World Journal of Surgery

, Volume 29, Supplement 1, pp S64–S66 | Cite as

Noninvasive Vascular Testing—A 35-Year Reflection

Article

Abstract

Noninvasive vascular testing has made a major contribution to the care of vascular surgery patients. This article a reflection on a 35-year corroborative association with Doctor Norman Rich, during which many of the advances in noninvasive vascular testing have been witnessed and effected. I served my vascular surgery fellowship under Doctor Rich in 1967–68 at Walter Reed Army Hospital. The only noninvasive vascular equipment then was a pencil probe Doppler. The value of the Doppler in the management of peripheral vascular disease that year and in determining limb viability in combat surgery in Vietnam the following year was established, and both experiences were published. Later, Doctor Rich established the annual Military Vascular Surgery Meeting and was appointed as the first Chair of the Department of Surgery at the Uniformed Services University for Health Sciences (USU). I entered private practice in Central California in 1976, and ultrasonic imaging was developed which allowed noninvasive examination of the carotid arteries. I then developed a protocol to screen for the three silent, immediate causes of stroke, employing a “a quick carotid scan” for carotid artery disease, a lead II rhythm strip for atrial fibrillation, and blood pressure determination for hypertension so that these common causes of strokes could be recognized and treated, and potentially prevent the majority of strokes. My association with USU, Doctor Rich, and others involved proved instrumental in initiating implementation of stroke prevention screening. The structure established at USU provides a means of establishing the protocol nationally. Noninvasive vascular testing is an addition to Medical Science that has led to significant improvements in individual patient care and that has the potential of allowing a major reduction in death and disability from stroke and other vascular diseases. Throughout a 35-year collaborative association with Doctor Norman M. Rich, I have witnessed and developed many of these advances. These contributions to noninvasive vascular testing reflect the value of our collaboration.

References

  1. 1.
    Lavenson, GS, Rich, NM 1970Value of ultrasonic flow detector in the management of peripheral vascular diseaseAm. J. Surg120522526PubMedGoogle Scholar
  2. 2.
    Lavenson, GS, Rich, NM, Strandness, DE 1971Ultrasonic flow detector value in combat vascular injuriesArch. Surg103644647PubMedGoogle Scholar
  3. 3.
    Executive Committee for the Asymptomatic Carotid Arteriosclerotic Study1995Endarterectomy for asymptomatic carotid artery stenosisJ. Am. Med. Assoc27314211428Google Scholar
  4. 4.
    Hobson, RW, Weiss, DG, Fields, WS,  et al. 1993Efficacy of carotid endarterectomy for asymptomatic carotid stenosisN. Engl. J. Med328221227PubMedGoogle Scholar
  5. 5.
    Cronenwett, JL, Birkmeyer, JD, Nackman, GB,  et al. 1997Cost effectiveness of carotid endarterectomy in asymptomatic patientsJ. Vasc. Surg25298311PubMedGoogle Scholar
  6. 6.
    Perry, JR, Szalai, JP, Norris, W 1997Consensus against both endarterectomy and routine screening for asymptomatic carotid artery stenosisArch. Neurol.542528PubMedGoogle Scholar
  7. 7.
    Lavenson, GS 1998A new accurate, rapid and cost-effective protocol for stroke prevention screeningCardiovasc. Surg.590593PubMedGoogle Scholar
  8. 8.
    Lavenson, GS, Sharma, D 1996Medical cost savings through stroke prevention from 100 consecutive new carotid duplex scansCardiovasc. Surg4753758PubMedGoogle Scholar
  9. 9.
    Lavenson, GS, Sharma, D 1994Cost savings of carotid endarterectomy: value of one vascular surgeon in one yearPerspect. Vasc. Surg.7120Google Scholar
  10. 10.
    Lavenson, GS 1997Carotid screening: preparing for the futureVasc. Ultrasound Today26372Google Scholar
  11. 11.
    Lavenson, GS 2003Stroke prevention screening: rationale, method and implementationVasc. Ultrasound Today8324Google Scholar
  12. 12.
    Jacobowitz, GR, Rockman, CB, Gagne, PJ,  et al. 2003A model for predicting occult carotid artery stenosis: screening is justified in a selected populationJ. Vasc. Surg38705709PubMedGoogle Scholar
  13. 13.
    Rockman, CB, Jacobowitz, GR, Gagne, PJ,  et al. 2004Focused screening for occult carotid artery disease: patients with known heart disease are at high riskJ. Vasc. Surg394451PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  1. 1.Kaweah Delta District Hospital, and Uniformed Services University for Health SciencesBethesda, MarylandUSA

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