Endovascular approach in abdominal aortic aneurysm (AAA) treatment (EVAR) became the treatment of choice for most patients suffering from that disease. However, a successful endovascular therapy of the AAA depends on some key anatomical and morphological factors highly influencing the procedure outcome. Among them, the most important feature is the anatomical situation in the aneurysm neck. The definitions of the terms “hostile neck” and “difficult neck” are explained in order to present unfavorable conditions in the landing zone of most commercially available stent graft models. In this chapter, a description of various criteria of the difficult neck and their basic features and shapes as well was presented. Also, the most popular methods of solving that clinical problem were outlined. At the end, an overall (APPROACH) strategy in the treatment of a hostile neck patient is described.
Part of the book: Abdominal Aortic Aneurysm
Trauma is a leading cause of death and disability in young adults in developed countries with the high impact on future patient quality of life and productivity. The traumatic injury of the vessels is one of the most dangerous types of injury, requiring a fast and reliable diagnosis and, in vast majority of cases, immediate surgical treatment. In this chapter, the authors describe various types of vascular injuries according to injury types and locations. The prehospital care algorithms in patients with vascular trauma are proposed with the emphasis on bleeding control techniques and transportation technique to the nearest hospital. In the next subsection, the various peripheral vascular injuries of specific body areas are described. The truncal vessel trauma is discussed in the next subsection, focusing on fast diagnosis and decision on surgery. In the last subsection, a problem of iatrogenic vascular injury is described due to a rapid increase of minimally invasive techniques in which a vascular injury, as a complication of therapy, may occur.
Part of the book: Emergency Medicine and Trauma