An abnormal bulging of the abdominal aorta, called an abdominal aortic aneurysm (AAA) is a potentially serious condition that can lead to death if it ruptures. An AAA is considered present when the maximum diameter of the aorta below the renal arteries (infrarenal AAA) expands to exceed 3.0 cm. In the United States, rupture of AAA accounts for approximately 9,000 deaths annually. Another 30,000-40,000 patients undergo elective surgical repair of asymptomatic AAA to prevent rupture, with perioperative mortality ranging from 2-8 percent. Death due to AAA rupture or repair is the thirteenth leading cause of death in the United States and tenth among older men. The majority of AAAs remain asymptomatic for years, though the risk of rupture increases with AAA size. Immediate death can result, and mortality remains between 40 and 60 percent, even when emergency care and repair are undertaken. Management options are primarily based on patient's life expectancy and AAA size and include no treatment, active surveillance and delayed repair, immediate open surgical repair (OSR), and endovascular aneurysm repair (EVAR). Recent recommendations for AAA screening in high-risk populations along with emerging endovascular methods for repair have led to increased interest in evaluating the effectiveness and adverse effects of treatment options for patients with AAA. The following questions were addressed related to elective treatment of nonruptured AAA that were nominated by America's Health Insurance Plans (AHIP). 1. What are the comparative effectiveness and adverse effects of treatment options of AAA including active surveillance, open repair, and endovascular repair? 2. What is the relationship of volume, both hospital and physician, to the benefits and harms of endovascular procedures to repair AAA? 3. How do the characteristics of the aneurysm (size/location/shape) and the patient (age/gender) affect the benefits and harms of endovascular and open-surgical repair? 4. What are the costs-benefits for each of the procedures?

Vascular surgery has experienced remarkable growth and diversification in the last decade, especially with its embracing the disruptive endovascular technological revolution. Vascular surgeons remain the only group of specialists capable of total treatment of patients with vascular disease, providing medical, minimally invasive, and surgical therapy. Although vascular surgeons practice in all areas of the world, practice patterns in different areas naturally have both similarities and differences that reflect both regional patterns of disease, genetic characteristics of local peoples, cultural preferences for treatment, local political and economic situations, different access to resources and devices, as well as different training paradigms. Thus, the practice of vascular surgery has diversified and evolved in parallel in many areas, converging and diverging in many ways. Vascular Surgery: A Global Perspective provides the first review and comparison of the diversity of vascular surgery practice around the world. The book is grouped according to common vascular diseases such as aneurysmal and occlusive arterial disease, as well as venous and lymphatic disease and dialysis access. Each major disease topic includes multiple chapters written by expert specialists from around the world, each discussing their local approach to the disease and its treatment. Similarly, the status of vascular surgery practice is addressed, including discussion of the influence of payment systems on practice, patient access to the internet for information, training paradigms, and the legal system including malpractice. This textbook provides the first worldwide summary of the care of patients with vascular disease and will be of interest to a wide audience including vascular surgeons, vascular medical specialists, cardiologists, radiologists, internists, and family practice physicians.

Abdominal aortic aneurysms (AAA) have historically and successfully been repaired through an open surgical approach. The desire for less invasive procedures has led to the development of endovascular techniques for repair of AAA. Given the weak study design, previous syntheses have been unable to provide comparisons between endovascular graft repair (EVG) and open repair. As with many new technologies, the diffusion and uptake of EVG in a Canadian context has not been studied. The objectives of this review were: (1) to examine the current status of EVG technology for elective repair of AAA in Canada, and (2) to critically review the literature comparing EVG with open repair, or with a 'wait-and-see' approach, in terms of morbidity and mortality. A postal survey was used to assess the current use of EVG among vascular surgeons for elective repair of AAA in Canada. For the critical appraisal of comparative studies, a comprehensive literature search strategy was used to identffy potential studies. It appears, from the survey of current practice, that EVG is being used in Canada mainly for patients who are considered moderate to high risk surgical candidates. The evidence available in the scientific literature does not suggest that the time has come to consider this technology universally for all patients undergoing elective AAA repair. Endovascular grafting for AAA is still a new technology. At this stage it appears as though EVG may offer a slight advantage over open repair in terms of perioperative mortality. However, there are possible drawbacks, which must be weighed against potential gains. The rate of successful primary placement of the device is lower with EVG and EVG patients appear to require more extensive long-term follow-up.

The clinical practice of anesthesia has undergone many advances in the past few years, making this the perfect time for a new state-of-the-art anesthesia textbook for practitioners and trainees. The goal of this book is to provide a modern, clinically focused textbook giving rapid access to comprehensive, succinct knowledge from experts in the field. All clinical topics of relevance to anesthesiology are organized into 29 sections consisting of more than 180 chapters. The print version contains 166 chapters that cover all of the essential clinical topics, while an additional 17 chapters on subjects of interest to the more advanced practitioner can be freely accessed at www.cambridge.org/vacanti. Newer techniques such as ultrasound nerve blocks, robotic surgery and transesophageal echocardiography are included, and numerous illustrations and tables assist the reader in rapidly assimilating key information. This authoritative text is edited by distinguished Harvard Medical School faculty, with contributors from many of the leading academic anesthesiology departments in the United States and an introduction from Dr S. R. Mallampati. This book is your essential companion when preparing for board review and recertification exams and in your daily clinical practice.

This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. It consists of a remarkable collection of contributions authored by internationally respected experts, featuring the most recent diagnostic developments and technological advances with a highly didactical approach. The chapters are disease-oriented and cover all the relevant imaging modalities, including standard radiography, CT, nuclear medicine with PET, ultrasound and magnetic resonance imaging, as well as imaging-guided interventions. As such, it presents a comprehensive review of current knowledge on imaging of the heart and chest, as well as thoracic interventions and a selection of "hot topics". The book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology.

The book is an on-the-spot reference for residents and medical students seeking diagnostic radiology fast facts. Its question-and-answer format makes it a perfect quick-reference for personal review and studying for board examinations and re-certification. Readers can read the text from cover to cover to gain a general foundation of knowledge that can be built upon through practice or can use choice chapters to review a specific subspecialty before starting a new rotation or joining a new service. With hundreds of high-yield questions and answer items, this resource addresses both general and subspecialty topics and provides accurate, on-the-spot answers. Sections are organized by subspecialty and body area, including chest, abdomen, and trauma, and chapters cover the anatomy, pathophysiology, differential diagnosis, hallmark signs, and image features of major diseases and conditions. Key example images and illustrations enhance the text throughout and provide an ideal, pocket-sized resource for residents and medical students.

This manual is designed to serve as the standard for the management of patients with ruptured abdominal aortic aneurysm (AAA) by means of modern techniques. All aspects are covered, from pathogenesis, clinical presentation, and diagnosis through to initial management, operative strategies, postoperative complications, outcomes and quality of life issues. The book is based on the experience gained at a leading U.S. institution (Harborview Medical Center, University of Washington) that treats up to 40 patients with ruptured AAA annually and is highly respected for its expertise in this medical emergency. The team at Harborview Medical Center has recently shown that the implementation of a structured protocol for the management of ruptured AAA, with emphasis on an “endovascular-first” strategy, dramatically reduces mortality and complications. This has led to a sea change in the way in which patients are managed. There is an increasing hunger for information on these codified protocols and Ruptured Abdominal Aortic Aneurysm: The Definitive Manual will be invaluable for both surgeons and critical care physicians.

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