Arterial and Venous Disease Second edition Arterial and Venous Disease Second edition Richard Donnelly Professor of Vascular Medicine School of Graduate-Entry Medicine and Health University of Nottingham Derby City General Hospital Derby UK Nick JM London Professor of Surgery Leicester University Leicester UK A John Wiley & Sons, Ltd., Publication This edition fi rst published 2009, © 2009 by Blackwell Publishing Ltd BMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by Blackwell Publishing which was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing programme has been merged with Wiley’s global Scientifi c, Technical and Medical business to form Wiley-Blackwell. 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No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data ABC of arterial and venous disease / [edited by] Richard Donnelly, Nick JM London. – 2nd ed. p. ; cm. – (ABC series) Includes bibliographical references and index. ISBN 978-1-4051-7889-1 1. Blood-vessels–Diseases. I. Donnelly, Richard, 1960– II. London, Nick J. M. III. Series: ABC series (Malden, Mass.) [DNLM: 1. Vascular Diseases–diagnosis. 2. Vascular Diseases–therapy. WG 500 A133 2009] RC691.A23 2009 616.1′3–dc22 2008052025 ISBN: 978-1-4051-7889-1 A catalogue record for this book is available from the British Library. Set in 9.25/12 pt Minion by SNP Best-set Typesetter Ltd., Hong Kong Printed & bound in Singapore by Ho Printing Singapore Pte Ltd 1 2009 v Contents Preface, vii Contributors, viii 1 Methods of Arterial and Venous Assessment, 1 Peter Gorman, Mario De Nunzio, Richard Donnelly 2 Acute Limb Ischaemia, 9 Timothy E Rowlands, Louise S Haine 3 Chronic Lower Limb Ischaemia, 14 Martin JS Dennis, William D Adair, Amman Bolia 4 Cerebrovascular Disease, 20 Christopher I Price, Gary A Ford 5 Carotid Artery Disease, 26 A Ross Naylor 6 Diabetes and Vascular Disease, 31 Garry Tan, Richard Donnelly 7 Renal Artery Stenosis, 37 Patrick B Mark, Alan G Jardine, Giles H Roditi, Adrian J Brady 8 Abdominal Aortic Aneurysms, 44 Matthew J Bown, Guy Fishwick, Robert D Sayers 9 Secondary Prevention of Peripheral Arterial Disease, 49 Julie Brittenden 10 Vasculitis, 55 Matthew D Morgan, Stuart W Smith, Caroline OS Savage 11 Varicose Veins, 61 Ali Arshad, Nick JM London, Mark McCarthy 12 Venous Thromboembolic Disease, 67 Akhtar Nasim, Nick JM London 13 Lymphoedema, 72 Vaughan Keeley 14 The Ulcerated Lower Limb, 77 Nick JM London, Richard Donnelly 15 Venous Ulceration, 84 Manj S Gohel, Keith R Poskitt vi Contents 16 Antiplatelet Therapy in Arterial Disease, 90 G Stansby, P Kesteven, DP Mikhailidis 17 Anticoagulation in Venous Thrombosis, 95 John Pasi Index, 100 vii Preface The clinical manifestations of arterial and venous disease are often the result of various pathophysiological mechanisms, including atherosclerosis, thrombosis, infl ammation, embolism and aneu- rysm formation. Recent developments in non-invasive imaging particularly duplex scanning, high resolution CT and magnetic resonance imaging have revolutionised the identifi cation of struc- tural and functional abnormalities in arteries and veins. There have been signifi cant changes in our knowledge of arterial and venous diseases since the last edition of this book in 2000. This revised and updated edition is designed to provide a contemporary and practical description of the techniques used to diagnose, inves- tigate and manage arterial and venous diseases. The authorship refl ects an integrated approach to clinical management involving surgeons, physicians, radiologists and vascular laboratory techni- cians working closely to achieve optimum outcomes. For example, the approach to carotid disease and renal artery stenosis demon- strates the importance of multidisciplinary input to clinical deci- sion making. This book is targeted primary at the non-specialist and wherever possible, we have tried to ensure that clinical practice recommenda- tions in this book are evidence based. However, clinical trials in patients with arterial and venous disease are relatively limited and there remain gaps in our knowledge. Nevertheless, we hope that this book provides an up-to-date text covering best practice in a rapidly changing and diverse group of common clinical disorders. Richard Donnelly University of Nottingham Nick JM London University of Leicester viii Contributors Peter Gorman Consultant Physician, Derby Hospitals NHS Foundation Trust, Derby, UK Louise S Haine Derbyshire Royal Infi rmary, Derby, UK Alan G Jardine BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK Vaughan Keeley Consultant in Palliative Medicine, Derby Hospitals NHS Foundation Trust, Derby, UK P Kesteven Northern Vascular Unit, Freeman Hospital, Newcastle-upon-Tyne, UK Nick JM London Professor of Surgery, Leicester University, Leicester, UK Patrick B Mark Department of Renal Medicine, Western Infi rmary, Glasgow, UK Mark McCarthy Consultant Vascular and Endovascular Surgeon, Leicester Royal Infi rmary, Leicester, UK DP Mikhailidis Northern Vascular Unit, Freeman Hospital, Newcastle-upon-Tyne, UK Matthew D Morgan Division of Immunity and Infection, The Medical School, University of Birmingham, Birmingham, UK Akhtar Nasim Consultant Vascular Surgeon/Honorary Senior Lecturer, Leicester Royal Infi rmary, Leicester, UK A Ross Naylor Professor of Vascular Surgery, Department of Surgery, Leicester Royal Infi rmary, Leicester, UK John Pasi Professor of Haemostasis and Thrombosis, Centre for Haematology, Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, London, UK William D Adair Consultant Radiologist, Department of Vascular and Endovascular Surgery, Leicester Royal Infi rmary, Leicester, UK Ali Arshad Speciality Registrar in Vascular Surgery, Leicester Royal Infi rmary, Leicester, UK Amman Bolia Consultant Vascular Radiologist, Department of Vascular and Endovascular Surgery, Leicester Royal Infi rmary, Leicester, UK Matthew J Bown Lecturer in Surgery, University of Leicester, Leicester, UK Adrian J Brady Department of Medical Cardiology, Glasgow Royal Infi rmary, Glasgow, UK Julie Brittenden Reader in Surgery, Aberdeen University, Aberdeen, UK Martin JS Dennis Consultant Vascular Surgeon, Department of Vascular and Endovascular Surgery, Leicester Royal Infi rmary, Leicester, UK Mario De Nunzio Consultant Radiologist, Derby Hospitals NHS Foundation Trust, Derby, UK Richard Donnelly Professor of Vascular Medicine, School of Graduate-Entry Medicine and Health, University of Nottingham, Derby City General Hospital, Derby, UK Guy Fishwick Consultant Radiologist, Leicester Royal Infi rmary, Leicester, UK Gary A Ford Professor of Pharmacology of Old Age, Institute for Ageing & Health, Newcastle-Upon-Tyne NHS Foundation Trust and Newcastle University, Clinical Research Centre, Royal Victoria Infi rmary, Newcastle-Upon-Tyne, UK Manj S Gohel Department of Vascular Surgery, Cheltenham General Hospital, Cheltenham, UK Contributors ix Keith R Poskitt Consultant Surgeon, Cheltenham General Hospital, Cheltenham, UK Christopher I Price Clinical Senior Lecturer in Medicine, Northumbria Healthcare NHS Trust, Wansbeck General Hospital, Ashington, UK Giles H Roditi Department of Radiology, Glasgow Royal Infi rmary, Glasgow, UK Timothy E Rowlands Consultant Vascular Surgeon, Derbyshire Royal Infi rmary, Derby, UK Caroline OS Savage Division of Immunity and Infection, The Medical School, University of Birmingham, Birmingham, UK Robert D Sayers Professor of Vascular Surgery, University of Leicester, Leicester, UK Stuart W Smith Division of Immunity and Infection, The Medical School, University of Birmingham, Birmingham, UK G Stansby Professor of Vascular Surgery, Northern Vascular Unit, Freeman Hospital, Newcastle-upon-Tyne, UK Garry Tan School of Graduate-Entry Medicine and Health, Derby City General Hospital, Derby, UK