Vascular Disease in Women

An Overview of the Literature and Treatment Recommendations

1st Edition - July 16, 2021
Editors: Caitlin Hicks, Linda Harris
Language: English
Paperback ISBN:
9 7 8 - 0 - 1 2 - 8 2 2 9 5 9 - 0
eBook ISBN:
9 7 8 - 0 - 1 2 - 8 2 3 1 0 5 - 0

Vascular Disease in Women highlights the epidemiology, natural history and treatment of vascular disease, specifically as it pertains to women. The book provides a thorough overvi… Read more

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Vascular Disease in Women highlights the epidemiology, natural history and treatment of vascular disease, specifically as it pertains to women. The book provides a thorough overview of what is known and waht is now known about vascular disease in women and highlights opportunities for further education and research on this topic. The book will serve as an essential reference for both clinicians and researchers, discussing the disease prevalence, treatment options, and treatment outcomes for vascular disease in women and explores the need for future research in vascular disease specifically as it pertains to women.

Cover image
Title page
Table of Contents
Copyright
Contributors
Foreword
Acknowledgments
Introduction
Section 1: Thoracic aortic disease
Chapter 1a: Thoracic aortic disease in women: Sex disparities in etiology, presentation, and outcomes
Abstract
Introduction
Epidemiology
Natural history
Anatomic considerations
Sex disparities in aortic pathophysiology
Future considerations in screening and diagnosis
Chapter 1b: Thoracic aortic aneurysm repair in women
Abstract
Introduction
Indications for repair
Anatomic considerations
Preoperative planning and landing zones
TEVAR devices
Conduct of the operation
Management of endoleak
Complications
Postoperative management/surveillance
Long-term surveillance
Conclusions
Chapter 1c: Thoracic aortic dissection repair in women
Abstract
Introduction
Epidemiology and risk factors
Pathophysiology of aortic dissection
Classification of aortic dissection
Complications of aortic dissections
Clinical presentation of aortic dissection
Diagnosis of aortic dissection
Treatment of aortic dissection
Outcomes of aortic dissection
Conclusions
Chapter 1d: Thoracic aorta—What we still don’t know
Abstract
What we do not know about thoracic aortic disease in women
Epidemiology of thoracic aortic aneurysms and dissections
Growth rate of thoracic aortic aneurysms
Preoperative considerations in women
Operative results for women after open and endovascular repair
Summary
Section 2: Abdominal aortic aneurysm
Chapter 2a: Abdominal aortic aneurysm—Do women present differently than men?
Abstract
Introduction
Epidemiological differences in AAA between men and women
Risk factors
Clinical presentation in women compared with men
Differences in pathophysiology between men and women
Sex differences in aortic structural and biomechanical properties
Expansion rate and rupture risk
Differences in screening recommendations
Conclusion
Chapter 2b: Abdominal aortic repair in women: Criteria for repair and device selection
Abstract
Sex-based anatomic differences in abdominal aortic aneurysms
Growth rate and rupture risk
Screening guidelines
Female response to abdominal aortic aneurysm interventions
Device selection
Chapter 2c: Abdominal aortic aneurysms in women, what we still do not know
Abstract
Introduction
Epidemiology
Screening
Surveillance
Indications for operative repair and outcomes
Summary
Section 3: Carotid artery disease
Chapter 3a: Carotid artery disease: Do women present differently than men?
Abstract
Introduction
Symptomatic carotid artery stenosis
Delay in presentation and medical treatment
Knowledge, awareness, and attitudes of stroke signs and symptoms
Asymptomatic carotid artery stenosis
Medical management in men versus women
Pathophysiology of carotid plaque in women versus men
Role of hormones
Chapter 3b: Outcomes of carotid interventions in women
Abstract
Background
Medical management of carotid atherosclerotic disease
Surgical management of carotid atherosclerotic disease
Conclusions
Chapter 3c: Carotid artery disease—What we still don’t know
Abstract
Introduction
Carotid endarterectomy for symptomatic carotid artery disease in women
Carotid endarterectomy for asymptomatic carotid artery disease in women
Carotid artery stenting in women
Possible explanations for sex disparities in carotid artery disease
Conclusions
Section 4: Hemodialysis access
Chapter 4a: Hemodialysis access: What we know
Abstract
Introduction
Historical review of access initiatives
Data on vascular access in women
KDOQI 2019 updates and current recommendations
Chapter 4b: Women and hemodialysis access: What we still do not know
Abstract
Hemodialysis access
Survival
Psychosocial impact of ESRD
Transplant
Pregnancy
Conclusion
Section 5: Venous disease
Chapter 5a: Venous insufficiency and varicose veins in women management tips and tricks
Abstract
Acknowledgment
Epidemiology of venous disease
Pathophysiology
Classification
Epidemiology
Screening programs
Risk factors and presentation for venous disease
Functional venous disease in women
Treatment
The decision to treat
Chapter 5b: The management of May-Thurner syndrome in women
Abstract
Introduction
Epidemiology and etiology
Diagnosis and imaging
Treatment of MTS
Outcomes of treatment of MTS
Unresolved issues regarding the management of MTS
Conclusion
Chapter 5c: Venous disease in pregnancy
Abstract
Physiologic changes in pregnancy
Anticoagulation
Superficial venous thrombosis in pregnancy
Acute deep venous thrombosis
Postthrombotic syndrome
Additional areas of concern
Conservative management of venous disease in pregnancy
Conclusions
Chapter 5d: Venous disease—What we still do not know
Abstract
Introduction
Venous disease in women
Pathophysiology of venous disease
Obesity
Pelvic reflux
Venous therapies in the pregnant patient
Sex disparities in the management of venous disease
Conclusions
Section 6: Suprainguinal peripheral artery disease
Chapter 6a: Suprainguinal and infrainguinal peripheral artery disease—Do women present differently than men
Abstract
Epidemiology of peripheral arterial disease in women
Risk factors for peripheral artery disease in women
Presentation of peripheral artery disease in women
Conclusion
Chapter 6b: Suprainguinal endovascular procedures in women: Are all treatments created equal?
Abstract
Introduction
Anatomy and physiology
Clinical relevance
Chapter 6c: Suprainguinal peripheral artery disease: Open management
Abstract
Aortoiliac endarterectomy
Aortofemoral bypass
Iliofemoral bypass
Extra-anatomic bypass
Femoro-femoral
Axillofemoral
Thoracofemoral
Obturator bypass
Adjunctive profundaplasty
Hybrid procedures
Chapter 6d: Suprainguinal peripheral artery disease—Topics for future investigation
Abstract
Tobacco abuse—The confounding variable
Effects on reproductive health
Coincidence of hypercoagulable disorders
Hypoplastic aortoiliac syndrome
Morbidity and mortality
Conclusions
Section 7: Infrainguinal peripheral artery disease
Chapter 7a: Infrainguinal peripheral artery disease—Endovascular treatment in women compared with men
Abstract
Access site
Vessel size
Patency
Complications
Conclusions
Chapter 7b: Outcomes of open treatment of infrainguinal peripheral artery disease in women
Abstract
Introduction
Considerations for the open treatment options of infrainguinal peripheral arterial disease in women
Outcomes in women following open infrainguinal revascularization
Conclusions
Chapter 7c: What we still do not know in the treatment of infrainguinal peripheral artery disease in women
Abstract
Introduction
Are hormones protective or harmful?
Does size matter?
Societal impacts
Future needs in the treatment of infrainguinal PAD in women
Section 8: Thoracic outlet syndrome
Chapter 8a: Thoracic outlet syndrome, do women present differently than men?
Abstract
Acknowledgments
Introduction
Incidence
Sex differences in the presentation of TOS
Neurogenic TOS
Venous TOS
Arterial TOS
Surgical intervention for TOS in the United States
Conclusion
Chapter 8b: Thoracic outlet syndrome: Treatment approaches
Abstract
Introduction
Neurogenic thoracic outlet syndrome
Venous thoracic outlet syndrome
Arterial thoracic outlet syndrome
Conclusions
Chapter 8c: What we do not know about thoracic outlet syndrome in women
Abstract
Introduction
Incidence and pathophysiology
Diagnosis
Management
Outcomes
Conclusions
Section 9: Vasculitis
Chapter 9: Vasculitis
Abstract
Introduction
Large vessel disease
Medium vessel disease
Small vessel disease—Immune complex-related vasculitis
Cryoglobulinemia vasculitis
Small vessel disease: Antineutrophil cytoplasmic antibody-associated vasculitis
Variable vessel diseases
Thromboangiitis obliterans
Cogan syndrome (Cogan disease)
Conclusion
Section 10: Sex issues in vascular surgery research
Chapter 10: Vascular disease prevention and screening in women
Abstract
Introduction
Prevention of vascular disease in women
Screening of vascular disease in women
Summary
Chapter 11: Race and cultural issues
Abstract
Introduction
Racial and ethnic trends in the United States
Racial and ethnic disparities in vascular disease
Addressing disparities in vascular disease
Future directions
Chapter 12: Sex bias in surgical research
Abstract
Introduction
Sex bias in basic and translational research
Sex bias in human clinical research
Sex bias in vascular surgery clinical trials
Impact of sex bias in research
Conclusion
Chapter 13: Assessment of female sex in preclinical vascular models
Abstract
Introduction
Atherosclerosis
Peripheral arterial disease
Angioplasty
Aneurysmal disease
Cerebral aneurysms
Venous remmodeling
Summary
Section 11: Practice issues
Chapter 14: Leadership and women: Two perspectives
Abstract
Leadership opportunities for vascular surgery women
We all have a journey worth telling
Chapter 15: Building an academic career
Abstract
Introduction
Pillars of academia
Research
Education
Clinical
Administrative/academic
Factors in choosing a specific program
Mentorship and advancement
Chapter 16: Joining and building a successful private practice
Abstract
Introduction
Private practice organizational model
Scope of work
Locations for practice and time allotted
Compensation and benefits
Setting and measuring productivity with key performance indicators (KPIs) and adjusting goals
Establishing, marketing, and growing
Website, social media, printed materials
Conclusion
Chapter 17: Radiation safety for women: What physicians and patients need to know
Abstract
Introduction
Definition of radiation and biologic effects
Clinical effects of ionizing radiation exposure
Females and increased risk of ionizing radiation
Estimating radiation dose
Protection from medical radiation
Occupational dose limits
Monitoring dose
Radiation dose and the embryo/fetus
Techniques to minimize radiation exposure in women and women of reproductive age
New technologies and radiation exposure reduction
Impact of radiation exposure on female interventionalists/surgeons and trainees
Quality improvement and radiation safety
Monitoring for radiation-induced tissue injury
Radiation safety oversight
Conclusion
Chapter 18: Gendered risk factors for burnout— Work-life integration and other workplace challenges
Abstract
Introduction and background
Work-life integration
Challenges in the workplace
Changing the cultural landscape (culturescape)
Conclusion
Chapter 19: Contemporary topics focused on the experience of women in the United States surgical workforce
Abstract
Changing demographics of the United States surgical workforce
Importance of equity, diversity, and inclusion
Being a woman surgeon when the prototype is male
Gender bias, discrimination, and harassment
Gender pay gap
Advancement and leadership
Looking into the future
Her time is now
Conclusion
Chapter 20: Pregnancy perceptions and experiences for surgeons and surgical trainees
Abstract
Introduction
Perceptions
Timing
Maternity leave
Schedule
Maternal and fetal health
Pumping
Childcare
Mentorship
Need for future research
Conclusions
Index

Caitlin Hicks

Dr. Hicks specializes in congenital aortic pathologies and is skilled in both open and endovascular surgery for the treatment of aortic and peripheral disease. She is also accomplished in clinical research with over 130 peer-reviewed publications and numerous textbook chapters; her research interests include clinical outcomes in aneurysm repair and lower extremity revascularization, as well as high-value care in vascular surgery. As a distinguished fellow of the American Board of Surgery, Dr. Hicks is the recipient of the Department of Surgery Rothman Early Career Development Award for Surgical Research and was selected as a Visiting Scholar to the American Board of Medical Specialties for 2018-2019. She is also an appointed member of a CMS Clinical Expert Subcommittee tasked with refining peripheral vascular disease cost measures for implementation in the Quality Payment Program.

Affiliations and expertise

Assistant Professor of Surgery, Associate Fellowship Program Director, Division of Vascular Surgery and Endovascular Surgery, Johns Hopkins University School of Medicine

Linda Harris

Linda M. Harris MD joined UBMD Surgery in 1995, and currently sits as a Professor of Surgery with tenure in the department of Surgery. Dr. Harris is Board certified by the American Board of Surgery in Vascular Surgery and General Surgery. She has received 21 awards and honors throughout her career and has worked with 53 various grants relating to her vascular expertise. Dr. Harris has been published 68 times in referred journals, contributed to 10 articles / editorials, contributed to 17 book chapters and has been featured in media spotlight 4 times. She is currently co-editing a book in vascular surgery. She has been invited to present 77 times about various relating topics, and has given 136 presentations relating to her expertise. Dr. Harris is the Program Director for the Vascular Fellowship and Vascular Residency Programs. She is also a Fellow of the Society of Vascular Surgeons and a member of the Society of University Surgeons. Dr. Harris belongs to numerous societies and is involved with their activities including: American College of Surgeons, Association of Women Surgeons, Association for Academic Surgery, and Western New York Vascular / Endovascular Society. She is past president of the Eastern Vascular Society, the largest regional vascular society in the US, and the Association of Program Directors in Vascular Surgery. She also sits on the editorial board for the Journal of Vascular Surgery, the Vascular Specialist, and ACS News. Within the University at Buffalo, Dr. Harris is involved with many programs including: Graduate Medical Education, Executive Council for Department of Surgery, and Academic Leadership Group representing the Department of Surgery for Kaleida Health.

Affiliations and expertise

Professor of Surgery, Residency and Fellowship Program Director, Department of Surgery, Division of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences