Textbook ofAngiology Springer Science+Business Media, LLC Textbook ofAngiology

John B. Chang, MD, FACS, FICA

Editor

Associate Editors Earl R. Olsen, MD, FICA Kailash Prasad, MD, PhD, FRCP(C) , FACC, FICA Bauer E. Sumpio, MD, PhD, FICA

With 984 Figures

Springer John B. Chang, MD, FACS, FICA· Earl R. Olsen, MD, FICA Chairman, Board of Directors Treasurer and Member, International College of Angiology, Inc. Board of Directors and International College of Angiology, Inc. Director Long Island Vascular Center 1050 Northern Boulevard Roslyn, NY 11576 USA

Kailash Prasad, MD, PhD, FRCP(C), FACC, FICA Bauer E. Sumpio, MD, PhD, FICA Member, Board of Directors Vice President, Scientific Council International College of Angiology, Inc. International College of Angiology, Inc. and and Associate Member Division of Vascular Surgery Department of Medicine Department of Surgery University of Saskatchewan College of Medicine Yale University School of Medicine Saskatoon, Saskatchewan New Haven, CT 06510 Canada USA

Library of Congress Cataloging-in-Publication Data

Chang, John B. Textbook of angiology / John B. Chang, Kailash Prasad, Earl R. Olsen, Bauer E. Sumpio p. cm. Includes bibliographical references and index. ISBN 978-1-4612-7039-3 ISBN 978-1-4612-1190-7 (eBook) DOI 10.1007/978-1-4612-1190-7 1. Blood-vessels-Diseases. I. Prasad, Kailash. II. Olsen, Earl R. III. Sumpio, Bauer E. IV. Title. [DNLM: 1. Cardiovascular Diseases. 2. Blood Vessels-physiology. 3. Blood Vessels-physiopathology. WG 120 C456t 1998] RC691.C518 1998 616.l'3-dc21 DNLM/DLC for Library of Congress

Printed on acid-free paper. 98-17068

© 2000 by Springer Science+Business Media New York Originally published by Springer-Verlag New Yark, Inc. in 2000 Softcover reprint of the hardcover 1st edition 2000 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+Business Media, LLC, except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc. in this publication, even if the for• mer are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publ;sher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with re• spect to the material contained herein.

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ISBN 978-1-4612-7039-3 This book is dedicated to all the devoted men and women who work so diligently in the field of angiology.

John B. Chang, MD, FACS, FICA Editor Preface

Cardiovascular disease is the greatest killer of people in the industrialized nations. With the advances in science during the past decade, our understanding of the dis• ease has increased much more than anticipated. Yet no matter how many goals have been realized and what progress has been made, we are still appalled by the increase in the incidence of cardiovascular disease, its inexorable progression in those afflicted, and the high morbidity and mortality rates. In some areas our un• derstanding of essential basic issues still remains incomplete, imprecise, and clouded by equivocal evidence. It is these problems that dictate the nature of our pursuits for understanding the disease processes and enhancing the capabilities of diagnosis, prevention, and treatment of vascular diseases be it medical or surgical. Although major achievements have been made, they are only minuscule compared with what remains to be achieved. We have made the most ambitious and formidable undertaking of compiling this book in an attempt to summarize our present knowledge of the understanding of the pathophysiology of vascular diseases, diagnostic modalities, preventive mea• sures, and treatment by medical and surgical means. Information on all aspects of vascular disease has become vast. Thus a single book can no longer adequately cover every aspect of the subject. We have, therefore, selected topics that focus on the important advances in cardiovascular disease that have occurred during the past decade. We have made an effort to ignore the classical disciplinary boundaries of the medical sciences because they are felt to be irrelevant for the organization of this book. Angiology is a unique discipline that covers all diseases related to blood ves• sels, including coronary artery disease, hypertension, atherosclerosis, stroke, and peripheral vascular disease. The field of angiology brings together basic scientists and clinicians to enhance our understanding of cardiovascular disease and to im• prove health care delivery. The interdisciplinary exchange of information and opinions is important because vascular diseases comprise multiple pathophysiolog• ical disorders, which are expressed as basic disturbances in the integrative physiol• ogy and biochemistry of organ systems. We have attempted to consolidate the knowledge from all disciplines to amplify our understanding of the mechanisms of vascular disease and improve the diagnosis and treatment of these diseases. This book covers the basic physiological principles of angiology, the pathophysi• ology and mechanism of disease processes, diagnostic principles, and the prevail• ing treatments. Topics encompass the integrative control mechanisms, the role of oxygen free radicals in peripheral vascular disease, the mechanism of atherosclero• sis, thrombotic and embolic arterial occlusive diseases of the extracranial carotid artery, the aortoiliac segment and visceral arteries, deep vein thrombosis and pul• monary embolism, arterial-venous malformations, aneurysmal diseases of the aorta

vii Vlll Preface and peripheral arteries, and ,the essentials of anesthesia for cardiovascular proce• dures. Specifically, we have included topics on valvular heart disease, Lyme disease, hypertension, coronary artery disease and bypass surgery, thromboangiitis obliter• ans, coarctation of the aorta, dissecting aortic aneurysms, the subclavian steal syn• drome, thoracic outlet syndrome, popliteal artery entrapment syndrome, vasculitis, diabetic vascular disease, endoluminal grafting, Behcet's disease, renovascular dis• ease, Marfan's syndrome, Budd-Chiari's syndrome, vascular trauma, venous diseases of the upper extremity, occlusive vascular disease in cancer, lymphade• nopathy, and phlebology. The chapters have been organized to provide an overview of the disease in the in• troduction, the description of the pathophysiology, a characterization of the clini• cal features, a discussion of the diagnostic modalities, and an assessment of current treatments. We hope that this format will be conducive for facilitating the manage• ment of patients. The contributors of the chapters in this book have provided a comprehensive and authoritative text on the latest concepts in our basic understanding of the pathophysiology of the disease, and for diagnosis and treatment. This book not only examines the mechanism of the disease, application of modern invasive and noninvasive diagnostic techniques, and the management of patients, but also stresses the rationale, techniques, and indications of vascular and cardiac surgery. Particular consideration has been placed on what is considered the cutting-edge of concepts for understanding the pathophysiology of the disease, 'and for diagnosis and treatment. Where concepts are still ambiguous, multiple authorship has con• tributed to diverse opinions on some topics. We believe that this book embraces the state of the art for practicing physicians and surgeons, the cutting edge of knowl• edge in the understanding of vascular disease, and the latest developments con• cerning the pathophysiology of the disease. This is the first written in English book on angiology that encompasses every dis• cipline related to blood vessels. Thus, this book should be of value for physicians, surgeons, basic scientists, medical students, residents, interns, and related health care professionals. Health professionals in the field of angiology should find this book very useful in their practice. We hope to continue with further editions of this book to update the changing advances in angiology. We wish to express our sincere thanks to the contributors, whose names and affil• iations are listed elsewhere, for giving their time and effort in making this book possible. The close relationship among the authors contributes to the strengths of this book. We also wish to express our appreciation to our many associates and col• leagues who, being experts in their fields, reviewed the chapters and have helped us with their constructive criticism and helpful suggestions.

Editor and Associate Ed~tors Acknowledgmen ts

A book of this magnitude and scope could not have been written without the assis• tance and forbearance of numerous individuals. All contributors, reviewers, and the people behind the scenes truly deserve my sincere thanks and appreciation for their roles in the realization of this dream. I extend my profound gratitude to the associate editors and chapter coordinators for their painstaking work that made it possible to undertake and successfully complete this book. I would like to congrat• ulate Springer-Verlag for their outstanding job in producing this book. I thank Ms. Denise M. Rossignol, Executive Director of the International College of Angiology, for her valuable assistance in establishing prompt and timely communications be• tween contributors and the editor. I would also like to thank my associate, Theodore Stein, PhD, for his editorial assistance. Finally, I take this opportunity to express my eternal gratitude and love to Lucy J. Chang, MD, my dear wife and life• time partner, for her endless support, unwitting sacrifices, and understanding.

John B. Chang, MD, FACS, FICA Editor

IX Contents

Preface ...... vii Acknowledgments ...... ix Chapter Coordinators ...... xx

Section 1 Basic Physiologic Principles in Angiology ...... 1

1 Structure and Function of Various Vascular Beds ... : ...... 3 Kailash Prasad

2 Endothelial Modulation of Vascular Tone ...... 11 Johan Van de Voorde and Bert Vanheel

3 Peripheral Circulation and Its Control Mechanism ...... 39 Kailash Prasad

4 Blood Pressure and Its Control Mechanism ...... 46 Kailash Prasad

5 Coronary Vasculature and Endothelium ...... 55 Rolf Bunger and Patricia A. Gwirtz

6 Pathophysiology of Atherosclerosis ...... 85 Kailash Prasad

7 Cellular Mechanisms of Myocardial Hibernation, Stunning, and Ischemic Preconditioning ...... 106 Herwig Koppel, Ernst Pilger, and Robert Gasser

8 Calcium Antagonists and Ischemic Heart Disease ...... 112 Andrea Obernosterer and Robert Gasser

9 Basic Mechanisms of Action of Nitrovasodilators and Development of Tolerance to Organic Nitrates ...... 122 Johan Van de Voorde and Marc Bogaert

10 Coronary Microcirculation ...... 132 M. G. Trivella and G. Pelosi

xi 11 Occupational Cardiovascular Risk Factors ...... 141 Francesco Tomei, Tiziana Paola Baccolo, Arianna Izzo, Bruno Papaleo, Benedetta Persechino, Enrico Tomao, and Maria Valeria Rosati

12 Pathophysiological Basis of the Acute Coronary Syndromes ...... 162 Kurt Huber and Fritz Kaindl

13 Clinical Subsets ...... 171 Otmar Pachinger and Hitz Kaindl

14 Echocardiography in Coronary Artery Disease ...... 177 S. Globits, A. Hassan, M. Zehetgruber, and D. H. Glogar

15 Intravascular Ultrasound ...... 196 Franz F. Weidinger, Paul Yang, and Ali Hassan

16 Magnetic Resonance Imaging in Cardiovascular Disease ...... 208 Herbert Frank and Sebastian Globits

17 Nuclear Cardiology ...... 236 Hans Martin Hoffmeister

18 Medical Treatment of Coronary Artery Disease ...... 267 MingK Heng

19 Cardiovascular Manifestations of Lyme Disease ...... 287 Peter Lercher, Renate Schollnast, and Robert Gasser

20 Minimally Invasive Direct Coronary Artery Bypass or Limited Access Myocardial Revascularization ...... 293 Vardhan J Reddy and Denton A. Cooley

21 Aortic Insufficiency ...... 304 Jacquelyn A. Quin and John A. Elefteriades

22 Valvular Heart Disease: Mitral Stenosis ...... 318 David W Drucker and John F. Setaro

23 Valvular Heart Disease: Mitral Regurgitation ...... 322 Habib Samady and John F. Setaro

24 Mitral Valve Prolapse ...... 328 Lynda E. Rosenfeld

25 Treatment of Mitral Valve Disease ...... 334 John A. Elefteriades and John Setaro

26 Prosthetic and Homograft Heart Valves ...... 347 Ozuru o. Ukoha and John A. Elefteriades

27 Techniques for Interventional Catheterization Guided by TransesophageaIEchocardiography ...... 366 Faruk Erzengin and Kemalettin Biiyiikoztiirk

28 Percutaneous Mitral Balloon Valvuloplasty ...... 370 Mehmet Meri{:, Nevres Koylan, and Kemalettin Biiyiikoztiirk Contents xiii

29 Atherosclerosis: Understanding the Relationship Between Coronary Artery Disease and Stenosis Flow Reserve ...... 381 Richard M. Fleming

30 Cholesterol, Triglycerides, and the Treatment of Hyperlipidemias ...... 388 Richard M. Fleming

31 Nuclear Cardiology: Its Role in the Detection and Management of Coronary Artery Disease ...... 397 Richard M. Fleming

32 Defining and Treating Heart Failure ...... 407 Richard M. Fleming

33 Role of Fibrinogen as a Vascular Risk Factor in Atherogenesis and Thrombogenesis ...... 419 P. Pola, P. Tondi, M. Serricchio, and R Pola

34 Oxygen Free Radicals and Peripheral Vascular Disease ...... 427 Kailash Prasad

35 Regulation of Vascular Tone and Capillary Perfusion ...... 439 Silvia Bertuglia, Antonio Colantuoni, and Marcos Intaglietta

Section 2 Occlusive Disease ...... 455

36 Atherosclerosis ...... 457 Graziana Lupattelli and Elmo Mannarino

37 Inflammatory Vascular Disease ...... 468 Gaetano Vaudo and Elmo Mannarino

38 Hyperviscosity Syndromes ...... 478 Giovanni Ciufetti and Rita Lombardini

39 Hemorheology ...... 492 Giovanni Ciufetti and Rita Lombardini

40 Lipid Pattern ...... 497 Graziana Lupattelli

41 Blood Coagulation ...... 501 Salvatore Innocente

42 Critical Limb Ischemia ...... 508 Leonella Pasqualini and Elmo Mannarino

43 Embolic Arterial Occlusion ...... 532 SibuP'Saha

44 Thromboangiitis Obliterans ...... 535 Hisao Masaki and Tatsuki Katsumura xiv Contents

Section 3 Visceral Arterial Occlusion ...... 543

45 Visceral Arterial Obstructive Disease ...... 545 Raymond A. Dieter, George Kuzycz, Ray A. Dieter, III, and Robert Dieter

46 Acute Mesenteric Ischemia ...... 559 Chittoor B. Sai Sudhakar, Jeffrey S. Pollock, and Bauer E. Sumpia

Section 4 Arterial Aneurysms ...... 573

47 Aneurysms ...... 575 Jose Alemany, Hartmut GOrtz, and Klaus Schaarschmidt

48 Peripheral Arterial Aneurysms ...... 584 Jose Alemany, Hartmut Gortz, and Klaus Schaarschmidt

49 Visceral Aneurysms: Splenic, Hepatic, Mesenteric, and Renal ...... 589 Ricardo Gesto Castromil and Jose Porto Rodriguez

50 Aneurysms of the Brachiocephalic Arteries as a Source of Brain Embolization ...... 599 JohnD. Corson, Roderick T A. Chalmers,Jamal] Hoballah, Chittur R. Mohan, William] Sharp, and Timothy F. Kresowik

Section 5 Abdominal Aortic Aneurysm ...... 609

51 Indications, Management, and Long-term Outcome of Abdominal Aortic Aneurysms ...... 611 John B. Chang and Theodore A. Stein

52 Inflammatory Abdominal Aortic Aneurysms ...... 616 Igor Huk, Joseph Nanobashvili, Georg Kretschmer, and Peter Polterauer

53 Aortic Aneurysm Repair: Endovascular Grafts ...... 622 Dieter Raithel

Section 6 Aortic Arch and Major Arteries ...... 627

54 Subclavian Steal Syndrome ...... 629 Raymond A. Dieter Jr, Robert O. Maganini, and Robert Dieter

55 Thoracic Outlet Syndrome ...... 635 Raymond A. Dieter, Jr, Timothy 0 'Brien, and Raymond A. Dieter, III

56 Surgery and the Vertebral Arteries ...... 644 Egidijus M. Barkauskas and Povilas A. Pauliukas

57 Traumatic Injuries to the Brachiocephalic Arteries ...... 667 David G. Stanley

58 Repair of Coarctation of the Aorta ...... 671 Kazutomo Goh, Yoshihiko Kubo, and Tadahiro Sasajima

59 Vascular Trauma ...... 679 Raul Mattassi and Cesare Zorzoli Contents xv

Section 7 Aortoiliac Occlusive Disease ...... 717

60 Aortoiliac Occlusive Disease ...... 719 Erich Minar, Herbert Ehringer, and Peter Polterauer

61 Recanalization and Stent Placement in Iliac Artery Obstructions ...... 743 Johannes Lammer and Siegfried Thurnher

62 Aortoiliac Occlusive Disease ...... 756 Aurel Andercou

63 Radio Contrast Agents: History and Evolution ...... 775 Mohammed A. Quader, Carol J Sawmiller, and Bauer E. Sumpio

Section 8 Femoropopliteal Occlusive Disease ...... 785

64 The Pathogenesis of Vascular Disease ...... 787 Richard M. Fleming

65 The Role of Angioscopy in Vascular Reconstructive Surgery of the Lower Extremities ...... 799 Peter M. Sanjelippo

66 Preoperative Cardiac Risk Evaluation and Management in the Patient with Peripheral Vascular Disease: The Surgeon's Perspective .... 802 Munier M. Nazzal, TimothyF. Kresowik,JamalJ Hoballah, William J Sharp, Beth A. Ballinger, andJohn D. Corson

67 Popliteal Artery Entrapment Syndrome ...... 815 Sibu P. Saha

68 Diabetic Vascular Disease: Biochemical and Molecular Perspectives ..... 817 Khurram Kamal, Rnbert Chang, and Bauer E. Sumpio

69 Composite Grafts for Limb Salvage ...... 835 John B. Chang and Theodore A. Stein

70 The Diabetic Foot ...... 846 Travis J Phifer

Section 9 Carotid Occlusive Disease ...... 857

71 Noninvasive Evaluation of Carotid Artery Disease ...... 859 David G. Stanley

72 Long-Term Benefit of Carotid Endarterectomy With Vein Patch Graft ...... 876 John B. Chang and Theodore A. Stein

73 Eversion Endarterectomy of the Carotid Artery ...... 882 D. Raithel

74 Surgically Excised Carotid Bifurcation Plaque ...... ' ...... 885 Anthony M. Imparato xvi Contents

75 Stroke ...... '...... 895 Maurice W. Nicholson and Sandra E. Ritz

Section 10 Other Vascular Diseases ...... •...... 931

76 Vasculitis ...... 933 Shigeyuki Sasaki and Keishu Yasuda

77 Occlusive Vascular Disease in Cancer ...... 954 Jochanan E. Naschitz, Daniel Yeshurun, and Jack Abrahamson

78 Beh{:et's Disease ...... 963 Hiroshi Inada and Tatsuki Katsumura

79 Budd-Chiari Syndrome: Physiopathology, Diagnosis, and Treatment .... 971 Zhong Gao Wang

80 Vasospastic Syndrome ...... 979 Shigeyuki Sasaki and Keishu Yasuda

Section 11 Chronic Venous Insufficiency Disease ...... 987

81 Classification of Venous Insufficiency: Diagnosis and Treatment ...... 989 Shunichi Hoshino and Hirono Satokawa

82 Physiology and Pathophysiology of Venous Return From the Lower Leg ...... 1002 Carl C. Arnoldi

83 Microvascular Aspects of Degenerative Joint Diseases ...... 1026 Carl C. Arnoldi

84 Internal Valvuloplasty: Surgical Technique, Valve Location, Indication, Quantitative Assessment, and Long-Term Follow-Up ...... 1073 V. S. Sottiurai

85 Chronic Venous Insufficiency Disease: Its Etiology and Treatment ...... 1082 Dinker B. Rai

86 Phlebography ...... 1093 Dinker B. Rai

87 The Venous Valve ...... 1101 Travis J Phifer

88 Superficial Venous Insufficiency: Varicosities and Management, Especially With Sclerotherapy ...... 1112 Joel Steinberg

Section 12 Deep Vein Thrombosis ...... 1153

89 Acute Vein Thrombosis ...... 1155 Michael Martin Contents XVII

90 Pulmonary Embolism ...... 1181 J Ernesto Molina

91 Venous Thrombectomy ...... 1191 Gunnar Plate

92 Principles in Hemostasis ...... 1201 Gernold Wozniak

Section 13 Chronic Lymphedema ...... •...... 1225

93 Chronic Lymphedema ...... 1227 Robert Lerner

Section 14 Vascular Malformations and Hemangiomas ...... •. 1237

94 Vascular Malformations and Hemangiomas ...... 1239 Stefan Belov

95 Vascular Malformations and Hemangiomas: Pathophysiology ...... 1243 Stefan Belov

96 Vascular Malformations and Hemangiomas: Clinical Features and Their Basis ...... 1248 Dirk A. Loose

97 Vascular Malformations and Hemangiomas: Diagnostic Tests and Nonsurgical Treatment ...... 1258 Dirk A. Loose

98 Radiological Diagnostic Strategies and Interventional Radiology ...... 1261 J Weber

99 Arteriovenous Malformations of the Upper Limb ...... 1270 S. Sulaiman Shoab andJ H. Scurr

100 Combined Treatment of Vascular Malformations: Indications, Methods, and Techniques ...... 1278 Dirk A. Loose

101 Vascular Malformations and Hemangio;mas: Surgical Treatment ...... 1284 Stefan Belov

102 Vascular Tumors (Hemangiomas) in Childhood ...... 1294 Hansjorg Cremer

Section 15 Tissue Plasminogen Activator: Biological Perspective for Surgeons ...... 1313

103 Tissue Plasminogen Activator: Biological and Physiological Relevance for Vascular Surgeons ...... 1315 Robert Chang, Khurrum Kamal, and Bauer E. Sumpio

Index ...... 1324 Editor John B. Chang, MD, FACS, FICA, Past-President, International College of Angiology, Inc.; Chairman, Board of Directors, International College of Angiology, Inc.; Past• President, The Phlebology Society of America; Chairman, Board of Directors, The Phlebology Society of America; Founding Chairman and Member, Board of Direc• tors, Asian Vascular Society; Editor-in-Chief, InternationalJournal ofAngiology; Direc- tor, Long Island Vascular Center, Roslyn, New York >

Associate Editors Earl R. Olsen, MD, FICA, Past-President, International College of Angiology, Inc.; Treasurer and Member, Board of Directors, International College of Angiology, Inc.; Senior Editor, InternationalJournal ofAngiology; San Francisco, California

Kailash Prasad, MD, PhD, FRCP(C), FACC, FICA, Past-President, International Col• lege of Angiology, Inc.; Member, Board of Directors, International College of Angi• ology, Inc.; Chairman, Scientific Committee, International College of Angiology, Inc.; Senior Editor, International Journal of Angiology; Associate Member, Depart• ment of Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada

Bauer E. Sumpio, MD, PhD, FICA, Vice President, Scientific Council, International College of Angiology, Inc.; Co-Chairman, Scientific Committee, International Col• lege of Angiology, Inc.; Senior Editor, InternationalJournal of Angiology; Division of Vascular Surgery; Department of Surgery; Yale University School of Medicine, New Haven, Connecticut

XIX Chapter Coordinators

Jose Alemany, MD, FICA, President-Elect and Member, Board of Directors, Interna• tional College of Angiology, Inc.; Editor, InternationalJournal ofAngiology; Head, De• partment of Surgery, Knappschafts-Krankenhaus, Bottrop, Germany

John D. Corson, ME, ChB, FICA, Professor of Surgery; Vice President, Scientific Council, International College of Angiology, Inc.; Co-Chairman, Scientific Com• mittee, International College of Angiology, Inc.; Editor, InternationalJournal of An• giology; Chief, Department of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa

John A. Elefieriades, MD, FICA, Professor of Surgery; Co-Chairman, Scientific Com• mittee, International College of Angiology, Inc.; Editor, InternationalJournal of An• giology; Chief, Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut

Robert Gasser, MD, PhD, FICA, Professor of Internal Medicine and Cardiology; Vice President, International College of Angiology, Inc.; Co-Chairman, Scientific Com• mittee, International College of Angiology, Inc.; Editor, InternationalJournal of An• giology; Department of Medicine, Division of Cardiology, University of Graz, Graz, Austria

Shunichi Hoshino, MD, PhD, FICA, Professor of Surgery; Editor, International Journal of Angiology; Department of Cardiovascular Surgery, Fukushima University School of Medicine, Fukushima,Japan

Anthony Imparato, MD, Professor of Surgery; Editor, International Journal of Angiol• ogy; Division of Vascular Surgery, New York University Medical Center, New York, New York

Fritz Kaindl, MD, FICA, Professor of Cardiology; Honorary Fellow, International College of Angiology, Inc.; Founding Member, International College of Angiology, Inc.; Member, Board of Directors, International College of Angiology, Inc.; Mem• ber, Advisory Council, International College of Angiology, Inc.; Past-President, In• ternational College of Angiology, Inc.; Senior Editor, InternationalJournal of Angiol• ogy; Vienna, Austria

xx Chapter Coordinators xxi

Tatsuki Katsumura, MD, FICA, Professor of Surgery; President and Member, Board of Directors, International College of Angiology, Inc.; Editor, International Journal ofAngiology; Dean, Kawasaki Medical School, Kurashiki City, Okayama,Japan

Yoshihiko Kubo, MD, FICA, Professor of Surgery; Vice President, Scientific Council, International College of Angiology, Inc.; Co-Chairman, Membership Committee, International College of Angiology, Inc.; Editor, International Journal of Angiology; First Department of Surgery, Asahikawa Medical College, Asahikawa,Japan

Dirk A. Loose, MD, FICA, Editor, International Journal ofAngiology; Center for Circula• tory Disturbances and Vascular Defects, Hamburg, Germany

Elmo Mannarino, MD, Department of Clinical Medicine, Pathology, and Pharmacol• ogy, Universita Degli Studi di Perugia, Perugia, Italy

Michael Martin, MD, FICA, Professor of Medicine; Editor, International Journal ofAn• giology; Personalhaus I der Stadtischen Kliniken, Duisburg, Germany

Maurice W. Nicholson, MD, FICA, Editor, InternationalJournal ofAngiology; Neurologi• cal Surgery, Queens Medical Center, Honolulu, Hawaii

Travis J Phifer, MD, FICA, Associate Professor of Surgery; Member, Board of Direc• tors, The Phlebology Society of America; Past-President, The Phlebology Society of America; Editor, International Journal of Angiology; Chief, Division of Vascular Surgery, Louisiana State University Medical Center, Shreveport, Louisiana

Peter Polterauer, MD, Professor of Surgery; Chairman and Director, Vascular Surgery, University of Vienna Medical School, Vienna, Austria

Kailash Prasad, MD, PhD, FRCP(C), E4CC, FICA, Professor Emeritus; Past-President, International College of Angiology, Inc.; Member, Board of Directors, Interna• tional College of Angiology, Inc.; Chairman, Scientific Committee, International College of Angiology, Inc.; Senior Editor, InternationalJournal ofAngiology; Associate Member, Department of Medicine, University of Saskatchewan College of Medi• cine, Saskatoon, Saskatchewan, Canada

John H. Scurr, FRCS, FICA, Editor, International Journal of Angiology; Senior Lecturer and Consultant Surgeon, Middlesex and University College Hospital, The Lister Hospital, London, England

Vikrom S. Sottiurai, MD, PhD, FICA, Professor of Clinical Surgery; Vice President, Sci• entific Council, International College of Angiology, Inc.; Co-Chairman, Scientific Committee, International College of Angiology, Inc.; President and Member, Board of Directors, The Phlebology Society of America; Editor, InternationalJournal of Angiology; Louisiana State University School of Medicine in New Orleans, New Orleans, Louisiana

Bauer E. Sumpio, MD, PhD, FICA, Professor and Vice Chairman of Surgery; Vice President, Scientific Council, International College of Angiology, Inc.; Co• Chairman, Scientific Committee, International College of Angiology, Inc.; Senior Editor, InternationalJournal ofAngiology; Chief, Division of Vascular Surgery; Depart• ment of Surgery; Yale University School of Medicine, New Haven, Connecticut xxii Chapter Coordinators

Francis Vella, MD, MA (OXON), PhD, DSc (Hon. Causo), Acting General Secretary, The International Union of Biochemistry and Molecular Biology, Department of Biochemistry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Keishu Yasuda, MD, PhD, FICA, Professor of Surgery; Vice President, Scientific Council, International College of Angiology, Inc.; Editor, InternationalJournal ofAn• giology; Chairman, Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Sapporo,Japan