Vascular surgery

This chapter begins by discussing the basic principles of haemostasis and coagulation and atherosclerosis, before focusing on the key areas of knowledge, namely assessment and management of peripheral arterial occlusive disease, acute lower limb ischaemia, extracranial arterial disease, abdominal aortic aneurysm, chronic venous insufficiency, varicose veins, lymphatic conditions, diabetic foot, lower limb ulceration, and miscellaneous vascular conditions. The chapter concludes with relevant case-based discussions.

The Value of Carotid Doppler Ultrasound in Asymptomatic Extracranial Arterial Disease

ABSTRACT:Carotid Doppler is an accurate, safe and repeatable method of assessing arterial calibre, for distinguishing harmless neck bruits and to identify the stroke prone individual. It is completely non-invasive and can be used serially to monitor progression in carotid stenosis. It is a valuable clinical tool in diagnosis and management in patients at risk of stroke, but has definite limitations, such as in differentiating carotid occlusion from severe stenosis. B-mode imaging, although valuable in identifying arterial anatomy, and detecting plaques, cannot accurately evaluate the degree of stenosis. It is of limited value in identifying plaque hemorrhage and ulceration. Doppler ultrasound technology has advanced rapidly in the last decade, especially in the combination of B-mode imaging and Doppler (Duplex), as well as in evaluating of the intracranial circulation (transcranial Doppler). In the next decade, it may become the new gold standard for evaluating the extracranial and intracranial circulation.