Why did you feel that it was important to write Rich’s Vascular Trauma, 4th Edition? What does it add to the field?
Dr. Rasmussen: The topic of vascular trauma is at the crossroads of multiple surgical specialties, is of extreme consequence to those injured in military and civilian settings and is an international problem. We were compelled to write this text as a one of a kind knowledge source that brings together highly experienced and internationally recognized authors from all of these different areas; authors from different surgical specialties, authors with military and civilian experience and international authors from around the world.
Dr. Tai: Trauma – whether from knife, gunshot, explosion, motor vehicle accident or fall-from-height – does not respect the anatomical boundaries that often distinguish surgical specialties. Where vascular injury is concerned, with its attendant and time-critical risks of blood loss and tissue ischaemia are concerned, patients need multi-specialty care from vascular surgeons, trauma surgeons, endovascular specialist, anaesthetic, critical care and pre-hospital teams working in concert. This book is one of the very few texts devoted to the field of vascular trauma, with content spanning resuscitation, surgery, endovascular interventions and reconstruction. The breadth of the authorship, which is truly international, not only represents the spread of specialties whose input in to acute patient care is so important, but also the different practice settings in which care is delivered, from sophisticated urban trauma center to austere field hospital.
What is the most exciting aspect of the new edition? What chapter or topic covered are you most excited about?
Dr. Rasmussen: I’m most excited about the Emerging Technologies and New Approaches section of the textbook. This section goes beyond the traditional open surgical approaches use for the management of vascular trauma and features new and emerging technologies and methods that will be applied in the future. The Emerging Technologies section includes information-rich chapters on endovascular-specific operating rooms and vascular trauma service lines as well as those that explore new and exciting areas of endovascular and extracorporeal resuscitation.
Dr. Tai: With so much new content it’s difficult to choose! I am particularly excited about the brand-new section at the front of the text where two new authors, both of whom are Surgical Residents, have helped us distil the key messages from the text into quickly digestible pearls. We developed this section in close collaboration so that busy residents, needing an accessible summary of a particular topic, would be able to review the key elements of a particular aspect of vascular injury management, saving a deeper in to the book’s richer content for later. In this way we hope we are giving the readership the traditional content associated with a text such as this, but also meeting their needs to pull out the “pearls” rapidly. I am also really pleased with the International Perspectives part, which details how the common problems that all clinicians working in this field are addressed in different regions around the world.
Who will find the greatest value from this book and why?
Dr. Rasmussen: Surgical trainees from the many specialties that intersect at the crossroads of vascular trauma are likely to get the greatest amount of information and excitement from the book. This includes general, trauma and vascular surgery students and trainees. However, the books appeal should extend to faculty, young and old who would benefit from a well-referenced resource dedicated to one of the most complicated and consequential forms of injury, vascular trauma. As an editor of the book I have learned volumes from the brilliantly talented authors who have contributed chapters and other forms of content to the 4th edition.
Dr. Tai: I think senior surgical trainees and recently appointed surgical attendings or consultants will derive most value, but anyone working in trauma care – from ED through to Interventional Radiologist, to Critical Care specialist – will find that this book lends itself well to their understanding of how best to manage vascular trauma patients.
What new ideas, practices, or procedures do you hope your readers take away from Rich’s Vascular Trauma, 4th Edition?
Dr. Rasmussen: We have tried to make the textbook a “one-stop” resource with which the reader, regardless of level of training or experience, can find an array of information on vascular trauma, from a new “resident’s perspective” section, to practical tips and tricks given, to seasoned guidance on open vascular surgery, to emerging technologies and perspectives from around the world. With the extent of content and perspective in the textbook, we hope that it avails itself to a personalized learning approach, allowing individual readers to take what fits best for them and their learning and practice needs.
Dr. Tai: There is a wealth of new knowledge being developed with regard to Damage Control endovascular techniques such as REBOA and its associated technologies, as well as much better understanding of how to set up the infrastructure needed to image and deliver endovascular & open procedures in the same space. These areas are covered in depth, as well as new research techniques that can be employed to develop the evidence base for trauma care.
What problem do you hope the future generation of vascular surgery will be able to solve?
Dr. Rasmussen: Improving interdisciplinary collaboration for the training and treating vascular injury is problem that needs solved. The number of different specialties that contribute to the optimal management of patients with this problem risks fragmenting the training paradigms and treatment algorithms. Taken to its extreme, this fragmentation risks vascular trauma becoming an orphaned topic to which no one of the contributing specialties is properly focused or engaged.
From a technology and innovation standpoint, the potential for endovascular technologies to improve the management of vascular trauma is in its infancy. General and trauma surgeons have relegated the use of endovascular technologies for vascular injury to vascular and endovascular surgeons and interventional radiologists and seem mostly disinterested or unable to muster the momentum to attain and use this skillset. Many vascular and endovascular surgeons and interventional radiologists view vascular trauma as a nuisance that interrupts sleep and elective schedules. It will be up to the next generation of surgeons to improve training for, familiarity with and the use of less invasive, endovascular techniques as more effective ways to manage vascular injury.
Dr. Tai: There are so many rewarding areas to explore! The use of endovascular techniques to halt blood loss, or bridge patients to a more definitive solution – perhaps employed in the pre-hospital space – is very exciting, as are new materials for vascular reconstruction and better prediction of which patients do best with different approaches (using the power of AI) are just a few.
Is there anything else about the book you’d like to say?
Dr. Rasmussen: The 4th edition follows in the legacy of its namesake Norman M. Rich who, in addition to being a wonderfully talented surgeon, Army officer and mentor to generations of students and trainees, was a global ambassador for vascular trauma. The editors have worked carefully to preserve and highlight the legacy of Dr. Rich throughout the textbook, including maintaining a robust International Perspectives section showcasing essays on vascular trauma written by military and civilian experts from 10 countries and regions around the world. It is our hope that the textbook will serve as an informative resource for military and civilian surgical learners, but also as an exemplar of the interdisciplinary and international collaboration that characterized the life and career of Dr. Norman M. Rich.
Dr. Tai: We’ve made a real effort to build on the legacy of the previous editions. The text is not merely a “refreshed” or updated version – it’s built around a core of new content and chapters that adds new value and which I hope readers will find of direct, practical help in managing these challenging injuries.
About the Authors
Todd Rasmussen is am a professor of surgery and now senior associate consultant in vascular surgery at the Mayo Clinic in Rochester, Minnesota. He recently retired after 28 years of service as a military surgeon in the United States Air Force. His career in the military included many deployments to surgical hospitals in the Iraq and Afghanistan Wars, leadership roles in military medical research and innovation, and a period of time as associated dean and attending surgeon at the Uniformed Services University and Walter Reed National Military Medical Center in Bethesda, Maryland.
Nigel Tai is a Trauma and Vascular Surgeon working in a busy major trauma center in London’s East End (The Royal London Hospital). He is also a British Army surgeon who has been deployed on operations many times.
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