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Cambridge University Press 978-0-521-13352-4 - Postgraduate Vascular Surgery: The Candidate’s Guide to the FRCS Edited by Vish Bhattacharya and Gerard Stansby Frontmatter More information

Postgraduate Vascular Surgery The Candidate’s Guide to the FRCS

© in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-13352-4 - Postgraduate Vascular Surgery: The Candidate’s Guide to the FRCS Edited by Vish Bhattacharya and Gerard Stansby Frontmatter More information

Postgraduate Vascular Surgery The Candidate’s Guide to the FRCS Edited by Vish Bhattacharya Queen Elizabeth Hospital Gerard Stansby Freeman Hospital

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First published 2010

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A catalogue record for this publication is available from the British Library

Library of Congress Cataloguing in Publication data Postgraduate vascular surgery : the candidate’s guide to the FRCS/[edited by] Vish Bhattacharya, Gerard Stansby. p. ; cm. Includes bibliographical references and index. ISBN 978-0-521-13352-4 (pbk. : alk. paper) 1. Blood-vessels–Surgery–Handbooks, manuals, etc. I. Bhattacharya, Vish. II. Stansby, Gerard. III. Title. [DNLM: 1. Vascular Surgical Procedures–Handbooks. 2. Vascular Diseases–surgery– Handbooks. WG 39] RD598.5.P67 2010 617.4′13–dc22 2010039933

ISBN 978-0-521-13352-4 Paperback

Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Contents

List of contributors page vii Preface ix

Section 1. Final FRCS vascular 9 Femoral artery aneurysms 123 Robert Davies, Asif Mahmood and clinicals Rajiv Vohra Introduction to the examination 10 Carotid, subclavian and vertebral and clinical cases 3 disease 129 Jonathan Smout and Asif Mahmood A. Ross Naylor 11 Diagnosis and management of Section 2. Final FRCS vascular thoracic outlet syndrome 146 topics Hassan Badri and Vish Bhattacharya 1 Vascular risk factors and their management 37 12 Diagnosis and management of hyperhidrosis Alasdair Wilson and Julie Brittenden 152 Hassan Badri and Vish 2 Management of acute limb Bhattacharya ischaemia 49 13 Chronic mesenteric Arun Balakrishnan and ischaemia David Lambert 156 Mohamed Abdelhamid, Robert 3 Chronic lower limb ischaemia, Davies and Rajiv Vohra critical ischaemia and the diabetic foot 58 14 Acute ischaemic colitis 164 Chris Davies and Cliff Shearman Vish Bhattacharya and Gerard Stansby 4 Endovascular and surgical options for peripheral revascularisation 72 15 Vascular trauma 172 Colin Nice Robbie George and Paul Blair 5 Abdominal aortic aneurysms 86 16 Indications and management of lower limb amputation Vish Bhattacharya and Rob Williams 183 Mark Kay and Colette Marshall 6 Thoracic, thoracoabdominal and suprarenal aortic aneurysms 99 17 Leg swelling and lymphoedema Jenny Richards and Rod Chalmers 195 Arun Balakrishnan and 7 Aortic dissection 108 Tim Lees Jenn Richards and Rod Chalmers 18 Varicose veins and chronic venous 8 Popliteal artery aneurysms 115 insuﬃciency 204 Robert Davies, Asif Mahmood and Marcus Cleanthis and Rajiv Vohra Tim Lees

vi Contents

19 Management of deep vein 24 Access surgery 288 thrombosis 220 David C. Mitchell and William D. Dharmendra Garg and Vish Neary Bhattacharya 25 Basic outline of solid organ 20 Infection in vascular surgery 229 transplantation 298 Mike Clarke Mathew Jacob, Jeremy French and Derek Manas 21 Vascular malformations 242 George Hamilton and Andrew Platts 22 Vasospastic disorders and Index 317 vasculitis 254 Mohammed Sharif, Jonathan Smout and Gerard Stansby 23 Critical care considerations and preoperative assessment for general and vascular surgery 272 Ian D. Nesbitt and David M. Cressey

Contributors

Mohamed Abdelhamid David M. Cressey Department of Vascular Surgery, Department of Anaesthesia, University Hospital Birmingham Freeman Hospital, High Heaton, NHS Foundation Trust, Selly Oak Hospital, Newcastle upon Tyne, UK Birmingham, UK Chris Davies Hassan Badri Department of Vascular Surgery, Gateshead Health NHS Foundation Trust, Southampton General Hospital, Queen Elizabeth Hospital, Sheriff Hill, Southampton, UK Gateshead, UK Robert Davies Arun Balakrishnan University Department of Vascular Th e Northern Vascular Centre, Surgery, Heart of England NHS Freeman Hospital, High Heaton, Foundation Trust, Birmingham, UK Newcastle upon Tyne, UK Jeremy French Vish Bhattacharya Transplantation and Hepatobiliary Surgery, Gateshead Health NHS Foundation Trust, Freeman Hospital, High Heaton, Queen Elizabeth Hospital, Newcastle upon Tyne, UK Sheriff Hill, Gateshead, UK Dharmendra Garg Paul Blair Gateshead Health NHS Foundation Trust, Department of Vascular Endovascular Queen Elizabeth Hospital, Surgery, Royal Victoria Hospital, Belfast, UK Sheriff Hill, Gateshead, UK Julie Brittenden Robbie George University Department of Surgery, Department of Vascular Endovascular Aberdeen Royal Infi rmary, Aberdeen, Surgery, Royal Victoria Hospital, Belfast, UK UK Rod Chalmers George Hamilton University Department of Surgery, University Department of Vascular Royal Infi rmary of Edinburgh, Surgery, Royal Free Hospital, London, Edinburgh, UK UK Mike Clarke Mathew Jacob Th e Northern Vascular Centre, Transplantation and Hepatobiliary Surgery, Freeman Hospital, High Heaton, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK Newcastle upon Tyne, UK Marcus Cleanthis Mark Kay Th e Northern Vascular Centre, Coventry and Warwickshire County Freeman Hospital, High Heaton, Vascular Unit, University Hospitals Newcastle upon Tyne, UK Coventry, UK

viii List of contributors

David Lambert Andrew Platts Th e Northern Vascular Centre, Consultant Vascular Interventional Freeman Hospital, High Heaton, Radiologist, Vascular Unit, Royal Free Newcastle upon Tyne, UK Hospital, University College Medical School, London, UK Tim Lees Th e Northern Vascular Centre, Jenny Richards Freeman Hospital, High Heaton, University of Edinburgh, Royal Infi rmary Newcastle upon Tyne, UK of Edinburgh, Edinburgh, UK Asif Mahmood Mohammed Sharif Department of Surgery, Good Department of Vascular and Hope Hospital, Sutton Coldfi eld, Endovascular Surgery, Belfast City Birmingham, UK Hospital, Belfast, UK Derek Manas Cliﬀ Shearman Transplantation and Hepatobiliary Surgery, Department of Vascular Surgery, Freeman Hospital, High Heaton, Southampton General Hospital, Newcastle upon Tyne, UK Southampton, UK Colette Marshall Jonathan Smout Coventry and Warwickshire County Th e Northern Vascular Centre, Vascular Unit, University Hospitals Freeman Hospital, High Heaton, Coventry, UK Newcastle upon Tyne, UK David C. Mitchell Gerard Stansby Department of Vascular Surgery, Th e Northern Vascular Centre, Southmead Hospital, Westbury-on-Trym, Freeman Hospital, High Heaton, Bristol, UK Newcastle upon Tyne, UK A. Ross Naylor Rajiv Vohra Department of Surgery, Leicester Royal Department of Vascular Surgery, Infi rmary, Leicester, UK Selly Oak Hospital, Birmingham, UK William D. Neary Rob Williams Department of Vascular Surgery, Department of Radiology, Southmead Hospital, Westbury-on-Trym, Freeman Hospital, High Heaton, Bristol, UK Newcastle upon Tyne, UK Ian D. Nesbitt Alasdair Wilson Department of Anaesthesia, Department of Surgery, University of Freeman Hospital, High Heaton, Aberdeen, Aberdeen Royal Infi rmary, Newcastle upon Tyne, UK Aberdeen, UK Colin Nice Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK

Preface

Examinations are always challenging although less so for the well prepared. The Intercollegiate Exit Examination in Surgery, in particular, often causes considerable anguish for the candidates. It is expensive to fail the examination, both financially and emotionally. It is a high stake examination and comes at a critical stage in a young surgeon’s career when he or she is nearing the end of training. Over many years, and having discussed the examination with both successful and unsuc- cessful candidates, we felt that a book was required that would provide a quick, easy read for candidates already under pressure to cover a vast array of subjects. It would need to be pitched at the right level and would complement both clinical experience and aid personal revision. This book has been divided into two sections. The clinical cases section has been written by two recently successful candidates who have incorporated the views of several trainees to make this section relevant to their needs. The second section has been written by experts in their respective fields who have provided succinct chapters in a concise format. All the co-authors are surgical trainees, most of whom have passed the examination or are preparing for it. Key points have been mentioned at the beginning of the chapters to aid quick revision before the examinations. References have been deliberately kept to a minimum. We thank all the contributors for their hard work and timely submission of manuscripts. We are especially grateful to Nick Dunton and Katie James of Cambridge University Press for their continuous support and timely reminders. Though we appreciate the fact that it takes more than a book to pass the examinations we hope this book serves as a useful tool for candidates to achieve success. Good luck!