DIFFICULT DECISIONS IN VASCULAR SURGERY. AN EVIDENCE-BASED APPROACH

• Section 1: Aortic Disease
Ch. 1: In patients with Acute Type B Aortic dissection, do current operative therapies reduce complications compared to medical management?
Ch. 2: In patients with a Chronic Type B dissection, does Endovascular treatment reduce long term complications?
Ch.3: In patients with a retrograde Type A Aortic dissection, does treatment like a type B Aortic dissection improve outcomes?
Ch.4: In patients with small AAA, does medical therapy prevent growth?
Ch.5: Challenging AAA Neck Anatomy: Does the Fenestrated or Snorkel/Chimney Technique Improve Mortality and Freedom from Reintervention Relative to Open Repair?
Ch.6: In patients who require Hypogastric artery coverage to treat an AAA with EVAR, does preservation improve outcomes when compared to exclusion of the vessel?
Ch.7: In patients with aortic graft infections, does EVAR improve long term survival compared to open graft resection?
Ch.8: Does EVAR improve outcomes or quality of life in patients unfit for open surgery?
Ch.9: In patients with type 2 endoleaks does intervention reduce aneurysm related morbidity and mortality compared to observation?
Ch.10: Ruptured Abdominal Aortic Aneurysm Treated with Endovascular Repair; Does Decompressive Laparotomy Result in Improved Clinical Outcomes?
Ch.11: In a Patient with Blunt Traumatic Aortic Injury, Does TEVAR Improve Survival Compared to Open Repair or Expectant Management?
• Section 2: Lower Extremity Arterial Disease
Ch.12: In patients with Aortoiliac occlusive disease, does Endovascular repair improve outcomes when compared to open repair?
Ch.13: In Patients with Aortoiliac Occlusive Disease, Does Extra-anatomic Bypass Improve Quality of Life and Limb Salvage?
Ch.14: In Patients with Critical Limb Ischemia Does Bypass Improve Limb Salvage and Quality of Life When Compared to Endovascular Revascularization?
Ch.15: In patients with limb-threatening ischemia who are not candidates for revascularization do non-operative options improve outcomes compared to amputation?
Ch.16: In the patient with Profunda artery disease, is open revascularization superior to endovascular repair for improving rest pain?
Ch.17: In patients with limb-threatening vascular injuries, is there a role of prophylactic fasciotomy to reduce ischemic injury?
Ch.18: In patients with Popliteal Entrapment Syndrome, does surgery improve quality of life?
• Section 3: Mesenteric Disease
Ch.19: In patients with Acute Mesenteric Ischemia does an endovascular or hybrid approach improve morbidity and mortality compared to open revascularization?
Ch.20: Chronic Mesenteric Arterial Disease. Does an endovascular/hybrid approach improve morbidity and mortality as compared to open revascularization?
Ch.21: In patients with mesenteric ischemia is single vessel reconstruction equivalent to multiple vessel revascularization?
Ch.22: In patients with celiac artery compression syndrome, does surgery improve quality of life?
Ch.23: In patients with the Superior Mesenteric Artery syndrome is Enteric Bypass superior to Duodenal Mobilization
Ch.24: In patients with Renovascular hypertension is there a role for open or endovascular revascularization compared to medical management?
Ch.25: Does endovascular repair reduce the risk of rupture compared to open repair in splanchnic artery aneurysms?
• Section 4: Cerebrovascular Disease
Ch.26: In patients with asymptomatic carotid artery stenosis does current best medical management reduce the risk of stroke compared to intervention (endarterectomy or stent)?
Ch.27: In patients with symptomatic carotid artery stenosis is endarterectomy safer than carotid stenting?

The complexity of decision making in medicine, and in surgery in particular, is growing exponentially. As new technology is introduced, physicians from nonsurgical specialties offer alternative and competing therapies for what was once the exclusive province of the surgeon. In addition, there is increasing knowledge regarding the efficacy of traditional surgical therapies. How to select among these varied and complex approaches is becoming increasingly difficult. The first two editions of “Difficult Decisions in Thoracic Surgery: An Evidence Based Approach” have found wide acceptance among practicing surgeons, trainees, and educators. Chapters from them are regularly cited by the Thoracic Surgery Directors Association as valuable resources for their weekly curriculum exercises. Downloads of individual chapters have been very popular. The 3rd edition is in production. Based on this success, this book is part of a series of such books covering other surgical specialties. The volumes will be multi-authored, containing brief chapters, each of which will be devoted to one or two specific questions or decisions within that specialty that are difficult or controversial. The volumes are intended as a current and timely reference source for practicing surgeons, surgeons in training, and educators that describe the recommended ideal approach, rather than customary care, in selected clinical situations.

Features
• This book will be edited by recognized experts
• Focused questions will be posed specifically and analyzed carefully according to the level of supporting evidence that is available
• Each chapter will contain a table summarizing specific characteristics relative to the question using PICO formatting (population, intervention, comparator and outcome)

Authors
• Christopher L. Skelly, MD FACS . Associate Professor of Surgery, Chief of Vascular Surgery & Endovascular Therapy; Director of Vascular Surgery Fellowship Program and Director of Vascular Lab.
Christopher Skelly, MD specializes in vascular surgery. He performs a full range of open and endovascular procedures, including the treatment of carotid disease, complex aortic pathologies and peripheral vascular disease. In addition, he performs minimally invasive surgery for the treatment of median arcuate ligament syndrome.
In addition to his clinical practice, Dr. Skelly directs a research laboratory aimed at improving outcomes and durability of vascular graft repairs. As a 2008 recipient of the NHLBI Jointly Sponsored Mentored Clinical Scientist Development Award, his research is funded by the American Vascular Association (AVA)/American College of Surgeons (ACS) and the National Heart, Lung and Blood Institute (NHLBI). Dr. Skelly has authored more than 35 scientific articles in peer-reviewed journals, and several book chapters and reviews. He is working on numerous clinical trials, including a below-knee arterial bypass trial, for which he serves as site-principal investigator.
• Ross Milner, MD. Director at the Center for Aortic Diseases
Ross Milner, MD, is an internationally recognized expert in vascular surgery. He specializes in the treatment of complex aortic diseases.
Dr. Milner has been the primary investigator on numerous endovascular device trials. In one study, he examined the use of remote pressure sensor monitoring for surveillance after endovascular aortic aneurysm repair. He also is working on the development of a prosthetic vein valve. His research has been funded by the Wallace H. Coulter Foundation.
A dedicated educator and mentor, Dr. Milner teaches medical students, residents and fellows about vascular disease management, including the use of aortic stents. In addition, he is frequently invited to speak at national and international conferences on vascular surgery and aortic aneurysms.