AI Textbook of Vascular Surgery

1

Overview of Vascular Disease

Part 1 • 20 sections

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Thromboembolic Disease

Diagnostics and Imaging

Surveillance Intervals

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Foundational vascular anatomy and hemodynamics

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2

Atherosclerosis and Risk Factors

Part 1 • 21 sections

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3

Vascular Diagnostics and Imaging

Part 1 • 25 sections

Segmental Pressure Measurements

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Pulse Volume Recordings

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Transcutaneous Oxygen Pressure (TcPO₂)

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Venous Plethysmography

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Duplex Ultrasound

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Computed Tomography Angiography

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Magnetic Resonance Angiography

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Catheter Angiography (Digital Subtraction Angiography, DSA)

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Intravascular Ultrasound

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Optical Coherence Tomography

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PET/CT and PET/MR

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Artificial Intelligence (AI) in Diagnostics

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Tables

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Exercise ABI, post-exercise testing, and handling noncompressible arteries

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Objective perfusion metrics for CLTI: toe pressure, TcPO2, skin perfusion pressure (SPP) and WIfI staging

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Standardized duplex ultrasound protocols and criteria

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CTA technical parameters for aorta and peripheral arteries

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MRA advances for PAD and aorta (non-contrast techniques, vessel wall imaging)

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Intravascular imaging: IVUS for iliac venous outflow obstruction and arterial optimization; OCT scope

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Nuclear medicine: PET/CT for large-vessel vasculitis and vascular graft/endograft infection

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Contrast-enhanced ultrasound (CEUS) for EVAR surveillance

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4

Aortic Aneurysmal Disease

Part 2 • 23 sections

Complex Anatomy Challenges

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Abdominal Aortic Aneurysm

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Key Trials and Registries

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General Principles

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Ruptured Abdominal Aortic Aneurysm

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Ruptured Iliac Artery Aneurysms

Screening and surveillance of intact small AAA (pre-repair)

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Explicit repair thresholds and sex-specific considerations

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Evidence synthesis of EVAR vs open for intact AAA with long-term outcomes

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IMPROVE trial and rAAA management

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UK Small Aneurysm Trial (UKSAT) and ADAM context for small AAA

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Definitions and nomenclature (infrarenal, juxtarenal, pararenal, suprarenal) and hostile neck criteria

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Iliac artery aneurysm thresholds and iliac branch device strategy

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Medical optimization and pharmacotherapy

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Post-repair antithrombotic and imaging surveillance strategy tailoring

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Clinical Reference Tables

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5

Peripheral Aneurysms

Part 2 • 18 sections

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Background

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Etiology and Risk Factors

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Pathophysiology

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Clinical Presentation

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Non-Invasive Assessment

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Screening

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Indications for repair

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Open repair (gold standard)

Acute limb ischemia due to PAA thrombosis

Natural history and risk stratification of asymptomatic popliteal artery aneurysms (PAA)

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Explicit evidence-based thresholds for elective repair (symptomatic vs asymptomatic)

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Structured surveillance protocols (by aneurysm size and after repair)

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Comparative outcomes: open vs endovascular repair with patient selection

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Associated aneurysm screening beyond AAA (contralateral popliteal and femoral aneurysms) with modality

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6

Thoracic and Complex Aortic Disease

Part 2 • 9 sections

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Aortic Dissection Classification

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Type B Aortic Dissection Management

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Type A Aortic Dissection

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Complex AAA and TAAA

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Thoracic Aortic Aneurysm

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Ruptured Thoracic Aortic Aneurysm

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Thoracic aortic aneurysm thresholds (ascending, arch, descending) and genetic disease considerations

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TAAA classification and spinal cord protection bundle

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Surveillance After Aortic Dissection

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7

Carotid and Cerebrovascular Disease

Part 3 • 27 sections

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Background

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Atherosclerosis (most common)

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Non-atherosclerotic causes

Clinical Presentation

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Stroke Risk by Category

Digital Subtraction Angiography

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Plaque Imaging

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Optimal Medical Therapy

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Carotid Endarterectomy

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Carotid Artery Stenting

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Transcarotid Artery Revascularization

Asymptomatic carotid stenosis (ACS): contemporary selection for intervention vs best medical therapy (BMT)

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Modern CEA vs CAS evidence synthesis and patient selection (ACT-1/ACST-2; age/anatomy modifiers)

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Timing of carotid intervention after TIA/minor stroke and after thrombolysis

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Imaging criteria: stenosis grading standards and plaque vulnerability features

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Peri-procedural antithrombotic therapy for CEA/CAS/TCAR

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Surveillance and restenosis management (including in-stent restenosis)

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Role and Indications of TCAR Relative to CAS and CEA

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Evidence-based carotid revascularization overview

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8

Vertebral and Subclavian Disease

Part 3 • 26 sections

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Vertebral-Subclavian Atherosclerosis

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Non-atherosclerotic etiologies

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Vertebral artery dissection management

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Vertebral artery disease

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Subclavian artery disease

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Collateral pathways

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Vertebral artery stenosis/occlusion

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Subclavian artery stenosis/occlusion

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Vertebral-Subclavian Clinical Assessment

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Duplex Ultrasound

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CTA (Computed Tomography Angiography)

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MRA (Magnetic Resonance Angiography)

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DSA (Digital Subtraction Angiography)

Endovascular therapy (preferred first-line in most)

Left subclavian artery management in TEVAR

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Vertebral-Subclavian Follow-up

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Coronary-subclavian steal syndrome

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Vertebral-Subclavian Tables

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Explicit differentiation: extracranial vertebral artery origin (VAO) stenosis vs intracranial vertebral/basilar stenosis (atherosclerotic) and how treatment differs

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Subclavian steal syndrome: pathophysiology grading and intervention thresholds

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Pre-CABG planning when a LIMA graft is intended: screening and timing of subclavian revascularization

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Comparative evidence for endovascular vs open surgical revascularization for subclavian lesions

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9

Upper Extremity Arterial Disease

Part 3 • 20 sections

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10

Lower Extremity Arterial Disease

Part 4 • 25 sections

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11

Mesenteric Ischemia

Part 4 • 25 sections

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Etiology of Renal Artery Stenosis

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Background

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Evidence from randomized trials (CORAL, ASTRAL) and patient selection for renal artery stenting

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Fibromuscular dysplasia (FMD) comprehensive evaluation and longitudinal management

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Imaging and Contrast Strategies in CKD for Renal and Mesenteric Interventions

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Etiology and Risk Factors

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Pathophysiology

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Clinical Presentation

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Diagnostics

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Treatment: Acute Mesenteric Ischemia

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Treatment: Chronic Mesenteric Ischemia

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Treatment: Mesenteric Venous Thrombosis

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Acute Mesenteric Ischemia

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Chronic Mesenteric Ischemia

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Median Arcuate Ligament Syndrome

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Hybrid and Endovascular Techniques

SMA Embolism vs SMA Thrombosis in AMI: Clinical and Imaging Distinctions

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CTA acquisition protocol and diagnostic performance for AMI

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NOMI-specific management (hemodynamics and intra-arterial vasodilators)

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CMI target vessel strategy and outcomes (endo vs open)

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Bowel viability assessment and second-look policy in AMI

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Duplex ultrasound thresholds and role in surveillance after mesenteric stenting

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12

Venous Thromboembolism

Part 5 • 20 sections

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13

Chronic Venous Insufficiency and Varicose Veins

Part 5 • 24 sections

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Background

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Etiology and Risk Factors

Clinical Presentation

Functional tests (rare in practice)

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General/Conservative

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Interventional (Superficial System)

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Interventional (Deep Venous System)

Complete CEAP classification (E, A, P components) and Venous Clinical Severity Score (VCSS)

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Ultrasound reflux thresholds and testing protocol

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Endothermal heat-induced thrombosis (EHIT) and post-ablation DVT surveillance/management

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Management of tributaries: ambulatory phlebectomy and ultrasound-guided foam sclerotherapy

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Perforator vein disease: indications and techniques

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Combined superficial reflux and iliac outflow obstruction

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Pregnancy and varicose veins

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Ulcer Care: Compression Levels and Adjuncts

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Venous disease classification (CEAP) and outcomes

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14

Lymphedema

Part 5 • 16 sections

Stages (ISL classification)

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Clinical Presentation

Conservative (cornerstone)

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Surgical and Interventional

Risk stratification and incidence of cancer-related lymphedema

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Differential diagnosis and objective limb measurement

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Antibiotic prophylaxis for recurrent cellulitis in lymphedema

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Patient selection and expectations for lymphatic surgery

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15

Vascular Trauma

Part 6 • 15 sections

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Background

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Etiology and Mechanisms

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Pathophysiology

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Hard Signs of Vascular Injury

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Diagnostics

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Principles of Damage Control Vascular Surgery

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Open Surgical Approaches

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Endovascular Approaches

Guidelines and Evidence

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Blunt thoracic aortic injury (BTAI) management

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Temporary intravascular shunts (TIVS): indications, technique, and outcomes

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Limb salvage decision-making and fasciotomy indications

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16

Endovascular Trauma Management

Part 6 • 17 sections

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Background

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Pathophysiology of Endovascular Resuscitation

Endovascular Stent-Grafts

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Endovascular Embolization

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Temporary Intravascular Shunts

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Hybrid Trauma and Endovascular Surgery

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EVTM in Resuscitation Workflows

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Outcomes and Evidence

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Complications

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Guidelines and Consensus

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References (Expanded)

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REBOA Deployment Details: Zones, Occlusion Times, and Techniques

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Femoral access specifics for EVTM (arterial and venous): sheath size, ultrasound technique, closure

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Pelvic hemorrhage algorithms integrating preperitoneal pelvic packing (PPP), REBOA, and angioembolization

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Post-occlusion management: reperfusion, metabolic derangements, distal perfusion catheter

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17

Abdominal Compartment Syndrome and Visceral Venous Disorders

Part 6 • 13 sections

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Abdominal Compartment Syndrome: Background

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ACS: Etiology and Risk Factors

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ACS: Pathophysiology

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ACS: Clinical Presentation and Diagnosis

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ACS: Stepwise Management Algorithm

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ACS: Decompressive Laparotomy

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ACS: Open Abdomen Management

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Visceral Venous Disorders: Overview

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Portal Vein Thrombosis

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Mesenteric Vein Thrombosis

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Budd-Chiari Syndrome

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Surveillance and Long-term Management

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Guidelines and Evidence

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18

Vascular Malformations

Part 7 • 14 sections

Clinical Presentation

Systemic and Adjunctive Therapies

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Follow-up

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Guidelines and Consensus

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Schobinger clinical staging of AVMs

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Hereditary hemorrhagic telangiectasia (HHT) and pulmonary AVMs

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Evidence summary for sclerotherapy and embolization outcomes/complications

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19

Hemodialysis Access

Part 7 • 17 sections

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Background

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Etiology and Indications

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Pathophysiology of Access Maturation and Failure

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Clinical Presentation

Endovascular Interventions

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Surgical Interventions

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Complications and Management

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Follow-up and Surveillance

Access planning using an ESKD Life-Plan and timing of referral/creation

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AVF maturation optimization (postoperative DUS, balloon-assisted maturation, early stenosis management)

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When to choose AVG over AVF (elderly, limited life expectancy, poor vessels)

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Central venous stenosis (CVS): evaluation and management nuances

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Evidence update on drug-coated balloons (DCB) for AVF stenosis

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20

Future Directions in Vascular Surgery

Part 7 • 13 sections

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Background

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Endovascular Expansion

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Hybrid Surgery

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Multidisciplinary Care

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Personalized Medicine

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Artificial Intelligence (AI) and Big Data

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Robotics and Automation

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Advanced Biomaterials

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Regenerative and Molecular Therapies

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Wearables and Remote Monitoring

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Education and Simulation

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Global and Societal Aspects

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Future Paradigms

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