iife, the great flame burns more intensely when one finds himself at the verge of attaining so me proposed design. The first phase of dream and failure has given way to a more structured ground on wh ich the final battle must be fought. Such a battle is taking place right now.

This book represents the first European effort to provide a collection of test descriptions used in evaluation of the compatibility of biomaterials in contact with tissues and blood. The urge to compile this book arose from the fact that it is the properties of the material which ultimatively seem to determine the functional outcome of a medical device, almost regardless of how ingenious the construction of the very device is. The longer the exposure is, the more important these basic properties become. Unfortunately only a small part of the interactive phenomena is fully elucidated and understood. This challenge reflects itself in an effort to cover numerous aspects of testing, beginning with fundamental analysis of the material, continuing with the mechanical properties, the resistance to degradation and the analysis of surface and chemical properties including adsorption patterns of proteins ending with test on cell cultures, ex vivo and in vivo. A number of the tests which are generally accepted as being important are already described as official requirements (primarily Pharmacopeas). These official requirements are not included in order to limit the size of the book. It is the aim of this book to present the tests like a recipe in a uniform way to ease the reader in finding his/her way through the material and to present it as a kind of "cook-book" in an order to provide an easy access to copy the procedures. This has unfortunately not been possible in all circumstances.

It was the genius of Gordon Murray in Toronto that introduced the use of allografts into cardiac surgery in the 1950s. Soon after this on opposite sides ofthe world, Sir Brian Barratt-Boyes in Auckland, New Zealand, and Mr. Donald Ross in London, undertook to use allografts for the replacement of diseased aortic valves. Since that time the global interest in allografts has been patchy, episodic, and without a con sensus. Nonetheless, for the last 20 years at least three groups in the world have steadfastly pursued the development of new and relevant information concerning the use of allograft valves in humans. These are the centres of Sir Brian Barratt Boyes, Mr. Donald Ross, and Mark O'Brien in Brisbane. More recently, talented investigators, including Drs. Yankah, Yacoub, and others, have been developing information concerning the immunological aspects of the use of allografts, as well as their clinical use. No doubt, at present, cardiac valve allografts of one sort or another are the devices of choice for conduits and have an important place in the surgery of aortic valve replacement. Even so, in the mind of this writer at least, the future usefulness of allografts for the replacement of diseased cardiac valves and conduits between a ventricle and the pulmonary artery, remains problematic, and depends upon improvements in other devices for this purpose and upon improve ments that may be made in preparing and using allografts."