January/February 2011 - SASSiT

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Editor Bradley A David Editorial Committee Ferhana gool Abri Bezuidenhout Shreya Rayamaji Publishing, Design and Layout Bradley A David ‘the Needleholder’ is the official online e-‐Journal of the South African Society of Surgeons in Training SASSiT Every effort has been made to ensure that all material is the original work of its authors and that where applicable outside material is appropriately referenced. Please feel free to email us with your concerns, comments, questions and ideas on how we can improve this publication: theneedleholder@gmail.com Volume 1 Issue 1 January – February 2011 Contents Editorial Planning a career in vascular surgery. What the future holds? Dr Phillip Matley, President of VASSA …………………………………………….4 Review A review of endovascular aortic repair (EVAR) in the elective management of abdominal aortic aneurysms. Gool F, Malherbe GF…………………………………………………………………………5 Case Reports Dysphagia Lusoria: A case of an aberrant right subclavian artery and a bicarotid trunk Rogers AD, Nel M, Eloff EP, Naidoo NG……………………………………………13 Case Report: Spontaneous Aortocaval Fistula Forgan T, Du Toit D…………………………………………………………….…………19 Miscellaneous A biographical guide to the surgical tray: Michael E DeBakey…………………………………………………………………………11 Thomas J. Forgarty………………………………………………………………………...18 2
A career in vascular surgery in Southern Africa presents numerous interesting challenges for surgeons in training. Currently there are less than 40 registered specialist vascular surgeons in active practice in a country with a population of over 40 million, making fully trained specialist vascular surgeons a very precious resource. Out of sheer necessity, a great deal of vascular care and many vascular procedures are being performed by general surgeons but this is not ideal, given the increasing level of sophistication of vascular and endovascular surgery and the increasing demands and expectations of patients. Vascular disease is on the increase and this is contributed to by the fact that in developed counties, people are simply living to an older age. The scourge of diabetes has already been recognized as an international epidemic of worrying proportions. Tobacco use has not been brought under control and within our country, hypertension, hyperlipidaemia and aneurysmal disease are not only very common but tend to reflect strong genetic factors. Vascular trauma and unusual vasculopathies such as Takayasu Disease and HIV vasculopathy are particularly prevalent in our sub-‐continent. Vascular surgery is one of the youngest surgical specialties. The endovascular revolution, particularly in the 1990s has almost totally changed the way that we work. In South Africa, unlike the United Kingdom and many other parts of the world, endovascular procedures have largely remained in the hands of vascular surgeons rather than radiologists and cardiologists. This has broadened the scope and interest level of vascular surgery enormously. Vascular surgeons provide primary vascular care and education, diagnosis and assessment as well as the whole range of medical, surgical and endovascular treatment. This is in contrast to several areas of surgical gastro-‐enterology where PLANNING A CAREER IN VASCULAR SURGERY IN SOUTH AFRICA What does the future hold? Dr Phillip Matley President of VASSA Guest Editorial primary care and diagnosis is provided by gastroenterologists, and cardiac surgery where this is provided almost exclusively by cardiologists. The modern vascular surgeon has an intimate knowledge of vascular medicine and the medical management of the risk factors and the disease processes themselves. Furthermore, vascular surgeons have “hands-‐on” involvement in diagnosis and imaging, particularly with the increasing use of colour-‐flow duplex ultrasound. Vascular surgery works well in private practice in this country. Several private hospitals have established vascular centres of excellence including dedicated vascular wards, hybrid operating theatres (with ceiling-‐mounted angiographic facilities) and multi-‐disciplinary medical and para-‐medical teams. Vascular disease is common in the group of patients who enjoy private medical cover and there appears to be an almost limitless number of patients with varicose veins requesting surgical treatment. The earning potential of vascular surgeons compares very well to other specialties in the general surgery arena. The endovascular revolution and the increasing sophistication of vascular care is challenging the conventional training and career pathways. 3
Page 1: Volume 1 Issue 1 January - February
Page 5 and 6: A review of endovascular aneurysm r
Page 7 and 8: aneurysm-related death were all mor
Page 9: However, endovascular repair was no
Page 13 and 14: Dysphagia Lusoria: A case of an abe
Page 15 and 16: has a wider diameter than the dista
Page 17 and 18: a covered wall stent with an occlud
Page 19 and 20: Case Report: Spontaneous Aortocaval
Page 21: Perioperative mortality is high, ra

January/February 2011 - SASSiT

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