Preface

Vascular surgery is one of the specialties of surgery focusing on the vascular system of the body, i.e. arteries and veins. The unique feature of this specialty is, unlike other surgical specialty, that vascular surgeons routinely perform not only the conventional open surgery but also the diagnostic and interventional endovascular procedures. For that reason, the field of vascular surgery has evolved rapidly since the introduction of the endovascular aneurysms repair (EVAR) as well as the numerous techniques and devices of endovascular procedures for peripheral artery disease and varicose veins. This book aims to provide a brief overview of conventional open vascular surgery, endovascular surgery and pre- and post-operative management of vascular patients.

The collections of contributions from outstanding vascular surgeons and scientists from around the world present detailed and precious information about the important topics of the current vascular surgery practice and research. This book covers a wide variety of issues and topics of the vascular surgery. I would like to acknowledge the authors around the world for their excellent contributions to this book. I also would like to express my special thanks to the managing editor of INTECH for providing me numerous supports and advices.

I hope this book will be used worldwide by young vascular surgeons and medical students enhancing their knowledge and stimulating the advancement of this field.

> **Dai Yamanouchi, MD, PhD** Assistant Professor of Vascular Surgery University of Wisconsin School of Medicine and Public Health USA

**Section 1** 

**Carotid Surgery** 

**Section 1** 

## **Carotid Surgery**

**Chapter 1** 

© 2012 Chiariello et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

In our Institution in 2005 we introduced a new therapeutic strategy consisting of a simultaneous hybrid revascularization by CAS, immediately followed by CABG and cases

and reproduction in any medium, provided the original work is properly cited.

**Simultaneous Hybrid Revascularization by** 

Significant atherosclerotic disease affecting also the carotid artery system is encountered in a substantial number of patients undergoing coronary artery bypass grafting (CABG) [1]. The optimal surgical management to prevent stroke and cardiac events in this subset of patients remains unclear [2-5]. Among patients undergoing carotid endoarterectomy (CEA) procedure in the Veterans Affair Cooperative Study and in the Asymptomatic Carotid Atherosclerosis Study, respectively 20% and 49% of deaths were related to cardiac causes [4]. Similarly, the incidence of perioperative stroke in patients undergoing CABG is high in those affected by concomitant significant carotid disease [2-4]. The combined surgical approach is associated with an increased risk for mortality and morbidity [5]. In the staged surgical approach which addresses the carotid artery lesion with carotid endoarterectomy first, followed several days to several weeks by CABG, incidence of perioperative stroke during CABG is reduced .However, the risk of myocardial infarction (MI) during the CEA procedure and in the period preceding CABG remains high (6%) [6]. Carotid artery stenting (CAS) using cerebral protection devices is rapidly evolving as an alternative to carotid endoarterectomy [7], mainly for patients with severe carotid artery stenosis at high surgical risk [8], such as patients with coronary artery disease. A staged CAS-CABG approach has been recently proposed, but the need of a dual anti-platelet aggregation therapy lasting 3-4

**Carotid Stenting and Coronary Artery** 

**Bypass Grafting – The SHARP Study** 

Luigi Chiariello, Paolo Nardi and Francesco Versaci

weeks after stenting may represent a limitation for CABG [9].

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/51731

**2. Clinical experience** 

**1. Introduction** 

**Chapter 1** 
