Oncovascular Surgery and the Making of the Oncovascular Surgeon

Patients diagnosed with tumors that are located in vicinity of the major axial vessels are inconsistently managed because they are often considered unresectable. The management of these patients remains at the periphery of various established sub-specialties that are prevalent under the current medical specialty. These patients are required to be treated by an oncovascular surgeon. This article discusses some key points in understanding the reasons for establishing a specialty branch, oncovascular surgery, to treat complex tumors with vessel invasion. This article also reviews important issues about leadership and how to train and educate oncovascular surgeons.

Unexplained arterial thrombosis after pelvic oncologic surgery: a report of a new pathologic entity of postoperative thrombosis in grossly normal arteries

Acute arterial ischemia of the lower limb post pelvic surgery can be caused by different pathopyhsyiologic mechanisms which include; contusion thrombosis, ligation, spasm, thrombosis on top of atherosclerosis. Treatment is bypass or replacement. This report describes 4 cases of unexplained iliac arterial thrombosis post pelvic surgery without gross underlying pathology in the arterial wall, neither traumatic nor atherosclerotic. Patients were successfully managed by simple thrombectomy only without the need for vessel replacement or bypass. Establishment of flow across the previously thrombosed segment was achieved with no rethrombosis. Simple thrombectomy through the groin, alone can be used successfully to treat a selected group of patients with post operative iliac artery occlusion

case of carotid artery secondary hemorrhage successfully managed by extra anatomic axillary-internal carotid bypass

Carotid artery rupture post oncologic Head and Neck surgery is relatively rare but potentially lethal complication. To the best of the author's knowledge, the management options are restricted to ligation and resection of the pathologic segment of the artery accepting with helplessness a potential of stroke and sometimes mortality secondary to interruption of the blood supply of the brain. A patient with recurrent tongue cancer post resection and radiofrequency ablation. Salivary leak and infection in the neck resulted in a "Blow out" of the bifurcation of the carotid artery. Bleeding was controlled by minimal digital pressure, awakening test during cross clamping of the internal carotid artery lead to neurologic deficit. An extra-anatomic bypass was constructed with the inflow from the axillary artery and the outflow at the internal carotid artery at the skull base above and separate from the infected area and the tunnel in the posterior triangle of neck away from infection. The patient suffered no neurologic deficit. The vascular exposure wounds healed uneventfully .The patient was sent to chemotherapy. Occlusion of the graft occurred silently and hence left well alone. We hope that this bypass, or perhaps any other better option, proves to offer a management option for this frustrating morbidity that carries the risk of adding a neurologic deficit to the misery of the advanced head and neck malignancy

Aneurysms of the popliteal artery: management strategy and study of outcome

This study summarizes our experience in the management of popliteal aneurysms in 23 limbs [21 patients] during a 3-year period. The aim being to provide what constitutes our strategy of management and to determine the factors that influence the outcome. The data of 21 patients with 23 aneurysms were reviewed. There were 20 males and only one female, age ranging between 28 and 70 years, 18 aneurysms were atherosclerotic and 5 were arteritic. Patients were classified into group 1, the acutely ischaemic, group II with no evidence of acute ischaemia and group Ill, the asymptomatic cases. All patients brad colour coded duplex assessment, arteriograpgy was done in cases presenting with, ischaemia whether acute or chronic. 21 aneurysms were managed by operative repair while only one small asymptomatic aneurysm with no mural thrombus was managed conservatively. Also, one limb was treated by primary amputation because of irreversible ischaemia. The overall limb salvage rate in this series was 82.6%. All lost limbs belonged to group I i.e. those presenting with acute ischaemia. There was no hospital mortality and a follow up period ranging from 6 to 18 months brought forth neither mortality nor complications. Operative repair is the ideal treatment for all popliteal aneurysms. Exclusion and bypass, is the recommended procedure. Resection being particularly indicated when compression symptoms are conspicuous. There is a place to conserve in small asymptomatic aneurysms with no mural thrombi as well as in symptomatic aneurysms in non- threatened limbs with poor outflow vessels. In the latter situation, ill-advised surgery may end in limb loss. The results of this study also confirm that the outcome is strongly related to the initial presentation, being worse in time acutely ischaemic cases and hence elective repair is recommended

Carotid body tumours: surgical management and predictors of operative risk

In spite of a low but constant incidence of neurologic complications, resection of carotid body tumours of all sizes in appropriate surgical candidates has been advocated as the sole line of treatment of these rare lesions. This study summarizes our experience in the diagnosis and treatment of these lesions trying to identify the factors that predict the magnitude of operative risk.22 patients with 23 non-familial carotid body tumours presenting to the Cairo and Alexandria University Hospitals over a 4-year period were reviewed. There were 10 females and 12 males and the mean age was 42 years. A preoperative diagnosis, of being carotid body tumour, was not reached in 7 patients. In the remaining 16 tumours, duplex scanning, angiography, CT scanning and MRA clenched the diagnosis preoperatively, one tumour had FNAB and another open biopsy. 21 tumours were resected and the remaining 2 were irradiated. Internal carotid artery reconstruction employing great saphenous vein was required in 7 cases, end to end anastomosis in one case and lateral repair in another. A temporary shunt was used in 5 instances. Three patients suffered a transient hemiparesis while another 3 suffered a transient hypoglossal nerve palsy .It was concluded that surgical resection remains an effective form of treatment but is not without risk. The predictors of operative difficulty and hence increased risk include lack of preoperative diagnosis, mid and large sized tumours, Shamblin classes 2 and 3, use of FNAB as well as previous surgery