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[Instrumental diagnosis for therapy decision making--what is possible and desirable, what is essential and what is
1Gefässchirurgische Abteilung, Städtisches Krankenhaus Neuperlach, München.
Insights
This review covers key vascular procedures: carotid surgery, abdominal aortic aneurysms (AAA), and varicose veins. It highlights essential diagnostic imaging like ultrasound and CT/MRI, while clarifying the role of angiography in specific clinical scenarios for effective vascular disease management.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Medical Procedures
Context:
- Vascular surgery encompasses diverse procedures, necessitating focused reviews on common interventions.
- Accurate diagnosis is crucial for effective treatment planning in vascular diseases.
- Technological advancements continuously refine diagnostic and intraoperative monitoring techniques.
Purpose:
- To outline essential diagnostic modalities for carotid artery disease, abdominal aortic aneurysms (AAA), and varicose veins.
- To delineate the necessity and utility of various imaging techniques, including ultrasound, CT, MRI, and angiography.
- To discuss intraoperative monitoring and quality control methods in vascular procedures.
Summary:
- Carotid surgery relies on ultrasound for screening; CT/MRI are necessary, with angiography's role limited, especially in symptomatic cases. Intraoperative Doppler/flowmetry ensure quality control.
- Abdominal aortic aneurysm (AAA) diagnosis mandates sonography and CT/MRI; angiography may identify accessory vessels.
- Varicose vein treatment requires color-coded sonography; phlebography offers detail but isn't essential.
Impact:
- Provides clinicians with a concise guide to appropriate imaging selection for common vascular conditions.
- Aids in optimizing diagnostic workflows, potentially reducing unnecessary procedures and costs.
- Supports evidence-based decision-making in the management of cerebrovascular and peripheral vascular diseases.
Abstract:
It is impossible to give a paper on the whole of vascular surgery, which represents a broad surgical specialty; so we will concentrate on three typical vascular procedures, namely Carotid surgery, abdominal aortic aneurysm, and varicose veins. Ultrasound examinations in carotid artery disease are inevitable because they are screening examinations. CCT or MRT are necessary, but not angiography, particularly in symptomatic patients. In asymptomatic patients, DSA may be of value for forensic documentation; MR angiography is now better, but is still not so evident as conventional DSA. CBF should be carried out in multiple vessel disease. Intraoperatively, quality control can be assured by Doppler or flowmetry; other techniques like DSA, EEG, SEP or transcranial Doppler are not necessary when a temporary shunt is routinely applied. In AAA, sonography and CT (or MRT) are absolutely necessary; angiography may reveal accessory visceral and renal vessels. In treatment of varicose veins, sonography (color-coded) is indispensible; phlebography can reveal more details, but is not absolutely necessary.