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