Vascular Surgery - Vascular Surgery in Cerebrovascular Disease

Vascular Surgery - Vascular Surgery in Cerebrovascular Disease

Introduction

A lot of advances have been made in the field of vascular surgery in cerebrovascular disease . These improvements have been manifested in inter alia , surgical processes , techniques and technology whose primary effect has been the improvement of prognostic outcomes in patients suffering from cerebrovascular diseases

This will discuss vascular surgery in the treatment and prevention of cerebrovascular disease as well as offer insights into new procedures , techniques and technology used in vascular surgery for the treatment of cerebrovascuar disease . Whereas our discussion

will be drawn from a number of peer reviewed articles , specific s that have played a role in influencing my thinking about vascular surgery will be looked at in an in-depth manner

The first is a summary by Doerfler et al (2004 ) which discusses recent advances in the treatment of cerebrovascular disease through endovascular therapy . The second is a prospective study by Stam et al (2007 ) titled `endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis . The third , `Vascular Surgery , is written by Stanley (1999 ) and it gives wide-ranging contributions that have been made in the field of vascular surgery

Discussion

In their seminal work , Doerfler et al (2004

. 481-87 ) give a detailed outlay of recent advances in the treatment of cerebrovascular disease through endovascular therapy . These advances include improvements in coils , stents and microcatheters as well as balloon assisted embolization . Novel hydrogel coils have been shown to vastly enhance aneurysm packing while nitinol stents have found use as indispensable adjuncts in the resolution of wide-necked aneurysms . The double stent technique holds promise for treatment of small wide necked aneurysms where surgery is contraindicated and other techniques are potentially hazardous or impractical

As Hacein-Bey and Varelas (2006

.699 ) note , stents are not used widely because of their many shortcomings . Recent efforts have however been directed at research and production of advanced stents which promise to overcome these shortcomings . Advances are being made in the production of bioabsorbable stents and self-expanding or balloon-expandable stents utilizing polymeric compounds such as poly-L-lactic acid and polyglycolic acid (Hacein-Bey and Varelas , 2006

.699

Balloon assisted embolization which employs an ethylene vinyl alcohol copolymer is becoming increasingly useful for treatment of aneurysms that are not amenable to coils or in instances where treatment has failed to attain occlusion . However , relatively little progress has been made so far in the endovascular treatment of arteriovenous malformations (AVMs . Recent research suggests that intranidal aneurysms or aprogressive neurological deficits are the only conditions that should necessitate therapy . However , it is indicated that newer embolic agents such as Onxy (an ethylene vinyl alcohol polymer ) are being over the traditional agents . theless , it remains to be seen whether they can improve the utility of the therapy (Doefler et al , 2004

Additionally , the transvenous approach used in the endovascular treatment of arteriovenous dural fistulae has been shown to give better prognostic outcomes than either the combined or transarterial approaches . More advances have been reported in...