Audible Bleeding: Recent Episodes

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Audible Bleeding is a resource for trainees and practicing vascular surgeons, focusing on interviews with leaders in the field, board preparation, and dissemination of best clinical practices and high impact innovations in vascular surgery.

Audible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by James Martinson, practicing general surgeon with an interest in vascular surgery currently serving as the ship's surgeon for the USS Harry S Truman aircraft carrier and Langford Green (@langfordgreen_), research fellow at the Center for Vascular Research at the University of Maryland currently applying to medical school, JVS editor Dr. Audra Duncan (@ADuncanVasc), and JVS-VI editor Dr. Anahita Dua (@AnahitaDua) to discuss two great articles in the JVS family of journals.

Articles:

Part 1: Open bypass versus endovascular therapy in chronic limb-threatening ischemia patients with prior endovascular attempts (Hamouda & Malas)
Part 2: Retrospective review of 3126 patients with chronic lower extremity wounds treated with intermittent topical oxygen therapy (Lohr & Dua)

Show Guests

Dr. Mohammed Hamouda was a postdoctoral research fellow at UC San Diego, Division of Vascular & Endovascular Surgery, and an incoming integrated vascular surgery resident at the Houston Methodist Hospital (LinkedIn)
Dr. Mahmoud Malas is the chief of vascular and endovascular surgery at UC San Diego, and the vice chair of surgery for clinical research at UC San Diego School of Medicine (@malas_mahmoud)
Dr. JoAnn Lohr is a vascular surgeon with her own practice in Cincinnati, OH, and has also worked in the VA system of Columbia, SC (LinkedIn)

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Welcome back to the Audible Bleeding Series: Landmark Papers in Vascular Surgery. In this episode, Audible Bleeding editor John Culhane and co-host Dr. Jesse Columbo are joined by our guests, Dr. David Stone, Dr. Salvatore Scali, and Dr. Anders Wanhainen to unpack one of the longest-running debates in aortic surgery: when (and whether) to repair an abdominal aortic aneurysm.

We'll start our episode with the open-repair era and the two trials that set the basis for the 5.5 cm threshold—UKSAT and ADAM—then move into the early EVAR years with PIVOTAL and CAESAR, which asked whether fixing smaller aneurysms with endovascular technology could do better. Finally, we'll look at how modern screening programs, improved medical therapy, and current guidelines have reshaped the practical decisions we make for these patients every day.

Links to Papers Discussed:

Open Surgery Era

UKSAT (1998)
ADAM (2002)

Endovascular Era

PIVOTAL (2010)
CAESAR (2012)

Contemporary Results

Oliver-Williams/NHS NAAASP
Rokosh/SVS Guidelines
ESVS 2026 Guidelines

Guests:

Dr. David Stone, MD (@DHStoneMD); Dartmouth

Dr. Salvatore Scali, MD (@UFVascular); University of Florida

Dr. Anders Wanhainen, MD, PhD (@AWanhainen); Uppsala University, Sweden

Hosts:

John Culhane, MD (@JohnCulhaneMD); Vascular Surgery Fellow, Montefiore

Dr. Jesse Columbo, MD; Dartmouth

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.

Guests:

Isabel Banks, MS4, SLU

Best of 2025 - rare, high-risk, and unforgettable vascular cases
Best of 2025: Venous disease
Hemodynamic and patient-level considerations in inferior mesenteric artery aneurysm management
Reply
Ultra-distal bypass remains a valuable option for tibial disease with tissue loss
Stewart Treves syndrome as a catastrophic sequela of chronic lymphedema: Clinical spectrum, management challenges, and outcomes
The best of 2025 - peripheral and splanchnic aneurysms and mesenteric vascular disease

Hosts:

John Culhane (@JohnCulhaneMD)

Follow us @audiblebleeding, @JVS-CIT

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

CORE RESOURCES:

Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94
Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9

ADDITIONAL RESOURCES:

Audible Bleeding Episodes

Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/
Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/

Videos

TCAR Technical Video: https://jnis.bmj.com/content/14/8/842

Articles

Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease: https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext
Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6

Referenced Studies

ROADSTER-1
https://pubmed.ncbi.nlm.nih.gov/30611582/
ROADSTER-2
https://pubmed.ncbi.nlm.nih.gov/32811386/
https://pubmed.ncbi.nlm.nih.gov/35381327/
TCAR Surveillance Project
https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral
https://pubmed.ncbi.nlm.nih.gov/36172943/

OUTLINE:

CAROTID ARTERY DISEASE

Pathophysiology/etiology
Carotid artery disease is primarily driven by atherosclerotic plaque deposition.
Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age.
Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma.
When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.
Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events.
Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.
Presentation
Patients are often asymptomatic and stenosis is incidentally found on imaging.
Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks
Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.
Diagnosis
USPTF recommends against screening for asymptomatic carotid artery stenosis.
In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.
These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.
Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.
Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost
CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure
MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease
DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening
Classification
Carotid artery stenosis is classified by degree of luminal narrowing.
NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.
Classification of stenosis:
1. Mild:
2. Moderate: 50-69% narrowing
3. Severe: ≥70% narrowing

TRANSCAROTID ARTERY REVASCULARIZATION (TCAR)

Relevant Trials
ROADSTER-1 trial: prospective, multicenter, single-arm study evaluating TCAR with dynamic flow reversal in patients at high risk for carotid endarterectomy (CEA), including both symptomatic (≥50% stenosis) and asymptomatic (≥80% stenosis) patients.
1. 30-day stroke rate of 1.4% and a combined stroke/death/MI rate of 3.5%, with technical success in 99% of cases
2. At 1 year, the ipsilateral stroke rate was 0.6%, indicating excellent durability in a high-risk population
3. Limitations: highly controlled environment with a select group of experienced operators, which raised concerns about the generalizability, especially among physicians new to TCAR. Additionally, ROADSTER-1 was a single-arm study without a comparison group.
4. ROADSTER-2: prospective, multicenter, post-approval registry format. Addressed limitations of ROADSTER-1 by enrolling a larger and more diverse group of operators, the majority of whom were TCAR-naïve.
5. The per-protocol population had a 30-day stroke rate of 0.6% and a combined stroke/death rate of 0.6%, with technical success in 99.7% of cases. These results confirmed the low perioperative stroke and death rates seen in ROADSTER-1, even with less experienced operators.
6. TCAR Surveillance Project: ongoing study that provides real-world, comparative data using the VQI registry.
7. In propensity-matched analyses, TCAR had similar in-hospital stroke/death rates to CEA (1.6% vs 1.6%) and significantly lower rates than transfemoral carotid artery stenting (TF-CAS, 2.9%).
8. TCAR was also associated with significantly lower cranial nerve injury and myocardial infarction rates compared to CEA (0.7 vs 2.4%, and 0.5 vs 0.9%, respectively).
9. At 1 year, stroke/death rates remained similar between TCAR and CEA (5.1-6.4% vs 5.2-6.6%, respectively), but TCAR outperformed TF-CAS (5.1-6.4% vs 9.6-9.7%).
Indications for Surgery
All patients with carotid artery stenosis benefit from best medical therapy (BMT): antiplatelet, high-intensity statin, aggressive risk factor control, and lifestyle modification.
Asymptomatic patients: ≥70% stenosis, provided the anticipated perioperative risk for stroke, MI, or death is <3%. The decision to intervene in asymptomatic patients is more nuanced due to advances in medical therapy and lower contemporary stroke rates. Life expectancy should also be taken into consideration.
Symptomatic patients: >50% stenosis, benefit of revascularization increases with higher degrees of stenosis.
1. Carotid intervention for symptomatic patients should be performed 2-14 days after stroke.
2. TCAR anatomic criteria:
3. Internal carotid artery diameter 4-9mm
4. Clavicle-carotid bifurcation distance ≥ 5cm
5. Common carotid artery (CCA) diameter ≥ 6mm
6. No or mild puncture site plaque
7. TCAR may be more favorable than CEA in patients who have a high lesion at or above C2 vertebral level, high carotid bifurcation, "hostile neck" (restenosis post-CEA, cervical spine immobility, history of neck irradiation or radical neck dissection)
8. Contraindications: 100% occlusion, or patients with severe comorbidities or life expectancy 3, unsuitable anatomy or an inability to tolerate flow reversal
Surgery
Preop
1. DAPT at least 3 days and statin for 5 days to reduce periprocedural risk of stroke and mortality.
2. Anesthesia: general anesthesia or MAC
3. Positioning: supine position with the head extended and turned to the contralateral side. The neck and contralateral groin are prepped and draped in sterile fashion.
4. Steps to the procedure and relevant anatomy

Common carotid artery exposure

Identify the triangle created by the sternal and clavicular heads of the sternocleidomastoid muscle (SCM) and the superior edge of the clavicle.
Create a 2- to 4-cm longitudinal or transverse incision between the two heads.
Electrocautery is used to divide through the subcutaneous tissue and platysma.
The SCM is retracted laterally to access the carotid sheath.
The carotid sheath contains three critical structures. From medial to lateral we have the common carotid artery, vagus nerve, and internal jugular vein.
The internal jugular vein is dissected and retracted.
A branch off of the internal jugular vein that we commonly encounter is the facial vein. This can be safely ligated when encountered.
In most patients, the vagus nerve lies lateral and posterior to the common carotid artery and care should be taken to avoid injury to it, especially in the later steps when we get to clamping the artery.
Other critical structures:
1. Hypoglossal nerve: crosses the carotid artery transversely approximately 2-3 cm above the carotid bifurcation
2. Ansa cervicalis: encountered in the carotid sheath as it branches from the hypoglossal nerve as it crosses the internal carotid artery
3. Carotid body: at the base of the carotid bifurcation
4. Marginal mandibular branch of the facial nerve: encountered at higher incisions, though this is not as common as with carotid endarterectomies
5. Once the common carotid artery is dissected and exposed, a vessel loop or umbilical tape is placed to facilitate manipulation of the vessel during carotid artery access.
6. A purse string or U-stitch 5-0 polyproline suture is placed on the common carotid for the closure of the arterial puncture site at the end of the procedure.

Femoral vein access

Femoral triangle anatomy:
1. Borders
  1. Superior: inguinal ligament
  2. Lateral: medial border of the sartorius muscle
  3. Medial: lateral border of the adductor longus muscle
    1. Contents
  4. Lateral to medial: femoral nerve, femoral artery, femoral vein, empty space/femoral canal, and lymphatics
  5. Mnemonic - NAVEL: nerve, artery, vein, empty space, lymphatics
  6. Using ultrasound guidance, the femoral vein contralateral to the common carotid artery we just exposed is visualized.
  7. The common femoral vein is typically accessed 1-2 cm below the inguinal ligament and is around 2-4 cm deep to the skin in most adults. We access the vein with a micropuncture system via Seldinger technique.
  8. The TCAR venous return sheath is advanced over a 0.035-inch guidewire. Blood is aspirated from the flow line and the sheath is flushed with heparinized saline to ensure proper access.
  9. Secure the venous return sheath with suture.
  10. The contralateral femoral vein is accessed to facilitate optimal circuit setup and minimize interference with arterial access and other steps.

Common carotid artery access and sheath placement

Heparin should be given prior to obtaining arterial access. An activated clotting time, also known as ACT, between 250-300 should be achieved.
Obtain micropuncture access of the common carotid at the site where we previously placed the suture. A 21-gauge micropuncture needle is slowly advanced into the anterior wall of the common carotid artery and a 0.018-inch micropuncture wire is advanced 3 cm into the common carotid artery. A micropuncture sheath and dilator are advanced 2-3 cm into the common carotid.
After removal of the dilator and micropuncture wire, brisk and pulsatile backbleeding confirms correct positioning.
Angiogram is obtained to delineate the carotid bifurcation and where the lesion is located.
A 0.035-inch ENROUTE J wire is positioned in the CCA, the micropuncture sheath is removed, and the arterial sheath and dilator are inserted (stop short technique).
The arterial access sheath is advanced to the 2.5-cm marker, predetermined by the sheath stopper.
The sheath position should be checked using angiography in two projections after removal of the dilator to ensure the sheath tip is placed coaxially within the common carotid.
Secure the sheath to the patient at 3 points using 2-0 silk stitches. The side ports are burped and a control run confirms no evidence of dissection or vessel injury.

Initiation of dynamic flow reversal

The flow controller is connected to the arterial access sheath. The column should be held upward and arterial blood should fill the column.
Once it fills to the line on the controller, connect the system to the venous return sheath. You have now established an extracorporeal AV shunt.
The integrity of the circuit is verified by flushing the venous sheath with hep saline and confirming rapid blood flow through the circuit.
Perform a TCAR time out, confirming systolic blood pressure 140–160 mmHg, heart rate >70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk.
Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.
Flow controller settings:
1. Low setting
2. High setting
3. Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).
4. Confirm flow reversal via two different ways:
The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion.
The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.

Carotid artery stenting, balloon angioplasty, and completion angiogram

At this point, a standard carotid angioplasty and stenting procedure is performed.
ENROUTE transcarotid Neuroprotection System device:
1. inner diameter of 8F and an outer diameter of 10F
2. Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.
3. Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent

Cessation of flow reversal and sheath removal

Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.
Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.
The patient is auto-transfused the blood from the flow line back to the venous system.
As the arterial access system is removed and the puncture site is closed with the U-stitch.
IV protamine is administered to reverse the heparin.
Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.
Postop care/complications
1. Postop care
  1. All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.
    1. Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion. 2. Dual antiplatelet therapy: continue for 45 days to 12 months 3. Aspirin and statin therapy: continued indefinitely 4. Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter.
      1. Postop complications
  2. Hematoma
  3. Stroke
  4. Myocardial infarction
  5. Cerebral hyperperfusion syndrome
    1. Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation
    2. Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms. 5. Cranial nerve injury
    3. Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.
    4. Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.
    5. Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.
    6. Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle
    7. Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR. 6. Stent restenosis 7. Pseudoaneurysm 8. Access site infection

Welcome back to the Audible Bleeding series: Landmark Papers in Vascular Surgery. In this episode, co-hosts John and Dr. Jesse Columbo are joined by our guest, Dr. Caitlin Hicks, to discuss one of the most studied—and most debated—topics in vascular surgery: asymptomatic carotid stenosis.

In this episode, we'll trace that evolution through three pivotal trials: ACAS and ACST-1, which established carotid endarterectomy as the standard of care; and the newly published CREST-2, which challenges us to reconsider everything we thought we knew. Along the way, we'll explore how advances in statin therapy, blood pressure control, and antiplatelet agents have fundamentally changed the natural history of this disease—and what that means for our patients today."

Links to Landmark Papers:

(ACAS) Endarterectomy for Asymptomatic Carotid Artery Stenosis
(ACST-1) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis: a multicentre randomised trial
(CREST-2) Medical Management and Revascularization for Asymptomatic Carotid Stenosis

Guests:

Dr. Caitlin Hicks, MD (@CaitlinWHicks); Associate Fellowship Program Director, Vascular Surgery & Endovascular Therapy at Johns Hopkins and Director of Research

Hosts:

John Culhane, MD (@JohnCulhaneMD); General Surgery Resident, Abrazo Health

Dr. Jesse Columbo, MD; Assistant Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editors Falen Demsas, an integrated vascular surgery resident at Massachusetts General Hospital, and Sasank Kalipatnapu (@ksasank), a fifth-year general surgery resident at UMass Chan Medical School, are joined by Megan Tracci (@MeganTracci), James Black (@JamesHBlackMD), and Lauren West-Livingston (LWestLivingston) for a discussion following the inaugural SVS Leadership and Advocacy Summit.

In this episode, the group reflects on the importance of surgeon advocacy, highlights key takeaways from the Summit, and discusses how vascular surgeons throughout training and practice can engage in policy, leadership, and organized medicine at local and national levels. The conversation explores the evolving role of advocacy within the Society for Vascular Surgery, including the work of the SVS Advocacy Council and its collaboration across Government Relations, Coding, VA advocacy, and quality and policy initiatives.

Dr. Tracci shares insights from her leadership roles within SVS advocacy efforts and her work as ACS Medical Director for Surgeon Engagement. Dr. Black discusses his longstanding advocacy work on behalf of patients and physicians, including numerous trips to Capitol Hill over the course of his career. Dr. West-Livingston reflects on her experience attending the recent Advocacy & Leadership Conference as a trainee and the importance of resident involvement in advocacy work.

Show Guests * Megan Tracci Leader within the SVS Advocacy Council, which includes Government Relations, Coding, VA advocacy, and quality and policy collaboration efforts. She also serves as the ACS Medical Director for Surgeon Engagement. * James Black Chief of Vascular Surgery and Endovascular Therapy at Johns Hopkins University and longtime advocate who has made countless trips to Capitol Hill to advocate for patients and physicians. * Lauren West-Livingston Integrated vascular surgery resident at Duke University and member of the SVS Government Relations Committee who attended the recent Advocacy & Leadership Conference.

Notable Mentions * The inaugural SVS Leadership and Advocacy Summit * Advocacy efforts within the Society for Vascular Surgery, including Government Relations, Coding, VA advocacy, and quality and policy collaboration. Learn more here SVS Advocacy Council * Opportunities for vascular surgeons to engage in advocacy throughout all stages of training and practice. Sign up for updates

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Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen (@WenKawaji) discusses international vascular surgery fellowships with Dr. Judith Lin (@JudithLin4), Dr. Adam Johnson, and Dr. Robbie Aru (@AruRobbie). Together, they reflect on what drove them abroad, what the experience actually looked like on the ground, and the professional, financial, and personal challenges that came with it. Whether you're a resident exploring your options or simply curious about roads less traveled in surgical training, this conversation offers a candid and practical look at what international fellowships in vascular surgery really entail. A must-listen for anyone considering fellowship training outside the U.S.

Articles:

A contemporary guide to an international aortic super-fellowship for surgical trainees and surgeons in the United States

Show Guests

Dr. Judith Lin: professor and chief of vascular surgery in the Department of Surgery at Michigan State University's College of Human Medicine
Dr. Adam Johnson: assistant professor of surgery and assistant professor in population health science at Duke university school of medicine
Dr. Robbie Aru: assistant professor of surgery at Thomas Jefferson university medical college

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.

Guests:

Isabel Banks, MS4, SLU

Selected publications regarding lower extremity chronic ischemia and the diabetic foot from the Journal of Vascular Surgery: Cases and Innovative Reports 2025, Volume 11
Best of 2025—abdominal aortic and iliac aneurysm
Double anonymous peer review in JVSCIT—lessons from our pilot trial and next steps
Endovascular stapling with Aortoseal as an adjunct for the hostile neck
The transcaval approach may be the new route vascular surgeons need in their arsenal
Intraoperative positioning system-guided antegrade in situ laser fenestration in an aortic model
Single-center experience using Endologix anatomically fixated endograft device for treatment of aortoiliac occlusive disease
Short-term analysis of botulinum toxin A for functional popliteal artery entrapment syndrome
Comparing neurological complications between endovascular and open surgical repair of the descending thoracic aorta

Hosts:

John Culhane (@JohnCulhaneMD)

Follow us @audiblebleeding, @JVS-CIT

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen Kawaji (@WenKawaji) is joined by integrated vascular surgery resident Falen Demsas, 5th-year general surgery resident Sasank Kalipatnapu (@ksasank), JVS editor Dr. Duncan (@ADuncanVasc), and JVS-VL editor Dr. Ruth Bush to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Weaver, student doctor Finn, Dr. Sridharan, and Dr. Anan.

Articles:

Evaluating the Vascular Quality Initiative's role in advancing minority health and health disparities research―a scoping review
Catheter-directed interventions versus surgical embolectomy in massive pulmonary embolism

Show Guests

Dr. Weaver: assistant professor of surgery and associate program director of the vascular surgery fellowship at the University of Utah. She is also the director of clinical operations efficiency at the University of Utah.
Finn Repella: rising 4th medical student at the University of Virginia
Dr. Sridharan: associate professor at the University of Pittsburgh Medical Center (UPMC). Site Chief of vascular surgery at UPMC Mercy.
Dr. Anan: research fellow in the division of vascular surgery at the University of Pittsburgh Medical Center (UPMC). She earned her MD from the American University of Beirut.

Notable mentions:

From Bench to Bill: How a Transplant Nuance Became 1 of Only 57 Laws Passed in 2013

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Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by 5th year general surgery resident Amol Kamat, JVS editor Dr. Audra Duncan (@ADuncanVasc), and JVS-VS editor Dr. John Curci (@CurciAAA) to discuss two great articles in the JVS family of journals. This episode hosts medical student Neha Shetty (LinkedIn), Dr. Katherine Reitz (@MollReitz), Dr. Yasir Alsiraj, and Dr. Linda Cassis.

Articles:

Part 1: Prioritizing high-volume repair hospitals with ruptured abdominal aortic aneurysms, for rural and nonrural patients (Shetty & Reitz)
Part 2: Role of adipocyte angiotensinogen or angiotensin type 1a receptors in the development of diet-induced atherosclerosis or angiotensin II-induced abdominal aortic aneurysms (Alsiraj & Cassis)

Show Guests

Neha Shetty is currently a medical student within the University of Pittsburgh School of Medicine's Class of 2027
Dr. Katherine Reitz is an Associate Professor of Surgery at the University of Pittsburgh School of Medicine.
Dr. Yasir Alsiraj is an Assistant Professor of Pharmacology and Nutritional Sciences, Pediatrics, at the Saha Aortic Center at the University of Kentucky.
Dr. Cassis is the Vice President of Research at the University of Kentucky College of Medicine.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Jacob Soucy (@JacobWSoucy) hosts an inside look at a timely and thought-provoking editorial published in The Vascular Specialist, the official news magazine of the Society for Vascular Surgery.

In this episode, we explore the evolving conversation around surgical call and compensation through the lens of the editorial "A Call for Call Pay." The discussion challenges the traditional framing of call as simply part of the job and instead examines it as a measurable burden of availability that carries legal, financial, and personal implications. This conversation highlights why the valuation of call may represent one of the defining structural issues in modern vascular surgery practice.

Jacob speaks with Dr. Malachi G. Sheahan III about the motivation behind the piece, how hospital systems value call, what the true cost of call coverage is, and what the future may hold if the current model remains unchanged.

Show Guest

Dr. Malachi G. Sheahan III is Professor and Chair of Surgery at Louisiana State University Health Sciences Center and Chief of the Division of Vascular Surgery. He previously served as Program Director for both the fellowship and integrated residency in vascular surgery at LSU. Nationally, Dr. Sheahan serves as Secretary of the Society for Vascular Surgery and as Chief Medical Editor of The Vascular Specialist. With more than two decades in academic surgery, he is a recognized leader in vascular education, workforce policy, and advocacy within the specialty.

Resources and Social Media

X (Twitter): @lsuvascular

Read the editorial: "A Call for Call Pay" – The Vascular Specialist

Special thanks to Dr. Malachi G. Sheahan III for sharing his time and insight and for his ongoing contributions to vascular surgery.

Follow us @audiblebleeding for updates on upcoming episodes and new research features. Learn more about us at audiblebleeding/about and share your feedback through our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen Kawaji (@WenKawaji) and 5th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School host SVS QPMC leadership Dr. Shutze, Dr. Hicks and Carrie McGraw to take a deep dive into the Vascular Surgery–specific Merit Based Incentive Payment System Value Pathway or MVP.

Show Guests

Dr. William Shutze: Associate Professor at Texas A&M College of Medicine at Texas A&M Health Science Center in Dallas Texas. He is a managing partner at Texas Vascular Associates. He is the co-chair for the SVS Vascular Center Verification and Quality Improvement program, vice chair for the SVS QPMC committee
Dr. Caitlin Hicks: Associate professor at Johns Hopkins University school of medicine, vice chair of research in the department of surgery. Chair for the SVS QPMC committee
Carrie McGraw: SVS manager of Quality Improvement and Practice

Important resources

2026 Vascular MVP PDF: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3100/Vascular-Surgery-MVP-Candidate.pdf
SVS Quality improvement contact email:

SvsQuality@vascular.org

Vascular Specialist article:

https://vascularspecialistonline.com/introducing-the-vascular-surgery-mips-value-pathway-a-new-era-for-meaningful-specialty-driven-quality-reporting/

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen Kawaji (@WenKawaji) is joined by Dr. Danielle Garcia, Dr. James Martinson, JVS editor Dr. Duncan (@ADuncanVasc), JVS-CIT editor Dr. Smeds (@MattSmeds) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Ullery, Dr. Bath, Dr. Lee, and Dr. Satam.

Articles:

Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry
A novel approach to thoracic endovascular aortic repair using "zone 1.5" deployment of the Gore thoracic branched endoprosthesis device

Show Guests

Dr. Ullery has served as the medical director of vascular and endovascular surgery at the Providence heart and vascular institute since 2017 and is the co-founder of the Laser In-Situ Fenestration of Aortic Endografts (LIFE) Registry
Dr. Bath is a practicing Vascular Surgeon at the University Hospital of the University of Missouri
Dr. Lee is the chief of vascular surgery at Stanford Medicine
Dr. Satam is a current vascular surgery resident in her PGY3 year at Stanford

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen Kawaji (@WenKawaji) is joined by integrated vascular surgery resident Falen Demsas, JVS editor Dr. Duncan (@ADuncanVasc), JVS-VI editor-in-chief Dr. Dua (@AnahitaDua) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Huber, Dr. Fassler, Nishanth Konduru (@n_konduru), and Dr. Rao.

Articles:

Outcomes of open bypass and superior mesenteric artery endarterectomy for patients with chronic mesenteric ischemia resulting from long-segment superior mesenteric artery occlusive disease

Retrograde tibiopedal access as an alternative procedural technique for genicular artery embolization

Show Guests

Dr. Huber
Former Division Chief (served as Chief for 13 years) of Vascular Surgery at the University of Florida and the Edward R. Woodward Professor of Surgery at the University of Florida College of Medicine. He was also the chair of the writing committee for the SVS Guidelines on Chronic Mesenteric Ischemia.
Dr. Fassler
PGY-4 General Surgery resident at the University of Florida.
Nishanth Konduru
Fourth year undergraduate at the University of North Carolina Chapel Hill
Dr. Rao
Interventional cardiologist with Vascular Solutions of North Carolina.
Founder of Rao Clinic https://www.raoclinic.org/

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

In this episode, we explore the Society for Vascular Surgery (SVS) Quality Improvement (QI) Consulting Program, a free member benefit that supports vascular surgeons in designing, executing, and refining QI projects across all stages—from problem identification to dissemination.

We're joined by Dr. Samantha Minc, a vascular surgeon and faculty member at Duke University, and Dr. Ashley Vavra, an Associate Professor of Surgery at Northwestern Feinberg School of Medicine and chair of the SVS Quality Improvement Committee. Both bring extensive experience in vascular care and quality-focused clinical practice.

Together, they break down how the QI Consulting Program helps clinicians:

Develop SMART goals and clear project aims
Identify stakeholders and select appropriate methodologies
Organize timelines and communication plans
Track process measures and assess intervention impact
Troubleshoot challenges and prepare presentation or publication materials

They also outline what the program does not provide—such as data analysis, formal instruction, or long-term mentorship—to help members understand its intended scope. The application process is straightforward: SVS members may apply during the first two weeks of each month, with up to five projects accepted per cycle.

This episode stresses the value of QI in vascular surgery and offers a practical, accessible overview of how the QI Consulting Program can support meaningful improvement efforts in vascular practices.

Learn more: https://vascular.org/vascular-specialists/practice-and-quality/quality/quality-improvement-consulting-program

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by 4th year general surgery resident Sasank Kalipatnapu (@ksasank), JVS editor Dr. Audra Duncan (@ADuncanVasc), and JVS-VL editor Dr. Ruth Bush (@RuthLBush) to discuss two great articles in the JVS family of journals. Today's episode hosts Dr. Lowenkamp, Dr. Sridharan (@domenickna1), and Dr. Lin.

Articles:

Part 1:Female patients at increased risk for adverse outcomes after acute limb ischemia (Dr. Lowenkamp & Dr. Sridharan)
Part 2: Evaluation of factors underlying differences in venous thromboembolism rates between Black and White patients (Dr. Lin)

Show Guests

Dr. Mikayla Lowenkamp - PGY4 Integrated Vascular Surgery Resident at the University of Pittsburgh
Dr. Natalie Sridharan - Associate Professor of Surgery at the University of Pittsburgh School of Medicine
Dr. Mary Lin - PGY3 General surgery resident at the University of Maryland School of Medicine applying into vascular surgery

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.You can

Guests:

Grant Lewin, MD, PGY4 SLU

Postoperative changes of wrist-brachial index following arteriovenous fistula implantation correlate with steal syndrome, a prospective study
Early and late outcomes of patient-specific endografts with retrograde outer branches for complex aortic aneurysms involving cranially oriented target vessels
Early reintervention for hemostasis following open abdominal aortic aneurysm repair using Ifabond surgical glue
Laser fenestration and shape memory polymer embolization of type II endoleaks
Thoracic aortic injury as a complication of spinal surgery: A new case and systematic review (1991-2024)
Benefit of virtual reality during visceral artery aneurysms open and endovascular surgery planning
Bioengineered human blood vessels to treat hospital-acquired vascular complications

Hosts:

John Culhane (@JohnCulhaneMD)

Follow us @audiblebleeding, @JVS-CIT

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen (@WenKawaji) is joined by 5th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, and JVS editor Dr. Duncan (@ADuncanVasc) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Newton and Dr. Goodney, the authors of the following paper.

Articles:

Association between imaging surveillance compliance and long term outcomes after endovascular abdominal aortic aneurysm repair at Veterans Affairs Hospitals

Show Guests

Dr. Goodney- section Chief of vascular surgery at Dartmouth Hitchcock Medical Center as well as associate Professor at Dartmouth. Chair of the research advisory committee within the SVS quality improvement program.
Dr. Newton- General Surgery resident at Dartmouth Health in New Hampshire.

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Jacob Soucy (@JacobWSoucy) hosts an inside look at one of the most active and collaborative vascular surgery research teams in the country, the Vascular Surgery Outcomes Research Team (VSORT) at Penn State College of Medicine.

VSORT is a dynamic academic group that brings together vascular surgery attendings, residents, postdoctoral fellows, and medical students to conduct impactful outcomes-based research. Meeting every Friday at 4 PM, the team has produced dozens of peer-reviewed manuscripts, podium presentations, and national collaborations, embodying the power of mentorship and structure in academic medicine.

In this episode, Jacob speaks with two of the key figures behind VSORT's success, Dr. Faisal Aziz and Dr. Ahsan Zil-E-Ali, to discuss how the program was founded, how it operates, and what other institutions can learn from its model.

Show Guests

Dr. Faisal Aziz (@FA_VascularMD) is the Chief of Vascular Surgery and Program Director of the Integrated Vascular Surgery Residency at Penn State Milton S. Hershey Medical Center, where he also serves as the Gilbert and Elsie Sealfon Endowed Professor of Surgery. A nationally recognized leader in vascular surgery, Dr. Aziz has authored more than 150 peer-reviewed publications and holds multiple national leadership roles. His work focuses on advancing surgical education, outcomes research, and mentorship within academic vascular surgery.

Dr. Ahsan Zil-E-Ali (@ahsanzileali) is a Postdoctoral Research Fellow at Penn State Milton S. Hershey Medical Center and a driving force behind VSORT's research productivity. A graduate of the University of Health Sciences in Lahore, Punjab, he has co-authored nearly 100 peer-reviewed publications and plays a central role in coordinating VSORT's data infrastructure, mentorship framework, and project pipeline. His passion for research efficiency and education continues to inspire medical students and trainees across the institution.

Resources and Social Media

Twitter: @VsortVasc, @PennStVascular Instagram: @vsortvasc, @pennstatevascular

Special thanks to Dr. Faisal Aziz and Dr. Ahsan Zil-E-Ali for sharing their time and insight, and to the entire VSORT team for their ongoing contributions to vascular surgery research and mentorship.

Follow us @audiblebleeding for updates on upcoming episodes and new research features. Learn more about us at audiblebleeding.com/about-1 and share your feedback through our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by 4th year general surgery resident Joe El Badaoui (@JosephBadaouiMD), JVS editor Dr. Audra Duncan (@ADuncanVasc), and JVS-VS editor Dr. John Curci (@CurciAAA) to discuss two great articles in the JVS family of journals. The first article discusses an extensive experience using cryopreserved arterial allografts for vascular reconstruction after major oncologic surgery. The second article sheds light on nanoplastics in atherosclerotic plaques. This episode hosts Dr. Sebastian Cifuentes, Dr. Randall DeMartino (@randydemartino), Dr. Pierce Massie, and Dr. Ross Clark, the first and senior authors of these two papers.

Articles:

Part 1:Ten-year experience using cryopreserved arterial allografts for vascular reconstruction during major oncologic surgery (Drs. Cifuentes & DeMartino)
Part 2: Micro- and nanoplastics are elevated in femoral atherosclerotic plaques compared with undiseased arteries (Drs. Clark & Massie)

Show Guests

Dr. Sebastian Cifuentes is a first year integrated vascular surgery resident at University of Michigan in Ann Arbor, MI
Dr. Randall DeMartino is a Professor of Surgery and the chair of the Division of Vascular and Endovascular Surgery at the Mayo Clinic in Rochester, MN
Dr. Pierce Massie is a general surgery resident in his research time at the University of New Mexico School of Medicine in Albuquerque, NM
Dr. Ross Clark is an Assistant Professor of Vascular Surgery and Assistant Professor of Cell Biology and Physiology at the University of New Mexico School of Medicine in Albuquerque, NM

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Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Audible Bleeding editor Wen (@WenKawaji) is joined by 4th year medical student Nishi (@Nishi_Vootukuru), JVS editor Dr. Duncan (@ADuncanVasc), JVS-CIT associate editor Dr. Jimenez to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Darling, Dr. Banks and Dr. Beck.

Articles:

Outcomes following drug-coated balloons and drug-eluting stents in patients with peripheral arterial disease
Fiber Optic RealShape (FORS) and three-dimensional overlay technology in preemptive segmental artery embolization to reduce the risk of spinal cord ischemia prior to fenestrated endovascular aortic aneurysm

Show Guests

Dr. Jeremy Darling- integrated vascular surgery resident at BIDMC
Dr. Charles Banks - integrated vascular surgery resident at UAB
Dr. Adam Beck- Director of the division of vascular surgery and endovascular therapy, professor of surgery, director of quality and associate chief medical quality officer at the University of Alabama.

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SAVC (Section on Ambulatory Vascular Care) formed a GPO to help SVS members in private practice access competitive pricing on medical supplies, devices, pharmaceuticals, and services. The podcast episode explores the history of the collaboration, the benefits for SVS private practice members, and how they can become involved.

Guest Info
Dr. Anil Hingorani is a previous President of the Eastern Vascular Society. He is currently the Chair of the Section on Ambulatory Vascular Care (SAVC) of the Society for Vascular Surgery.
Dr. Naveed A. Rahman, Editor, is a Vascular Surgery Fellow at the University of Maryland.
Website Links
SVS launches partnership to help private practice vascular surgeons cut costs
Section on Ambulatory Vascular Care in SVS.
How to Join the SVS - Group Purchasing Organization

Audible Bleeding editor Wen (@WenKawaji) is joined by 5th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Duncan (@ADuncanVasc), JVS-VLD associate editor Dr. Hingorani (@hingorani_anil) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Omar Moussa-Pasha, Dr. David Ebertz, Dr. Rashad Bishara, and Dr. Ahmed Gaweesh, the authors of the following papers.

Articles:

An audit of physical waste and ﬂuoroscopy energy consumption in vascular surgery and suggestions for the future
Impact of great saphenous vein ablation on healing and recurrence of venous leg ulcers in patients with post-thrombotic syndrome: A retrospective comparative study

Show Guests

Dr. Omar Moussa-Pasha: Medical student at St Louis University.
Dr. David Ebertz (@EbertzDavid): second year vascular surgery fellow at St. Louis University
Dr. Rashad Bishara (@agaweesh): Chairman of Vascular Surgery Organization for Teaching Hospitals

of Egypt President, Egypt & Africa Vein and Lymph Association, Chair of the

International Committee of the American Venous Forum

Dr. Ahmed Gaweesh: Dr. Gaweesh is a Consultant Vascular Surgery in Egypt/UAE; Senior Lecturer in Alexandria University. Founder and Board Chairman of iVein Clinics – the first specialized chain of vein clinics in the Middle East since 2013.

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Resources:

Rutherford Chapters (10th ed.): 174, 175, 177, 178
Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/
The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext
KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/
Venous Hypertension
Definition
A functioning AV circuit delivers high volume arterial flow towards a stenotic venous segment, causing buildup in pressure and venous hypertension.
If there are few or no branching veins between the access and stenosis, thrombosis could occur
Etiology
The most common etiology is venous stenosis caused by a history of vessel wall trauma by centrally-inserted venous devices such as tunneled and non-tunneled dialysis catheters, central lines, pacemakers, or defibrillator.
In a study performed at a large academic medical center1, new hemodynamically significant central venous stenosis was associated with the duration of catheter dependence (26% in patients with CVCs for more than 6 months, versus 11% in patients with CVCs for less than 6 months).
PICC lines can directly damage cephalic and basilic veins
Venous stenosis can often go undetected until AV access creation occurs
Patient Presentation
Symptoms of venous insufficiency will be present– most commonly regional edema, in the area of venous stenosis. If there are patent venous branches between the AV anastomosis and the stenotic area, swelling can occur throughout the arm. Pigmentation, induration, dermatosclerosis, and ulceration may also be observed.
An extensive collateral network of veins may be visible throughout anterior chest, shoulder, or flank
SVC obstruction can result in swelling of the head, neck and shoulders, as well as a feeling of head and neck fullness, airway compromise, and visual problems
Normal palpable thrill can be replaced by a strong pulse
Dialysis can be complicated by difficulty with needle access, recirculation syndrome, and arm swelling after dialysis sessions.
Workup
Central vein thrombosis can be hard to detect on ultrasound because clavicle and sternum can block transmission
Venography is essential to determine the presence and severity of venous stenosis or occlusion.
Prevention
The ideal scenario is to avoid central dialysis catheters completely, and this involves evaluating CKD patients and placing AVF or AVG before the need for dialysis arises.
If a patient presents placement of an AVF/AVG, it is important to perform venography if a patient has a history of a central venous catheter or clinical signs of venous hypertension.
A history of SVC obstruction from any cause can preclude permanent AV access creation in both upper extremities
Treatment
Endovascular approaches to venous outflow stenosis can be first-line treatment options, due to their minimal risk. They can also be performed at the same time as a diagnostic venogram.
Angioplasty alone or with stenting are the endovascular options.
In a study by Bakken et al2 that compared primary high-pressure balloon angioplasty versus stenting, primary patency was equivalent between groups, with 30-day rates of 76% for both groups and 12-month rates of 29% for angioplasty and 21% for stenting. Assisted primary patency was also equivalent with a 30-day patency rate of 81% and 12-month rate of 73% for the angioplasty group, 84% at 30 days, and 46% at 12 months for the stenting group. This study, along with others, shows that the major downside of endovascular interventions, whether angioplasty or stenting, often require repeat intervention and have poor long-term patency.
For subclavian vein stenosis, angioplasty alone is appropriate due to its anatomical location that can put a stent at risk for extrinsic compression from the first rib and clavicle.
Surgical bypass can be performed
Possible bypasses include axillary-axillary, axillary-jugular, axillary-right atrial, and axillary-femoral. In these bypasses, the preferred conduits are autogenous saphenous or femoral veins.
In cases where the proximal subclavian vein is obstructed, a jugular vein turndown can be performed. In this procedure the distal jugular vein is transected, sewed end-to-side at the distal subclavian vein, effectively acting as a bypass route for that obstructed segment.
The Hemoaccess Reliable Outflow (HeRO) Vascular Access Device can be used as a hybrid approach, combining endovascular and open surgical techniques to bypass a central venous occlusion and provide a reliable outflow for dialysis.
This device has a PTFE inflow limb that is sewn end-to-side onto the brachial artery. This limb is tunneled subcutaneously and connected to a silicone-coated nitinol outflow catheter that is inserted into a central vein and tracked directly into the right atrium. This effectively bypasses central venous stenoses. In the largest study to date on HeRO access grafts placed in 167 patients,3 HeRO primary and secondary patency was 48.8% and 90.8%, respectively, at 12 months. Interventions to maintain or re-establish patency were required in 71.3% of patients resulting in an intervention rate of 1.5/year. Access-related infections were reported in 4.3% patients. The authors concluded that HeRO device had performed comparably to standard AVGs and had proven superior to tunneled dialysis catheters in terms of patency, intervention, and infection rates.
If no treatment options for venous hypertension or outflow obstruction are available, an alternate AV access site can be created, either in the contralateral arm if the SVC is uninvolved, or through placement of femoral AV access or a peritoneal dialysis catheter.
Bleeding Access Site
Etiology and Risk Factors
Bleeding can be caused by high venous pressure after dialysis, pseudoaneurysm rupture, or trauma.
Patients with end stage renal disease (ESRD) have a baseline elevated risk of bleeding due to uremia-induced platelet dysfunction and use of systemic anticoagulation within the hemodialysis circuit. Additional risk factors include dialysis through an AV graft, hypertension, longer duration of access use, and compromised integrity of the vascular access due to complications (clotting, infection) or invasive procedures.
Dual antiplatelet therapy is also associated with overall bleeding events in ESRD patients. Dialysis patients could be on antiplatelet therapy for management of comorbid cardiovascular risk and/or patency of AV graft
Patients with bleeding fistulas often present from their dialysis unit when standard digital pressure at the cannulation site fails to stop the bleeding.
This is a very serious condition since most mature fistulas have high blood flow and the patients are at risk for hemorrhagic shock and death.
Initial Management
The first step of management is to obtain hemostasis. Elevate the limb above the level of the heart and apply firm and directed pressure at the site of bleeding using gauze for at least 30-40 minutes
Milosevic et al4 reviewed non-operative management of bleeding fistulas and grafts and found that compared to standard dressings, the use of specialized hemostatic dressings decreased bleeding time at arterial and venous cannulation sites. These hemostatic materials included the IRIS compression bandage and cellulose-based, chitosan-based, poly-N-acetyl glucosamine-based, and thrombin-soaked dressings.
There has been a “bottlecap method” described where the hollow side of a bottlecap is pressed on top of the puncture site. Maintaining pressure on the cap will cause the cap to fill with blood and clot, which tamponades the bleeding.
The provider can also place a shallow figure-of-8 or purse string stitch just below the skin surface to aid in hemostasis. It is important to avoid placing the suture too deep as this can cause inadvertent fistula ligation. During this process, an assistant applies pressure just proximal and distal to the bleeding site to stop blood flow so the sutures can be placed.
If these methods fail to achieve hemostasis, apply a tourniquet proximal to the fistula and tighten it until bleeding stops and the radial pulse is lost. This signifies complete occlusion of arterial inflow to the fistula. Tourniquet use should be limited to 3 hours or less, since limb ischemia beyond this timepoint is associated with permanent neuromuscular damage.
Regardless of the method used for initial hemostasis, the patient is at risk for repeat hemorrhage, hematoma formation, vessel stenosis, and thrombosis. They should be evaluated by a vascular surgeon as soon as possible.
Definitive Management
Definitive management depends on etiology of each case, and there are a variety of interventions that can be pursued (i.e. aneurysmorrhaphy for aneurysmal bleeding)
If skin erosion over the conduit is present, it should be assumed that the AV access is infected and emergency intervention should be pursued. A jump graft can be placed through with healthy tissue.
A covered stent could be introduced through a separate percutaneous puncture site
Finally, coagulopathy can be addressed by administering cryoprecipitate, DDAVP, erythropoietin, estrogen, tranexamic acid.
Aneurysms and Pseudoaneurysms
Definition and Etiology
Aneurysms involve all three layers of the vessel wall and they develop due to hemodynamic changes causing remodeling of the vein wall in an AV fistula. This is necessary for vein maturation, but becomes problematic if the post-anastomotic vein continues to dilate and becomes aneurysmal.
Aneurysms can also occur at anastomosis sites due to technical aspects of the surgery.
Pseudoaneurysms only involve some layers of the vessel wall caused by repeated puncture for hemodialysis.
Both aneurysms and pseudoaneurysms can enlarge due to venous outflow stenosis causing increased intraluminal pressures.
Both true aneurysms and pseudoaneurysms can lead to overlying skin erosion and subsequent hemorrhage, pain, AV access dysfunction, and cannulation difficulties.
Dialysis cannulation should be avoided at the aneurysmal sites to prevent bleeding complications.
Diagnosis
They can be diagnosed on ultrasound, which also provide information on flow rates, presence inflow/outflow/stenoses, and vessel diameters.
Indications for Treatment
Treatment is indicated for aneurysms that are rapidly expanding or ulcerating through the skin surface. These are at high risk for rupture and hemorrhage, which is life-threatening.
Treatment is also indicated when the aneurysm occurs at the anastomotic site of the AV fistula, the patient has a cosmetic concern, cannulation becomes difficult, there is concern for infection, or the patient has high-output heart failure that could be exacerbated by high flow through the fistula.
Treatment is not indicated in asymptomatic aneurysms, regardless of their size. True aneurysms and pseudoaneurysms are not prone to spontaneous rupture.
Treatment Options
Aneurysmorrhaphy is the most common treatment. It involves the resection of the aneurysmal vein wall to restore a normal diameter and removal of excess skin. Anastomosis is performed along the lateral wall to prevent issues with cannulation along the suture line.
Aneurysm resection with interposition grafting is also possible.
If multiple aneurysmal segments require treatment, staging their repairs can allow for continuation of dialysis without needing to place a temporary dialysis catheter.
AV access ligation is an appropriate alternative to AV access salvage in certain situations but usually requires excision of the aneurysm/pseudoaneurysm due to the potential to develop thrombophlebitis and the cosmetic appearance of the thrombosed segment.
If there is concern for an infected pseudoaneurysm or aneurysm, surgery should include removal of all infected material.

References

Al-Balas A, Almehmi A, Varma R, Al-Balas H, Allon M. De Novo Central Vein Stenosis in Hemodialysis Patients Following Initial Tunneled Central Vein Catheter Placement. Kidney360. 2022;3(1):99-102. doi:10.34067/KID.0005202021
Bakken AM, Protack CD, Saad WE, Lee DE, Waldman DL, Davies MG. Long-term outcomes of primary angioplasty and primary stenting of central venous stenosis in hemodialysis patients. J Vasc Surg. 2007;45(4):776-783. doi:10.1016/j.jvs.2006.12.046
Gage SM, Katzman HE, Ross JR, et al. Multi-center Experience of 164 Consecutive Hemodialysis Reliable Outflow [HeRO] Graft Implants for Hemodialysis Treatment. Eur J Vasc Endovasc Surg. 2012;44(1):93-99. doi:10.1016/j.ejvs.2012.04.011
Milosevic E, Forster A, Moist L, Rehman F, Thomson B. Non-surgical interventions to control bleeding from arteriovenous fistulas and grafts inside and outside the hemodialysis unit: a scoping review. Clin Kidney J. 2024;17(5):sfae089. doi:10.1093/ckj/sfae089

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.

Guests:

Juliet Blakeslee-Carter, MD (@AWBeckMD)

The value and structure of writing a vascular surgery case report: A student's guide

Neha Gupta (@nehaha00)

We don’t know what we don’t know, until we do

Colonic ischemia and the role of inferior mesenteric artery reimplantation after abdominal aortic aneurysm repair

Abdominal aortic aneurysm classification based on dynamic intraluminal thrombus analysis during cardiac cycle

Quantitative intra-arterial fluorescence angiography for direct monitoring of peripheral revascularization effects

Ben Li, MD (@ben_li123)

An introduction to the journal review and editorial process

Hosts:

John Culhane (@JohnCulhaneMD)

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by vascular surgery fellow Javaneh Jabbari (@JabbariMD) in hosting Dr. Gustavo Oderich (@GustavoOderich), Dr. Shahab Toursavadkohi (@Toursavadkohi ), and Dr. Mehrdad Ghoreishi (@dr_ghoreishi) to discuss the “final frontier” in the endovascular management of aortic pathology, or the Endo-Bentall Procedure.

This episode highlights collaboration between vascular and cardiac surgery as we take a deep dive into physician modification of grafts to manage aortic root pathology. We will discuss the off-label use of endovascular devices and hear insights into the future of endovascular and open aortic surgery from these leaders and innovators in the field.

For some background on the topic, see the resources below Articles:

First-in-Human Endovascular Aortic Root Repair (Endo-Bentall) for Acute Type A Dissection
Link to the Presentation on this by Dr. Ghoreishi at AATS for more procedural details

Show Guests

Dr. Shahab Toursavadkohi - Professor of Vascular surgery and Co-director of the Center for Aortic Disease at the University of Maryland Medical System
Dr. Mehrdad Ghoreishi - Associate Professor of Cardiac Surgery and Co-director of aortic surgery and medical director of cardiac surgery research at Baptist Health Miami Cardiac & Vascular Institute
Dr. Gustavo Oderich - Professor and Chief of the Division of Vascular Surgery and Endovascular Therapy at the Texas Heart Institute and director of the new Baylor Medicine Center for Aortic Surgery

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by 4th year general surgery resident Sasank Kalipatnapu (@ksasank), JVS editor Dr. Thomas Forbes (@TL_Forbes), and JVS-VS editor Dr. John Curci (@CurciAAA) to discuss two great articles in the JVS family of journals. The first article discusses disability from periprocedural stroke in patients undergoing carotid artery stenting. The second article discusses the application of contrast-enhanced ultrasound and plasma biomarkers to abdominal aortic aneurysm monitoring. This episode hosts Dr. Andrea Alonso, Dr. Jeffrey Siracuse(@MdSiracuse), Dr. Adham Ali (@AdhamAbouAli), and Dr. Rabih Chaer (@rchaer2) authors of these two papers.

Articles:

Part 1: Disability and associated outcomes among patients suffering periprocedural strokes after carotid artery stenting (Alonso, Siracuse)
Referenced article - Postoperative disability and one-year outcomes for patients suffering a stroke after carotid endarterectomy (Levin, Siracuse)
Audible Bleeding Episode - JVS Author Spotlight August 2023
Part 2: Contrast-enhanced ultrasound microbubble uptake and abnormal plasma biomarkers are seen in patients with abdominal aortic aneurysms (Ali, Chaer)

Show Guests

Dr. Alonso is a general surgery resident in her second year of research at Boston Medical Center on an AHRQ T32 grant.
Dr. Siracuse is the Chief of vascular and endovascular surgery and the associate chair for quality and patient safety in the Department of Surgery at Boston Medical Center. He is also the program director for the vascular surgery fellowship and the medical director for the Vascular Study Group of New England.
Dr. Ali is Assistant Professor of Vascular Surgery at Charleston Area Medical Center.
Dr. Chaer is a Professor of Surgery and Division Chief of Vascular and Endovascular Surgery at Stony Brook University.

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.

Guests:

Juliet Blakeslee-Carter, MD (@AWBeckMD)

The value and structure of writing a vascular surgery case report: A student's guide

Neha Gupta (@nehaha00)

We don’t know what we don’t know, until we do

Colonic ischemia and the role of inferior mesenteric artery reimplantation after abdominal aortic aneurysm repair

Abdominal aortic aneurysm classification based on dynamic intraluminal thrombus analysis during cardiac cycle

Quantitative intra-arterial fluorescence angiography for direct monitoring of peripheral revascularization effects

Ben Li, MD (@ben_li123)

An introduction to the journal review and editorial process

Hosts:

John Culhane (@JohnCulhaneMD)

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Welcome to the VESS 50th Year Anniversary Episode, where we celebrate all the achievements and the future direction of the Vascular and Endovascular Surgery Society! We hope to see you all in person at the spring annual meeting on June 4, 2025 in New Orleans, and the Winter Annual Meeting at Everline Resort in Olympia, California on February 5-8, 2026.

Guest Info
Dr. Ravi Rajani is the current president of VESS. He is Executive Associate Dean for Emory at Grady Hospital and is the Leon L. Haley, Jr. Distinguished Professor within the Emory University School of Medicine.
Dr. Matthew Smith is Assistant Professor at UW School of Medicine and on the Membership Development Committee of VESS.
Dr. Erin Greenleaf is the Chair of the Membership Development Committee of VESS and Assistant Professor at Baylor. She is a surgeon in the US Army Reserves.
Dr. Naveed A. Rahman (@naveedrahmanmd) is an Audible Bleeding Editor and currently a vascular surgery fellow at University of Maryland.
Website Links
VESS Spring Meeting 2025.
VESS Winter Annual Meeting 2026.
About VESS.
Why Join VESS?

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

In this episode, Audible Bleeding Editors Sasank Kalipatnapu (@ksasank), Falen Demsas sit down with Dr. Rabih Chaer (@rchaer2), Dr. Michael Conte(@MichaelSConteMD), Dr. Sherene Shalhub and Dr. Malachi Sheahan III, the four SVS secretary candidates for this year to learn more about them as part of the ongoing election process.

Show links:

SVS 2025 Meet the Secretary Candidates—Home Page—provides a comprehensive overview of all the candidates. Their professional biographies and answers to questions about their plans for the future are available in both text and video formats.

Show Guests:

Dr. Rabih Chaer, Professor of Surgery and Chief of the Division of Vascular Surgery at Stony Brook University
Dr. Michael Conte, Professor and Chief of the Division of Vascular & Endovascular Surgery at the University of California, San Francisco.
Dr. Sherene Shalhub, Professor and Chief of the Division Vascular and Endovascular Surgery at Oregon Health & Science University (OHSU).
Dr. Malachi Sheahan, Professor and Chair of the Division of Vascular and Endovascular Surgery at Louisiana State University Health Sciences Center in New Orleans.
Sasank Kalipatnapu - PGY4 general surgery resident, University of Massachusetts
Falen Demsas- PGY 3 integrated vascular surgery resident, Massachusetts General Hospital

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In this episode, Audible Bleeding Editors Sasank Kalipatnapu (@ksasank), Richa Kalsi (@KalsiMD) sit down with Dr. Andres Schanzer and Dr. William Shutze, the two SVS vice presidential candidates for this year to learn more about them as part of the ongoing election process.

Show links:

SVS 2025 Meet the VP Candidates provides a comprehensive overview of all the candidates. Their professional biographies and answers to questions about their plans for the future are available in both text and video formats.

Show Guests:

Dr. Andres Schanzer, Professor and Chief in the Division of Vascular and Endovascular Surgery, UMass Medical School, Worcester, MA
Dr. William P Shutze, Texas Vascular Associates, Plano TX

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Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year medical student Nishi (@Nishi_Vootukuru), 2nd year vascular fellow Donna, JVS editor Dr. Forbes (@TL_Forbes), and JVS-CIT editor Dr. Matt Smeds (@mattsmeds) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Aridi, Dr. Motaganahalli, Dr. Nagarsheth, and Dr. Madabhushi, the authors of the following papers.

Articles:

Physicians preference for carotid revascularization impacts postoperative stroke and death outcomes
Simultaneous percutaneous transmural arterial bypass and deep venous arterialization for treatment of critical limb ischemia

Show Guests

Dr. Hanaa Aridi (@aridi_hanaa)- PGY3 at Indiana University School of Medicine
Dr. Raghu L. Motaganahalli (@Rmotaganahalli)- Professor of Surgery at the Indiana University School of Medicine and an attending Surgeon at the Indiana University Methodist Hospital. He is the Division Chief of Vascular Surgery and the Program Director of vascular surgery training program
Dr. Nagarsheth (@KNagarshethMD) -Associate Professor of Surgery and Associate Program Director of Vascular Surgery Fellowship Program at the University of Maryland Medical Center in Baltimore. Program director of the integrated vascular surgery program.
Dr. Madabhushi -Vascular Surgery Fellow at the University of Maryland Medical Center in Baltimore

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Dr. Ezra Schwartz (@ezraschwartz10) interviews Dr. Firas Mussa and Mr. Jake Howitt to discuss the IMPROVE-AD Trial, a landmark, multi-institutional study investigating treatment strategies for uncomplicated Type B Aortic Dissection (uTBAD).

The IMPROVE-AD Trial is a multicenter randomized trial funded by the NIH/NHLBI that compares thoracic endovascular aortic repair (TEVAR) plus optimal medical therapy (OMT) vs. OMT and surveillance with selective TEVAR in patients with uncomplicated TBAD. The trial aims to address critical gaps in evidence left by prior studies (INSTEAD-XL, ADSORB), with a unique focus on quality of life, cost-effectiveness, and genetic data.

Dr. Firas Mussa is a professor of Surgery at McGovern Medical School at UTHealth Houston. He previously served as the Director of the Vascular Surgery Residency and Fellowship programs at NYU Langone Health. Dr. Mussa earned his medical degree from the University of Baghdad, followed by general surgery training at Johns Hopkins University and a vascular surgery fellowship at Baylor College of Medicine. His research focuses on complex aortic pathology, and he serves as the principal investigator of the IMPROVE AD trial.

Mr. Jake Howitt is the Community Engagement Co-Chair of the IMPROVE AD trial and a leading patient advocate within the PCORI-funded Aortic Dissection Collaborative. As a survivor of aortic dissection, he is passionate about improving patient-provider communication and raising awareness of hereditary aortic disease. His work emphasizes the importance of education, empathy, and community-building in clinical research and care delivery.

Special thank you to Jacob Soucy (@JacobWSoucy).

Resources:

· Treatment of Uncomplicated Type B Aortic Dissection: Optimal Medical Therapy vs TEVAR + Optimal Medical Therapy- https://journals.sagepub.com/doi/10.1177/15385744231184671?url_ver=Z39.88-2003𝔯_id=ori:rid:crossref.org𝔯_dat=cr_pub%20%200pubmed

· INSTEAD Trial - https://pubmed.ncbi.nlm.nih.gov/19996018/

· INSTEAD-XL 5-Year Follow-Up - https://pubmed.ncbi.nlm.nih.gov/23922146/

· ADSORB Trial - https://pubmed.ncbi.nlm.nih.gov/24962744/

· Feasibility of a proposed randomized trial in patients with uncomplicated descending thoracic aortic dissection: Results of worldwide survey - https://pubmed.ncbi.nlm.nih.gov/27823685/

· Treatment of AD: Meta-Analysis - https://pubmed.ncbi.nlm.nih.gov/29066151/

· TEVAR vs Medical Therapy- https://pubmed.ncbi.nlm.nih.gov/36334259/

· IMPROVE AD Trial website - https://improvead.org

· John Ritter Foundation for Aortic Health - https://johnritterfoundation.org

· Think Aorta US - https://thinkaorta.us

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.

Guests:

Antonio L. Solano, MD (@solanotono)

Rotational flap versus long plantar flap for transmetatarsal amputation closure following revascularization

Lucerne milestone approach for benchmarking and education: Towards ultra-low dose endovascular aortic repair

The use of stent grafts for management of junctional vascular injuries: Is this accepted practice?

Hosts:

John Culhane (@JohnCulhaneMD)

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Audible Bleeding editor Wen (@WenKawaji) is joined by first year vascular fellow Eva (@urrechisme), JVS editor Dr. Forbes (@TL_Forbes), to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Fereydooni and Dr. Satam, the authors of the following paper.

Articles:

Comparison of EndoSuture vs fenestrated aortic aneurysm repair in treatment of abdominal aortic aneurysms with unfavorable neck anatomy

Show Guests

Dr. Arash Fereydooni: PGY5 integrated vascular resident at Stanford
Dr. Keyuree Satam: PGY2 integrated vascular resident at Stanford @StanfordVasc

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In this episode we catch up with first-year fellows Imani, Yasong, Wen, and Seth as they recap the first 6 months of training and the transition from general surgery to vascular surgery. They recount learning their way around new hospitals, navigating new cities, and settling into life as vascular surgeons.

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Audible Bleeding editor Wen (@WenKawaji) is joined by first year vascular fellow Eva (@urrechisme), second year vascular fellow Java (@JabbariMD), JVS editor Dr. Forbes (@TL_Forbes), and JVS-VS associate editor Dr. Hedin to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Ann Gaffey, Dr. Mohammed Hamouda, and Dr. Young Erben, the authors of the following papers.

Articles:

Outcomes of Prosthetic and Biological Grafts Compared to Arm Vein Grafts in Patients with Chronic Limb Threatening Ischemia
Proteomic Analysis of Carotid Artery Plaques With and Without Vulnerable Features on MRI with Vessel Wall Imaging: A pilot study

Show Guests

Dr. Ann Gaffey (@Ann_Gaffey_MD): Assistant professor of surgery at UC San Diego School of Medicine in the Division of Vascular and Endovascular Surgery. Dr. Gaffey's clinical interests include examining new approaches to peripheral arterial disease and improving the patency of current bypass options.
Dr. Mohammed Hamouda (@hamouda_mmz): Postdoctoral research fellow at UC San Diego, Division of Vascular & Endovascular Surgery
Dr. Young Erben (@ErbenYoung): vascular surgeon from Mayo Clinic in Jacksonville Florida. She earned her medical degree from Goethe University in Frankfurt, Germany, and completed her general surgery as well as vascular surgery training at the Mayo Clinic in Rochester, Minnesota. Her clinical interests include cerebrovascular, aortic, and peripheral pathologies, as well as initiatives to eradicate disparities in care.

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors.

Guests:

Kelsey Schmittling, Medical Student (@kelseyum2plus)

“What can go wrong during thoracic endovascular aortic repair for type B aortic dissection”

Development and feasibility testing of a new device for home-based leg heat therapy in patients with lower extremity peripheral artery disease

Radiation-induced injury in endovascular surgery: How long is too long?

Hosts:

John Culhane (@JohnCulhaneMD)

Nishi Vootukuru (@Nishi_Vootukuru)

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In this episode of Audible Bleeding, Jamila, Anh, and Naveed discuss the LifeBTK Trial with Principal Investigator Dr. Brian DeRubertis, where we discuss the new Abbott Esprit everolimus-eluting resorbable scaffold for the below-knee popliteal space.

Guest:

Dr. DeRubertis, is the Principal Investigator of the LIFE-BTK trial. He is the Chief of the Division of Vascular & Endovascular Surgery at New York-Presbyterian and Weill Cornell Medicine in New York City.

Audible Bleeding Team

Dr. Jamila Hedhliis a general surgery resident at the University of Illinois.

Anh Dang, (@QuynhAnh_Dang), is a fourth year medical student at the University of Pennsylvania.

Dr. Naveed A. Rahman, (@naveedrahmanmd), is a Vascular Surgery Fellow at the University of Maryland.

References:

Drug-Eluting Resorbable Scaffold versus Angioplasty for Infrapopliteal Artery Disease (LIFE-BTK).
Advances in Endovascular Treatment of CLTI: Insights From the LIFE-BTK Trial.
Diversity, Equity, and Inclusion in the LIFE-BTK Trial Evaluating the Esprit™ BTK Drug-Eluting Resorbable Scaffold for the Treatment of Infrapopliteal Lesions in Patients with Chronic Limb-Threatening Ischemia, VIVA 2024.
Sirolimus-eluting stents vs. bare-metal stents for treatment of focal lesions in infrapopliteal arteries: a double-blind, multi-centre, randomized clinical trial (YUKON).
Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease (DESTINY).
A prospective randomized multicenter comparison of balloon angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with ischemic peripheral arterial disease (ACHILLES).
Sex Differences in Outcomes Following Endovascular Treatment for Symptomatic Peripheral Artery Disease: An Analysis From the K- VIS ELLA Registry.
Drug-Coated vs Uncoated Percutaneous Transluminal Angioplasty in Infrapopliteal Arteries: Six-Month Results of the Lutonix BTK Trial.
Paclitaxel-Coated Balloon in Infrapopliteal Arteries: 12-Month Results From the BIOLUX P-II Randomized Trial (BIOTRONIK'S-First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries).
The IN.PACT DEEP Clinical Drug-Coated Balloon Trial: 5-Year Outcomes.

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Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year medical student Nishi (@Nishi_Vootukuru), JVS editor Dr. Forbes (@TL_Forbes), and JVS-CIT associate editor Dr. Jimenez to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Trisha Roy (@trisharoymd), Dr. Judit Csore (@JuditCsore), and Dr. Maham Rahimi, the authors of the following papers.

Articles:

Employing magnetic resonance histology for precision chronic limb-threatening ischemia treatment plan
Biodesign: Engineering an aortic endograft explantation tool

Show Guests

Dr. Trisha Roy- Assistant professor of cardiovascular surgery at the Houston Methodist Debakey Heart and Vascular Center. Background of Material engineering, vascular imaging, research interest in peripheral vascular disease.
Dr. Judit Csore-Radiologist and assistant lecturer at the Heart and Vascular Center of Semmelweis University, Budapest, Hungary. Her primary focus is on cardiovascular imaging and vascular MRI. She recently spent two years in the United States at Houston Methodist Hospital, where she had been collaborating with Dr. Trisha Roy since 2022 as a postdoctoral fellow, specializing in peripheral arterial disease imaging.
Dr. Maham Rahimi-Associate professor in the department of cardiovascular surgery at Houston Methodist Hospital, His research interests include nanotechnology and Biomedical Engineering

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of the SVS Social Media Ambassadors.

Guests:

Dr. Gregory Magee, MD (@gregamagee)

The past, present, and future of abdominal aortic aneurysm repair

Dr. Eric Pillado, MD (@drpillado)

The need for standardizing care for pediatric and geriatric vascular trauma patients

Dr. Ben Li, MD (@ben_li123)

Advanced chronic venous insufficiency and the role of the incompetent perforator vein: A 100-year quest for the right strategy

Pediatric carotid body tumors: A case report and systematic review

Early experience with baroreflex activation therapy from a vascular surgery perspective

Dr. Donald Baril, MD (@DonaldBaril)

Early graft failure following lower extremity bypass

Dr. Michael Malinowski, MD

Current challenges to vascular trauma training across levels and regions

Hosts:

John Culhane (@JohnCulhaneMD)

Nishi Vootukuru (@Nishi_Vootukuru)

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*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year medical student Nishi (@Nishi_Vootukuru), JVS editor Dr. Forbes (@TL_Forbes), and JVS social media liaison Dr. Haurani to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Marc Schermerhorn, Dr. Andrew Sanders, Dr. Mitchell Cox and Dr. Junji Tsukagoshi, the authors of the following papers.

Articles:

Ten Years of Physician Modified Endografts
Peri-operative and intermediate outcomes of patients with pulmonary embolism undergoing catheter-directed thrombolysis vs. percutaneous mechanical thrombectomy

Show Guests

Dr. Marc Schermerhorn: Chief of vascular and endovascular surgery at Beth Israel Deaconess and professor of surgery, Harvard Medical School
Dr. Andrew Sanders: PGY4 general surgery resident at Beth Israel Deaconess
Dr. Mitchell Cox: Division chief of vascular surgery and endovascular therapy, program director of the vascular surgery residency program at the University of Texas Medical Branch.
Dr. Junji Tsukagoshi: Fourth year vascular surgery resident at the University of Texas Medical Branch in Galveston Texas.

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Guest:

Dr. Christian de Virgilio is the Chair of the Department of Surgery at Harbor-UCLA Medical Center. He is also Co-Chair of the College of Applied Anatomy and a Professor of Surgery at UCLA's David Geffen School of Medicine.

He completed his undergraduate degree in Biology at Loyola Marymount University and earned his medical degree from UCLA. He then completed his residency in General Surgery at UCLA-Harbor Medical Center followed by a fellowship in Vascular Surgery at the Mayo Clinic.

Resources:

Rutherford Chapters (10th ed.): 174, 175, 177, 178
Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/
The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext
KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/

Outline:

Steal Syndrome
Definition & Etiology
Steal syndrome is an important complication of AV access creation, since access creation diverts arterial blood flow from the hand.
Steal can be caused by multiple factors—arterial occlusive disease proximal or distal to the AV anastomosis, high flow through the fistula at the expense of distal arterial perfusion, and failure of the distal arterial networks to adapt to this decreased blood flow.
Incidence and Risk Factors
The frequency of steal syndrome is 1.6-9%1,2, depending on the vessels and conduit choice
Steal syndrome is more common with brachial and axillary artery-based accesses and nonautogenous conduits.
Other risk factors for steal syndrome are peripheral vascular disease, coronary artery disease, diabetes, advanced age, female sex, larger outflow conduit, multiple prior permanent access procedures, and prior episodes of steal.3,4
Long-standing insulin-dependent diabetes causes both medial calcinosis and peripheral neuropathy, which limits arteries’ ability to vasodilate and adjust to decreased blood flow.
Patient Presentation, Symptoms, Grading
Steal syndrome is diagnosed clinically.
Symptoms after AVG creation occurs within the first few days, since flow in prosthetic grafts tend to reach a maximum value very early after creation.
Native AVFs take time to mature and flow will slowly increase overtime, leading to more insidious onset of symptoms that can take months or years.
The patient should have a unilateral complaint in the extremity with the AV access. Symptoms of steal syndrome, in order of increasing severity, include nail changes, occasional tingling, extremity coolness, numbness in fingertips and hands, muscle weakness, rest pain, sensory and motor deficits, fingertip ulcerations, and tissue loss.
There could be a weakened radial pulse or weak Doppler signal on the affected side, and these will become stronger after compression of the AV outflow.
Symptoms are graded on a scale specified by Society of Vascular Surgery (SVS) reporting standards:5
Workup
Duplex ultrasound can be used to analyze flow volumes.
A high flow volume (in autogenous accesses greater than 800 mL/min, in nonautogenous accesses greater than 1200 mL/min) signifies an outflow issue. The vein or graft is acting as a pressure sink and stealing blood from the distal artery. A low flow volume signifies an inflow issue, meaning that there is a proximal arterial lesion preventing blood from reaching the distal artery.
Upper extremity angiogram can identify proximal arterial lesions.
Prevention
Create the AV access as distal as possible, in order to preserve arterial inflow to the hand and reduce the anastomosis size and outflow diameter.
SVS guidelines recommend a 4-6mm arteriotomy diameter to balance the need for sufficient access flow with the risk of steal.
If a graft is necessary, tapered prosthetic grafts are sometimes used in patients with steal risk factors, using the smaller end of the graft placed at the arterial anastomosis, although this has not yet been proven to reduce the incidence of steal.
Indications for Treatment
Intervention is recommended in lifestyle-limiting cases of Grade II and all Grade III steal cases.
If left untreated, the natural history of steal syndrome can result in chronic limb ischemia, causing gangrene with loss of digits or limbs.
Treatment Options
Conservative management relies on observation and monitoring, as mild cases of steal syndrome may resolve spontaneously.
Inflow stenosis can be treated with endovascular intervention (angioplasty with or without stent)
Ligation is the simplest surgical treatment, and it results in loss of the AV access. This is preferred in patients with repetitive failed salvage attempts, venous hypertension, and poor prognoses.
Flow limiting procedures can address high volumes through the AV access.
Banding can be performed with surgical cutdown and placement of polypropylene sutures or a Dacron patch around the vein or graft.
The Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) technique employs a percutaneous endoluminal balloon inflated at the AVF to ensure consistency in diameter while banding
Plication is when a side-biting running stitch is used to narrow lumen of the vein near the anastomosis.
A downside of flow-limiting procedures is that it is often difficult to determine how much to narrow the AV access, as these procedures carry a risk of outflow thrombosis.
There are also surgical treatments focused on reroute arterial inflow.
The distal revascularization and interval ligation (DRIL) procedure involves creation of a new bypass connecting arterial segments proximal and distal to the AV anastomosis, with ligation of the native artery between the AV anastomosis and the distal anastomosis of the bypass. Reversed saphenous vein with a diameter greater than 3mm is the preferred conduit. Arm vein or prosthetic grafts can be used if needed, but prosthetic material carries higher risk of thrombosis. The new arterial bypass creates a low resistance pathway that increases flow to distal arterial beds, and interval arterial ligation eliminates retrograde flow through the distal artery.
The major risk of this procedure is bypass thrombosis, which results in loss of native arterial flow and hand ischemia. Other drawbacks of DRIL include procedural difficulty with smaller arterial anastomoses, sacrifice of saphenous or arm veins, and decreased fistula flow.
Another possible revision surgery is revision using distal inflow (RUDI). This procedure involves ligation of the fistula at the anastomosis and use of a conduit to connect the outflow vein to a distal artery. The selected distal artery can be the proximal radial or ulnar artery, depending on the preoperative duplex. The more dominant vessel should be spared, allowing for distal arterial beds to have uninterrupted antegrade perfusion. The nondominant vessel is used as distal inflow for the AV access. RUDI increases access length and decreases access diameter, resulting in increased resistance and lower flow volume through the fistula. Unlike DRIL, RUDI preserves native arterial flow.
Thrombosis of the conduit would put the fistula at risk, rather than the native artery.
The last surgical revision procedure for steal is proximalization of arterial inflow (PAI). In this procedure, the vein is ligated distal to the original anastomosis site and flow is re-established through the fistula with a PTFE interposition graft anastomosed end-to-side with the more proximal axillary artery and end-to-end with the distal vein. Similar to RUDI, PAI increases the length and decreases the diameter of the outflow conduit. Since the axillary artery has a larger diameter than the brachial artery, there is a less significant pressure drop across the arterial anastomosis site and less steal. PAI allows for preservation of native artery’s continuity and does not require vein harvest.
Difficulties with PAI arise when deciding the length of the interposition graft to balance AV flow with distal arterial flow.
Ischemic Monomelic Neuropathy
Definition
Ischemic monomelic neuropathy (IMN) is a rare but serious form of steal that involves nerve ischemia. Severe sensorimotor dysfunction is experienced immediately after AV access creation.
Etiology
IMN affects blood flow to the nerves, but not the skin or muscles because peripheral nerve fibers are more vulnerable to ischemia.
Incidence and Risk Factors
IMN is very rare; it has an estimated incidence of 0.1-0.5% of AV access creations.6
IMN has only been reported in brachial artery-based accesses, since the brachial artery is the sole arterial inflow for distal arteries feeding all forearm nerves.
IMN is associated with diabetes, peripheral vascular disease, and preexisting peripheral neuropathy that is associated with either of the conditions.
Patient Presentation
Symptoms usually present rapidly, within minutes to hours after AV access creation.
The most common presenting symptom is severe, constant, and deep burning pain of the distal forearm and hand. Patients also report impairment of all sensation, weakness, and hand paralysis.
Diagnosis of IMN can be delayed due to misattribution of symptoms to anesthetic blockade, postoperative pain, preexisting neuropathy, a heavily bandaged arm precluding neurologic examination.
Treatment
Treatment is immediate ligation of the AV access. Delay in treatment will quickly result in permanent sensorimotor loss.
Perigraft Seroma
Definition
A perigraft seroma is a sterile fluid collection surrounding a vascular prosthesis and is enclosed within a pseudomembrane.
Etiology and Incidence
Possible etiologies include: transudative movement of fluid through the graft material, serous fluid collection from traumatized connective tissues (especially the from higher adipose tissue content in the upper arm), inhibition of fibroblast growth with associated failure of the tissue to incorporate the graft, graft “wetting” or kinking during initial operation, increased flow rates, decreased hematocrit causing oncotic pressure difference, or allergy to graft material.
Seromas most commonly form at anastomosis sites in the early postoperative period.
Overall seroma incidence rates after AV graft placement range from 1.7–4% and are more common in grafts placed in the upper arm (compared to the forearm) and Dacron grafts (compared to PTFE grafts).7-9
Patient Presentation and Workup
Physical exam can show a subcutaneous raised palpable fluid mass
Seromas can be seen with ultrasound, but it is difficult to differentiate between the types of fluid around the graft (seroma vs. hematoma vs. abscess)
Indications for Treatment
Seromas can lead to wound dehiscence, pressure necrosis and erosion through skin, and loss of available puncture area for hemodialysis
Persistent seromas can also serve as a nidus for infection.
The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines10 recommend a tailored approach to seroma management, with more aggressive surgical interventions being necessary for persistent, infected-appearing, or late-developing seromas.
Treatment
The majority of early postoperative seromas are self-limited and tend to resolve on their own
Persistent seromas have been treated using a variety of methods-- incision and evacuation of seroma, complete excision and replacement of the entire graft, and primary bypass of the involved graft segment only.
Graft replacement with new material and rerouting through a different tissue plane has a higher reported cure rate and lower rate of infection than aspiration alone.9
Infection
Incidence and Etiology
The reported incidence of infection ranges 4-20% in AVG, which is significantly higher than the rate of infection of 0.56-5% in AVF.11
Infection can occur at the time of access creation (earliest presentation), after cannulation for dialysis (later infection), or secondary to another infectious source. Infection can also further complicate a pre-existing access site issue such as infection of a hematoma, thrombosed pseudoaneurysm, or seroma.
Skin flora from frequent dialysis cannulations result in common pathogens being Staphylococcus, Pseudomonas, or polymicrobial species. Staphylococcus and Pseudomonas are highly virulent and likely to cause anastomotic disruption.
Patient Presentation and Workup
Physical exam will reveal warmth, pain, swelling, erythema, induration, drainage, or pus. Occasionally, patients have nonspecific manifestations of fever or leukocytosis.
Ultrasound can be used to screen for and determine the extent of graft involvement by the infection.
Treatments
In AV fistulas:
Localized infection can usually be managed with broad spectrum antibiotics.
If there are bleeding concerns or infection is seen near the anastomosis site, the fistula should be ligated and re-created in a clean field.
In AV grafts:
If infection is localized, partial graft excision is acceptable.
Total graft excision is recommended if the infection is present throughout the entire graft, involves the anastomoses, occludes the access, or contains particularly virulent organisms
Total graft excision may also be indicated if a patient develops recurrent bacteremia with no other infectious source identified.
For graft excision, the venous end of the graft is removed and the vein is oversewn or ligated. If the arterial anastomosis is intact, a small cuff of the graft can be left behind and oversewn. If the arterial anastomosis is involved, the arterial wall must be debrided and ligation, reconstruction with autogenous patch angioplasty, or arterial bypass can be pursued.

References

Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and Characteristics of Patients with Hand Ischemia after a Hemodialysis Access Procedure. J Surg Res. 1998;74(1):8-10. doi:10.1006/jsre.1997.5206
Ballard JL, Bunt TJ, Malone JM. Major complications of angioaccess surgery. Am J Surg. 1992;164(3):229-232. doi:10.1016/S0002-9610(05)81076-1
Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg. 2002;36(2):351-356. doi:10.1067/mva.2002.125848
Malik J, Tuka V, Kasalova Z, et al. Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies. J Vasc Access. 2008;9(3):155-166. doi:10.1177/112972980800900301
Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-610. doi:10.1067/mva.2002.122025
Thermann F, Kornhuber M. Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access. 2011;12(2):113-119. doi:10.5301/JVA.2011.6365
Dauria DM, Dyk P, Garvin P. Incidence and Management of Seroma after Arteriovenous Graft Placement. J Am Coll Surg. 2006;203(4):506-511. doi:10.1016/j.jamcollsurg.2006.06.002
Gargiulo NJ, Veith FJ, Scher LA, Lipsitz EC, Suggs WD, Benros RM. Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008;48(1):216-217. doi:10.1016/j.jvs.2008.01.046
Blumenberg RM, Gelfand ML, Dale WA. Perigraft seromas complicating arterial grafts. Surgery. 1985;97(2):194-204.
Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4):S1-S164. doi:10.1053/j.ajkd.2019.12.001
Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J Vasc Surg. 2008;48(5):S55-S80. doi:10.1016/j.jvs.2008.08.067

In this special series, core faculty members of the SVS Leadership Development Program, Dr. Manuel Garcia-Toca, Dr. Kenneth Slaw, and Steve Robischon, discuss the program origins, research regarding good leadership, and how to join.

Manuel Garcia-Toca, MD completed his MD at the Universidad Anahuac in Mexico (1999) and MS in Health Policy at Stanford University (2020). Dr. Garcia-Toca completed his residency in General Surgery at Brown University (2008) and a fellowship in Vascular Surgery at Northwestern University (2010). He will serve within the Department of Surgery in the Division of Vascular Surgery and Endovascular Therapy and the Division of Emory Surgery at Grady based primarily at Grady Memorial Hospital.

Kenneth Slaw, PhD is the executive director of the Society for Vascular Surgeons. Dr. Slaw received his master's and doctoral degrees in educational psychology from the University of Illinois. He has over 35 years of executive leadership experience in the medical society and philanthropic communities, having served in numerous previous roles, including as president of the American Association of Medical Society Executives, as chairman of the board of Make A Wish Illinois, and as senior staff member at the Academy of Pediatrics, where he assisted in efforts with the Pediatric Leadership Alliance Program, which has provided leadership skill building sessions for approximately 3, 000 physicians.

Steve Robischon, PA-C is a Physician Assistant with the Division of Vascular and Endovascular Surgery at the Medical College of Wisconsin in Milwaukee, Wisconsin, and is also a member of the PA Section Steering Committee.

More about the SVS PA Section

More about the SVS Leadership Program

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovates, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of the SVS Social Media Ambassadors.

Readers:

Nick Schaper (@schapernj)

Nabeeha Khan (@Nabeeha_Khan_)

Hosts:

John Culhane (@JohnCulhaneMD)

Nishi Vootukuru (@Nishi_Vootukuru)

Reference Articles:

The Gore Iliac Branch Endoprosthesis as an alternate aortic main body: Promising results in select patients

A classic article that has never been read in English

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Audible Bleeding editor Wen (@WenKawaji) is joined by 4th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes), JVS-VS associate editor Dr. John Curci (@CurciAAA) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Mota, Dr. Liang and Dr. Weinkauf, authors of the following papers.

Articles:

The impact of travel distance in patient outcomes following revascularization for chronic limb-threatening ischemia
Serum detection of blood brain barrier injury in subjects with a history of stroke and transient ischemic attack

Show Guests:

Dr. Lucas Mota- third-year general surgery resident at the Beth Israel Deaconess Medical Center
Dr. Patrick Liang- assistant professor at Harvard medical school and a practicing vascular surgeon at the Beth Israel Deaconess medical center.
Dr. Weinkauf - assistant professor with the Department of Surgery Division of Vascular and Endovascular Surgery at the University of Arizona College of Medicine

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Nishi Vootukuru (@Nishi_Vootukuru) and Dr. Ezra Schwartz (@ezraschwartz10) interview Dr. William Shutze and Dr. Anahita Dua (@AnahitaDua) to discuss the Get a Pulse on PAD Campaign.

The Get a Pulse on PAD initiative (#PulseonPAD), launched in February, 2024, is a patient education and advocacy campaign designed to increase the understanding of peripheral artery disease's risk factors and potential symptoms.

Dr. Shutze is a vascular surgeon with Texas Vascular Associates in Dallas, Texas and the Secretary of the SVS. Dr. Shutze completed his medical studies at Baylor University after completing general surgery residency at University of Alabama in Birmingham. Dr. Shutze returned to Baylor to complete his vascular fellowship. Dr. Shutze is one of the Get a Pulse on PAD initiative’s chairs and a leading expert in PAD. He has actively published in the field with over 100 abstracts and articles, with his most recent work focusing on prosthetics, and advocating for successful prosthetic referral after amputation.

Dr. Dua is a vascular surgeon at Mass General Hospital and associate professor at Harvard Medical School. At Mass General, she is the director of the Vascular Lab, co-director of the Peripheral Artery Disease Center and Limb Evaluation and Amputation Program (LEAPP), associate director of the Wound Care Center, director of the Lymphedema Center and director of clinical research for the division of vascular surgery. She serves as the Editor-in-Chief of Journal of Vascular Surgery-Vascular Insights. Dr. Dua completed her undergraduate medical studies at the Aberdeen University School of Medicine in Aberdeen, Scotland. She then completed her general surgery residency at the Medical College of Wisconsin and vascular fellowship at Stanford University Hospital. She holds multiple master’s degrees including degrees in trauma sciences and business administration in healthcare management. She also completed certificate programs at the Massachusetts Institute of Technology in health economics and outcomes research as well as in drug and device development. Dr. Dua is a prolific researcher, researcher, and advocate, with much of her work centered on PAD. She furthers patient care not only through research but through her political work as Founder of the Healthcare for Action political action committee (PAC) and member of the SVS PAC Steering Committee.

Special thank you to Jacob Soucey (@JacobWSoucy)

Resources:

https://www.secondscount.org/get-a-pulse-pad
https://evtoday.com/news/pad-pulse-alliance-survey-highlights-disconnect-in-public-knowledge-of-pad-risks
Association of Black Cardiologists (ABC)
Society for Cardiovascular Angiography & Interventions (SCAI)
Society of Interventional Radiology (SIR)
CardioVascular Coalition (CVC)
Outpatient Endovascular and Interventional Society (OEIS)
https://vascular.org/advocacy/political-action-committee
https://evtoday.com/articles/2021-may/the-arc-act-fighting-amputation-via-legislation
https://evtoday.com/articles/2006-may/EVT0506_10.html#:~:text=The%20Screening%20Abdominal%20Aortic%20Aneurysm,screening%20as%20a%20Medicare%20benefit
CLariTI Study: Natural Progression of High-Risk Chronic Limb-Threatening Ischemia
Socioeconomic and hospital-related predictors of amputation for critical limb ischemia
ARC Act of Congress
Painkiller: TV Series
Congressman Payne
SAAAVE Act

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In this episode of Audible Bleeding, editor Dr. Imani McElroy (@IEMcElroy) is joined by General Surgery PGY-4 Sasank Kalipatnapu(@ksasank) along with Dr.David Rigberg, MD (@drigberg), and Dr. Guillermo Escobar, MD (@GAEscobarMD) to discuss the Society for Clinical Vascular Surgery (SCVS) Rising Seniors / Incoming Fellows Program. This episode brings out a conversation exploring the history behind the development of the program, the current state of the program, and the overwhelming importance of the program in the current day. The episode also provides a broad overview of the content presented in the program and the reasoning behind the talks.

Guests:

Dr. David Rigberg - Professor of Surgery, Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Program Director for the Vascular fellowship and integrated vascular surgery residency at the David Geffen School of Medicine, UCLA, Los Angeles, California
Dr. Guillermo Escobar- Associate Professor, Division of Vascular Surgery and Endovascular Therapy, Program Director for the Vascular Surgery Fellowship and Residency at Emory University School of Medicine

Relevant links:

Rising Seniors / Incoming Fellows Program - Program Details
SCVS - Fellows & Chief Residents Program
SCVS - Young Vascular Surgeons Program

To apply for the Rising Seniors / Incoming Fellows Program, go to apply now!

Audible Bleeding team:

Dr. Imani McElroy is 1st year vascular surgery fellow at USC/LA and editor at Audible Bleeding
Dr. Sasank Kalipatnapu, PGY-4 general surgery resident, Dept of Surgery, UMass Chan Medical School, Worcester, MA

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Audible Bleeding contributor and first year vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by vascular fellow Donna Bahroloomi (@DonnaBahroloomi), fourth year general surgery resident, Sasank Kalipatnapu (@ksasank), JVS editor-in-chief, Dr. Thomas Forbes (@TL_Forbes), and JVS-CIT editor Dr. Matt Smeds (@mattsmeds) to discuss two great articles in the JVS family of journals. The first article analyzes seven years worth of VQI data on TCAR, CEA, and TF-CAS to elucidate modern management of carotid disease. The second article provides a simple but powerful method of assessing adequacy of revascularization in the management of hemodialysis access-induced distal ischemia. This episode hosts Dr. Marc Schermerhorn (@MarcScherm), Sabrina Straus MS3 (LinkedIn), and Dr. Yana Etkin (@YanaEtkin), authors of these papers.

Articles:

Part 1: “Seven years of the transcarotid artery revascularization surveillance project, comparison to transfemoral stenting and endarterectomy” by Sabrina Straus, Dr. Schermerhorn, and colleagues.

Part 2: “Proximalization of arterial inflow with adjunctive arterial pressure measurements for management of hemodialysis access-induced distal ischemia” by Dr. Etkin and colleagues.

Show Guests:

Sabrina Straus BS, 3rd year medical student at UCSD
Dr. Marc Schermerhorn, George H.A. Clowes, Jr. Professor of Surgery, Harvard Medical School and Chief of Vascular and Endovascular Surgery, BIDMC
Dr. Yana Etkin- Associate Professor of Surgery at the Zucker School of Medicine at Hofstra/ Northwell, Program Director for the Vascular Surgery Fellowship and Integrated Vascular Surgery Residency and Associate Chief of Vascular Surgery

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Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen (@WenKawaji) is joined by 1st year vascular surgery fellow Richa Kalsi (@KalsiMD), 3rd year medical student Nishi (@Nishi_Vootukuru), 4th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes), JVS-VLD associate editor Dr. Arjun Jayaraj and JVS social media liaison Dr. Haurani to discuss some of our favorite articles in the JVS family of journals.

This episode hosts Dr. Amy Felsted, Dr. Salvatore Scali, and Dr. Arjun Jayaraj, the authors of the following papers. Dr. Arjun Jayaraj and Dr. Haurani will also spend time discussing a virtual special issue, centered around iliofemoral venous stenting published in the Journal of Vascular Surgery, Venous and Lymphatic Disorders that includes six articles published between August 2023 and May 2024.

Articles:

Part 1: A patient-centered textbook outcome measure effectively discriminates contemporary elective open abdominal aortic aneurysm repair quality by Dr. Felsted, Dr. Scali and colleagues.
Part 2: Virtual special issues on contemporary role of iliofemoral venous stenting

Show Guests

Dr. Amy Felsted (@aefelsted): Completed fellowship at Dartmouth-Hitchcock, Currently an assistant professor of surgery at Boston University School of Medicine and practicing vascular surgeon at the VA in Boston
Dr. Salvatore Scali: Professor of Surgery at University of Florida Division of Vascular Surgery and Endovascular Therapy, program director of the vascular fellowship at University of Florida.
Dr. Arjun Jayaraj: Vascular surgeon at the RANE Center in Jackson, Mississippi with a focus on the management of venous and lymphatic diseases, Associate Editor of JVS-VL.

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovates, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of the SVS Social Media Ambassadors.

Readers:

David Ebertz (@EbertzDavid)

Kori Snider (@KoriSnider)

Nabeeha Khan (@Nabeeha_Khan_)

Hosts:

John Culhane (@Johnculhanemd)

Nishi Vootukuru (@Nishi_Vootukuru)

Reference Articles:

Sutureless endovascular bypass technique in long femoropopliteal occlusions

Technical feasibility and device stability of the Gore Excluder iliac branch endoprosthesis as abdominal aortic bifurcated device Retrograde aortic dissection during thoracic endovascular aortic repair: How to prevent and treat Retroperitoneal approach for ilio-superior mesenteric artery bypass: Technique and case series Randomized controlled trials in emergency settings: Taking a HEADSTART on acute type A aortic dissection trials Presentation and management of true aneurysms of the pancreaticoduodenal arcade with concomitant celiac artery stenosis using the endovascular approach Regarding “Aortic rupture during STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) technique” Temporary mesenteric venous shunting for portal vein reconstruction: A novel technical adjunct Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

The Audible Bleeding team (Wen Kawaji and Anh Dang) is here at the annual EVS meeting in Charleston, SC. We wanted to highlight some of the research being presented at the conference by medical students and residents.

In this episode, Sasank Kalipatnapu (@ksasank) and Leana Dogbe (@ldogbe4) sit down with Dr.Joseph Mills(@jmills1955), Dr. Douglas Jones and Dr. Premchand Gupta (@pcvasc) to discuss the origin of the SVS Step Challenge. This episode features a conversation about the history behind the SVS Step challenge and the role of walking in treating peripheral artery disease (PAD). It also covers the origin of “Walkathon”, the Indian equivalent of SVS Step Challenge.

Dr. Joseph Mills is Professor and Chief of the Division of Vascular Surgery and Endovascular Therapy at Michael E DeBakey Department of Surgery at Baylor College of Medicine in Houston, Texas. He is also the John W. Reid and Josephine L. Reid Endowed Professorship in Surgery and is currently the chair of the SVS Foundation.

Dr. Douglas Jones is an associate professor of Vascular Surgery at UMass Chan Medical School, Worcester, MA. He currently leads the Limb Preservation Center at UMass Memorial Health.

Dr. PC Gupta is the clinical director of vascular and endovascular surgery and vascular interventional radiology at the Care Hospitals in Hyderabad, India. He is President of the Vascular Society of India and now President of the World Federation of Vascular Societies.

Relevant links:

SVS Step Challenge - Home Page - Link to look up the details of the Step Challenge

vascular.org/step2024 - Link to sign up for the Step Challenge 2024

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The Audible Bleeding team is here at the annual EVS meeting in Charleston, SC. We wanted to share with you some of the attendees' experiences in their own words!

In this episode, we discuss the challenges of explanting aortic grafts, the diagnosis and management of infected aortic grafts, as well as tips and tricks for once we're in the operating room.

Interviewers/Editors: Mark Basilious, MD Candidate (@markrbasilious)

Eva Urrechaga, MD (@urrechisme) Sharif Ellozy, MD (@SharifEllozy)

Guests:

Dr. Francis Caputo (@FrankCaputoMD) is an Associate Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, Vascular Surgery Director of the Aorta Center, and Program Director of the Vascular Surgery Training Programs. His clinical interests include complex open and endovascular repair of thoracic, thoracoabdominal, and abdominal aortic aneurysms, management of thoracic dissection, and endovascular and open repair of failed endograft. Dr. Caputo earned his medical degree from the University of Medicine and Dentistry New Jersey, Newark, NJ, where he also served his surgical residency and two years as a National Institutes of Health research fellow. He completed his fellowship in vascular surgery at Barnes-Jewish Hospital of Washington University, St. Louis, MO and joined the Cleveland Clinic medical staff in 2018.

Dr. Peter Rossi (@peterjrossi) is a Professor of Surgery, Radiology, and Orthopedic Surgery, and Chief of the Division of Vascular and Endovascular Surgery at the Medical College of Wisconsin. His primary research and clinical interests are in complex “re-do” and revision surgery, including for thoracoabdominal and abdominal aortic aneurysms, carotid artery surgery, and renal and mesenteric arterial disease, as well as vascular reconstruction for complicated soft tissue sarcomas. Dr. Rossi completed medical school at the University of Illinois College of Medicine before completing his general surgery training at the University of Chicago and his vascular surgery training at the Medical College of Wisconsin, where he has been a member of the faculty since 2009.

Dr. Xavier Berard (@XavierBerardMD) is a French vascular surgeon who has been a Consultant in the Department of Vascular Surgery and Professor of Vascular and Endovascular Surgery in Bordeaux University Hospital in Bordeaux, France since 2010 and a full Professor of Vascular Surgery at the University of Bordeaux since 2016. He has also completed a PhD in Vascular Biomaterials and in 2010 worked as a research fellow at Lausanne University Hospital in Switzerland. He has been board certified by the French College of Vascular and Endovascular Surgeons since 2008 and by the European Society for Vascular and Endovascular Surgery since 2010. He has served as an examiner for the FEBVS exam since 2014 and as a reviewer for the European Journal of Vascular and Endovascular Surgery since 2016. Additionally, he is a member of the ESVS guidelines writing group for vascular graft infection and AAA. His personal surgical interests include open surgery of (thoraco)abdominal aneurysms, redo aortic surgery, infections in vascular surgery, EVAR explantation, and biomaterials. He works closely with Institut Bergonié Bordeaux Cancer Center for sarcomas. You can see educational videos and learn more about Dr. Xavier Berard here.

Helpful links and resources:

Video of explantation of infected chimney EVAR with duodenal fistula (courtesy of Dr. Berard)

Video of reimplanting the IMA after explanting an infected graft

Video of explantation of infected graft with suprarenal fixation

Videos of using the syringe technique to remove an aortic stent graft here and here (courtesy of Dr. Berard)

References

Kim YW. Aortic Endograft Infection: Diagnosis and Management. Vasc Specialist Int. 2023 Sep 21;39:26. doi: 10.5758/vsi.230071. PMID: 37732343; PMCID: PMC10512004.
Papas TT. Patient Selection Is Essential for Explantation of Infected Abdominal Aortic Endografts. Angiology. 2023 Nov 23:33197231218622. doi: 10.1177/00033197231218622. Epub ahead of print. PMID: 37995099.
Anagnostopoulos A, Mayer F, Ledergerber B, Bergadà-Pijuan J, Husmann L, Mestres CA, Rancic Z, Hasse B; VASGRA Cohort Study. Editor's Choice - Validation of the Management of Aortic Graft Infection Collaboration (MAGIC) Criteria for the Diagnosis of Vascular Graft/Endograft Infection: Results from the Prospective Vascular Graft Cohort Study. Eur J Vasc Endovasc Surg. 2021 Aug;62(2):251-257. doi: 10.1016/j.ejvs.2021.05.010. Epub 2021 Jun 14. PMID: 34140225.
Lumsden AB. Explant of the Aortic Endograft: Today's Solutions, Tomorrow's Problems. Methodist Debakey Cardiovasc J. 2023 Mar 7;19(2):38-48. doi: 10.14797/mdcvj.1176. PMID: 36936357; PMCID: PMC10022536.

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We are excited to bring back part two of our discussion on Robotic Vascular Surgery. Yasong (@yasongyumd) and Eva (@urrechisme) are joined by Dr. Lumsden and Dr. Bavare from Houston Methodist Hospital

Show Guests:

Alan Lumsden: Chair of Cardiovascular Surgery at Houston Methodist and DeBakey Heart and Vascular Center

Charu Bavare: Vascular Surgeon at Houston Methodist and Debakey Heart and Vascular Center

Hosts:

Eva Urrechaga - Vascular fellow at University of Pennsylvania

Yasong Yu - Vascular fellow at University of Chicago

Robotic Vascular Surgery Episode 1 with Dr. Judith Lin and Dr. Petr Stadler

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Audible Bleeding contributor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by vascular fellow Eva Urrechaga (@urrechisme), fourth year medical student Leona Dogbe (@ldogbe4), JVS Editor-in-Chief, Dr. Thomas Forbes (@TL_Forbes), and JVS-VS editor Dr. John Curci (@CurciAAA) to discuss two great articles in the JVS family of journals. The first article analyzes amputation trends over 12 years in Oklahoma, and identifies risk factors that can be used to target intervention strategies. The second article explores the role of toll-like receptor 4 in skeletal muscle damage caused by chronic limb-threatening ischemia. This episode hosts Dr. Kelly Kempe (@KellyKempe) and Dr. Ali Navi (@VascularChap), authors of these two papers.

Articles:

Part 1: “Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions” by Drs. Kempe, Nelson, and colleagues.

Part 2: “Role of toll-like receptor 4 in skeletal muscle damage in chronic limb-threatening ischemia” by Drs. Navi, Tsui, and colleagues.

Show Guests:

Dr. Kelly Kempe: Associate Professor and Vascular Surgery Program Director at the University of Oklahoma in Tulsa, Oklahoma.

Dr. Ali Navi: Consultant Vascular Surgeon at Cambridge University Hospitals, UK.

Follow us: @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Authors:

Sebouh Bazikian - PGY1 at Emory School of Medicine Integrated Vascular Surgery Program

Miguel F. Manzure - vascular surgery attending the University of Southern California Keck School of Medicine involved in complex limb preservation

Core Resources:

Rutherford Chapters: 107, 108, 109 (Includes further information on anatomy), 112

Additional Resources:

Relevant trials
BEST CLI: https://pubmed.ncbi.nlm.nih.gov/36342173/
BASIL 2: https://pubmed.ncbi.nlm.nih.gov/37116524/
Relevant Audible Bleeding episodes
Audible Bleeding Endovascular Basics: https://open.spotify.com/episode/7jDpkhGMauBslk8SBklCyB?si=75f0931773d24b91
Audible Bleeding eBook, CLTI Chapter: https://adam-mdmph.quarto.pub/vascular-surgery-exam-prep/clti.html
Anything else useful
WIFI: https://pubmed.ncbi.nlm.nih.gov/24126108/
GLASS: https://pubmed.ncbi.nlm.nih.gov/31159978/
Monophasic, Biphasic, Triphasic Waveforms: https://pubmed.ncbi.nlm.nih.gov/32667274/

Underlying disease featured in episode - peripheral arterial disease

Pathophysiology/etiology
1. narrowing of peripheral arteries caused by atherosclerotic plaques causing arterial insufficiency distal to the point of occlusion. This reduces oxygen supply to the muscles.
2. When oxygen demand increases but cannot be met, it leads to an imbalance such as pain and poor wound healing.
3. Risks: smoking, diabetes, hypertension, dyslipidemia, and older age
4. Equal prevalence in men and women, peak incidence age 60-80
5. Coexists with CAD, DM, stroke, Afib, and renal disease
6. Patient Presentation
7. 20-50% asymptomatic, rest can be intermittent claudication, rest pain, or tissue loss
8. claudication=pain or discomfort felt in the legs due to a lack of blood flow, especially during physical activity.
9. CLTI=chronic limb threatening ischemia: rest pain lasting greater than 2 weeks or nonhealing ulcers and gangrene
10. Physical exam:
  1. decreased skin temperature, less hair on the legs, brittle nails, atrophied muscles, shiny skin, livedo reticularis.
  2. Absent or diminished pulses
  3. Buerger sign
  4. Diagnosis
11. Ankle brachial index:

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of our SVS Social Media Ambassadors and authors.

Readers:

Shourya Verma (@shourya__verma)

Nabeeha Khan (@Nabeeha_Khan_)

Miguel Fernandez (@MGfernandez21)

Amit Chaudhary (@VascularKGMU)

Dr. Jayer Chung (@Jayer_Chung)

Hosts:

Nishi Vootukuru (@Nishi_Vootukuru)

John Culhane (@Johnculhanemd)

Editorials (E) and Abstracts (A):

E- Arteries of fibromuscular dysplasia tell a sympathetic story

A- Transcarotid arterial revascularization is feasible and safe with concomitant inferior vena cava occlusion

A- Surgical anteriorization of the left common iliac vein results in improved venous outflow and quality of life for May-Thurner syndrome

E- Longer is better, discussing length of coverage and timing of intervention in type B aortic dissection

A-Endovascular repair of ascending aortic pathologies in patients unfit for open surgery: Case series and literature review

A-Improved gait parameters following surgical revascularization in patients with intermittent claudication

A- Totally percutaneous endovascular renal allograft salvage for common iliac artery pseudoaneurysm

A- Early results of transcatheter electrosurgical aortic septotomy for endovascular repair of chronic dissecting aortoiliac aneurysms

E- Impact of the infrapopliteal bypass with distal arteriovenous fistula and distal cuffs in the management of small arterial disease

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In this episode, Sasank Kalipatnapu (@ksasank), John Culhane and Leana Dogbe (@ldogbe4) sit down along with Dr. Dalman (@RLDalmanMD) as chair of the SVS Nominating Committee for this year, along with the two vice presidential candidates Dr. Harris and Dr Shaw to learn more about them as part of the ongoing election process.

Show links:

SVS 2024 Meet the VP Candidates—Home Page—provides a comprehensive overview of all the candidates. Their professional biographies and answers to questions about their plans for the future are available in both text and video formats.

Show Guests:

Dr. Linda Harris, Professor of Surgery at Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY
Dr. Palma Shaw, Professor of Surgery at State University of New York, Syracuse, NY
Dr. Ronald L. Dalman, Elsa R. and Walter C. Chidester Professor and Division Chief Emeritus of Vascular Surgery at Stanford University, CA, Associate Dean for Market Development and Outreach for Stanford Medicine and Vice Chair for Clinical Affairs in the Department of Surgery

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Audible Bleeding contributor and 5th year general surgery resident Richa Kalsi (@KalsiMD) is joined by first-year vascular surgery fellow Zach Mattay (@ZMatthay), fifth-year general surgery resident Naveed Rahman (@naveedrahmanmd), JVS editor Dr. Thomas Forbes (@TL_Forbes), and JVS-CIT editor Dr. Matthew Smeds (@mattsmeds) to discuss two great articles in the JVS family of journals. The first article discusses national trends in surgeon-modified graft utilization for complex and thoracoabdominal aortic aneurysms. The second article discusses a novel technique, transcatheter electrosurgical aortic septotomy, to treat chronic dissecting aortoiliac aneurysms. This episode hosts Dr. Thomas O’Donnell (@tfxod) and Dr. Carlos Timaran (@ch_timaran), the authors of these two papers.

Articles:

Part 1:“National Trends in utilization of surgeon-modified grafts for complex and thoracoabdominal aortic aneurysms” by Dr. O’Donnell and colleagues.
- Mentioned during the discussion:
- - “Application of Investigational Device Exemptions regulations to endograft modification” by Abel and Farb.
Part 2: “Early results of transcatheter electrosurgical aortic septotomy for endovascular repair of chronic dissecting aortoiliac aneurysms” by Dr. Timaran and colleagues.
- Mentioned during discussion:
  - “Transcatheter Electrosurgery: JACC State-of-the-Art Review” by Khan and colleagues.
  - “A Novel Way to Fenestrate a Type B Dissection Flap Using Endovascular Electrocautery” by Dr. Kabbani and colleagues.

Show Guests

Dr. Thomas O’Donnell: Assistant professor of surgery in the aortic center at New York Presbyterian/Columbia University Irving Medical Center.
Dr. Carlos Timaran: Professor and Chief of Endovascular Surgery at University of Texas Southwestern Medical Center’s Department of Surgery.

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This episode of Audible Bleeding features Drs. Adam Johnson and Jeniann Yi, members of the Society for Vascular Surgery Health Information Technology Committee, to discuss the application of large language models in vascular surgery with two experts in the field, Dr. Andrew Gonzalez and one of his collaborators, Shantanu Dev. The episode promises a conversation exploring machine learning and large language models with insights from the guests' diverse expertise in vascular surgery, health informatics, and artificial intelligence.

Dr. Andrew Gonzalez, an assistant professor in vascular surgery at Indiana University School of Medicine and also an SVS HITC committee member, has clinical and research interests in peripheral arterial disease and artificial intelligence applications for amputation prevention.

Shantanu Dev, a computer science PhD student at Ohio State, focusing on multimodal modeling for clinical applications in AI. Shantanu worked at PWC for eight years in their AI R&D division and co-owns Satsong Digital Health, an AI company addressing healthcare inequities and quality of care.

Relevant links:

AI Revolution in Medince: GPT4 and Beyond by Peter Lee
Artificial Intelligentce in Surgery: Understanding the Role of Ai in Surgical Practice by Dan Hashimoto
Data Skeptic Podcast
Deep Medicine: How Artificial Intelligence can make Helathcare Human Again by Eric Topel

Co-Hosts:

Dr. Jennian Yi is an Assistant Professor of Surgery at the University of Colorado.

Dr. Adam Johnson is an Assistant Professor of Surgery at Duke University, and editor at Audible Bleeding.

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Audible Bleeding editor Wen (@WenKawaji) is joined by 5th year general surgery resident Richa Kalsi (@KalsiMD) from University of Maryland Medical Center, 4th year general surgery resident Nitin Jethmalani from New York Presbyterian Hospital-Weill Cornell, JVS (@JVascSurg) editor Dr. Forbes (@TL_Forbes) and JVS-VL (@jvsvl) editor Dr. Bush (@ruthlbush) to discuss two great articles in the JVS family of journals regarding chronic pain and resident burnout and SFJ reflux and its implication in C2 and C3 chronic venous insufficiency. This episode hosts Dr. Pillado (@drpillado), Dr. Coleman (@ColemanDM_vasc) and Dr. Lal.

Articles:

Reported pain at work is a risk factor for vascular surgery trainee burnout by Dr. Pillado and colleagues.
Effect of junctional reflux on the Venous Clinical Severity Score in Patients with Insufficiency of the great saphenous vein (JURY study) by Dr. Lal and colleagues.

Show Guests:

Dr. Coleman: Professor of Surgery at Duke University and Division Chief of Vascular and Endovascular Surgery at Duke University Medical Center.
Dr. Pillado: vascular surgery resident at Northwestern Hospital in Chicago, IL
Dr. Lal: Professor of Surgery at the University of Maryland, Professor of neurology at Mayo clinic, and professor of biomedical engineering at George Mason University. and Director of Center for Vascular Research at University of Maryland Medical Center

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In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of our SVS Social Media Ambassadors and Editor in Chief of JVS CIT, Dr. Matthew Smeds.

Readers:

Matthew Smeds (@mattsmeds)

Christopher DeHaven (@ChrisDeHavenPSU)

Ethan Vieira

Litton Whittaker

Nicholas Schaper

Nishi Vootukuru (@Nishi_Vootukuru)

Editorials:

Accomplishments and goals: Review of 2023 and previous of 2024 for the Journal of Vascular Surgery Cases, Innovations, and Techniques.

The enduring success of the DRIL technique and new advances in dialysis access.

Abstracts:

Intraprocedural application of a peripheral blood flow monitoring system during endovascular treatment for femoropopliteal disease.

Thoracic outlet syndrome: single-center experience on the transaxillary approach with the aid of the TRIMANO Arthrex arm.

Inferior vena cava hemangioma resected using a novel Toumai robotic surgical platform.

Surgical release of anterior tibial artery entrapment with associated popliteal artery entrapment.

Revisiting Heinz-Lippman disease as a complication of chronic venous insufficiency.

Utilization of coronary computed tomography angiography and computed tomography-derived fractional flow reserve in a critical limb-threatening ischemia cohort.

A rare case of Bannayan-Riley-Ruvalcaba syndrome with concurrent arteriovenous malformation.

Autologous and synthetic pediatric iliofemoral reconstruction: A novel technique for pediatric iliofemoral artery reconstruction.

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In this episode Abena Appah-Sampong (@abenasamp) and Leana Dogbe (@leanadogbe) partner with Vaiva Dabravolskaite (vaivadabravolskaite@gmail.com) from ESVS to host an episode discussing social deprivation in vascular surgery. Dr. Tara Mastracci and Dr. Olamide Alabi join us to offer insights into how social deprivation drives disparities in outcomes and steps to how we can shift practice paradigms to better address our patient needs.

Dr. Tara Mastracci (@aorticsurgeon) is a vascular surgeon with over 15 years of experience treating and managing complex aortic pathologies. She is currently working at St. Bartholomew’s Hospital in London, UK, on the Cardiothoracic Team doing complex aortic surgery. On top of her clinical duties, Dr. Mastracci is dedicated to studying the social and non-clinical factors influencing vascular outcomes.

Dr. Olamide Alabi (@OAlabiMD) is an Associate Professor of Surgery in the Department of Surgery at Emory University School of Medicine. Her clinical effort focuses on the full scope of vascular disease for patients at Emory University Hospital and the Atlanta VA HealthCare System, however, her academic portfolio and funded research is focused primarily on the intersection of peripheral artery disease, quality, and health equity.

References:

Social Deprivation and the Association With Survival Following Fenestrated Endovascular Aneurysm Repair/2021 https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00872-4/fulltext
Is social deprivation an independent predictor of outcomes following cardiac surgery? An analysis of 240,221 patients from a national registry. BMJ/2015 https://bmjopen.bmj.com/content/5/6/e008287.long
Survival Disparity Following Abdominal Aortic Aneurysm Repair Highlights Inequality in Ethnic and Socio-economic Status/ https://www.ejves.com/article/S1078-5884(17)30521-X/fulltext
Nash, D., McClure, G., Mastracci, T. M., & Anand, S. S. (2022). Social deprivation and peripheral artery disease. Canadian Journal of Cardiology, 38(5), 612-622.
Vart, P., Coresh, J., Kwak, L., Ballew, S. H., Heiss, G., & Matsushita, K. (2017). Socioeconomic status and incidence of hospitalization with lower‐extremity peripheral artery disease: atherosclerosis risk in communities study. Journal of the American Heart Association, 6(8), e004995.
Henry, A. J., Hevelone, N. D., Belkin, M., & Nguyen, L. L. (2011). Socioeconomic and hospital-related predictors of amputation for critical limb ischemia. Journal of vascular surgery, 53(2), 330-339.
Demsas, F., Joiner, M. M., Telma, K., Flores, A. M., Teklu, S., & Ross, E. G. (2022, June). Disparities in peripheral artery disease care: A review and call for action. In Seminars in vascular surgery (Vol. 35, No. 2, pp. 141-154). WB Saunders.

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Join Audible Bleeding team Matthew Chia, Nitin Jethmalani, and Leana Dogbe and editors from the JVS family of publications Thomas Forbes and Gale Tang as we discuss two of the latest highlights in vascular research. First, we welcome Mary McDermott, MD to discuss the discordance between patient-reported outcomes and objective PAD measures in the latest episode of the JVS. The episode finishes with a stimulating discussion with Alex Chan, PhD to discuss the effect of nicotine on angiogenesis in a murine model of PAD.

Articles:

Discordance of patient-reported outcome measures with objectively assessed walking decline in peripheral artery disease by McDermott et al. https://doi.org/10.1016/j.jvs.2023.12.027

Chronic nicotine impairs the angiogenic capacity of human induced pluripotent stem cell-derived endothelial cells in a murine model of peripheral arterial disease by Chan et al. https://doi.org/10.1016/j.jvssci.2023.100115

Related Articles:

Clinical characteristics and response to supervised exercise therapy of people with lower extremity peripheral artery disease by Patel et al. https://doi.org/10.1016/j.jvs.2020.04.498

Effects of supervised exercise therapy on blood pressure and heart rate during exercise, and associations with improved walking performance in peripheral artery disease: Results of a randomized clinical trial by Slysz et al. https://doi.org/10.1016/j.jvs.2021.05.033

Show Guests:

Mary McDermott, MD is the Jeremiah Stamler Professor of Medicine and Preventive Medicine at the Feinberg School of Medicine at Northwestern Medicine. Among her many accolades and titles, she serves as deputy editor of the Journal of the American Medical Society, and has an extensive career focused on improving our understanding of peripheral arterial disease.

Alex Chan, PhD is a researcher who studied regenerative medicine and cell therapeutics as a postdoctoral fellow in the lab of Dr. Ngan Huang, PhD at the Stanford Cardiovascular Institute.

In today’s episode, Dr. Rachael Forsythe (@ROForsythe), consultant vascular surgeon at NHS Lothian, leads a fictional case-based discussion with leaders in managing diabetic foot ulcers. Joining the conversation are Professor Andrew Boulton, Mr. Patrick Coughlin, Dr. David Armstrong, Dr. Dane Wukich, and Dr. Edgar Peters.

Professor Boulton is a professor of medicine at Manchester University in England and is co-chair of the Malvern Diabetic Foot Conference meeting. He served as president of numerous distinguished societies, including the International Diabetes Federation.

Dr. Coughlin (@Coughlin_pa) is a consultant vascular surgeon in Leeds, England. He is a very active member of the Vascular Society of Great Britain and Ireland Council and has a special academic and clinical interest in peripheral artery disease.

Dr. Armstrong (@DGArmstrong) is a podiatric surgeon and professor of surgery at Keck School of Medicine of the University of California and director of the Southwestern Academic Limb Salvage Alliance. Dr. Armstrong is very well known for his work on amputation prevention, the diabetic foot and wound healing.

Dr. Wukich (@DaneWukich) is a professor and chair of the Department of Orthopedics at the University of Texas, Southwestern and Medical Director of Orthopedic Surgery at UT Southwestern University Hospitals. Dr. Wich has an interest in foot and ankle surgery, including the management of diabetes-related complications.

Dr. Edgar Peters is an associate professor of internal medicine, infectious diseases, and acute medicine at Amsterdam University Medical Centers, Dr. Peter's main interest is infection of the musculoskeletal system, particularly in patients with diabetes and is the Scientific Secretary of the International Symposium on the Diabetic Foot.

Malvern Diabetic Foot Conference info:

https://www.facebook.com/MalvernDiabeticFootConference/

https://eu.eventscloud.com/website/8151/

If this episode was of interest to you, please take a listen to this Transatlantic Series episode where we speak with the authors of the SVS, ESVS, and IWGDFU joint guidelines on the management of peripheral arterial disease (PAD) in patients with diabetes.

Articles, resources, and societies referenced in the episode:

DF Blog. “Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review @bradspellberg @lacuscmedcenter @usc,” January 1, 2022. https://diabeticfootonline.com/2022/01/01/oral-is-the-new-iv-challenging-decades-of-blood-and-bone-infection-dogma-a-systematic-review-bradspellberg-lacuscmedcenter-usc/.

Gariani, Karim, Truong-Thanh Pham, Benjamin Kressmann, François R Jornayvaz, Giacomo Gastaldi, Dimitrios Stafylakis, Jacques Philippe, Benjamin A Lipsky, and Lker Uçkay. “Three Weeks Versus Six Weeks of Antibiotic Therapy for Diabetic Foot Osteomyelitis: A Prospective, Randomized, Noninferiority Pilot Trial.” Clinical Infectious Diseases 73, no. 7 (October 5, 2021): e1539–45. https://doi.org/10.1093/cid/ciaa1758.

Li, Ho-Kwong, Ines Rombach, Rhea Zambellas, A. Sarah Walker, Martin A. McNally, Bridget L. Atkins, Benjamin A. Lipsky, et al. “Oral versus Intravenous Antibiotics for Bone and Joint Infection.” New England Journal of Medicine 380, no. 5 (January 31, 2019): 425–36. https://doi.org/10.1056/NEJMoa1710926.

Magliano, Dianna, and Edward J. Boyko. IDF Diabetes Atlas. 10th edition. Brussels: International Diabetes Federation, 2021.

Østergaard, Lauge, Mia Marie Pries-Heje, Rasmus Bo Hasselbalch, Magnus Rasmussen, Per Åkesson, Robert Horvath, Jonas Povlsen, et al. “Accelerated Treatment of Endocarditis—The POET II Trial: Ration

ale and Design of a Randomized Controlled Trial.” American Heart Journal 227 (September 2020): 40–46. https://doi.org/10.1016/j.ahj.2020.05.012.

Price, Patricia. “The Diabetic Foot: Quality of Life.” Clinical Infectious Diseases 39 (2004): S129–31.

Sharma, S., C. Kerry, H. Atkins, and G. Rayman. “The Ipswich Touch Test: A Simple and Novel Method to Screen Patients with Diabetes at Home for Increased Risk of Foot Ulceration.” Diabetic Medicine: A Journal of the British Diabetic Association 31, no. 9 (September 2014): 1100–1103. https://doi.org/10.1111/dme.12450.

Shin, Laura, Frank L. Bowling, David G. Armstrong, and Andrew J.M. Boulton. “Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities.” Diabetes Care 43, no. 8 (August 1, 2020): 1704–9. https://doi.org/10.2337/dc20-1176.

Tone, Alina, Sophie Nguyen, Fabrice Devemy, Hélène Topolinski, Michel Valette, Marie Cazaubiel, Armelle Fayard, Éric Beltrand, Christine Lemaire, and Éric Senneville. “Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study.” Diabetes Care 38, no. 2 (February 1, 2015): 302–7. https://doi.org/10.2337/dc14-1514.

Wukich, Dane K., Katherine M. Raspovic, and Natalie C. Suder. “Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death.” Foot & Ankle Specialist 11, no. 1 (February 2018): 17–21. https://doi.org/10.1177/1938640017694722.

Audible Bleeding editor Wen (@WenKawaji) is joined by 5th integrated vascular resident Yang (@YangYang_MD) and Moira 3rd year medical student discussing the International Society for Women Vascular Surgeons and Women’s Vascular Summit with Dr. Linda Harris.

Show Guests:

Dr. Linda Harris: Dr. Harris joined University of Buffalo in 1995 and currently sits as Professor of Surgery with tenure in the Department of Surgery. She is also the Program Director for the Vascular Fellowship and Vascular Residency Programs. She is the president of the international society for women vascular surgeons.

SVS Women's section episodes

SVS Women’s Section with Dr. Duncan and Dr. Shaw
SVS Women's Section: Advice for Young Surgeons

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In this episode of Audible Bleeding, editor Dr. Adam Johnson is joined by General Surgery PGY-3 Sasank Kalipatnapu, MS2 Nishi Vootukuru, along with Dr. Anton Sidawy, MD, and Dr. William Schutze to discuss the nuances of the recently launched Society for Vascular Surgery (SVS) Outpatient Verification Program, in collaboration with the American College of Surgeons.

This episode brings out a conversation exploring the history behind the development of the program, the current state of the program, and the overwhelming importance of the program in the current day. The episode will also cover the broad steps that need to be taken by a facility looking to become verified and will also show the value added by being verified by this joint ACS/SVS Vascular Verification program.

Dr. Anton Sidawy, MD, MPH, FACS is the Lewis B. Saltz Chair and Professor of Surgery at George Washington School of Medicine, Washington DC. He is the chair of the Vascular Verification Program steering committee and oversees the development and implementation of inpatient and outpatient vascular verification programs.

Dr. William Patrick Shutze is a Vascular Surgeon from Texas Vascular Associates in Plano, TX, and Chair of the Outpatient Committee. He is also the secretary for the Society for Vascular Surgery and is also the chair of the Communications Committee. He has led the efforts with the implementation of the recently launched Outpatient Verification Program.

Relevant links:

Official page of the Vascular Verification Program

Co-Hosts:

Dr. Adam Johnson is an Assistant Professor of Surgery at Duke University and editor at Audible Bleeding.

Dr. Sasank Kalipatnapu is a PGY-3 General Surgery resident at UMass Chan Medical School, Worcester, MA.

Nishi Vootukuru is a 2nd-year medical student at Rutgers NJMS University, Newark, NJ.

Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year general surgery resident Ryan Ellis discussing robotic vascular surgery with Dr. Judith Lin (@JudithLin4) and Dr. Petr Stadler. Dr. Lin and Dr. Stadler will share their personal journey in robotic vascular surgery, cases they have done, and what think the future looks like. This is part one of our robotic vascular series. Our next episode will feature Dr. Lumsden and Dr. Bavare from Houston Methodist.

Show Guests:

Dr. Judith Lin: professor and chief of vascular surgery in the Department of Surgery at Michigan State University’s College of Human Medicine
Dr. Petr Stadler: Professor of Surgery, Head of Vascular Surgery Department, Na Homolce Hospital, Prague, Czech Republic

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Audible Bleeding editor Wen (@WenKawaji) is joined by second year medical student Nishi (@Nishi_Vootukuru), 3rd year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes) and JVS-CIT associate editor Dr. O’Banion (@limbsalvagedr) to discuss two great articles in the JVS family of journals regarding endovascular management of acute limb ischemia and ultrasound-based femoral artery calcification score. This episode hosts Dr. Thomas Maldonado (@TomMaldonadoMD) and Dr. Raul J. Guzman, the authors of the following papers:

Articles:

Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia by Dr. Maldonado and colleagues.
An ultrasound-based femoral artery calcification score by Dr. Raul Guzman and colleagues.

Show Guests:

Dr. Thomas Maldonado is the Schwartz - Buckley endowed professor of surgery in the Vascular Division at New York University Langone Medical Center in New York, Co-Director of Center for Complex Aortic Disease
Dr. Raul J. Guzman is the Donald Guthrie Professor of Vascular Surgery, Chief of Division of Vascular Surgery at Yale New Haven Hospital. He is also Surgeon-in-Chief of Vascular Surgery, Heart and Vascular Center for the Yale New Haven Health System. (raul.guzman@yale.edu)

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Authors:

Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California

Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program

Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center

Resources:

Rutherford’s 10th Edition Chapters: 88, 89, and 91
The North American Symptomatic Carotid Endarterectomy
Asymptomatic Carotid Atherosclerosis Study
Audible Bleeding’s eBook chapter on cerebrovascular disease
Houston Methodist CEA Dissection Video:

Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ

Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w

Outline:

Etiology of Carotid Artery Stenosis
Risk factors: advanced age, tobacco use, hypertension, diabetes.
Atherosclerosis as the primary cause.
Development of Atherosclerotic Disease and Plaque Formation
- LDL accumulation in arterial walls initiating plaque formation.
- Inflammatory response, macrophage transformation, smooth muscle cell proliferation.
- Role of turbulent blood flow at carotid bifurcation in plaque development.
Clinical Features of Carotid Artery Stenosis
- Asymptomatic nature in many patients.
- Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit.
- Carotid bruit as a physical finding, limitations in diagnosis.
Importance of Evaluating CAS
- Assessing stenosis severity and stroke risk.
- Revascularization benefits dependent on stenosis severity.
Classification of Stenosis Levels
- Clinically significant stenosis: ≥ 50% narrowing.
- Moderate stenosis: 50%–69% narrowing.
- Severe stenosis: 70%–99% narrowing.
Stroke Risk Associated with Carotid Stenosis
- Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis.
Diagnosis and Screening
- No population-level screening recommendation.
- Screening for high-risk individuals as per SVS guidelines.
- Carotid Duplex Ultrasound as primary diagnostic tool.
- Additional tools: CT angiography, Magnetic Resonance Angiography.
- Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4.
Revascularization Criteria
- Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively.
- Asymptomatic Patients: 70% stenosis, considering life expectancy.
Surgical Indications and Contraindications
- Indications: symptomatic patients, life expectancy considerations.
- Contraindications: Stenosis

Welcome to the Transatlantic series, a co-production of Audible Bleeding (a publication of the SVS) and the ESVS podcast. In today’s episode, we explore the intersocietal guidelines on peripheral arterial disease in patients with diabetes and foot ulcers authored by the International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS), and the Society for Vascular Surgery (SVS).

Dr. Robert Fitridge is a Professor of Vascular Surgery at University of Adelaide in Australia. He is a member of the IWGDF and is also a member of the steering committee for the Global Vascular Guideline on the management of Chronic Limb-threatening Ischaemia.

Dr. Vivienne Chuter is a Professor in the Department of Podiatry at Western Sydney University and Honorary Professor in the School of Health Science at The University of NewCastle. She is a member of the IWGDF. She has published extensively on diabetic foot disease and leads a clinically based research program focusing on the prevention and management of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and for non-Indigenous Australians.

Dr. Nicolaas Schaper is an emeritus professor of Endocrinology at Maastricht University Hospital in the Netherlands. Dr. Schaper was the coordinator of the European diabetic foot research consortium, Eurodiale. He is Chair of the 2023 Diabetic Foot Symposium (ISDF 2023) and is Chair of the IWGDF.

Dr. Joseph L. Mills is a Professor of Vascular Surgery at Baylor in Houston, Texas. He is a member of the IWGDF. Dr. Mills is a leader in the vascular surgery global community, has served as president of the Peripheral Vascular Surgery Society, and is currently a member of the Surgery Residency Review Committee of the ACGME.

Further reading and links:

The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer.
Global vascular guidelines for CLTI
Best-CLI
Engaging patients and caregivers to establish priorities for the management of diabetic foot ulcers
A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial
Release of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary
Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases
Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events
Low-Dose Aspirin for the Primary Prevention of Cardiovascular Disease in Diabetic Individuals: A Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis
Diabetes, Lower-Extremity Amputation, and Death
Outcomes in patients with chronic leg wounds in Denmark: A nationwide register‐based cohort study
Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia
Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review.
Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review.
Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review.
The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI).
Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia.
A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial.

Mobile Applications:

Society for Vascular Surgery Mobile App for Staging of Chronic Limb-Threatening Ischemia.
European Society for Vascular Surgery Clinical Practice Guidelines Mobile Edition.

Hosts:

Dr. Naveed A. Rahman is a chief surgery resident at SUNY Upstate in Syracuse, NY. He will pursue a vascular surgery fellowship at the University of Maryland starting in 2024. His Doximity profile is https://www.doximity.com/pub/naveed-rahman-md. Twitter: @naveedrahmanmd
Dr. Suzanne Stokmans is a fifth-year vascular surgery resident at the Isala Hospital in Zwolle, the Netherlands.

Dr. Ezra Schwartz is a medical graduate from McGill University currently completing a Master of Medical Science in Medical Education at Harvard Medical School. He is an aspiring vascular surgeon and surgical education researcher. Twitter: @ezraschwartz10

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In today’s episode, Dr. Sharif Ellozy, Gowri Gowda, Ezra Schwartz, and Kundanika Lakkadi interview Dr. Premchand “PC” Gupta, a vascular surgeon in India.

Dr. Gupta is the clinical director of vascular and endovascular surgery and vascular interventional radiology at the Care Hospitals in Hyderabad, India. He is President of the Vascular Society of India and Vice President of the World Federation of Vascular Societies. He is actively involved in research, sits on numerous editorial boards and has had many publications and awards.

Dr. Gupta received his medical degree from the Armed Forces Medical College in Pune, India and completed his MS in Surgery at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. He completed his vascular surgery fellowship at Nagoya University School of Medicine, Japan. Dr. Gupta pursued additional training in carotid surgery at the University of North Carolina at Chapel Hill as well as in complex aortic surgery at Houston Methodist Hospital.

Twitter:

Dr. PC Gupta (@pcvasc)
Dr Sharif Ellozy (@sharifellozy)
Dr. Ezra Schwartz (@ezraschwartz10)
Dr. Gowri Gowda (@gowrigowda11)
Kundanika Lakkadi (@kundanikalakka1)

Articles, resources, and societies referenced in the episode:

Indian healthcare system summary
George R, Gupta PC. Vascular Surgery in India - the Challenge and the Promise.
Indian Journal of Vascular and Endovascular Surgery
Vascular Society of Kerala
Vascular Society of India and Vascular Society of India Annual Conference (VSICON)
Aortic Rupture in the Indian Context
Indian National Vascular Day and Amputation Free India and Walkathon
Vascular Awareness In India: What More Needs to be Done
CDC Disinfection & Sterilization Guide

Audible Bleeding editor Matt Chia (@chia_md) is joined by Nishi Vootukuru (@Nishi_Vootukuru) and Lili Sadri (@lilisadri) are joined by Drs. Joel Ramirez, James Iannuzzi, and James Pavel Kibrik to discuss their latest publications in the JVS family of journals. Along with insight from JVS Assistant Editor Dr. Paul Dimuzio and JVS-VL Editor-in-Chief Dr. Ruth Bush (@RuthLBush), hear about the latest trends in AAA repair and the value of postoperative duplex after venous thermal ablation. Don't miss it!

Articles:

Decreasing prevalence of centers meeting the Society for Vascular Surgery abdominal aortic aneurysm guidelines in the United States, by Ramirez et al.

Value and limitations of postoperative duplex scans after endovenous thermal ablation, by Kibrik et al.

Additional Links:

Factors associated with ablation-related thrombus extension following microfoam versus radiofrequency saphenous vein closure, by Chin et al.

Outcomes of a single-center experience in eliminating routine postoperative duplex ultrasound screening after endovenous ablation, by Woodhouse et al.

Show guests:

Joel Ramirez, MD - Integrated Vascular Surgery Resident at the University of California, San Francisco

James C. Iannuzzi, MD MPH - Assistant Professor, Division of Vascular and Endovascular Surgery at the University of California, San Francisco

Pavel Kibrik, DO - Graduate of New York Institute of Technology Osteopathic School of Medicine and current vascular surgery researcher at the NYU Langone School of Medicine

Ruth Bush, MD JD MPH FACS - Professor of Vascular Surgery and Associate Dean of Educational Affairs at the University of Texas, Medical Branch and Editor-in-Chief of the Journal of Vascular Surgery Venous and Lymphatic Disorders

Audible Bleeding editor Wen (@WenKawaji) is joined by second year medical student Nishi (@Nishi_Vootukuru), third year medical student Leana Dodge (@ldogbe4), JVS editor Dr. Forbes (@TL_Forbes) and JVS-VS associate editor Dr. Curci (@CurciAAA) to discuss two great articles in the JVS family of journals regarding Medicare reimbursement for complex endovascular aortic aneurysm repair and novel drug delivery method involving tissue factor targeting peptides in reducing vascular injury response. This episode hosts Dr.Brinster, Dr. Conte, and Dr. Kim, the authors of the following papers:

Articles:

Current Medicare reimbursement for complex endovascular aortic repair is inadequate based on results from a multi-institutional cost analysis by Brinster et al.
Tissue factor targeting peptide enhances nanoparticle binding and delivery of a synthetic specialized pro-resolving lipid mediator to injured arteries by Dr. Levy et al.

Show Guests:

Dr. Clayton Brinster: Associate Professor of Surgery at University of Chicago, and Co-Director of Center for Aortic Diseases, Department of Vascular Surgery and Endovascular Therapy
Dr. Michael Conte: E.J. Wylie Chair, professor and chief of the division of Vascular and Endovascular Surgery at UCSF. Co-Directot of Heart and Vascular Center, Co-Director of UCSF Center for Limb Preservation and Diabetic Foot.
Dr. Alexander Kim: Vascular surgery fellow and research fellow at UCSF

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Audible Bleeding editor Wen (@WenKawaji) is joined by 5th year general surgery resident Richa Kalsi (@KalsiMD) from University of Maryland Medical Center, 3rd year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes), and JVS-CIT editor Dr. Smeds (@matsmeds) to discuss two great articles in the JVS family of journals regarding endosuture aneurysm repair mid-term follow-up and endovascular repair of thoracic aortic aneurysm with aberrant subclavian artery. This episode hosts Dr. Frank Arko (@farkomd), Dr. Sukgu Han (@SukguH), and Dr. Fernando Fleischman, authors of the following papers:

Articles:

Five-year outcomes of endosuture aneurysm repair in patients with short neck abdominal aortic aneurysm from the ANCHOR registry by Arko et al
Sandwich thoracic branch endoprosthesis technique for endovascular repair of thoracic aortic aneurysm with aberrant right subclavian artery by Fleischman and Han et al

Show Guests:

Dr. Arko is the Chief of Vascular and Endovascular Surgery with Atrium Health, Siverling Endowed Chair of vascular surgery clinical professor at Wake Forest University, and co-director of Center for Aortic Disease at Sanger Heart and Vascular Institute.
Dr. Sukgu Han is an Associate Professor of Surgery and Program Director for the residency/fellowship in the Division of Vascular Surgery and Endovascular Therapy at Keck School of Medicine of USC. He is also the Co-Director of the Comprehensive Aortic Center at Keck Hospital of USC.
Dr Fernando Fleischman is a cardiothoracic surgeon with extensive aortic expertise at Keck Hospital of USC. He is an Associate Professor of Surgery and Associate Program Director of cardiac surgery at USC. He is also the Co-Director of the Comprehensive Aortic Center.

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Audible Bleeding editors Matt (@chia_md) and Gowri (@GowriGowda11) are joined by 3rd year General Surgery resident Sasank Kalipatnapu (@ksasank), 2nd year medical student Nishi Vootukuru (@Nishi_Vootukuru), JVS editor-in-chief Dr. Thomas Forbes (@TL_Forbes), and JVS-VL Associate Editor Dr. Meryl Logan (@ProleneQueen), to discuss two great articles in the JVS family of journals regarding treatment of asymptomatic carotid artery disease and comparison of venous insufficiency treatment via radiofrequency ablation and microfoam ablation. This episode hosts Dr. Robert Chang, Dr. Stephanie Talutis, and Dr. Juan Carlos Jimenez, the authors of the following papers:

Articles:

JVS: A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system by Chang et al.

JVS-VL: Comparison of outcomes following polidocanol microfoam and radiofrequency ablation of incompetent thigh great and accessory saphenous veins by Talutis et al.

Additional article discussed for JVS-VL: Adjunctive techniques to minimize thrombotic complications following microfoam sclerotherapy of saphenous trunks and tributaries by Jimenez et al.

Show Guests:

Dr. Robert Chang – Assistant Chair of Vascular Surgery, Adjunct Investigator, KP Division of Research Northern California
Dr. Stephanie Talutis - Assistant Professor of Vascular Surgery, Tufts Medical Center
Dr. Juan Carlos Jimenez, Clinical Professor of Surgery, Director, Gonda Venous Center, Vice-Chair for Justice, Equity, Diversity, and Inclusion at UCLA

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In this episode, Imani (@iemcelroy) sits down with Dr. Lyssa Ochoa, vascular surgeon and founder of The San Antonio Vascular and Endovascular (SAVE) Clinic, discussing her efforts to decrease diabetic foot amputations in South Texas. Dr. Ochoa was born and raised along the Texas-Mexico border and attended medical school, general surgery residency, and vascular surgery residency at Baylor College of Medicine in Houston, TX. Understanding that collaboration is key to change health outcomes, Dr. Ochoa has partnered with hospitals, managed care organizations, universities, non-profit organizations, local school districts, city council districts, and clinicians of all kinds to develop amputation prevention programs, awareness platforms, and additional resources.

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Dr. Matt Chia and Dr. Ezra Schwartz (@ezraschwartz10) continue the exploration of how vascular surgeons and patients communicate. They discuss how we share stories with one another and what may get lost in translation.

We are excited to welcome Katie Wright (@Translucentone) and Dr. Sherene Shalhub (@ShereneShalhub) to discuss the patient experience of living with Vascular Ehlers-Danlos Syndrome or vEDS.

Katie Wright is the vEDS Natural History Study project coordinator in the Division of Vascular Surgery at Oregon Health & Science University, a podcaster, and a patient advocate. They served as the Director of the Marfan Foundation’s vEDS Division, The VEDS Movement until this past March, and they sit on the VEDS Collaborative (@vEDSCollabo) and Aortic Dissection Collaborative (@ADCollab) advisory board. Katie was diagnosed with vEDS in 2017 at the age of 28. Shortly after diagnosis, they started raising awareness and fostering community through YouTube videos. Katie then began a podcast titled Staying Connected, a space to share the stories of other patients and patient families. In 2018, Katie started volunteering on the advisory board of the vEDS Collaborative, a patient-centered research collaborative group led by Dr. Sherene Shalhub.

Dr. Sherene Shalhub is the inaugural John M. Porter Chair in Vascular Surgery and Division Head of the Division of Vascular and Endovascular Surgery at Oregon Health & Science University. She is also the Vice Chair of Regional Strategy & Surgical Operations for the Department of Surgery. Dr. Shalhub’s research interests focus on improving healthcare and outcomes for those with genetic vascular conditions. She is the lead investigator for the vEDS Collaborative Natural History Study and the PCORI-funded Aortic Dissection Collaborative. Dr. Shalhub obtained an MPH followed by her medical degree at the University of South Florida. Dr. Shalhub completed her general surgery training at the University of Washington. She then pursued fellowships in trauma research and vascular surgery at the University of Washington.

Resources:

The VEDS Movement
VEDS Collaborative & Natural History Study
If you are interested in taking part in the study or would like more information, please contact the study team VEDSColl@ohsu.edu
Donate to the vEDS Natural History Study here.
Aortic Dissection Collaborative for Patient-Centered Research | BeCertain.org
Staying connected
Episode: What Medical Professionals Should Know about VEDS
Splenic artery pathology presentation, operative interventions, and outcomes in 88 patients with vascular Ehlers-Danlos syndrome
Open repair of abdominal aortic aneurysms in patients with vascular Ehlers-Danlos syndrome
Audible Bleeding Exam Prep Aortopathies Episode with Dr. Shalhub
Free Chime Sound Effects Download - Pixabay

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Audible Bleeding editor Wen (@WenKawaji) is joined by first-year vascular surgery fellow Zach (@ZMatthay), 5th year integrated vascular surgery resident Kaitlyn (@DunphyKaitlyn), JVS editor Dr. Forbes (@TL_Forbes) and JVS-VS associate editor Dr. Curci (@CurciAAA) to discuss two great articles in the JVS family of journals regarding machine learning in carotid endarterectomy and abdominal aortic aneurysm. This episode hosts Dr.Li (@ben_li123), Dr. De Mestral (@vasc_surg), Dr. Kiang (@sharon_Kiang_MD), and Dr. Tomihama (@roger_tomihama), the authors of the following papers:

Articles:

Using Machine Learning to predict outcomes following carotid endarterectomy by Li et al.
Machine learning analysis of confounding variables of a convolutional neural network specific for abdominal aortic aneurysms by Tomihama et al

Show Guests:

Dr. Li is a vascular surgery resident and PhD candidate at the University of Toronto
Dr. De Mestral is an associate professor of vascular surgery at the University of Toronto who also has a PhD in health services research and focuses on clinical effectiveness, cost, and quality of surgical care.
Dr. Sharon Kiang is the chief of vascular surgery at the Loma Linda Veteran’s affairs hospital as well as an associate professor and vice-chair of research of surgery at Loma Linda University. She is also the PI for the Center for Artificial Intelligence and Vascular Engineering.
Dr. Roger Tomihama is an associate professor of interventional radiology with 18+ years of experience in clinical medicine, biomedical research, graduate medical education, and professional organizations. He was a former officer in the United States Navy and recipient of the Navy Commendation Medal. As a clinician scientist, he has procured $1.4 million dollars of extramural research grant funding, have 22 peer-reviewed publications, 4 invited publications, and 4 book chapters. His current research focus includes artificial intelligence in imaging for vascular disease. Lastly, he is currently pursuing a Master's of Business Administration at the Wharton School of Business at the University of Pennsylvania.

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Vascular Team Talk is back with our second episode! This podcast mini-series is brought to you by the Society of Vascular Surgery Physician Assistant Section and Audible Bleeding. How does your Vascular team communicate or organize the day? Teams can consist of many people who have different responsibilities and due to the busy nature of vascular surgery services, it may be difficult to ensure urgent matters get passed on. In this episode, we focus on the importance of communication and relationships between vascular surgery students, residents, APPs, fellows and attendings.

Jessica Fernandes, PA-C, a Vascular Surgery physician assistant at Boston Medical Center (BMC), interviews Dr. Katie Shean, a vascular surgeon at St. Elizabeth's Medical Center, regarding the importance of communication and the transition from a fellowship to an attending position. Both Jessica and Dr. Shean discuss how they worked together at BMC and compare how Dr. Shean runs her current vascular team at St. Elizabeth's Medical Center.

Show Guests:

Jess Fernandes, PA-C, is an inpatient physician assistant in the Division of Vascular and Endovascular Surgery at Boston Medical Center. She is also a member of the SVS PA committee and NESVS PA committee. She graduated with her bachelor degree and Master in Physician Assistant Studies from MCPHS University in 2016.
Katie Shean, MD is a vascular surgeon in the Division of Vascular and Endovascular Surgery at St. Elizabeth's Medical Center in Brighton, Massachusetts. She completed medical school at University of Vermont Medical School in 2013, followed by her general surgery residency at St. Elizabeth's Medical Center and vascular surgery fellowship at Boston Medical Center which she completed in 2022.

Show Links:

SVS Physician Assistant Section

St. Elizabeth's Medical Center Vascular and Endovascular Division

Audible Bleeding editors Wen Kawaji (@WenKawaji), Yasong Yu (@YasongYuMD), and Imani McElroy (@IEMcElroy) are joined by Seth Sankary to discuss their experiences this past year going through the fellowship match process. They discuss the pearls and pitfalls of the interview trail and what influenced their final rank list decisions.

Show Guests:

Seth Sankary, MD - General Surgery Chief Resident at the University of Chicago

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Audible Bleeding editors Wen (@WenKawaji) and Matt (@chia_md) are joined by Lara Lopes (@laralopesMD), Nitin Jethmalani (@nijethmalani), JVS editor-in-chief Thomas Forbes (@TL_Forbes), and JVS-VS Associate Editor Gale Tang, to discuss two great articles in the JVS family of journals. This month’s articles discuss the outcomes of aortic repair after Medicaid expansion, and the process of developing a novel device for repair of aortic injury. Don’t miss this fantastic discussion with the authors and editors at the forefront of vascular surgery!

Articles:

Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair by Ramadan et al.
A dumbbell rescue stent graft facilitates clamp-free repair of aortic injury in a porcine model by Kenawy et al.

Show Guests:

Omar Ramadan, MD - Chief General Surgery Resident at University of Pennsylvania
Grace Wang, MD MSCE FACS - Director of the Vascular Lab and Associate Professor of Surgery in the Division of Vascular and Endovascular Surgery at the Hospital of the University of Pennsylvania
Bryan Tillman, MD PhD - Vascular Surgeon Wexner Medical Center, Associate Professor of Surgery and Director of vascular research at the Ohio State College of Medicine

Audible Bleeding Contributors:

Lara Lopes, MD - Vascular Surgery Integrated Resident, Northwestern University
Nitin Jethmalani, MD - General Surgery Resident, Vascular Surgery Research Fellow, NYP Cornell

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In the International Series, we interview international vascular surgeons and trainees with the focus of learning and exploring how vascular surgery is practiced around the world and by doing so, gain new insight into how we practice vascular surgery in the United States. In today’s episode, Ezra Schwartz interviews Dr. Ahmed Kayssi, a vascular surgeon in Canada.

Dr. Ahmed Kayssi is a vascular surgeon at Sunnybrook Health Sciences Centre, an Assistant Professor at the University of Toronto and an associate scientist in evaluative clinical sciences at the Sunnybrook Research Institute. Dr. Kayssi completed his general surgery residency and vascular surgery fellowship at the University of Toronto and a limb preservation and wound care fellowship under the supervision of Dr. Richard Neville. Dr. Kayssi holds a Master’s degree in Public Health from the Harvard Chan School of Public Health and is currently pursuing a Doctorate of Public Health in Health Policy and Management from the Johns Hopkins School of Public Health under the supervision of Dr. Lilly Engineer. Dr. Kayssi recently joined the editorial board of Seminars in Vascular Surgery.

Contact Information: Dr. Ahmed Kayssi

Email: ahmed.kayssi@sunnybrook.ca

Twitter:

Dr. Ahmed Kayssi (@ahmedkayssi)
Dr. Ezra Schwartz (@ezraschwartz10)
Dr. Morgan Gold (@morgansgold)
University of Toronto Division of Vascular Surgery

Articles, resources, and societies referenced in the episode:

Canadian Society of Vascular Surgery Research Committee
Wounds Canada and Wounds Canada Research Committee
Canadian Medical Protective Association
Dr. Charles de Mestral
University of Toronto Limb Preservation Fellowship
Dr. Heather Gill, The PREHAAAB Trial, and Preoperative Exercise Rehabilitation in Cardiac and Vascular Interventions
International Symposium on the Diabetic Foot
SVS Vascular Annual Meeting 2024
Canadian Society of Vascular Surgery Annual Conference
Health Canada. Canada’s Health Care System - Canada.ca.
Canada: Health system review. Health Systems in Transition

Today, Dr. Ezra Schwartz and Dr. Nakia Sarad continue exploring how vascular surgeons and patients communicate. They discuss how we share stories and what may get lost in translation.

Dr. Rita Charon is a general internist, professor of medicine, and professor and founding chair of medical humanities at Columbia University. Dr. Charon originated the field of narrative medicine and is the founder and executive director of the Program in Narrative Medicine at Columbia. A literary scholar, Dr. Charon completed a Ph.D. in English at Columbia, concentrating on narratology and the works of American-British author Henry James. She is the author of Narrative Medicine: Honoring the Stories of Illness, co-author of Principles and Practice of Narrative Medicine, and co-editor of Stories Matter: The Role of Narrative in Medical Ethics and Psychoanalysis and Narrative Medicine.

Dr. Abraham Fuks is a clinical immunologist, a Professor in the Department of Medicine and Division of Experimental Medicine at McGill University, a Professor of Oncology at the Goodman Cancer Institute, and served as Dean of the McGill University Faculty of Medicine from 1995 to 2006. Dr. Fuks’ has published on the metaphors of medicine and ethics in clinical research. In 2021, Dr. Fuks published a book, The Language of Medicine, in which he explores the ability of language to heal or harm and the potent metaphors prevalent in clinical care, especially military metaphors.

Dr. Anahita Dua is a vascular surgeon at the Massachusetts General Hospital, an associate professor of surgery at Harvard Medical School, and a frequent guest on Audible Bleeding.

Resources:

Dr. Charon’s related works:
- Narrative Medicine: Honoring the Stories of Illness
- The Principles and Practice of Narrative Medicine
- Stories Matter: The Role of Narrative in Medical Ethics and Psychoanalysis and Narrative Medicine
- TEDx Talk
Dr. Fuks’ related works:
- The Language of Medicine
- The Mindful Medical Learner Podcast featuring Dr. Fuks
- Arthur Frank, The Wounded Storyteller: Body, Illness, and Ethics
Dr. Dua’s related works:
- Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia
- Peripheral Artery Disease: Where We Are and Where We Are Going
Validated QOL surveys and Patient Reported Outcome Measures:
- PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories): Overview of Design and Rationale of an International Prospective Peripheral Arterial Disease Study
- Patient-Reported Outcomes for Peripheral Vascular Interventions for the Vascular Quality Initiative
- Eric Cassell & Functionality
- Vasc QOL Questionnaire
- PAD QOL Questionnaire
- Vasc QL-6 Questionnaire
- European QL 5D 5L Questionnaire

X Handles (previously known as Twitter):

Dr. Anahita Dua (@AnahitaDua)
Dr. Rita Charon (@RitaCharon)
Dr. Abraham Fuks (@Abe_McGill)
Dr. Ezra Schwartz (@ezraschwartz10)
Dr. Nakia Sarad (@NakSaradDO)

Audible Bleeding editor Wen (@WenKawaji) is joined by 5th year integrated vascular surgery resident Kaitlyn (@DunphyKaitlyn), JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd) and JVS-VL assistant editor Dr. Dua (@AnahitaDua) to discuss two great articles in the JVS family of journals regarding Post-operative stroke risk after carotid endarterectomy and use of Varithena in treating venous leg ulcers. This episode hosts Dr. Baohui Xu and Dr. Gregory Modrall, the authors of the following papers:

Articles:

Postoperative disability and one-year outcomes for patients suffering a stroke after carotid endarterectomy by Levin et al.
VIEW-VLU observational study of the effect of Varithena on wound healing in the treatment of venous leg ulcers by Shao et al.

Show Guests:

Dr. Siracuse- Professor of surgery and radiology at Boston University
Dr. Shao—vascular surgeon at Swedish hospital, Northshore University Healthsystem in Chicago, IL
Dr. Levin—plastic and reconstructive surgery fellow at the University of California Davis

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Modern-day evidence-based medicine mandates a strong understanding of current local and international guidelines. Surgeons rely heavily on these reports, but what to do when they differ? We have partnered with the ESVS podcast in creating the Transatlantic Series, where we compare and contrast our respective society guidelines. In this inaugural episode, we explore the SVS carotid artery disease guidelines published in 2022 and the recently updated ESVS guidelines published in 2023.

Representing the American perspective, we are excited to speak with Dr. Ali AbuRahma. Dr. AbuRahma is the former president of the Society of Vascular Surgery, the Chief of Vascular and Endovascular Surgery at the Charleston Area Medical Centre at West Virginia University, and the corresponding author of the latest SVS guidelines on extracranial cerebrovascular disease.

Representing the European perspective, we are delighted to speak with Dr. Barbara Rantner. Dr. Rantner is the co-chair of the 2023 European Society of Vascular Surgery Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease and a leading physician at the Ludwig-Maximillian University Hospital in Munich, Germany.

Further reading and links:

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) & Audible Bleeding Landmark Papers NASCET Episode
Randomized trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST)
The 2nd European Carotid Surgery Trial (ECST-2): rationale and protocol for a randomized clinical trial comparing immediate revascularisation versus optimized medical therapy alone in patients with symptomatic and asymptomatic carotid stenosis at low to intermediate risk of stroke
European Stroke Organisation (ESO) guideline on endarterectomy and stenting for carotid artery stenosis
A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system
SVS Patient Safety Organization (PSO) TCAR Surveillance Project
SVS Vascular Quality Initiative (VQI) & VQI TCAR Registry
Important recommendations of the German-Austrian S3 guidelines on the management of extracranial carotid artery stenosis (Paper only available in German)

Hosts:

Laurence Bertrand is a 5th-year vascular surgery resident at the Ludwig Maximilian University Hospitals of Munich, Germany. She is a medical graduate from KULeuven, Belgium, and has a Master of Science in International Health from the London School of Hygiene and Tropical Medicine.
Ezra Schwartz (@EzraSchwartz10) is a medical graduate from McGill University pursuing a Master of Medical Science in Medical Education at Harvard Medical School. He is applying to integrated vascular residency programs this year.

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We are delighted to review the SVS VAM Diversity and Resident/Medical Student travel scholarships in today's episode. Dr. Ezra Schwartz and Dr. Nakia Sarad speak with three scholarship recipients to explore their reasons for applying, their experience at the 2023 Vascular Annual Meeting, and the impact of their attendance on their goals and aspirations.

Nathaniel Forrester (@Nathaniel_For) is a fourth-year medical student at Emory University SOM from Lawrenceville, GA. He will be applying to vascular residencies in this cycle. He received the Diversity Scholarship to attend his first VAM.
Gayatri Pillai (@GayatriPillai10) is a third-year medical student from Geisinger Commonwealth School of Medicine. She, too, received the SVS Diversity Scholarship to attend her first VAM.
Carlo Angello Sánchez Montaño (@carlo_angello) is a first-year vascular surgery resident who transferred from a general surgery program. He is a November 20th National Medical Center trainee in Mexico City, Mexico. He received the General Surgery Resident/Medical Student Travel Scholarship to attend his first VAM.

VAM 2024 will be held in Chicago June 19-22, 2024. The following are links for more information on SVS Awards and Scholarships offered. We encourage you to apply!

SVS Awards and Scholarship Page
SVS General Surgery Resident/Medical Student Vascular Annual Meeting Travel Scholarship
SVS Diversity Medical Student Vascular Annual Meeting Travel Scholarship

Twitter:

Dr. Ezra Schwartz (@Ezraschwartz10)
Dr. Nakia Sarad (@NakSaradDO)
Nathaniel Forrester (@Nathaniel_For)
Gayatri Pillai (@GayatriPillai10)
Dr. Carlo Angello Sánchez Montaño (@carlo_angello)

Vascular Origin Stories (VOS) is a podcast series that explores the fun and engaging stories that shaped vascular surgery. Today we are kicking off a new origin stories series: the vascular offspring stories, where we interview practicing vascular surgeons about their vascular surgeon parents.

In this episode, we chat with Dr. Alan Dardik about his father, a pioneering vascular surgeon, Dr. Herbert Dardik. Dr. Alan Dardik recollects many great stories of his father and how he ultimately followed in his footsteps.

Further reading and links:

Herbert Dardik 1935-2020, Leaders in Vascular Surgery, Journal of Vascular Surgery
Remembering Dr. Herbert Dardik, The JewishStandard
Dr. Alan Dardik, Yale Profile

Host: Marlene (@GarciaNeuer) is a first-year integrated vascular surgery resident at the Mayo Clinic in Scottsdale, AZ.

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Today, Dr. David Ebertz (@EbertzDavid), a rising vascular fellow at St Louis University, and Dr. Jason Turner (@JasonTyTurner), a graduating integrated vascular resident from Case Western Cleveland Medical Center, discuss with multiple leaders in vascular surgery about VESS (@VESurgery) and SVS (@VascularSVS). The Vascular & Endovascular Surgery Society, commonly called VESS, is one of the foremost societies within vascular surgery that was started in 1976. Its mission is to improve the quality and safety of vascular & endovascular surgical procedures and general vascular care through education, scholarship, advocacy & leadership. This episode will feature VESS's history, current status, and pearls of wisdom, from finding mentors to navigating social media to becoming a leader within societies.

Faculty Guests:

Dr. Leigh Ann O'Banion (@limbsalvagedr) - Assistant Professor of Vascular Surgery at UCSF-Fresno, California
Dr. Vikram Kashyap (@VikKashyapMD) - Vice President and Frederik Meijer Chair, Meijer Heart and Vascular Institute in Grand Rapids, Michigan
Dr. Nick Mouawad (@NickMouawadMD) – Chief of Vascular Surgery at McLaren Health Systems in Bay City, Michigan
Dr. Saideep Bose (@academicaorta) – Assistant Professor of Vascular Surgery at St Louis University, Missouri
Dr. Matthew Smeds (@mattsmeds) – Professor of Vascular Surgery at St Louis University, Missouri

Additional Links:

VESS Student Mentor Program
VESS Mentorship Program for young surgeons
SVS Mentorship Match

Audible Bleeding editor Wen (@WenKawaji) and Matt (@chia_md) are joined by MD/PhD student Rahul Ghosh (@ghoshrx), JVS editor-in-chief Dr. Thomas Forbes (@TL_Forbes), and JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd), to discuss two great articles in the JVS family of journals regarding renal stenting in the CORAL trial and metformin in AAA progression. This episode hosts Dr. Baohui Xu and Dr. Gregory Modrall, the authors of the following papers:

Articles:

Mechanisms and efficacy of metformin-mediated suppression of established experimental abdominal aortic aneurysms by Xu et al.
Retrieval of renal function after renal artery stenting improves event-free survival in a subgroup analysis of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions trial by Modrall et al.

Show Guests:

Dr. Gregory Modrall - Professor of Surgery, Division of Vascular and Endovascular Surgery at The University of Texas Southwestern Medical School
Dr. Baohui Xu – Senior research scientist at Stanford University in collaboration with ShanDong First Medical University in Jinan.

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Today, Dr. Ezra Schwartz and Dr. Nakia Sarad begin an exploration of how vascular surgeons and patients communicate. We will discuss how we share stories with one another and what may get lost in translation. The first episode in this series features Dr. Anahita Dua in conversation with her patients and their experience with deep venous arterialization.

Faculty Guest:

Dr. Anahita Dua is a vascular surgeon at the Massachusetts General Hospital and an associate professor of surgery at Harvard Medical School. She wears many hats at the MGH including director of the Vascular Lab, co-director of the Peripheral Artery Disease Center and Limb Evaluation and Amputation Program, associate director of the Wound Care Center, director of the Lymphedema Center, associate director of the Vascular Surgery Clerkship, and director of clinical research for the division of vascular surgery.

Dr. Dua completed her undergraduate medical studies at the Aberdeen University School of Medicine in Aberdeen, Scotland. She then completed her general surgery residency at the Medical College of Wisconsin and a vascular fellowship at Stanford University Hospital. She holds multiple master’s degrees, including trauma sciences and business administration in healthcare management. She also completed certificate programs at the Massachusetts Institute of Technology in health economics, outcomes research, and drug and device development. She has published over 140 peer-reviewed papers and has edited five vascular surgery textbooks.

For more information on the CLariTI Study, click here.

Patient Guests: (Shared with consent)

John McConnell - patient of Dr. Dua
Daniel Debovie - son of a patient of Dr. Dua.

Deep Venous Arterialization References:

Ho, Vy T., Rebecca Gologorsky, Pavel Kibrik, Venita Chandra, Anna Prent, Jisun Lee, and Anahita Dua. “Open, Percutaneous, and Hybrid Deep Venous Arterialization Technique for No-Option Foot Salvage.” Journal of Vascular Surgery 71, no. 6 (June 1, 2020): 2152–60. https://doi.org/10.1016/j.jvs.2019.10.085.
Shishehbor, Mehdi H., Richard J. Powell, Miguel F. Montero-Baker, Anahita Dua, Jorge L. Martínez-Trabal, Matthew C. Bunte, Arthur C. Lee, et al. “Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia.” New England Journal of Medicine 388, no. 13 (March 30, 2023): 1171–80. https://doi.org/10.1056/NEJMoa2212754.

Twitter:

Dr. Anahita Dua (@AnahitaDua)
Dr. Ezra Schwartz (@ezraschwartz10)
Dr. Nakia Sarad (@NadSaradDO)

Audible Bleeding editor Wen Kawaji (@WenKawaji) is joined by MD/PhD student Rahul Ghosh (@ghoshrx), JVS editor-in-chief Dr. Thomas Forbes (@TL_Forbes), JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd), and Associate Editor of the Journal of Vascular Surgery-Cases, Innovations and Techniques, Dr. Sherene Shalhub (@ShereneShalhub, @OHSUvascular), to discuss two great articles in the JVS family of journals regarding uncommon vascular conditions, including aberrant subclavian artery/Kommerell’s diverticulum and vascular Ehlers-Danlos syndrome. This episode hosts Dr. Jonathan Bath, Dr. Peter Lawrence, and Dr. Bernardo Mendes, the authors of the following papers:

Articles:

Contemporary Outcomes after Treatment of Aberrant Subclavian Artery and Kommerell’s Diverticulum by Bath et al.
Open repair of an infected abdominal aortic aneurysm in a patient with vascular Ehlers-Danlos syndrome by Mendes et al.

Show Guests:

Dr. Jonathan Bath (@MizzouVascular) - Assistant Professor of Surgery and program director for vascular fellowship at the University of Missouri
Dr. Peter Lawrence - Professor of surgery at @UCLAVascular, served as senior editor for both JVS and JVS-VL previously.
Dr. Benardo Mendes (@drbermendes) - Consultant in the Division of Vascular and Endovascular Surgery at Mayo Clinic, and is Associate Professor of Surgery at Mayo Clinic College of Medicine and Science.

Additional Notes:

Vascular Low Frequency Disease Consortium Website
- Visit here for a list of completed projects and publications.
- The VEDS Collaborative research study is still enrolling! Any patient interested in enrolling should reach out to VEDSColl@ohsu.edu and follow @VEDSCollabo and @OHSUvascular on Twitter.
- JVS-CIT will be dedicating a full virtual issue to patients with genetic aortopathy and arteriopathy.
- Resources for patients: https://thevedsmovement.org/ and https://www.ehlers-danlos.com/

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In today’s episode, Gowri Gowda, Ezra Schwartz and Morgan Gold, and Dr. Sharif Ellozy interview Dr. Daniel Silverberg about his experiences practicing and teaching vascular surgery in Israel.

Dr. Silverberg is the deputy director of the Department of Vascular Surgery and the Director of the endovascular service at the Chaim Sheba Medical Center in Ramat Gan in the municipality of Tel Aviv, Israel. He completed his undergraduate medical studies with honors at the Ben-Gurion University of the Negev in Beer-Sheva, Israel, and his clinical internship year at Meir Medical Center, Kfar-Saba, Israel. Dr. Silverberg performed his general surgery training at Meir Medical Center, Kfar-Saba, Israel, and later at Mount Sinai Medical Center, New York City. He then remained at Mount Sinai, where he completed his vascular surgery fellowship. Dr. Silverberg worked as an attending vascular surgeon at the James J. Peter VA Medical Center in New York for three years until returning to Israel in 2009.

Contact Information for Dr. Daniel Silverberg

Email: daniel.silverberg@sheba.health.gov.il

Twitter:

Dr. Gowri Gowda (@GowriGowda11)

Dr. Ezra Schwartz (@ezraschwartz10)

Dr. Morgan Gold (@MorganSGold)

Articles, resources, and societies referenced in the episode:

Israeli Society for Vascular and Endovascular Surgery: https://israelivascular.ima.org.il/ViewEvent.aspx?EventId=3630
https://www.commonwealthfund.org/international-health-policy-center/countries/israel
Zhang LP, Silverberg D, Divino CM, Marin M. Building a Sustainable Global Surgical Program in an Academic Department of Surgery. Ann Glob Health. 2016 Jul-Aug;82(4):630-633. doi: 10.1016/j.aogh.2016.09.003. Epub 2016 Oct 1. PMID: 27986231.

Follow us @AudibleBleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Endovascular 101

Authors:

Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California

Sukgu Han - Associate Professor of Surgery at the University of Southern California. Co-director of Comprehensive Aortic Center at Keck Hospital of USC. Program Director of the Integrated Vascular Surgery Residency and Vascular Fellowship

Editor: Yasong Yu

Reviewers: Matt Chia and Kirthi Bellamkonda

Core Resources:

Rutherford's Vascular and Endovascular Therapy 10th Edition Chapter#26-28

Additional Resources:

Relevant Audible Bleeding episodes
- Holding Pressure Case Prep - AKA/BKA
- Journal Review in Vascular Surgery: Introduction to Endovascular Surgery – A Prime
- Peter A. Schneider, MD and Endovascular Skills - history, personal techniques and updates in the 4th Edition
Closure devices:
- Angioseal
- Mynx
- Proglide

Endovascular procedures are minimally invasive techniques used to treat conditions affecting blood vessels, such as aneurysms, stenosis, or occlusions, by accessing the affected vessels through an incision in a peripheral artery and using imaging guidance to navigate catheters and devices through the blood vessels to the treatment site.

Endovascular procedures can be broken down into 4 key steps

Establishing arterial access
Navigating to target treatment zone or vessel
Treating the lesion
Closure

Basic definition of wire, sheaths, and catheters

Wires are thin, flexible metal devices used to navigate through blood vessels and to guide other devices, such as catheters or sheaths, to the target location. They are measured in thousands of an inch
- A 0.018 wire is 0.018 inch in diameter
- There are two categories of wires: Flexible and support

Flexible wires are soft and hydrophilic. They are considered the “workhorses” because they are useful for navigating through vessels.

A common type of wire is called the Glidewire which is slippery and useful in traveling across tortuous vascular anatomy.
Support wire are generally a lot stiffer and not hydrophilic. For that reason they are used to deliver and deploy devices
- A common type of support wire is called the Lunderquist which is used for the deployment of stent grafts in endovascular aortic repair
Catheters are flexible hollow tubes used in conjunction with wires to navigate vascular anatomy
- Various characteristics include the degree and shape of the taper, the lengths, and the stiffness.
- They are inserted inside the sheath
Sheaths are hollow tubes of various diameters that are inserted into a blood vessel to provide a pathway for catheters or wires.
- They have a one way valve to prevent backflow of arterial blood and a side port that permits aspiration and administration of fluids.
- They also come with a dedicated dilator which is used to fill the lumen of the sheath and allows the surgeon to insert the sheath safely into the vessel.
If the wire is the rail and the catheter is the train, the sheath is the ground.

Sheaths and catheters sizing

Both are measured in French
- 1 French equals 0.33 mm. French size divided by 3 equals the approximate diameter in millimeters.
- Another way to think about Fr is roughly the circumference in mm. Divide by 3 instead of 3.14 to get the diameter
- Sheaths are defined by their inner diameter (ID)
- Catheters are defined by their outer diameter (OD)
- This is because catheters go inside the sheath, so the size of a catheter must be smaller or equal to the size of the sheath for it to fit inside.For example, a 5 Fr sheath can accommodate 5 Fr catheter/devices
- Of note, the hole in the artery will roughly be 2-4Fr larger than the sheath size. This is important when considering the type of closure that will be used at the end of the procedure.

Step One: Establishing Arterial Access

Preop preparation:
- During physical exam, make sure there’s a palpable femoral pulse to rule out iliofemoral disease
- Review the CT if available for high femoral bifurcation or presence of vessel disease
Patient positioning on the angio table, depends on the access site of choice.
- Typical position (for retrograde femoral artery access) is supine, arms tucked.
- Alternative access sites (ie. radial, brachial, carotid) may require arms to be out and prepped.
How do you choose arterial access, location?
- Depends on location of lesion you are trying to treat and complexity of the path from the access site
- Size of the access vessel and device size must be considered when deciding on the access site
- The most common is retrograde femoral artery access
- When would other access points be used?
- - Radial artery, brachial, antegrade femoral access. The goal, target location, and path complexity defines the access point.
Arterial puncture
- Femoral access:
- - Look for pulsatile vessel on the US (vein is medial, artery is lateral; “venous penis”)
  - Usually access at the level of femoral head for common femoral artery
- Seldinger technique is used to establish access to a vessel or cavity using needle, wire, catheters, and sheath.
- E.g. using the micropuncture kit:
- - contralateral arterial CFA access with s 21 gauge needle
  - .018” guidewire is passed through the needle
  - Needle is removed and a short 4 or 5 Fr microcatheter with an inner dilator is passed over the guidewire
  - The dilator and guidewire are removed leaving the catheter in place to maintain access
  - Bigger wire is inserted through the catheter, which is then removed over the wire
  - A sheath is inserted over the wire
The overall purpose is to start with smaller arterial puncture and exchange to larger size to minimize complication should the access fail
Often, percutaneous closure devices are preloaded at this step. We will discuss this later.

Step Two: Navigating to treatment zone or vessel

With sheath in place, a guidewire is inserted into the vessel under fluoroscopic guidance.

Continuous fluoroscopy is taken with the C-arm during key steps to visualize wire movement
- The C-arm can be portable or built into the room
- X rays are emitted from the X-ray generator below the patient
- And the subsequent image is generated from the image intensifier above the patient
- Radiation safety:
- - wear protective gear which is made of lead. In addition, use the tableside lead shield whenever possible
  - minimize use of continuous fluoroscopy whenever possible
  - limit use of magnification, and digital subtraction angiography
  - keep the image intensifier as close to the patient as possible to minimize scattering
- The C-arm can rotate around the patient to get optimal viewing of the vessels
- - Frequently used terminology: 30 degrees RAO which stands for right anterior oblique, describing the relationship of image intensifier to the patient

Common projections used for lower extremity angiograms

Iliacs: 20-30 degrees contralateral anterior oblique
Femoralsl: 20-30 degrees ipsilateral anterior oblique
Trifurcation and tibials: anatomic anterior-posterior or 20 degrees ipsilateral anterior oblique with feet in neutral supine position
Thoracic aorta/distal aortic arch: 30~45 degree LAO
Renals: AP
maximizing image quality by limiting patient movement and with breath holding and collimating
Contrast
- Two types of contrasts: Iodinated contrast vs carbon dioxide
- - Iodinated contrast has better resolution but patients can have allergic reactions and are at risk of contrast induced renal injury. Therefore, CO2 is preferred for patients with compromised renal function in which an image is created by transiently displacing blood. The downside is that it has lower image resolution than iodinated contrast, and rare but potentially serious complications of air locking.
- Power injection vs manual injection
- - When using power injection, you have control over pressure, the amount of contrast, timing, and rate or rise of injection. It allows for rapid filling of large arteries at high flow rates. Manual injection is more efficient for small vessels since you can control dilution and volume

Types of Wires

Characteristics: wire tip, stiffness, diameter, and length
Guide wires
- To assist in catheter placement, navigate different arteries, cross lesions, and deliver devices.
The most common sizes used in vascular surgery
- Large .035” - generally used for the aorta and iliac.
- Small .014”/.018” - used for smaller branches like the SFA
Length: from 120 to 360cm
- Based on distance from access site to the lesion
- Long enough to reach target lesions and beyond (inside pt) and deliver catheters (outside pt) but not too long that it’s falling off the table and slowing down exchange
Flexible vs stiff/support wires
- How do you decide which wire to use?
- - Typically, you start with flexible wire inside an angle tip catheter to navigate to the target vessel. Once you reached and crossed the target vessel, the wire is exchanged to a stiff/support wire, which allows you to deliver
- common brands and models used that every medical student should know and the settings they are used in?
- - Example answer:
  - Glidewire (Tumero): a floppy wire with a hydrophilic coating which is useful for navigating stenosis and tortuous vessels and is used in a variety of different vessels.
  - Lunderquist (Cook): it is very stiff and used for endovascular repairs of AAAs
  - Rosen wire: support wire with a J tip with intermediate stiffness. Less stiff than Lunderquist. Used to catheterize visceral and renal arteries.
  - Bentson: starter wire, that’s short in length with a very long floppy tip that prevents vessel trauma.

Types of Catheters

Main purpose of the catheters
- Allows to approach the target vessel based on the shape of the catheter
- Allows wire exchange from flexible to stiff
Sizes are based on Fr (4-5)
- 5 Fr are the most common.
- Microcatheters are for embolizations (2.5Fr)
Nonselective (Angiographic catheter)
- Common types are omni flush, pigtail, and straight
- They have multiple side holes along the tip so they can inject high volume of contrast into large blood vessels like the aorta
Selective catheters/Guide (shape) catheters
- Have an end hole only with no side holes so they can cannulate specific branch vessels
- A variety of lengths and shapes depending on the curvature and tortuosity of the pathway to the target vessel.
- - Catheter with specific shapes can align your vector (the force you are exerting by pushing the wire forward at the access site) to the stenotic lesion.
- Type of catheter that can be used to cross to the contralateral side at the aortic bifurcation – generally the omni.

Types of sheaths

- Size range: 4-26Fr (larger available for endografts)
  - Size is decided by the device you have to deliver to the target lesion
  - Length is based on the support required from the procedure. The distance from the access site to the target site determines the length of the sheath required.
  - Common lengths range from 5 to 110cm
  - What are some of the common sheaths used and for which procedure?
    - For endovascular aortic repairs, Dryseal sheaths range from 12Fr ~ 26Fr with lengths of 33cm to 65cm.
    - For visceral and renal artery intervention, Ansil or Raabi sheaths range from 5Fr to 9Fr, with lengths of 45cm to 90cm.
    - For lower extermity work, Ansil, Raabi, Balkin sheaths ranging from 4Fr to 7Fr with lengths of 45cm to 110cm.
    - Steerable sheaths can actively articulate the shape of the sheath, allow you to navigate and treat more challenging anatomy.

Step Three: Treating the lesion

The lesion has to be crossed with wire and catheters before treating the lesion. They may require the need to exchange sheath
Stent and balloon sizing is measured by diameter in millimeters x length in centimeters

Balloons

Generally need to exchange wire to stiff support wire through the catheter, then the catheter is exchanged over the wire with the balloon mounted catheter
Balloons have a wide variety of diameters and lengths
Nominal vs Burst pressures
- Nominal: pressure is where the balloon will inflate to the labeled diameter
- Burst: pressure where 99.9% of tested balloons ruptured
- Typically you inflate to nominal but can go higher depending on the type of lesion
Compliant balloon vs a semi-compliant vs non-compliant balloon
- Most of the time, we use a compliant balloon, but in certain situations where we need high pressure dilation, we use non-compliant balloon. This has to do with the nature of the lesion and risk of vessel rupture.
Additional features
- Cutting balloons have microblades on the wall. So the idea is to perform control rupture of calcified atherosclerotic lesions, so that the expansion happens more evenly.
- Drug coated balloons are coated with paclitaxel to reduce the risk of neo-intimal hyperplasia So, it is sometimes used in peripheral cases where the surgeons feel that the lesions are more prone to developing neo-intimal hyperplasia or areas that have restenosed.

Stents

small mesh-like device made of metal that is used to prop open a blocked or narrow blood vessel. It is inserted through a catheter and deployed at the site of the blockage to improve blood flow and reduce the risk of future blockages.
balloon expandable vs self-expanding stents
- Balloon expandable
- - Better radial force at the time of deployment
  - More accurate deployment
  - Mounted on balloons, so it is more difficult to track them across tight stenosis.
  - May cause damage to the surrounding tissue due to balloon inflation.
- Self-expanding
- - Usually more flexible in tortuous vessels
  - More resistant to kinking
  - Higher risk of migration or dislodgement during deployment
  - Post-dilation is often needed
covered stents vs bare metal stents
- Covered stents
- - Covered by PTFE, polyurethane, or silicone
  - May be more resistant to in-stent restenosis, compared to bare metal stents.
  - useful in ruptured vessel
  - EVAR/TEVAR/FEVAR devices are essentially fancy covered stents.

Step Four: Closure

Hole in the artery is outer diameter of the sheath, and is bigger than the sheath size since sheath is measured by inner diameter
Manual compression
- Direct pressure with fingertips
- Enough pressure without bleeding, but not too much that it cuts off circulation
- No peeking!
- Timing depends on sheath size, coagulation status, and vessel health.
Closure devices
- Extravascular plug
- - Angio-seal: sandwiches the arteriotomy with a biodegradable anchor and collagen sponge. https://www.youtube.com/watch?v=XhgAs2SxNjA
  - Mynx: utilized a small balloon to create temporary hemostasis within the artery and covers the outside with a polyethylene glycol sealant. https://www.youtube.com/watch?v=_kcJM1lnQo8
- Suture-based
- - Sometimes placed at beginning of the case for large bore access
  - Proglide: https://www.youtube.com/watch?v=Wol22SlEpxE
Complications
- What are the most common complications that you experience and how do you mitigate them?
- - Access site
  - - Hematoma, pseudoaneruysm, AV fistula, occlusion, infection
  - Navigation related
  - - Dissection, perforation, thromboembolism
  - Systemic
  - - Contrast induced AKI

—-----------------------------------------------------------------------------------------------------------------------

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Audible Bleeding team Matt Chia (@chia_md) and Gowri Gowda (@GowriGowda11) are joined by the co-principle investigators of the BEST-CLI trial, Dr. Matthew Menard and Dr. Alik Farber. We talk about the results of BEST-CLI, marking what is sure to be the next landmark trial in vascular surgery. Drs. Menard and Farber give their insights on being clinical trialists and surgeons in the modern era, reflecting on challenges in conducting this work and its broad-reaching implications.

Links:

Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia

Comprehensive List of BEST-CLI Literature

Show Guests:

Dr. Matthew Menard (@MattMenard6) is the program director for the vascular and endovascular fellowship program and co-director of the Endovascular Surgery Program at Brigham and Women’s Hospital. He is a vascular and endovascular surgeon at BWH and an Associate Professor of Surgery at Harvard Medical School.

Dr. Alik Farber is the Chief of the Division of Vascular and Endovascular Surgery at Boston Medical Center and Professor of Surgery and Radiology at Boston University School of Medicine

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Audible Bleeding editor Wen Kawaji (@WenKawaji) is joined by MD/PhD student Rahul Ghosh (@ghoshrx), JVS editor-in-chief Dr. Thomas Forbes (@TL_Forbes) and JVS-VL Editor-in-chief Dr. Ruth Bush to discuss two great articles in the JVS family of journals. This episode hosts Dr. Siracuse and Dr. Chang, the authors of the following papers discussing mental health in CLTI patients and anticoagulation in venous treatments.

Articles:

Relationship between Wifi stage and quality of life at revascularization in the BEST-CLI trial by Siracuse et al.
Direct oral anticoagulant agents might be safe for patients undergoing endovenous radiofrequency and laser ablation by Dr. Chang et al.

Show Guests:

Dr. Chang is an assistant professor of surgery at New York Medical College and a vascular surgeon at Westchester medical center, completed his general surgery training at U mass and vascular fellowship at NYU.
Dr. Siracuse (@MDsiracuse) is a practicing surgeon in the division of vascular and endovascular surgery at Boston Medical Center and a professor of Surgery and Radiology at Chobanian and Avedisian School of Medicine.

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Vascular Origin Stories is a podcast series that explores the fun and engaging stories that shaped vascular surgery.

Today’s episode will be the second part of a multi-episode series exploring how the young battalion surgeons serving in MASH units in the Korean war pioneered wartime vascular repair. Today we’ll explore in detail the individual stories of adversity, courage, and perseverance that led to the re-introduction of arterial repair in the military. Representative images, significant sources for the episode, and a complete reference list can be found on the episode webpage.

Author + Host:

Marlene Garcia-Neuer (@GarciaNeuer) is a PGY1 General Surgery Resident at Mayo Clinic Arizona.

We are calling all medical students!

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year
Who do you want to address the question to (resident, fellow, attending, or someone specific)
Please send them in writing or voice-recorded format.

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Music by ZakharValaha and Kaazom from Pixabay,

Welcome to Vascular Team Talk, a podcast mini-series by the Society for Vascular Surgery Physician Assistant Section and Audible Bleeding. In this podcast, we interview people who work in the vascular world and discuss their roles and life on their vascular team to learn more about how different vascular teams are built and function. We look to highlight the good and learn from the bad so that we can take those experiences back to our teams and make positive changes that will make our teams more robust and improve the care we provide to our patients.

In this first episode, Steve Robischon, PA-C, and Laura Needler, APNP, both advanced practice providers at the Medical College of Wisconsin (MCW), review the history of the physician assistant and nurse practitioner professions, discuss similarities and differences in their training, and describe how they function on their vascular team. They also interview Dr. Nate Kugler, a vascular surgeon at MCW, regarding his experiences working with PAs and NPs both during his training and now as a practicing surgeon.

Show Guests:

Steve Robischon, PA-C, is a physician assistant in the Division of Vascular & Endovascular Surgery at the Medical College of Wisconsin in Milwaukee, WI, and he’s currently the Lead Outpatient APP for the Division. He’s also a member of the SVS PA Steering Committee. He received his Master of Physician Assistant Studies from Marquette University in 2007
Laura Needler, APNP, is a nurse practitioner in the Division of Vascular & Endovascular Surgery at the Medical College of Wisconsin in Milwaukee, WI, and she’s currently the Lead Inpatient APP for the Division. Laura received her Master of Science in Nursing from Concordia University of Wisconsin in 2013
Dr. Nate Kugler is a vascular surgeon and assistant professor in the Division of Vascular & Endovascular Surgery at the Medical College of Wisconsin in Milwaukee, WI. He completed medical school at Southern Illinois University in 2012, followed by both his general surgery residency and vascular surgery fellowship training at MCW which he completed in 2021.

Show Links:

American Academy of Physician Assistants / Associates (AAPA)
American Association of Nurse Practitioners (AANP)
SVS Physician Assistant Section
Society of Vascular Nursing
MCW Division of Vascular & Endovascular Surgery

This three-episode mini-series republished a webinar that was recorded by the Easter Vascular Society on important diversity issues in various settings including workplace, academia, training, and education.

In this episode, Dr. Julia Glaser will discuss diversity in education and training. Dr. Julia Glaser is an assistant professor of clinical surgery at University of Pennsylvania department of vascular and endovascular surgery.

Articles highlighted in episode 3:

Discrimination, abuse, harassment, and burnout in surgical residency training by Hu et al. https://doi.org/10.1056/nejmsa1903759
Experiences of gender discrimination and sexual harassment among residents in general surgery programs across the US by Schlick et al. https://doi.org/10.1001/jamasurg.2021.3195
Experiences of LGBTQ+ residents in US general surgery training programs by Heiderscheit et al. https://doi.org/10.1001/jamasurg.2021.5246

Learn more about us at www.audiblebleeding.com and provide us with your feedback via our listener survey.

This three-episode mini-series republished a webinar that was recorded by the Eastern Vascular Society on important diversity issues in various settings including workplace, academia, training and education.

In this episode, Dr. Vincent Rowe will discuss diversity in academia. Dr. Rowe is a professor of surgery and division chief of vascular and endovascular surgery at UCLA. Dr. Rowe serves as the chair of diversity equity and inclusion committee in the society of vascular surgery.

Articles highlighted in episode 2:

Update on workforce diversity in vascular surgery by Dorsey et al. https://doi.org/10.1016/j.jvs.2020.12.063
National evaluation of racial/ethnic discrimination in US surgical residency programs by Yuce et al. https://doi.org/10.1001/jamasurg.2020.0260
Black vascular surgeons survey: who are they? Where are they? Who do they treat? by Kirksey et al. https://doi.org/10.1016/j.jvs.2021.06.414

Learn more about us at www.audiblebleeding.com and provide us with your feedback via our listener survey.

This three-episode mini-series republish a webinar that was recorded by the Eastern Vascular Society on important diversity issues in various settings including workplace, academia, training and education.

In this episode, Dr. Sharita Golden will discuss diversity in the workplace. Dr. Sharita Golden is a professor of endocrinology and metabolism and vice president and chief diversity officer at Johns Hopkins Medicine.

Articles highlighted in this episode:

Diversity improves performance and outcomes by Gomez et al. https://doi.org/10.1016/j.jnma.2019.01.006
Diversity, Representation, and Performance: Evidence about Race and Ethnicity in Public Organizations by Pitts et al. https://doi.org/10.1093/jopart/mui033
Integrating the 3Ds—Social determinants, health disparities, and healthcare workforce diversity by LaVeist et al. https://doi.org/10.1177/00333549141291s204

Audible Bleeding editor Matt Chia (@chia_md) is joined by MD/PhD student Rahul Ghosh (@ghoshrx), JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd), and JVS-VS Associate Editor Dr. John Curci (@CurciAAA) to discuss two great articles

in the JVS family of journals. This episode hosts Dr. Sanuja Bose (@SanujaBose), Dr. Caitlin Hicks (@CaitlinWHicks), and Dr. Elizabeth Chou (@LizChou), the authors of the following papers discussing sex disparities in medical management around carotid revascularization and smooth muscle cell pathobiology in carotid atherosclerosis.

Articles:

“Females are less likely to receive best medical therapy for stroke prevention before and after carotid revascularization than males” by Bose et al.
“Vascular smooth muscle cell phenotype switching in carotid atherosclerosis” by Chou et al.

Show Guests:

Dr. Sanuja Bose (@SanujaBose) is a graduate from University of Rochester School of Medicine and Johns Hopkins Bloomberg School of Public Health. She is currently a postdoctoral research fellow in the Department of Vascular Surgery at Johns Hopkins.
Dr. Caitlin Hicks (@CaitlinWHicks) is an associate professor of surgery at the Johns Hopkins Department of Vascular and Endovascular surgery and the research director of the multidisciplinary diabetic foot and wound service.
Dr. Elizabeth Chou (@LizChou) completed her vascular training at Mass General Hospital in 2022 and is currently a vascular surgeon at Cedars Sinai. Dr. Chou’s research interests include translational research in therapeutic outcomes of aortic and peripheral vascular disease and vascular disease amongst under-represented minorities and women.

Listeners may also be interested in our episode about getting started using the VQI for research.

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On behalf of the Young Surgeons' Section of the SVS, Dr. Saideep Bose and Gowri Gowda sit down with two editors of the JVS journals and take a behind-the-scenes look at the publishing process and tips and tricks for authors and reviewers.

Show Guests

Dr. Thomas Forbes (Faculty Page) is the Surgeon-in-Chief and Chair of the Sprott Department of Surgery at the University Health Network, and Professor of Surgery at the University of Toronto. He is the current Editor in Chief of the Journal of Vascular Surgery. Email: Thomas.Forbes@uhn.ca
Dr. Matthew Smeds (Faculty Page) is a Professor of Surgery at Saint Louis University. He is the current Editor-in-Chief of the Journal of Vascular Surgery – Cases, Innovations, and Techniques. Email: matt.smeds@health.slu.edu

JVS Companion Journal Links:

JVS Venous and Lymphatic Disorders
JVS Cases, Innovations and Techniques
JVS - Vascular Science
JVS - Vascular Insights

JVS Internship Program: https://vascularspecialistonline.com/bright-future-predicted-for-jvs-internship-program/

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship.

In this episode of Audible Bleeding, we sit down with Chloe Powell and discuss her research in physical resilience, understanding patient treatment goals, and pre-operative evaluation before undergoing major vascular intervention. We also delve into her motivations.

Dr. Chloe Powell is an integrated vascular surgery resident at the University of Michigan.

For more on Dr. Powell’s research.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Audible Bleeding editors Matt (@chia_md) and Wen (@WenKawaji) are joined by JVS-CIT assistant editor Dr. Bernardo Mendes (@drbermendes) and JVS Editor-in-chief Dr. Thomas Forbes (@TL_Forbes) , to discuss two great articles in the JVS family of journals. They’re joined by Dr. Powell, Dr. Corriere and Dr. Cooper, the authors of each of the papers discussing patient reported outcomes in claudication and gut microbiome in chronic mesenteric ischemia.

Articles:

“Characterizing patient-reported claudication treatment goals to support patient-centered treatment selection and measurement strategies” by Powell et al. “Chronic Mesenteric Ischemia Intestinal Dysbiosis Resolves after Revascularization” by Cooper et al.

Show Guests:

Dr. Chloe Powell: PGY-V vascular surgery resident at University of Michigan Dr. Matthew Corriere (@MCorriereMD): Associate professor in the department of vascular surgery at University of Michigan. Dr. Michol Cooper (@CooperMichol): Assistant professor in the division of vascular surgery and endovascular therapy at the University of Florida College of Medicine.

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Drs. Matthew Chia and Maggie Reilly present a high-yield review on some topics frequently seen on the VSITE examination.

Vascular Surgery Exam Prep eBook - Rapid Review

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Drs. Alaska Pendleton and Anahita Dua. Originally published Jan 06, 2022.

Vascular Surgery Exam Prep eBook - Vascular Lab

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Drs. Adam Johnson and Melissa Kirkwood discuss radiation safety.

Vascular Surgery Exam Prep eBook - Radiation Safety

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Drs. Sammy Siada and Rafael Malgor discuss safe access for endovascular surgery. Originally published on April 29, 2020.

Vascular Surgery Exam Prep eBook - Endovascular Access

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Drs. Matthew Chia and Nick Mouawad discuss the diagnosis and management of mesenteric vascular disease. Originally published on April 9, 2020.

Vascular Surgery Exam Prep eBook - Mesenteric

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Drs. Cullen McCarthy and Matthew Edwards discuss the diagnosis and management of renovascular disease. Originally published on June 29, 2020. Check out our ebook chapter for additional details on FMD, renal artery dissection, nutcracker syndrome, renal vein thrombosis and renal AV fistulas.

Vascular Surgery Exam Prep eBook - Renal

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Mr. Andrew Nickinson, Mr. Aminder Singh, and Mr. Manj Gohel discuss the diagnosis and management of venous disease. Miss. Leanna Erete oversaw content development. Originally published on Nov 28, 2021. Check out our ebook chapter for additional details on EHIT, coagulation factors, anticoagulants, PERT, SVC syndrome and lymphedema.

Vascular Surgery Exam Prep eBook - Venous Disease

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Drs. Alex Forsyth and Sarah Carlson discuss acute limb ischemia. Originally published on Oct 17, 2020. Check out our ebook chapter for additional content on blue toe syndrome, popliteal entrapment syndrome, and cystic adventitial disease.

Vascular Surgery Exam Prep eBook - Lower Extremity: Acute Limb Ischemia

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Audible Bleeding editor Adam Johnson (@Adam_mdmph) is joined by MD/Ph.D. student Rahul Ghosh (@ghoshrx) and JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd) to discuss two great articles in the JVS family of journals. Dr. David Gordon and Dr. David Williams, the authors of the following paper, join them:

“Pathologic characteristics of human venous in-stent stenosis and stent occlusion” by Williams et al.

Show Guests:

Dr. David Gordon (faculty page) is the Emeritus Professor of Pathology at the University of Michigan, and serves as the Director for Cardiovascular Pathology. He has also had much experience with both human cardiovascular and associated animal model research.
Dr. David Williams (faculty page) is the Kyung J. Cho Collegiate Professor of Radiology in the Division of Vascular and Interventional Radiology at the University of Michigan Medical School

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Drs. Nedal Katib and Danielle Bajakian discuss chronic limb threatening ischemia. Originally published on Jan 3, 2021.

Vascular Surgery Exam Prep eBook - Lower Extremity: CLTI

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Drs. Nedal Katib and Danielle Bajakian discuss the medical management of peripheral arterial occlusive disease and claudication. Originally published on Aug 24, 2020.

Vascular Surgery Exam Prep eBook - Lower Extremity: Medical Management and Claudication

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Audible Bleeding editor Adam Johnson (@Adam_mdmph) is joined by MD/PhD student Rahul Ghosh (@ghoshrx), JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd) to discuss two great articles in the JVS family of journals. They’re joined by Dr. Jasmine Bhinder to discuss the following paper:

“Understanding radiation exposure and improving safety for vascular surgery trainees” by Bhinder et al.

Show Guests:

Dr. Jasmine Bhinder (@JasmineB_MD) is a PGY-4 General Surgery Resident at the University of Buffalo, applying to vascular surgery this year!

Link to the National survey of vascular surgery residents and fellows on radiation exposure and safety practices by Bhinder et al. mentioned in the podcast.

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Tags: JVS, SVS, Paul DiMuzio, Adam Johnson, Matthew Chia, Wen Kawaji, Rahul Ghosh, Season 5, Jasmine Bhinder, Wellness/Burnout, Vascular Resident, Vascular Fellow

Drs. Kevin Kniery, Marlin "Wayne" Causey, and Todd Rasmussen discuss endovascular management of vascular trauma, particularly focusing on blunt thoracic aortic injuries. Originally published on Feb 9, 2021, and was created in collaboration with Behind the Knife: The Premier Surgery Podcast.

Vascular Surgery Exam Prep eBook - Trauma: Endovascular

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Drs. Kevin Kniery, Nicole Rich, and Todd Rasmussen discuss vascular cerebrovascular trauma of the neck. Originally published on May 25, 2020, and was created in collaboration with Behind the Knife: The Premier Surgery Podcast.

Vascular Surgery Exam Prep eBook - Trauma: Cerebrovascular

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Adam and Ezra review the highlights of 2022 and what to look forward to in 2023! This episode lists this year’s five most downloaded episodes and other recap topics.

Check out our team favorites:

Uncomfortable Conversations - Mental Health Awareness in Surgery
Role of the Modern Vascular Surgeon in Oncologic Surgery
SVS Women’s Section with Dr. Duncan and Dr. Shaw
Inside the Vascular Surgery Board - the Past, Present, and Future of Your Certification
SAVS 2022 Recap

COVID-19 Publication

Boreskie PE, Chan TM, Novak C, Johnson AP, Wolpaw J, Ong A, Priddis K, Buddhdev P, Jessica Adkins J, Silverman JA, Davis T, Siegler JE. Medical Education Blog and Podcast Utilization During the COVID-19 Pandemic. Cureus. Mar 2022. 14(3):e23361. PMID: 35475051

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Sound Effect from pixaby.com

Drs. Kevin Kniery, Adham Elmously, and Todd Rasmussen discuss vascular trauma of the major abdominal veins. Originally published Jan 18, 2020, and was created in collaboration with Behind the Knife: The Premier Surgery Podcast.

Vascular Surgery Exam Prep eBook - Trauma: Abdomen Venous

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Drs. Kevin Kniery, Adham Elmously, and Todd Rasmussen discuss vascular trauma of the abdominal arteries. Originally published Dec 22, 2019, and was created in collaboration with Behind the Knife: The Premier Surgery Podcast.

Vascular Surgery Exam Prep eBook - Trauma: Abdomen Arterial

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Drs. Kevin Kniery, Jason Bingham, and Todd Rasmussen discuss peripheral vascular trauma. Originally published Sep 22, 2019, and was created in collaboration with Behind the Knife: The Premier Surgery Podcast.

Vascular Surgery Exam Prep eBook - Trauma: Peripheral

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Today, Gowri and our Holding Pressure team republish the Vascular and Endovascular Surgery Society (VESS) National Student-Run Vascular Surgery Interest Group (VSIG) Webinar on "Discover: Vascular Surgery." This webinar originally occurred on November 10, 2022.

Featured Physician Speakers:

Gabriela Velazquez MD, FACS, RPVI; Associate Professor, Program Director Vascular and Endovascular Surgery Fellowship, Director Vascular Surgery Clerkship; Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine
Todd Berland, MD, FACS, RPVI; Associate Professor of Surgery, Division of Vascular Surgery at NYU Grossman School of Medicine; Director, Outpatient Vascular Interventions NYU Langone Health
Ravi Rajani, MD, FACS, DFSVS; Professor of Vascular Surgery, Assistant Dean for Medical Education, Emory University School of Medicine; Chief, Vascular and Endovascular Surgery, Co-Director, Grady Heart and Vascular Center, Grady Memorial Hospital

VESS VSIG Team/Moderators

Audible Bleeding Resources:

Episodes geared towards medical students: Audible Bleeding (Holding Pressure)
Exam Prep Book: https://adam-mdmph.quarto.pub/vascular-surgery-exam-prep/

VESS VSIG Resources for Medical Students interested in Vascular Surgery:

VESS membership link: https://vesurgery.org/my-vess/why-join-vess
Website: https://vesurgery.org/vess-vsig/
Email: vessvsig@gmail.com
VESS VSIG Resources for Medical Students: publication date TBD; stay tuned for an updated link once published

Mr. Mohamed Barkat, Mr. Nicholas Greaves, and Mr. Michael Jenkins discuss thoracoabdominal aneurysms. Originally published Dec 2, 2021, and was created in collaboration with the Rouleaux Club in the United Kingdom.

Vascular Surgery Exam Prep eBook - TAAA

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Drs. Anna Ohlsson and Sherene Shalhub review genetically inherited aortopathies. Originally published May 18, 2020.

Vascular Surgery Exam Prep eBook - Aortopathies

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Audible Bleeding editor Wen (@WenKawaji) is joined by JVS-VS Associate Editor Dr. Jose Diaz, JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd) , and JVS Editor-in-Chief Dr. Thomas Forbes (@TL_Forbes) to discuss two great articles in the JVS family of journals. They’re joined by Dr. Oliver Aalami and Dr. Terence Ryan, authors of each of the papers discussing SVS supervised exercise therapy and two proteins (S100A8 and S100A9) that play an integral role in the ischemic limb pathophysiology.

“Use of an app-based exercise therapy program including cognitive behavioral techniques for the management of intermittent claudication” by Aalami et al.

“S100A8 and S100A9 are elevated in chronically threatened ischemic limb muscle and induce ischemic mitochondrial pathology in mice” by Ryan et al.

Show Guests:

Dr. Oliver Aalami (@DrAalami) is a clinical professor of surgery at Stanford University. He is also the director of Stanford Byers Center for Biodesign since 2018.
Dr. Terence Ryan (@TerenceRyan_PhD) is an assistant professor on tenure track in the department of applied physiology and kinesiology at the University of Florida. Dr. Ryan’s work focuses on understanding the molecular pathways that regulate muscle and vascular responses to environmental and endogenous stressors.

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Drs. Matthew Spreadbury, Adham Elmously, Einar Brevik and Joseph Lombardy review aortic dissections. Originally published November 1, 2021.

Vascular Surgery Exam Prep eBook - Aortic Dissection

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Drs. Mia Miller and Julie Duke review abdominal aortic aneurysms (AAA). Originally published March 30, 2021.

Vascular Surgery Exam Prep eBook - AAA

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REGISTER HERE for the NEXT webinar 3-D, at 7 pm EST/4 pm PST on December 12, 2022. From 3-D printing to presurgical planning using 3-D modeling, this webinar will explore how 3-D technology is being utilized in vascular surgery today.

Today, we are republishing the Health Information Technology (HITC) Webinar from September 7, 2022, Hacking the EMR: Making the EMR work for you.

A blessing and a curse, the EMR is an integral part of the modern practice of providing medical care. The Community Practice Section, Health Information Technology Committee, and Wellness Committee have collaborated to develop a webinar about making the EMR work for you. We review how to manage the EMR to benefit your daily practice needs; make the EMR work for small independent practices, including OBLs; how to manage EMR burnout; and a few hacks to make the EMR work for you.

Faculty & Topics:

Mal Sheahan, MD - Stating the problem of whether the EMR works for us or the other way around. Vascular surgeons, burnout, and the EMR. Mitigation strategies and SVS’ role in resolving this issue.
Daniel Bertges, MD - Strategies/updates on SVS discussions with EPIC/Powerchart on ways to integrate vascular-specific documentation requirements and streamline data entry (including VQI, etc.).
London Guidry, MD, and James Craven, MD - How does the smaller independent group effectively use EMR in daily practice/OBL setting? Barriers/challenges/advantages.
Robert Beaulieu, MD, presenting for Jeniann Yi, MD - Challenges and opportunities of integrating different EMRs.

Moderator - Geetha Jeyabalan, MD; Vascular Surgeon, MedStar Heart & Vascular Institute.

Full Webinar Video

Relevant Links

Epic dot phrase - .vasexam
Weed. “Medical Records That Guide and Teach.” (1968) NEJM. 278(11): 593–600
Longman. Best Care Anywhere: Why VA Healthcare is Better than Yours. (2012) Penguin Random House
Chaiyachati et al. “Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations.”(2019) JAMA IM 179(6):760–67.
Chawla et al. “Settled Science: The Indisputable Link between EHR and Burnout.” (2021) Vascular Specialist
Corby et al.. “A Qualitative Study of Provider Burnout: Do Medical Scribes Hinder or Help?”(2021) JAMIA Open 4(3)
Sheahan. “An Open Letter to Epic Systems.” (2021) Vascular Specialist.
IOM. To Err Is Human: Building a Safer Health System. Edited by Kohn et al.(2000) National Academies Press (US).
Balasubramanian. “Physicians Would Need Almost 27 Hours A Day To Provide Optimal Patient Care, Per New Study.” (2022) Forbes.
Morgenstern. “Of Clamps, Clips, and Computers.” (2006) Texas Heart Institute Journal. 33(3):279–80.
Sinsky et al. “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.”(2016) Annals of Internal Medicine. 165(11):753.
Stark. “H.R.6898 - 110th Congress (2007-2008): Health-e Information Technology Act of 2008.” (2008) Legislation,
“VQI & Epic Electronic Health Record Integration.” Accessed November 23, 2022.
Specialty Steering Boards Improve Quality on a Global Scale. Epic Publication. 2016
Suki.ai AI Voice Assistant for Healthcare.

SVS members can join the Community Practice Section by emailing svscps@vascularsociety.org.

What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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The COVID pandemic has resulted in increased rates of burnout and mental illness among surgeons. The quiet epidemic of mental illness continues to leave both surgical trainees and staff at increased risk of self-harm or suicide. In this episode, we talk with Dr. Carrie Cunningham and Dr. Dawn Coleman about their efforts to change the narrative and provide data on the impacts of mental health on surgical training and practices.

Disclaimer: Topics covered in this episode may be sensitive for some listeners. If you or someone you know is experiencing suicidal thoughts or a crisis, please get in touch with a trained professional or call 988 for the Suicide Prevention Lifeline.

Guests

Dr. Carrie Cunningham (nee Lubitz) (@lubitz_carrie) is an Associate Professor of Surgery at Harvard Medical School, Section head of the Massachusetts General Hospital Endocrine Surgery Unit, and Associate Director at the Massachusetts General Hospital Institute for Technology Assessment.
Dr. Dawn Coleman (@DawnDM_vasc) is the newly appointed Division Chief for the Division of Vascular and Endovascular Surgery at Duke University.

Additional Resources

Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force
If you need Mental Health Resources for Physicians or the National Suicide Prevention Lifeline.
For more information on the Lorna Breen Foundation.
For more information about Jo Shapiro.

What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Drs. Young Lee and Matthew Smeds review hemodialysis access. Originally published March 28, 2020

Vascular Surgery Exam Prep eBook - Hemodialysis

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Drs. Matt Smith and Nedal Katib review thoracic outlet syndrome. Originally published November 27, 2019.

Vascular Surgery Exam Prep eBook - Thoracic Outlet Syndrome

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In this episode, we explore the role of vascular surgeons in oncologic surgery. We will be discussing the nuances of vascular involvement in oncologic resection, common practices, and future directions of this collaborative surgical culture.

Dr. Adam Beck (@AWBeckMD) is a vascular surgeon and Professor of Surgery at the University of Alabama at Birmingham where he serves as the Director of the Division of Vascular Surgery and Endovascular Therapy, holds the Holt A. McDowell, Jr, MD Endowed Chair in Vascular Surgery and serves as the Director of Quality and Associate Chief Medical Quality Officer for the UAB Cardiovascular Institute. Dr. Beck completed his general surgery residency training and a surgical oncology research fellowship at the University of Texas-Southwestern Medical Center. He trained in vascular surgery at the Dartmouth-Hitchcock Medical Center and then completed a fellowship in advanced endovascular techniques, including branched and fenestrated endografts for aortic aneurysmal disease, at the University Medical Center of Groningen in The Netherlands. You can learn more about Dr. Adam Beck here.

Dr. Xavier Berard (@XavierBerardMD) is a French vascular surgeon and serves as a Consultant in the Department of Vascular Surgery and Professor of Vascular and Endovascular Surgery in Bordeaux University Hospital in Bordeaux, France. He is board certified from the French College of Vascular and Endovascular Surgeons and from the European Society for Vascular and Endovascular Surgery. He has also completed a PhD in Vascular Biomaterials and has built a library of educational video content. He works closely with Institut Bergonié Bordeaux Cancer Center for sarcomas. You can see educational videos and learn more about Dr. Xavier Berard here

Dr. Sharif Ellozy (@SharifEllozy) is a vascular surgeon at the New York-Presbyterian/Weill Cornell Medical Center where he serves as Associate Professor of Clinical Surgery in the Division of Vascular and Endovascular Surgery, and Program Director of the Vascular Surgery Fellowship program. He is also one of the founders of Audible Bleeding. He is readily involved in oncologic resection at the Memorial Sloan Kettering Cancer Center and works closely with surgical oncologists on operative cases that have vessel involvement.

Authors/Interviewers:

Dr. Sree Kanna, MD - McGill, Montreal (@VulnerableAorta)

Dr. Nakia Sarad, DO, MS - New York-Presbyterian/Queens - Weill Cornell, New York (@NakSaradDO)

Editors:

Morgan Gold, MD,CM candidate - McGill, Montreal (@MorganSGold)

Ezra Schwartz, MD,CM, MS, MMSc-Med Ed candidate - Harvard, Boston (@EzraSchwartz10)

Helpful Resources:

To learn more about sarcoma resections, check out the Schwarzbach papers on lower extremity sarcomas and retroperitoneal sarcomas

Click here to learn more about the NCCN Guidelines on Resectability of Pancreatic Cancers

Click here to learn more about IVC Reconstruction Techniques in Oncologic Surgery

Video of IVC Leiomyosarcoma Reconstructions here (courtesy of Dr. Berard)

Click here to learn more about the Renal Cell Carcinoma Mayo Staging System

Click here to find the original article on the Shamblin Classification for Carotid Body Tumors

Check out this review paper on Oncovascular Surgery

Check out this paper on spiral endografts here

Video of spiral saphenous vein graft technique here (courtesy of Dr. Berard)

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Drs. Kush Sharma and Ashraf Mansour review vascular disease affecting the upper extremity. Originally published on Jan 29, 2021.

Vascular Surgery Exam Prep Ebook - Upper Extremity

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Nicole Rich, Adam Johnson, and Kevin Kniery review cerebrovascular.

Vascular Surgery Exam Prep Ebook - Cerebrovascular

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Audible Bleeding editors Matt (@chia_md) and Wen (@WenKawaji) are joined by JVS-CIT Editor Matthew Smeds (@Mattsmeds) and JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd) , to discuss two great articles in the JVS family of journals. They’re joined by Dr. Callie Dowdy and Dr. Larry Kraiss, the first authors of each of the papers discussing endovascular use of biocomposite antibiotics material and VQI frailty assessment.

Link to “A Minimally Invasive Approach to the Infected Aorta with Novel Endovascular Use of Biocomposite Antibiotic Material” by Dowdy et al. : https://doi.org/10.1016/j.jvscit.2022.09.002

Link to “A Vascular Quality Initiative frailty assessment predicts postdischarge mortality in patients undergoing arterial reconstruction,” by Kraiss et al. : https://doi.org/10.1016/j.jvs.2022.05.017

Show Guests:

Dr. Callie Dowdy (@CDNanoMD) is a vascular surgeon practicing in Kentucky, she finished her vascular surgery fellowship at Pennsylvania hospital in June of this year.
Dr. Larry Kraiss is a Professor of Surgery and Medical Director of the University of Utah Hospital Vascular Laboratory.

Information for the SVS VQI FIT Program can be found using this hyperlink: https://www.vqi.org/quality-fellowship-in-training-fit-program/. A link for New FIT Trainee Applications will be available starting January 9, 2023.

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Adam and Matt introduce the new exam prep curriculum and accompanying e-book.

Vascular Surgery Exam Prep E-Book
Vascular Surgery Exam Prep Curriculum Calendar

What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Adam and Matt introduce the new exam prep curriculum and accompanying e-book.

Vascular Surgery Exam Prep E-Book
Vascular Surgery Exam Prep Curriculum Calendar

What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

We are excited to have Dr. Robert Molnar, Dr. Anil Hingorani, and Dr. Edward Arous to discuss the SVS Sub-Section on Outpatient & Office Vascular Care (SOOVC). In 2018, the SVS created a new membership section for clinicians who work in outpatient and office vascular care centers. The section’s mission is to establish a forum where members can work to advance the care of patients with vascular disease in outpatient settings by enhancing SVS efforts in education, advocacy, quality practice, ethics and research. Since its start, the section has grown to more than 130 members. It is now a subsection of the SVS Community Practice Section (SVSCPS).

Dr. Robert Molnar has practiced with the Michigan Vascular Center since 1998. He completed his undergraduate studies at the University of Notre Dame, his medical degree at the Medical College of Ohio, his General Surgery at Michigan State University and his Vascular Fellowship at Vanderbilt University. He serves as the chair of the SVS Community Practice Section and is on the SVS executive Board. One of his main interests is in high quality outpatient vascular care, especially in the OBL space.

Dr. Anil Hingorani has been practicing vascular surgery in Brooklyn, New York since 1998. He completed his undergraduate studies at Rensselaer Polytechnic Institute and graduated medical school from Albany Medical college. He performed his general surgery residency at St. Luke’s Roosevelt Medical center at Columbia University and his vascular fellowship at Maimonides Medical Center. He serves as the chair of the Subsection for Outpatient and Office Vascular Care. He is affiliated with NYU Langone in Brooklyn New York

Dr. Edward Arous received his medical degree from the University of Massachusetts Medical School, his master’s in public health from the Harvard School of Public Health, and completed his residency in vascular surgery at the University of Massachusetts Medical School. Prior to joining The Vascular Care Group, Dr. Arous was an Assistant Professor of Vascular and Endovascular Surgery at the University of Massachusetts Medical School and the Director of the Limb Preservation Center.

Learn more about the SOOVC here: SVS SOOVC webpage

Learn more about the SVS Clinical Practice Section here:

SVS Community Practice Section webpage

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this second episode highlighting the SVS women’s section, Wen (@WenKawaji) and Amanda (@AmandaFobare) are joined by Dr. Furey, Dr. Bunnell and Dr. Kumar to discuss important topics such as the needs of a young vascular surgeon and how to pick your optimal practice.

Show Guests:

Dr. Bunnell @avi-bunnell: Private practice vascular Surgeon in Tampa Florida specializing in venous disease, PAD, and carotid revascularization

Dr. Furey @drpfureymd: Chief of vascular surgery and president of medical staff at Catholic Medical Center in Manchester, NH. Associate director of surgical services for New England Heart and Vascular

Dr. Kumar @ShivaniKumarMD : Graduates of Mount Sinai Medical Center in 2021, currently a vascular surgeon at Tufts medical center.

Show Resource:

We have shared a list of questions recent graduates have generated for the job search process. Check it out!

For those of you who are not familiar with the women’s section, we have a great episode that was recently published in September (see link below). To learn more about the Women’s Section, please visit the SVS Women’s Section website below.

https://www.audiblebleeding.com/svs-womens-section/

https://vascular.org/vascular-specialists/networking/svs-womens-section

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this second episode highlighting the SVS women’s section, Wen (@WenKawaji) and Amanda (@AmandaFobare) are joined by Dr. Furey, Dr. Bunnell and Dr. Kumar to discuss important topics such as the needs of a young vascular surgeon and how to pick your optimal practice.

Show Guests:

Dr. Bunnell @avi-bunnell: Private practice vascular Surgeon in Tampa Florida specializing in venous disease, PAD, and carotid revascularization

Dr. Furey @drpfureymd: Chief of vascular surgery and president of medical staff at Catholic Medical Center in Manchester, NH. Associate director of surgical services for New England Heart and Vascular

Dr. Kumar @ShivaniKumarMD : Graduates of Mount Sinai Medical Center in 2021, currently a vascular surgeon at Tufts medical center.

Show Resource:

We have shared a list of questions recent graduates have generated for the job search process. Check it out!

For those of you who are not familiar with the women’s section, we have a great episode that was recently published in September (see link below). To learn more about the Women’s Section, please visit the SVS Women’s Section website below.

https://www.audiblebleeding.com/svs-womens-section/

https://vascular.org/vascular-specialists/networking/svs-womens-section

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

We are very excited to have Dr. Bruce Gewertz on the pod today, with guest hosts Dr. Ali Azizzadeh and Dr. Ben Pearce. We discuss Dr. Gewertz’s career as a surgeon-scientist, with an emphasis on the importance of emotional intelligence and the leadership lessons he has learned along the way.

Dr. Gewertz (@jackgiraffe1) is the H and S Nichols Distinguished Chair, Vice Dean for Academic Affairs and Vice President, Interventional Services at Cedars-Sinai Health System. Prior to his tenure at Cedars-Sinai, he spent 25 years at the University of Chicago, the last 14 of which as the Dallas Phemister Chair of the Department of Surgery. He also served as the inspiration for Harrison Ford’s character, Dr. Richard Kimble, in the Academy Award nominated 1993 movie classic, “The Fugitive”, starring Harrison Ford and Tommy Lee Jones.

Dr. Ali Azizzadeh (@DrAliAzizzadeh)is a Professor and Director of the Division of Vascular Surgery at Cedars-Sinai, Vice Chair of the Department of Surgery, Associate Director, Smidt Heart Institute, and Associate Dean of Faculty Affairs. Before being recruited by Dr. Gewertz to join the staff at Cedars-Sinai in 2017, he served as Professor and Chief of Vascular and Endovascular Surgery at McGovern Medical School at UTHealth and the Memorial Hermann Heart and Vascular Institute in Houston, TX.

Dr. Ben Pearce (@HawkeyeBJP) is the William D. Jordan, Jr. Endowed Professor of Vascular Surgery and Program Director of the Vascular Training Programs at the University of Alabama-Birmingham. Dr. Pearce completed his general surgery residency at the University of Chicago Hospitals where he was mentored by today's guest. He even wore Dr. Richard Kimble's loupes as an intern! He then completed his fellowship at UAB in Vascular Surgery and was an assistant professor at UT Health before returning to Birmingham to take on his current position. He is pleased to count Dr. Gewertz as a trusted mentor, but, more importantly, dear friend for the past 22 years

Learn more about Dr. Gewertz here: https://brucegewertzmd.com/about/

Selected videos and publications by Dr. Gewertz

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

We are very excited to have Dr. Bruce Gewertz on the pod today, with guest hosts Dr. Ali Azizzadeh and Dr. Ben Pearce. We discuss Dr. Gewertz’s career as a surgeon-scientist, with an emphasis on the importance of emotional intelligence and the leadership lessons he has learned along the way.

Dr. Gewertz (@jackgiraffe1) is the H and S Nichols Distinguished Chair, Vice Dean for Academic Affairs and Vice President, Interventional Services at Cedars-Sinai Health System. Prior to his tenure at Cedars-Sinai, he spent 25 years at the University of Chicago, the last 14 of which as the Dallas Phemister Chair of the Department of Surgery. He also served as the inspiration for Harrison Ford’s character, Dr. Richard Kimble, in the Academy Award nominated 1993 movie classic, “The Fugitive”, starring Harrison Ford and Tommy Lee Jones.

Dr. Ali Azizzadeh (@DrAliAzizzadeh)is a Professor and Director of the Division of Vascular Surgery at Cedars-Sinai, Vice Chair of the Department of Surgery, Associate Director, Smidt Heart Institute, and Associate Dean of Faculty Affairs. Before being recruited by Dr. Gewertz to join the staff at Cedars-Sinai in 2017, he served as Professor and Chief of Vascular and Endovascular Surgery at McGovern Medical School at UTHealth and the Memorial Hermann Heart and Vascular Institute in Houston, TX.

Dr. Ben Pearce (@HawkeyeBJP) is the William D. Jordan, Jr. Endowed Professor of Vascular Surgery and Program Director of the Vascular Training Programs at the University of Alabama-Birmingham. Dr. Pearce completed his general surgery residency at the University of Chicago Hospitals where he was mentored by today's guest. He even wore Dr. Richard Kimble's loupes as an intern! He then completed his fellowship at UAB in Vascular Surgery and was an assistant professor at UT Health before returning to Birmingham to take on his current position. He is pleased to count Dr. Gewertz as a trusted mentor, but, more importantly, dear friend for the past 22 years

Learn more about Dr. Gewertz here: https://brucegewertzmd.com/about/

Selected videos and publications by Dr. Gewertz

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Audible Bleeding editors Matt (@chia_md) and Wen (@WenKawaji) are joined by JVS-VL Editor Anahita Dua (@AnahitaDua), JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd) , and JVS Editor-in-Chief Dr. Thomas Forbes (@TL_Forbes) to discuss two great articles in the JVS family of journals. They’re joined by Dr. Steven Deak and Dr. Rens Varkevisser, the first authors of each of the papers discussing polidocanol endovenous microfoam and mortality difference between open and endovascular aneurysm repair in the VQI.

Link to “Treatment of superficial venous insufficiency in a large patient cohort with retrograde administration of ultrasound-guided polidocanol endovenous microfoam versus endovenous laser ablation,” by Deak: https://doi.org/10.1016/j.jvsv.2021.11.007

Link to “Long-term age-stratified survival following endovascular and open abdominal aortic aneurysm repair,” by Varkevisser et al: https://doi.org/10.1016/j.jvs.2022.03.867

Show Guests:

Dr. Steven Deak is a vascular surgeon who specializes in the treatment of venous disease. He practices at the Deak Vein NJ Clinic.
Dr. Rens Varkevisser is a trainee at the Erasmus University medical center in Rotterdam, as well as being a clinical research fellow at the department of vascular and endovascular surgery at the Beth Israel Deaconess medical center.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship.

In this episode, Imani talks with Dr. Bryan T. Fisher (@AmputationSuck) about finding balance in your life, practicing in the private-academic sector, and caring for high-risk patients with peripheral arterial disease.

Dr. Fisher is a board-certified vascular surgeon and the physician lead for Tri-Star Health for Middle Tennessee and Southern Kentucky.

To learn more about the NMQF 40 Under 40 and the Congressional Black Caucus.

To learn more about Lead Public Schools Nashville.

To learn more about Historically Black Colleges & Universities (HBCUs).

What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Audible Bleeding editors Matt Chia and Wen Kawaji are joined by JVS Assistant Editor Dr. Paul Dimuzio and JVS Editor-in-Chief Dr. Thomas Forbes to discuss a recent article in the JVS. They’re joined by Dr. Elizabeth Andraska, the first author of the paper discussing long-term followup after EVAR, available now in the August 2022 issue of the JVS. Find out how this paper can have an immediate impact on your patients, and hear insights directly from Dr. Andraska in this exciting episode!

Link to “Longer follow-up intervals following endovascular aortic aneurysm repair are safe and appropriate after marked aneurysm sac regression” by Andraska et al.: https://doi.org/10.1016/j.jvs.2022.01.079

Show Guests:

Dr. Elizabeth Andraska (@eandraska) is in her sixth year of training in the integrated vascular surgery residency at the University of Pittsburgh. She has a Masters in Clinical Research from the University of Michigan and has completed two years of dedicated research time at the University of Pittsburgh. She is excited to pursue a career in academic vascular surgery.

Previous episode with Dr. Elizabeth Andraska on Getting Started with Basic Science in Vascular Surgery:

https://www.audiblebleeding.com/getting-started-in-basic-science/

Previous episode with Dr. Thomas Forbes and Dr. Ron Dalman on the next chapter of the JVS:

https://www.audiblebleeding.com/2022/06/14/interview-with-the-incoming-editors-of-the-jvs/

JVS Host Introductions:

Dr. Paul Dimuzio (@pdimuziomd) is the William M. Measey Professor of Surgery, Director of the Division of Vascular and Endovascular Surgery at Thomas Jefferson University Hospital and Co-Director of the Jefferson Vascular Center in Philadelphia, as well as being one of the new Assistant Editors for the JVS.
Dr. Thomas Forbes (@TL_Forbes) is the Surgeon-in-Chief and James Wallace McCutcheon Chair of the Sprott Department of Surgery at the University Health Network, Professor of Surgery at the University of Toronto, as well as being one of the new Editors-in-Chief for the JVS.

Audible Bleeding Host Introductions:

Dr. Wen Kawaji (@WenKawaji) is a general surgery resident at Medstar Health in Baltimore, MD. She is passionate about vascular, trauma, and critical care and recently completed a burn/surgical critical care fellowship at Johns Hopkins. Wen has been a loyal audible bleeding fan throughout residency and is excited to learn from and work with the podcast team. In her spare time, she enjoys traveling, food adventures, and puzzles.
Dr. Matthew Chia (@chia_md) is in his final year of the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research at Northwestern.

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Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Soni and Wen discuss the new SVS Women's Section with the steering committee co-chairs, Drs. Audra Duncan and Palma Shaw.

In 2021, the society of vascular surgery approved a new membership section for women in vascular surgery. The SVS Women’s Section serves as a centralized home for women in vascular surgery to discuss gender-based issues, support each other in practice, academic research, and leadership roles, and engage the participation of women in the SVS. The section had its inaugural events at VAM 2022 in Boston with fantastic feedback.

Dr. Audra Duncan and Dr. Palma Shaw are co-chairs of the SVS Women’s Section steering committee. Dr. Duncan is a professor of surgery and chair of the division of vascular surgery at Western University in London, Ontario. Dr. Shaw is a professor of surgery and program director of the vascular fellowship at Upstate Medical University in Syracuse, NY.

You will get an insider’s look at how the Women’s section was created, what inspired its creation, what kind of activities and support it provides, and lastly, how you can be involved. For more information, please visit the SVS Women’s Section website below:

https://vascular.org/vascular-specialists/networking/svs-womens-section

Authors: Wen Kawaji and Soni Nag.

Editors: Yasong Yu and Amanda Fobare

Reviewer: Matt Chia and Adam Johnson

What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

REGISTER HERE for the NEXT webinar Hacking the EMR: Making the EMR work for you, at 6 PM CT on September 7, 2022. This webinar is a collaboration between the Society for Vascular Surgery Community Practice Section, Health Information Technology Committee, and the Wellness Committee.

Today, we are republishing the HITC Webinar from May 4, 2022, on New Technologies in Vascular Surgery. New technologies designed to improve surgical techniques are rapidly emerging in the vascular specialty. These technologies include Blue Dop, which assists in determining limb preservation; Voythos, an EMR assistant; FORS technology, which provides real-time 3D visualization of the full shape of devices inside the body without the need for fluoroscopy; and Cydar AI, which advances surgical visualization and decision-making to build a future where all surgery works exactly as planned.

Click here for the full webinar video.

Faculty:

Blue Dop - Patrick Kelly, MD, Vascular Surgeon at Sanford Health
Voythos - Sophia Khan-Makoid, MD, CEO and Founder of Voythos
Fiber Optic RealShape (FORS) Technology - Andre Schanzer, MD, Professor and Chief of Vascular Surgery at the University of Massachusetts
Cydar AI - Murray Shames, MD, Professor and Chief of Vascular Surgery at the University of South Florida

Moderators:

Judith C. Lin, MD, MBA; Chair, HIT Committee; Professor and Chief of Vascular Surgery, Michigan State University College of Human Medicine
Oliver O. Aalami, MD; Clinical Professor and Vascular Surgeon, Stanford

Editor and Reviewers: Adam Johnson and Ezra Schwartz

REGISTER HERE for the NEXT webinar Hacking the EMR: Making the EMR work for you, at 6 PM CT on September 7, 2022. This webinar is a collaboration between the Society for Vascular Surgery Community Practice Section, Health Information Technology Committee, and the Wellness Committee.

Today, we are republishing the HITC Webinar from May 4, 2022, on New Technologies in Vascular Surgery. New technologies designed to improve surgical techniques are rapidly emerging in the vascular specialty. These technologies include Blue Dop, which assists in determining limb preservation; Voythos, an EMR assistant; FORS technology, which provides real-time 3D visualization of the full shape of devices inside the body without the need for fluoroscopy; and Cydar AI, which advances surgical visualization and decision-making to build a future where all surgery works exactly as planned.

Click here for the full webinar video.

Faculty:

Blue Dop - Patrick Kelly, MD, Vascular Surgeon at Sanford Health
Voythos - Sophia Khan-Makoid, MD, CEO and Founder of Voythos
Fiber Optic RealShape (FORS) Technology - Andre Schanzer, MD, Professor and Chief of Vascular Surgery at the University of Massachusetts
Cydar AI - Murray Shames, MD, Professor and Chief of Vascular Surgery at the University of South Florida

Moderators:

Judith C. Lin, MD, MBA; Chair, HIT Committee; Professor and Chief of Vascular Surgery, Michigan State University College of Human Medicine
Oliver O. Aalami, MD; Clinical Professor and Vascular Surgeon, Stanford

Editor and Reviewers: Adam Johnson and Ezra Schwartz

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship.

In this episode, Imani talks with Dr. Keith Jones and discusses his experiences transitioning from an academic practice to running and building his private practice and his experiences within both practice environments. He discusses how he manages to deal with racism in and out of the hospital and his hopes for how medicine will change moving forward.

Dr. Keith Jones currently works in private practice in Sacramento, CA.

Learn more about the Society of Black Vascular Surgeons.

Learn more about Steptember! Find out from Dr. Ben Pearce why "Why I Walk".

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Name of Surgery: Endovascular Aortic Aneurysm Repair (Infrarenal)

In today's episode of our Holding Pressure (HP) Series, developed by medical students for medical students, Janhavi and Andrew review the basics of endovascular abdominal aortic aneurysm repair (EVAR).

Authors:

Janhavi Nikhil Patel is a third and final year medical student at McMaster University. She previously completed her undergraduate in Physiology from Western University.

Andrew Lazar (@Lazar_andy) is a PGY-4 General Surgery resident at Morristown Medical Center in New Jersey. He completed a T32 research fellowship in vascular surgery at Columbia University. He graduated from Weill Cornell Medicine.

Editor: Yasong Yu

Reviewers: Imani McElroy and Amanda Fobare

Core Resource:

Rutherford's Vascular and Endovascular Therapy 9th Edition Chapter#69, 70, 72, 73

Additional Resources:

EVAR-1 Trial - Endovascular versus Open Repair of Abdominal Aortic Aneurysm. N Engl J Med, 362 (20) (2010), pp. 1863-1871, Endovascular versus Open Repair of Abdominal Aortic Aneurysm | NEJM
OVER Trial - F.A. Lederle, T.C. Kyriakides, K.T. Stroupe, J.A. Freischlag, F.T. Padberg, J.S. Matsumura, et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med, 380 (2019), pp. 2126-2135. Open versus Endovascular Repair of Abdominal Aortic Aneurysm | NEJM
Relevant Audible Bleeding episodes
Landmark Papers - IMPROVE
VSITE Review - AAA
Endovascular Aortic Repair Preoperative Sizing
VSITE Review - Vascular Access

For a full outline check out our website.

Calling all medical students

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year
Who do you want to address the question to (resident, fellow, attending, or someone specific)
Send them in writing or voice-recorded format.

Send to audiblebleeding@vascularsociety.org.

Please share your feedback through our Listener Survey!

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Vascular Origin Stories is a podcast series that explores the fun and engaging stories that shaped vascular surgery.

Today’s episode will be the first part of a multi-episode series exploring how the young battalion surgeons serving in MASH units in the Korean war pioneered wartime vascular repair. This episode introduces the Mobile Army Surgical Hospital (MASH), as well as some of the real-life stories from the surgeons unknowingly changing the field of medicine, which inspired the hit movie and TV series MAS*H. We’ll look at what caused arterial repair to be removed from the army surgical handbook after WWI and how changing medical education helped create the environment for ingenuity in the MASH units. In part 2, we’ll explore in detail the individual stories of adversity, courage, and perseverance that led to the re-introduction of arterial repair in the military.

Major sources for the episode are linked below, and a full reference list can be found at the bottom of the page.

Articles

In Ukraine, Gruesome Injuries and Not Enough Doctors to Treat Them, by Michael Schwirtz and Lynsey Addari
Korea, MAS*H, and the accidental pioneers of vascular surgery by Dr. Steven Friedman, MD

Books

Of Life and Limb: Surgical Repair of the Arteries in War and Peace, 1880-1960 by Dr. Justin Barr, MD, PhD
MASH: An Army Surgeon in Korea by Dr. Otto Apel, MD and Pat Apel
MASH: A Novel About Three Army Doctors by Richard Hooker

References

Robinson, A. Galen: Life Lessons from Gladiatorial Contests. The Lancet Perspective. Vol 382, Is. 9904. November 2013.
Friedman, S.G. A History of Vascular Surgery. Futura Publishing. 1989.
Van Way, C. War and Trauma: A History of Military Medicine. Mo Med. 2016 Jul-Aug;113(40:260-263
Hernigou, P. Ambroise Pare II: Pare’s contributions to amputation and ligature. Int Orthop. 2013 Apr; 37(4): 769-772
Van Way, C. War and Trauma: A History of Military Medicine- PArt II. Mo Med. 2016 Sep-Oct; 113 950:336-340
Apel, O. Apel, P. MASH: An Army Surgeon in Korea. The University Press of Kentucky. 1998.
King, B. Jatoi, I. The Mobile Army Surgical Hospital (MASH): A Military and Surgical Legacy. Journal of the National Medical Association. Vol. 97, No 5. May 2005.
Friedman, S. Korea, MASH and the Accidental Pioneers of Vascular Surgery. Journal of Vascular Surgery. 2007.
Wesselingh, R. From Milites Medici to Army Medics- A two Thousand Year Tradition of Military Medicine. Journal of Military and Veterans’ Health. Vol 16, No 4
Gabriel, R. Between Flesh and Steel: A History of Military Medicine from the Middle Ages to the War in Afghanistan. Potomac Books. 2016
Jorgensen,T.J. How Marie Curie Brought X-Ray Machines To the Battlefield. Smithsonian Magazine. Oct 11. 2017
Of Life and Limb: Surgical Repair of the Arteries in War and Peace, 1880-1960. Joseph Barr. University of Rochester Press; 1st edition. November 1, 2019.
Duffy, T.P. The Flexner Report- 100 Years Later. Yale Journal of Biological Medicine. 2011 Sep;84(3): 269-276
Andrew Dale. Band of Brother: Creators of Modern Vascular Surgery. Deweese. 1996
John Kobler. The Reluctant Surgeon, a Biography of John Hunter. Doubleday and Company. 1960
Eugene Custers, Ollen ten Cate.The History of Medical Education in Europe and the United States, With Respect to Time and Proficiency. Academic Medicine. March 2018-Vol. 93 Is. 3S
Kapp, K. Talbot, G. John Hunter, The Father of Scientific Surgery. The American College of Surgeons. Poster CC2017
“Alpha Omega Alpha’ History”. Website
Kenneth M. Ludmerer. Learning to Heal: The Development of American Medical Education. Basic Books, Inc., Publishers. New York. 1985
Richard Hooker and WC Heinz. MASH: A Novel About Three Army Surgeons. Pocket Books. 1968.
Jahnke Jr., E.J., Seeley S.F. Acute vascular injuries in the Korean War: an analysis of 77 consecutive cases. Ann Surg. 1953; 138: 158-177

Author + Host:

Marlene Garcia-Neuer (@GarciaNeuer) is a PGY1 General Surgery Resident at Mayo Clinic Arizona.

Calling all medical students!

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast. Include the following: Your name, school, year, and to whom you want to address the question (resident, fellow, attending, or someone specific). Send them in writing or voice-recorded format.

Send them to audiblebleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Credits:

Author: Marlene Garcia-Neuer

Editor: Sharif Ellozy

Reviewer: Eilidh Gunn

Music and Sound Effects from Pixabay, special thanks to ZakharValaha and BlenderTimer.

The Spring VESS Session covered a wide breadth of topics ranging from disparities in care, innovation in endovascular techniques, and vascular surgery in younger patient populations. Imani sat down with Dr. Yazan Duwaryi, the VESS session program directory, to give a quick recap.

Dr. Duwayri is an Associate Professor of Surgery in the Vascular Surgery Division at Emory University School of Medicine. He serves as Medical Director of the Heart and Vascular service line at Emory University Hospital. He joined the faculty after completing his vascular surgery fellowship at Washington University in Saint Louis in 2011. He specializes in endoluminal and open vascular surgery, with his primary area of clinical interest being complex abdominal and thoracic aortic pathology. His academic interests are outcomes research in vascular surgery, quality improvement in vascular surgery, healthcare payment reform, and endovascular device design.

To submit an abstract to this year’s VESS Winter Meeting.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Join us as we cover VAM 2022! (#VAM22)

Today we caught up with Dr. Sharee Wright (@DrASW6) who was a moderator of the Medical Student Program: How to Success as a Vascular Surgery Residency Applicant.

We also met some medical student attendees to see how their experiences has been so far.

Stay tuned for more coverage of #VAM22

Please share your feedback through our Listener Survey!

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

As the official journal of the Society for Vascular Surgery, the Journal of Vascular Surgery (JVS) aims to be the premier journal of medical, endovascular, and surgical care of vascular disease. This year, JVS transitions to a new executive board headed by Dr. Ron Dalman (Executive Editor) and Dr. Thomas Forbes (Editor-in-Chief). Many thanks to our outgoing executive board led by Dr. Peter Gloviczki and Dr. Peter Lawrence!

In this episode, Imani and Sharif sit down with the incoming Executive Editor and Editor-in-Chief, Dr. Dalman and Dr. Forbes. We discuss their transition into their new roles, their goals for the journal, and how they hope to grow academic publishing in the era of social and digital media.

Come to the JVS Special Session at VAM on Thursday, June 16th, 2022 at 1:30 PM EDT. Submit ideas/topics for the session here.

If you want to submit an article to JVS.

Follow JVS on Twitter!

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

We are very excited to bring you the top papers from the 2022 Society for Clinical Vascular Surgery meeting. This episode features 3 papers, discussed by the primary author with commentary provided by Dr. Caron Rockman, President of the SCVS, Professor of Surgery at NYU, and program director of Vascular Surgery training programs. Vice-President Dr. Ashraf Mansour, Professor and Chair of Surgery at Michigan State University, and Dr. Jean Bismuth, SCVS Secretary, from Houston, Texas.

Clinical Presentation, Operative Management and Long-term Outcome of Rupture Following Previous Abdominal Aortic Aneurysm Repair
- Discussed by: Dr. Indrani Sen
- Authors: Indrani Sen, Irina Kanzafarova, Jennifer Yonkus, Bernardo Mendes, Jill Colglazier, Fahad Shuja, Randall DeMartino, Manju Kalra, Todd Rasmussen
Utilization of Thromboelastography with Platelet Mapping Assay to Predict Graft Thrombosis in Lower Extremity Revascularization
- Discussed by: Dr. Monica Majumdar
- Authors: Monica Majumdar MD MPH, Zach M Feldman MD, Imani McElroy MD, Natalie Sumetsky MS, Harold D Waller MD, Srihari Lella MD, Ryan P Hall MD, Young Kim MD, Kathryn Nuzzolo BS, Amanda Kirshkaln MS, David Chang PhD MPH MBA, Jessica Cardenas PhD, Eric Grabowski MD, Rushad Patell MD, Matthew Eagleton MD, Anahita Dua MD MS MBA
Outcomes Of Upper Extremity Vs. Transfemoral Access For Fenestrated-branched Endovascular Aortic Repair (FB-EVAR)
- Discussed by: Dr. Khalil Chamseddin
- Authors: Khalil Chamseddin MD, Carlos H. Timaran MD, Gustavo S. Oderich MD, Emanuel R. Tenorio MD, PhD, Mark A. Farber MD, F. Ezequiel Parodi MD, Darren B. Schneider MD, Andres Schanzer MD, Adam W. Beck MD, Matthew P. Sweet MD, Sara L. Zettervall MD, Bernardo Mendes MD , Matthew J. Eagleton MD, on behalf of the U.S. Aortic Research Consortium

Follow us on twitter at: @audiblebleeding

Dr. Amanda Fobare: @amandafobare

Dr. Caron Rockman: @CaronRockman

Dr. Jean Bismuth: @Jean Bismuth

Dr. Indrani Sen: @IndraniSenvasc

Dr. Monica Majumdar: @Monica_Majumdar

In this month’s episode of our JVS Editor’s Choice series, Adam and Wen discuss the Journal of Vascular Surgery: Venous and Lymphatic Disorders Editors' Choice articles for May 2022 with the Senior Editor, Dr. Peter Lawrence.

Submit your questions here for the JVS VAM Session

Video Summary of the Articles

Articles Discussed:

Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience.
Dr Quinones-Bladrich’s paper on IVC Leiyomyosarcoma
Editor's Choice--Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia.
Severity of disease and treatment outcomes of anterior accessory great saphenous veins compared with the great saphenous vein.
CME--Comparative analysis of the results of cyanoacrylate ablation and radiofrequency ablation in the treatment of venous insufficiency.

JVS Journal Club Website

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Credits:

Guest: Peter Lawrence
Authors: Yasong Yu and Wen Kawaji
Editor: Adam Johnson

In 2021, the SVS approved a membership section dedicated to vascular surgeons in the first 0-10 years of practice. The mission of the Young Surgeons Section (YSS) of the SVS is to foster and accelerate the learning and career development of SVS members within their first ten years in clinical practice. We are excited to have Dr. Chelsea Dorsey and Dr. Leigh Ann O’Banion to discuss the evolution of the YSS, their plans for the upcoming VAM, and how people can get involved. Dr. Chelsea Dorsey (@MdDorsey) is an Associate Professor of Surgery in the Section of Vascular Surgery at the University of Chicago and serves as the Vice Chair of Diversity, Equity and Inclusion in the Department of Surgery. In keeping with her medical education interests, she was recently appointed the Associate Dean for Medical Student Academic Advising and Advancement at the Pritzker School of Medicine. She currently sits on a number of regional and national committees focused on surgical education and also serves on the SVS Communications and Appointments Committee. In January of this year, she was formally appointed the Chair of the newly formed SVS Young Surgeons Section.

Dr. Leigh Ann O'Banion (@limbsalvagedr) is an Assistant Professor of Vascular Surgery at UCSF Fresno, where she also completed her general surgery residency. She did her fellowship in vascular surgery at UCSF, graduated in 2017 and then returned to UCSF Fresno as an attending. She has a busy clinical practice with a focus on limb salvage and outcomes of vascular amputees and shares a passion for mentoring the next generation of vascular trainees. She is on the steering committee of the Young Surgeons Section of the SVS.

Young Surgeon Section page on the SVS website

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this episode, we are fortunate to hear three interviews from guest experts in the field discussing occupational hazards in vascular surgery. We cover physical pain and discomfort with Dr. Max Wohlauer, radiation safety with Dr. Melissa Kirkwood, and pregnancy and radiation with Dr. Venita Chandra.

Show Guests:

Dr. Max Wohlauer (@doctormaxw) is an assistant professor at the University of Colorado School of Medicine, as well as an associate program director of their residency and fellowship. He founded the Vascular Surgery COVID-19 Collaborative (VASCC, https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/vascular/research/vascc/vascc). He obtained his medical degree from the Albany Medical College and completed general surgery residency at the University of Colorado followed by vascular surgery fellowship at the Cleveland Clinic.

Audible Bleeding with Dr. Samuel Money on Ergonomics in Surgery: https://www.audiblebleeding.com/money-ergonomics/
Physical discomfort, professional satisfaction, and burnout in vascular surgeons: https://doi.org/10.1016/j.jvs.2018.11.026
Physical pain and musculoskeletal discomfort in vascular surgeons: https://doi.org/10.1016/j.jvs.2020.07.097
Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force: https://doi.org/10.1016/j.jvs.2020.10.065

Dr. Melissa Kirkwood is an associate professor at the UT Southwestern Medical Center and chief of the division of vascular surgery. She completed her medical degree at Yale University School of Medicine, followed by a general surgery residency at The University of Chicago, and vascular surgery fellowship at the University of Pennsylvania Medical Center. One of her major research interests is radiation dose control and novel technology for decreasing radiation exposure.

Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair: https://doi.org/10.1016/j.jvs.2020.05.031
Disposable, lightweight shield decreases operator eye and brain radiation dose when attached to safety eyewear during fluoroscopically guided interventions: https://doi.org/10.1016/j.jvs.2021.11.067
Radiation brain dose to vascular surgeons during fluoroscopically guided interventions is not effectively reduced by wearing lead equivalent surgical caps: https://doi.org/10.1016/j.jvs.2017.12.054

Dr. Venita Chandra (@ChandraVenita) is a clinical associate professor at Stanford University as well as the program director for vascular surgery residency and fellowship. She obtained her medical degree from the University of Chicago followed by general surgery residency and vascular surgery fellowship at Stanford University. She also completed a technology development fellowship in the Stanford Biodesign Program. She is part of the SVS Wellness Task Force and has an interest in radiation safety in pregnancy.

Monitoring of fetal radiation exposure during pregnancy: https://doi.org/10.1016/j.jvs.2013.01.052
Incidence of Infertility and Pregnancy Complications in US Female Surgeons: https://doi.org/10.1001/jamasurg.2021.3301

Host Introductions:

Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research from Northwestern.

Dr. Jessie Ho (@JessieHo_) is in her 4th year general surgery resident at Northwestern University. She obtained her medical degree from the Texas A&M College of Medicine, and is completing a Master’s in Clinical Investigation at Northwestern.

Authors: Matt Chia, MD, MS, Jessie Ho, MD, Janhavi Patel, BMSc

Editor: Matt Chia, MD

Reviewers: Sharif Ellozy, MD, Adam Johnson, MD

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship.

In this episode, Imani talks with Dr. Eric Pillado about his experiences thus far in training, finding comfort in being himself, and his ambitions in addressing health disparities in Latin-X and Spanish-speaking populations.

Dr. Pillado (@drpillado) is an integrated vascular trainee at McGaw Medical Center of Northwestern University.

To read Dr. Pillado’s perspective piece “Being Queer Without Proximal or Distal Control”.
To learn more about The Surgical Outcomes & Quality Improvement Center (SOQIC) and the SECOND Trial.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Holding Pressure AKA/BKA Shownotes

Name of Surgery: Above Knee Amputation/Below Knee Amputation

Authors:

Dominique Dockery, MS3, Alpert Medical School of Brown University

Robert Patterson, MD, FACS, Alpert Medical School of Brown University/Providence Surgical Care Group

Editor:

Yasong Yu

Reviewer:

Ryan Meyer

Core Resources:

Rutherford's Vascular and Endovascular Therapy 9th Edition Chapters 104, 105, 111, 112
Anson and McVeigh’s Surgical Anatomy

Additional Resources:

Article Explaining WIfI (https://www.jvascsurg.org/article/S0741-5214(13)01515-2/fulltext)
Links to Apps for CLTI Calculators (https://vascular.org/news-advocacy/society-vascular-surgery-launches-mobile-apps-staging-chronic-limb-threatening)
Callander Technique Original Article (https://jamanetwork.com/journals/jama/article-abstract/1155011)
Logan, Meryl Simon & Bush, Ruth L. Vascular surgeons are health disparities doctors. JVS. Vol 74; Issue 5p1437. November 2021.

Underlying disease featured in episode: Peripheral arterial disease (PAD)/chronic limb threatening ischemia (CLTI)

Pathophysiology/etiology
- Blockage of the arteries supplying blood to the lower limbs usually secondary to atherosclerosis
  - Affects an estimated 8-12 million Americans
  - Associated with smoking, diabetes, hypertension, obesity
  - CLTI is more severe form of PAD (up to 20% of PAD patients)- associated with rest pain, ischemia ulceration, or gangrene
Patient presentation
Varies based on disease progression and prior intervention
- Ranges from asymptomatic to major tissue loss
- Often have patients with intermittent claudication, rest pain, or wounds/ulceration
Patients can be classified using Rutherford scale or WIfI classification
Diagnosis
Ankle-brachial index is diagnostic (<0.9 or >1.3)
Often obtain CTA with run-off to visualize vessels prior to angiogram
Angiogram to plan intervention
Surgical treatment
Revascularization: either endovascular (angioplasty vs stenting) or open (bypass based on targets with either vein or graft)
Amputation: after failed revascularization or irreversible/severe ischemia with no revascularization options
- Minor (toe/foot) vs major (below knee/through knee/above knee)

Indications for surgery:

acute ischemia: for irreversible ischemia, for severe ischemia with no revascularization options, or following unsuccessful attempts at revascularization
chronic ischemia: failure of revascularization, lack of suitable conduit or target arteries, severe patient comorbidities, poor functional status, or extensive gangrene or infection such that foot salvage is not possible
foot infection
severe traumatic injury
lower extremity skeletal or soft tissue malignancy

Preop Preparation: linking the patient with a prosthetist prior to surgery is ideal and helps with surgical planning, addressing patients’ fears and concerns, determining level of amputation (pulses/blood flow, level of infection, etc.)

Surgical steps with relevant images:

Below the knee amputation (posterior flap technique):

Create a hemi-circular incision anteriorly (generally about 1 handbreadth below the tibial tuberosity that goes from just anterior to the fibula to an equidistant portion of the other side) and a long posterior flap
Cut through the muscles of the anterior compartment (muscle bundle on the lateral side of the tibia) and expose the anterior tibial artery and vein- ligate and suture ligate
Using a periosteal elevator, which is something like a chisel, strip the periosteum proximally from the tibia and divide the tibia with an oscillating saw. Then strip the periosteum and attachments of the fibula at this level and divide either with the saw or a bone shear.
Use an amputation knife to create the posterior flap along the skin and fascia incision lines (fashion it to make sure it will reach anteriorly without muscle bulk/tension). The remaining tibial vessels are then identified and individually suture ligated. Identify the tibial nerve, bluntly dissect it quite proximally and divide it with electrocautery.
After hemostasis has been established, remove a wedge of bone from the anterior portion of the tibia so that that doesn’t provide a pressure point on the prosthesis and resect the fibula 1-2 centimeters above the line of tibial transection with a rib cutter to be sure that the fibula doesn’t wear against the prosthesis laterally and create an ulceration or painful protrusion.
Loosely approximate the posterior flap to the anterior fascia with several interrupted Vicryl sutures and then carefully re-approximate the skin with vertical mattress sutures of Prolene using a Keith needle to avoid traumatizing the skin with forceps.

Above knee amputations (Callander technique): Does not cut across any muscle bellies but is purely dividing all muscular attachments through the tendinous insertions. It is similar to a through the knee amputation, but it involves dividing the femur immediately above the flare of the condyle with curved anterior and posterior fish mouth type flaps that again allow division without the trauma of muscular transection.

Postoperative care: knee immobilizer post-operatively after BKA to reduce risk of contractures, non–weight bearing on the stump until the fitting of a prosthesis 4 to 6 weeks after surgery, close follow up with vascular surgeon

Complications: primary healing fails in 20% to 30% of patients and approximately 1 in 5 patients undergoing BKA need a higher-level amputation due to wound problems

Top Asked Questions:

What ankle-brachial index is diagnostic of peripheral arterial disease?

Less than 0.9, severe PAD is less than 0.4. An ABI greater than 1.3 or 1.4 is considered non-diagnostic and further workup is indicated.

What is the Rutherford classification for peripheral arterial disease?

0- asymptomatic, 1- mild claudication, 2- moderate claudication, 3- severe claudication, 4- ischemic rest pain, 5- minor tissue loss, 6- major tissue loss

Which amputation level requires more energy to ambulate with a prosthesis?

Above knee amputations require 50-70% more energy than below knee amputations

What are the compartments of the lower leg, and which major vessels and nerves are in each compartment?

Anterior- anterior tibial artery and vein, deep peroneal nerve

Lateral- superficial peroneal nerve

Deep posterior- posterior tibial artery and vein, peroneal artery and vein, tibial nerve

Superficial posterior- mostly musculature

We are very excited to have Dr. Kellie Brown, the current Vice-Chair of the Vascular Surgery Board, and Dr. Malachi Sheahan, the Vice-Chair Elect, to pull back the curtain on how the VSB serves the public and the vascular surgery community at large while defining our specialty. They discuss the history of the VSB, provide some insight into board examination development, and clarify the process of Continuous Certification Assessment. They also discuss the new nomination process adopted this year by the VSB, and how interested people can get more involved.

Dr. Kellie Brown is Professor of Surgery and Radiology in the Division of Vascular and Endovascular Surgery at The Medical College of Wisconsin, and the Chief of Vascular Surgery at the Zablocki VA Medical Center. She is the Program Director for the Vascular Surgery Fellowship at the Medical College of Wisconsin.

Dr. Malachi Sheahan is Professor of Surgery and Chair of Vascular and Endovascular Surgery and Program Director for the Vascular Surgery Integrated Residency and Fellowship at LSU Health Sciences Center in New Orleans.

Vascular Surgery Continuous Certification Assessment

VSB Update - Spring 2021

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Have you ever wondered how physicians create new medical technology or how they receive funding for creating new medical products? Five entrepreneurs, who have developed medical products and received funding, will share the process of developing a company and the different types of funding. This webinar is presented by the SVS Health Information Technology Committee.

Webinar Faculty:

Anahita Dua, MD, MS, MBA - Asst. Prof., Harvard Medical School
Sophia Khan, MD - Asst. Prof., UTHealth; CEO & Founder, Voythos AI
Pratap Khanwilkar, PhD, MBA - Vice-President, InCube Labs
Dave Kuraguntla, MD - Founder & CEO, Alio
Hari Radhakrishnan, MD - Co-Chief Executive Officer, Decisio Health, Inc.

Moderators:

Judith Lin, MD, MBA - Prof. & Chief, Vascular Surgery, Michigan State University College of Human Medicine
Shivprasad Nikam, MD, MBA - Vascular Surgeon, Geisinger; President & CEO, Mundaii

Join us on May 4 for the next HITC Webinar - New Technologies in Vascular Surgery. Register Here

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship.

In this episode, Imani talks with Dr. Garietta Falls about her journey to vascular surgery and the lessons she learned along the way.

Dr. Falls (@drgfalls) is an assistant professor at Case Western Reserve School of Medicine and also serves as the director of the vascular lab at Metro Health in Cleveland, Ohio.

For more information on the Midwestern Vascular Society

For more information on the goals and objectives of the SVS DEI Committee

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Adam and Farooq discuss Journal of Vascular Surgery Editor’s Choice articles for April 2022 with the Senior Editor, Dr. Peter Lawrence.

Video Summary of the Articles

Articles Discussed

Treatment of carotid stenosis in asymptomatic, non-octogenarian, standard risk patients with stenting versus endarterectomy trials.
Predictors of mortality in nonagenarians undergoing abdominal aortic aneurysm repair: Analysis of the National Surgical Quality Improvement Program dataset.
Hospital-based delays to revascularization increase risk of postoperative mortality and short bowel syndrome in acute mesenteric ischemia.
Outcomes of carotid artery stenting in patients with radiation arteritis compared with those with atherosclerotic disease.

JVS Journal Club Website

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Help us improve through our ALL NEW Listener Survey!

Follow us on Twitter: @AudibleBleeding

Credits:

Guest: Peter Lawrence
Authors: Adam Johnson and Farooq Usmani
Editor: Adam Johnson
Reviewers: Shivik Patel

Holding Pressure and Vascular Origin Stories: History of Hemodialysis Access

In this crossover episode of Holding Pressure and Vascular Origin Stories Gowri and Marlene explore the history of hemodialysis access, the creation of arteriovenous fistulas and prosthetic grafts. During this episode Gowri interviews Dr. Appell- the surgeon who created the first AV fistula for hemodialysis access and Marlene interviews Dr. Schanzer about his experience with early hemodialysis access and the development of the distal revascularization and interval ligation procedure. Below you can find a picture of the first Teflon shunt used for hemodialysis, The Artificial Kidney Center Admission and Policy Committee (aka ‘God Squad’), evolution of early A-V shunts and Drs. James E Cimino, Kenneth Appell, Michael J. Brescia.

Links to other podcasts on bioethics and finance of hemodialysis and the God Squad:
Beside Rounds: Episode 26 The God Squad

Freakonomics: Is dialysis a test case of medicare for all?

References:

[1] Klaus Konner. History of vascular access for haemodialysis. Nephrol Dial Transplant (2005) 20: 2629–2635.

[2] B.H. Scribner, R. Buri, J.E.Z. Caner, R. Hegstrom, J.M. Burnell. Preliminary report on the treatment of chronic uremia by means of intermittent hemodialysis. Trans Am Soc Artif Intern

Organs 1960; 6: 114–12.

[3] Wayne Quinton, David Dillard, and Belding H. Scribner Authors. Cannulation of Blood Vessels for Prolonged Hemodialysis. Transactions of the ASA10, 1960, Vol. 6, pp. 104–107.

[4] Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275: 1089–1092

[5] Cimino JE, Brescia MJ. The early development of the arteriovenous fistula needle technique for hemodialysis. ASAIO J 1994; 40: 923–927

[6] Scribner. Hemodialysis Using an Arteriovenous Fistula. N Engl J Med 1966;

[7] Baker, L. D., Jr, Johnson, J. M., & Goldfarb, D. (1976). Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis. Transactions - American Society for Artificial Internal Organs, 22, 382–387.

[8] Blagg, CR. Development of ethical concepts in dialysis: Seattle in the 1960s. Nephrology 1998; 4, 235-238

[9] Blagg CR. The Early History of Dialysis for Chronic Renal Failure in the United States: A View From Seattle. World Kidney Forum.

[10] Rettig, RA. Origins of the Medicare Kidney Disease Entitlement: The Social Security Amendments of 1972. Biomedical Politics. Institute of Medicine (US) Committee to Study Decision Making; 1992

[11] Scribner, B. Treatment of Chronic Uremia.

[12] United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020.

[13] Scribner, Belding. A Personalized History of Chronic Hemodialysis. American Journal of Kidney Diseases. Vol XVI No 6. December 1990. pp511-519

Hosts:

Marlene Garcia-Neuer (@GarciaNeuer) is a MS4 at THE Ohio State University College of Medicine.

Gowri Gowda (@GowriGowda11) is an MS3 at Tulane University School of Medicine.

Guests:

Dr. Harry Schanzer, Vascular Surgeon Mount Sinai Hospital and Bronx VA (retired)

Dr. Kenneth Appel, General Surgeon, Bronx VA (retired)

Calling all medical students!

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year
Who you want to address the question to (resident, fellow, attending, or someone specific)
Send them in writing, or in voice recorded format.

Send them to HoldingPressure.AudibleBleeding@gmail.com. Also send us any ideas, suggestions, or comments.

Please share your feedback through our Listener Survey!

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Please share your feedback through our Listener Survey!

Credits:

Author: Marlene Garcia-Neuer, Gowri Gowda

Editor: Yasong Yu

Reviewers: Sharif Ellozy, Adam Johnson

Holding Pressure AVF/AVG Creation Show Notes

Name of Surgery: AVF/AVG Creation

Authors:

Gowri Gowda, Tulane University School of Medicine, MS3

Daniela Medina, Penn State College of Medicine, MS4

Dr. Gerry Victor, LSU Health New Orleans, PGY1

Editor:

Yasong Yu

Reviewers:

Amanda Fobare

Farooq Usmani

Core Resources:

Rutherford's Vascular and Endovascular Therapy 9th Edition Chapter# 175,176,178,179

Additional Resources:

Landmark paper: benefits of regional vs local anesthesia on AV fistula outcomes titled“Effect of regional versus local anesthesia on outcome after arteriovenous fistula creation: a randomized controlled trial” by Aitken et. al found that regional brachial plexus block anesthesia results in greater vasodilation and increased short-term blood flow was associated with higher primary patency at 3 months compared to local anesthesia.
SVS reporting standards for HA access: reference for surgical dialysis access placement and revision
VSITE Review - Vascular Access

Underlying disease featured in episode

Pathophysiology/etiology: Chronic Kidney Disease (CKD) is defined as decreased kidney function (estimated as an eGFR<60) for three or more months or the presence of kidney damage indicated by a urinary albumin excretion of ≥30 mg/day).
Pathophysiology: The pathophysiology of CKD is variable based on the underlying condition. Two common etiologies are diabetic nephropathy and hypertensive nephropathy. Diabetic nephropathy is a result of chronic hyperglycemia which results in the glycosylation of the basement membrane and plasma hyperfiltration. This ultimately results in glomerular damage. Hypertensive nephropathy is a result of long standing arterial hypertension and increased capillary hydrostatic pressure in the glomeruli as well as ischemic glomerular damage.
Etiology: Conditions that can cause chronic kidney disease include diabetic nephropathy, hypertensive nephropathy, glomerulonephritis, and polycystic kidney disease. CKD stage is used to guide the management and risk stratify for major complications of CKD such as all-cause mortality, cardiovascular mortality, and progression of kidney disease. . Appropriate staging includes cause of disease, eGFR level, and category of albuminuria. Decline in kidney function is typically asymptomatic. However, when a patient reaches ESRD (eGFR<15) they may show signs such as uremia, electrolyte imbalances, volume overload, and bone disease.
Epidemiology: With an aging population and a rise in the incidence of diabetes, CKD and ESRD are becoming increasingly prevalent diagnoses in the United States. The prevalence of ESRD reached 746,557 in 2017 with an increase in incidence by 2.3% from 2017 to 2018. Data from the United States Renal Data System reported a rise in ESRD patients receiving hemodialysis from 84,537 to 112,818 between the years of 2000-2018. Medicare spending for ESRD patients increased from $36.1 billion in 2009 to $38.7 billion in 2018.
Patient Presentation
Case: Our patient is a 60 year old right-hand dominant female with a past medical history of diabetes, hypertension, hyperlipidemia, and CKD with an eGFR of 20. She has no surgical history and has a family history of heart failure and diabetes. She does not currently work, drinks around 2 glasses of wine a week, and quit smoking 10 years ago. Her current medications include atorvastatin, lisinopril, and aspirin.
Diagnosis
History: H&P of a patient referred for access creation should elicit hand dominance and work history because they can affect where the fistula or graft should be positioned. It is especially important to note any previous access procedures, prior central lines, pacemakers, thoracic surgeries, or other venous system procedures. A history of chronic infections, immunosuppression, skin diseases, history of stroke, and extremity weaknesses may also affect choice of procedure.
Physical Exam and Imaging: discussed in preop assessment section.
Treatment (Medical/Surgical)
Non-temporary treatment options include kidney transplantation and dialysis (requires AV Fistula creation, AV graft creation, or peritoneal dialysis access placement).
Indications for surgery:
The treatment of choice for ESRD is kidney transplantation as it provides a higher quality of life and a lower mortality risk for patients when compared with dialysis.
Patients who are unable to receive a transplant have a choice between hemodialysis through a hemodialysis catheter, AV Fistula, AV graft, or peritoneal dialysis based on various patient-specific factors.
The SVS’s clinical practice guidelines and the National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (NFK-KDOQI) guidelines align in their recommendation to refer patients to a vascular access surgeon for permanent hemodialysis access when their creatinine drops below 25 mL/min. So for our patient, her GFR of 20 warranted a referral to vascular surgery.
Early access placement, ideally more than 4 months before the initiation of dialysis, decreases the risk of sepsis and death. This has been attributed to a decreased need for the use of central venous catheters for temporary hemodialysis access.
Preop Preparation:
The first step in a successful permanent AV access placement is a thorough preop evaluation.
Comorbid conditions impacting access patency rates include age, diabetes, peripheral vascular disease, smoking, hyperparathyroidism, and anemia.
Comorbidities:
Age, Diabetes, and Smoking have been more extensively studied than others. Retrospective observational studies have shown that smoking increases both early and late failure of AV access. ESRD patients who are smokers should be counseled on smoking cessation and referred to a tobacco cessation program before their AV access procedure.
Studies regarding age and its effects have also been largely retrospective observational studies but with conflicting results. A meta-analysis of 13 studies by Lazarides et al. looked at dialysis outcomes in elderly patients and found a higher rate of radiocephalic AV access failure in elderly patients compared with the non elderly. Additionally this analysis found a statistically significant higher rate of brachiocephalic AVF patency compared to radiocephalic access and no statistically significant difference in AVG placement within the elderly population. In conclusion, for elderly patients, upper arm brachial-cephalic AVF or AVG is the preferable access placement site when compared to a distal radial-cephalic AVF.
For patients with DM, studies have suggested an increased long term risk of thrombosis and arterial steal. Taking inflow as distal as possible decreases the risk of steal syndrome.
Surgical steps (relevant images can be found in Rutherford Chapter 175):

Autogenous Access Steps

The selected artery and vein are identified and dissected.
The distal end of the vein is transected. Side branches are identified and ligated to maximize flow into the vein and prevent delayed maturation.
Prior to clamping the artery, systemic heparin may be considered. Alternatively, the artery may be clamped and flushed with heparinized saline.
An arteriotomy of 4 to 6 mm is made. Limiting the length decreases the incidence of arterial steal
An end to side AV anastomosis between the end of the vein and side of the artery is performed using a 6-0 or 7-0 monofilament nonabsorbable (prolene) suture. The anastomosis is flushed just prior to completion. An end to side vs side to side anastomosis has been shown to decrease the risk of venous hypertension.
After the anastomosis is completed, remaining side venous branches are identified and ligated through the main incision. Depending on practice style, stable incisions may be done to ligate additional venous branches not accessible through the main incision. This final step increases flow into the main venous segment and promotes maturation.

Autogenous Access with a Transposition

If a transposition is required, a one-stage or two-stage technique may be utilized. The benefit of a one-stage technique is the need for only one procedure. The benefit of the two stage procedure is being able to assess whether the vein will mature and be usable. Two stage procedures are recommended for small veins <4 mm.
If a two stage procedure is selected, the first stage consists of creating the arterio-venous fistula.
The second stage , the transposition, is performed 4 to 6 weeks later. A superficial tunnel is created. The venous limb of the fistula is transected and passed through the tunnel. A new anastomosis is created between the two ends of the venous limb of the fistula.
Alternatively, a superficialization of the fistula may be performed. The vein is exposed, side branches ligated, and the vein is mobilized superficially by approximating the subcutaneous tissue below the vein. The vein is transected and mobilized proximal to the anastomosis. A tunnel is created in the subcutaneous tissue. The vein is then passed through the tunnel and once again

Prosthetic Access

A 6 mm PTFE graft is the graft of choice for an AV graft creation. A tapered graft (4-6mm) should be considered to decrease risk of steal
The artery and vein selected for use are identified and dissected.
Subcutaneous tunnel is created using Gore Sheath, the Noon, or the Kelly-Weck tunneler.
The graft is first anastomosed to the vein in an end-to side fashion using a 6-0/7-0 monofilament suture. The venotomy should ideally be made to optimize venous outflow and prevent any turning or twisting of the vein. Systemic heparin is administered to prevent arterial occlusion. The inflow artery is clamped and arterial anastomosis is completed in a similar fashion. Unlike the autogenous access procedure, the arteriotomy does not need to be strictly limited to 4 to 6 mm as the graft size will limit arterial steal.
Postoperative care: Postop Care and Evaluation of fistulas and grafts revolve around assessing maturation
AV fistulas generally can take up to 12 weeks to mature whereas AV grafts are ready in 2 weeks.
Patients who receive an AV fistula should be assessed by the vascular surgeon 2 weeks post-op, for patency and any early surgical complications such as infection, nerve compression, ischemia, steal syndrome, or extremity swelling.
Around 4-6 weeks, the fistula should be evaluated for maturity by using a duplex ultrasound to assess diameter, depth, flow through the fistula, and length of access.
Physical examination for maturity should include feeling for a thrill and pulse, evaluation of the body with the optimal length being 6 to 10 cm, and evaluation of the depth ideally within 1 cm of the skin surface.
Patency:
Primary patency is the interval from time of access placement to any intervention required to maintain or reestablish patency.
Primary assisted patency is the interval time from access placement to maintenance of access patency and includes surgical or endovascular interventions needed to maintain functionality of a patent access as long as it is not occluded.
Once a conduit gets occluded, you move on to measuring secondary patency, which is the interval time from time of access placement to access abandonment. To learn more about this, listeners can check out the section “time of measurement of patency” in the SVS reporting standards for hemodialysis access.
The DOPPS study indicated an improvement in AVG primary patency with calcium channel blockers, AVG secondary patency with aspirin, decreased AVG primary patency with warfarin, and improvement in AVF secondary patency with ACE inhibitors.
Complications:
There are a multitude of complications that can arise and affect the patency of the AV fistula or graft. In fact, a large portion of the rise in costs during the transition from CKD to ESRD can be attributed to hospitalizations for AV access failures, revision procedures, repeated access placements, and thrombectomies.
Primary AVF failure is defined as an AVF that fails within three months of use or has never been usable for dialysis. Radio-cephalic fistulas have the highest failure rate and are commonly caused by anatomic problems or lesions that were preexisting or arose after the procedure.
Thrombosis: Hemodynamic changes and flow disturbances can cause intimal hyperplasia primarily at the outflow anastomosis in an AVG and anywhere along the outflow vein in an AVF. Another factor that can contribute to intimal hyperplasia is repeated puncture of the fistula or graft. Intimal hyperplasia can ultimately lead to stenosis and thrombosis.
Infection: Infection is the second most common cause of loss of access patency, accounting for 20% of cases. Some of the risk factors for infection include the presence of AV grafts, diabetes, increased age, and repeated cannulation.
Pseudoaneurysm: Repeated cannulation in the same area of access can result in the formation of a pseudoaneurysm which is a disruption of the vessel wall with a collection of blood contained by fibrous tissue. Pseudoaneurysms have a risk of rupture and infection.
Dialysis Access Steal Syndrome: Due to the increased blood flow through the AV access, there can develop a decrease in blood flow to the distal extremity. Clinical features of steal syndrome include hand pain, diminished sensory or motor function, or coolness. Risk factors include previous access procedures, diabetes, PAD, CAD, a history of steal syndrome, and female gender. Steal syndrome can lead to permanent neurological damage to the extremity if not dealt with in an expeditious manner.
Venous Hypertension: Venous HTN commonly occurs due to central venous stenosis primarily caused by chronic endothelial trauma from a previous catheter placement. Venous HTN impacts access patency and function and can lead to severe edema.
Top Asked Questions:
What are the rules of 6’s?
The rule of 6s is an easy way to evaluate the maturity of a fistula. Six weeks after the AV fistula is created, the fistula should be able to support a blood flow of 600ml/min, be at a maximum of 6mm from the surface, and have a diameter greater than 6mm
What are the indications for choosing an AV graft vs. an AV fistula vs a temporary catheter?
Indications for choosing AVF:
Preferred over AVGs due to their superior patency rates if the patient's vascular anatomical characteristics such as diameter and depth are deemed appropriate through physical examination and vascular mapping via ultrasound.
Less chances of infection compared to AVGs and temporary catheter.
Indications for choosing AVGs:
Once native fistulas in the non dominant arm have been exhausted you move on to the consideration of AVGs.
If a patient’s vascular anatomy is inadequate for AVF placement.
If a patient requires an expedited catheter removal, AVGs can be considered to avoid longer maturation time of AVF
Older age and smaller vein size have been associated with appropriateness of using AVG or AVF
Indications for choosing temporary catheters include the following:
Patient is in need of dialysis but has not yet received an AVF/AVG or their AVF/AVG is not ready for use
AVF/AVG/Peritoneal Dialysis with complications and temporarily not able to be utilized
Patient requires dialysis but has a transplant confirmed in <90 days
Acute need of dialysis without indications for permanent HA access placement
How long do AV Fistulas and AV grafts typically last?
Autogenous AV access has better primary and secondary patency rates compared to prosthetic AV access (refer to patency paragraph #9 above for definitions of patency).

| Patency Measure | Autogenous Access | AV graft | | 1-year Primary Patency | 43%-85% | 40%-54% | | 2-year Primary Patency | 40%-69% | 18%-30% | | 1- year Secondary Patency | 46%-90% | 59%-65% | | 2-year Secondary Patency | 62%-75% | 40%-60% |

Apart from an AV Graft and AV Fistula, what is another method of permanent dialysis?
Peritoneal dialysis (PD) is an alternative method of dialysis that utilizes the peritoneum as a membrane for fluid dissolution and exchange.
PD is as effective as hemodialysis access (HA) with the only absolute contraindication being a lack of peritoneal membrane. However, there are other factors to consider when choosing between PD and HA for dialysis access. Medical considerations include previous peritoneal scarring, adhesions, or hernias. Additionally, because PD is performed by the patient and not in a dialysis center, it is vital to assess any patient specific factors (physical, social, environmental) that could prevent them from adhering to their dialysis regimen.
When working up a patient for dialysis access, PD should be considered as a potential option. If a patient is deemed suitable for PD, it can provide a much higher quality of life than HA. PD can be performed from the home relieving the patient of visits to a dialysis center multiple days during the week. PD can also be performed overnight while the patient is asleep and does not require needle sticks.

References:

Misskey, J., & Hsiang, Y. (2015). The First Arteriovenous Fistula: A History of Hemodialysis Access and a Forgotten Pioneer. In Journal of Vascular Surgery (Vol. 61, Issue 6, p. 81S). Elsevier BV. https://doi.org/10.1016/j.jvs.2015.04.156
Polo JR. Kenneth Charles Appell, M.D.: the surgeon who performed the first radiocephalic fistulas for hemodialysis. Am Surg. 2006 Feb;72(2):172-3. PMID: 16536251.
Annual data report. USRDS. (n.d.). Retrieved February 21, 2022, from https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities
Chopra, V. Central venous access devices and approach to device and site selection in adults. In T. Post (Ed.). UpToDate, Waltham, MA (accessed on February 20, 2022): UpToDate.
Oliver, M., Quinn, R. Approach to the adult patient needing vascular access for chronic hemodialysis. In T. Post (Ed.). UpToDate, Waltham, MA (accessed on February 20, 2022): UpToDate.
Woo, K. Arteriovenous fistula creation for hemodialysis and its complications. InUpToDate. UpToDate, Waltham, MA. (Accessed on February 22, 2022)
Woo, K. Arteriovenous graft creation for hemodialysis and its complications. In T. Post (Ed.),UpToDate. UpToDate, Waltham, MA. (Accessed on February 22, 2022).
Aitken, E., Jackson, A., Kearns, R., Steven, M., Kinsella, J., Clancy, M., & Macfarlane, A. (2016). Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial.Lancet (London, England),388(10049), 1067–1074. https://doi.org/10.1016/S0140-6736(16)30948-5
Lazarides, M. K., Georgiadis, G. S., Antoniou, G. A., & Staramos, D. N. (2007). A meta-analysis of dialysis access outcome in elderly patients.Journal of vascular surgery, 45(2), 420–426. https://doi.org/10.1016/j.jvs.2006.10.035
Pisoni, R. L., Gillespie, B. W., Dickinson, D. M., Chen, K., Kutner, M. H., & Wolfe, R. A. (2004). The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology.American journal of kidney diseases : the official journal of the National Kidney Foundation,44(5 Suppl 2), 7–15. https://doi.org/10.1053/j.ajkd.2004.08.005
Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, Miller A, Scher L, Trerotola S, Gregory RT, Rutherford RB, Kent KC. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002 Mar;35(3):603-10. doi: 10.1067/mva.2002.122025. PMID: 11877717.

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Calling all medical students

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year
Who you want to address the question to (resident, fellow, attending, or someone specific)
Send them in writing, or in voice recorded format.

Send them to HoldingPressure.AudibleBleeding@gmail.com. Also send us any ideas, suggestions, or comments.

Please share your feedback through our Listener Survey!

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Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Soni and Wen discuss the Journal of Vascular Surgery Venous and Lymphatics March Editors' Choice articles with the Editor-in-Chief, Dr. Peter Gloviczki.

Video Summary of the Articles

Articles Discussed:

Institutional trends over a decade in catheter-directed interventions for pulmonary embolism.
Contemporary rates of inferior vena cava filter thrombosis and risk factors.
Pregnancy after iliac vein stenting for pelvic venous insufficiency.
A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins.

JVS Journal Club Website

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Help us improve through our ALL NEW Listener Survey!

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Credits:

Guest: Peter Gloviczki
Authors: Soni Nag, Wen Kawaji
Editor: Adam Johnson
Reviewer: Eilidh Gunn and Matthew Chia

The Society for Vascular Surgery was founded on July 3rd, 1946 at the Fairmount Hotel in San Francisco, California by thirty-one vascular surgeons looking to improve the field. In August 2021, the SVS kicked off a year-long celebration of its 75th anniversary. As part of this celebration, the SVS Foundation will be hosting the "Cheers to 75 Years Gala" in Boston on June 17th. This fundraiser will allow the SVS Foundation to make even greater progress in accomplishing its mission of optimizing the vascular health and well-being of patients and the public through support of research. To discuss the upcoming gala and the SVS Foundation, we have three guests with us today:

Dr. Ronald Dalman, MD, DFSVS, Past President of the SVS, is here with us today in his role as Chair of the Gala Committee. @RLDalmanMD

Dr. Venita Chandra is an Associate Professor of Surgery and the Program Director for the vascular surgery fellowship at Stanford. She is here today in her role as co-Chair of the Gala Committee. @ChandraVenita

Dr. Peter Lawrence is Wiley Barker Professor and Chief of the Division of Vascular and Endovascular Surgery at UCLA and Senior Editor of the Journal of Vascular Surgery. He joins us today in his role as the Chair of the SVS Foundation.

Listen to the SVS Foundation episode, April 3rd, 2021

Listen to the VISTA Program episode, May 3rd, 2021

Want to donate to the auction? Contact Rupa Brosseau at rbrosseau@vascularsociety.org

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this month’s episode of our JVS Editor’s Choice series, Soni and Wen discuss Journal of Vascular Surgery March’s Editor’s Choice articles with the Editor-in-Chief, Dr. Peter Gloviczki Video Summary of the Articles Articles Discussed:

Perioperative outcomes of carotid endarterectomy and transfemoral and transcervical carotid artery stenting in radiation-induced carotid lesions.
(CME Article) Incidence, predictive factors, and outcomes of intraprocedure adverse events during fenestrated-branched endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms.
Dr Schanzer Editorial: Fenestrated and branched endografts are transformational but we haven't made it to the top of the mountain yet
Timing of endovascular repair impacts long-term outcomes of uncomplicated acute type B aortic dissection
Percutaneous arteriovenous fistula creation with the 4F WavelinQ EndoAVF System.

JVS Journal Club Website

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Help us improve through our ALL NEW Listener Survey!

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Credits:

Guest: Peter Gloviczki
Authors: Soni Nag, Wen Kawaji
Editor: Adam Johnson
Reviewers: Chris Audu and Fanny Alie-Cusson

We are very excited to bring you the top papers from the Southern Association for Vascular Surgery 2022 Meeting in Manalapan, Florida. This episode features 4 different papers, discussed by the primary author(s) with commentary provided by Drs. Adam Beck (Secretary-Treasurer of SAVS) and Dr. Hernan Bazan (Program Chair). Index Atherectomy Peripheral Vascular Interventions Performed for Claudication are Associated with More Reinterventions than Non-Atherectomy Procedures

Discussed by: Dr. Qingwen (Wen) Kawaji and Dr. Caitlin Hicks, Johns Hopkins, Baltimore, MD
Authors: Qingwen Kawaji, Chen Dun, Christi Walsh, David P Stonko, Christopher Abularrage, James Black III, Bruce Perler, Martin Makary, Caitlin Hicks

Analysis of Wound Healing Time and Wound Free Period in Patients With Chronic Limb Threatening Ischemia Treated With and Without Revascularization

Discussed by: Dr. Katharine McGinigle, UNC Chapel Hill, NC
Authors: Katharine McGinigle, Smith Ngeve, Sydney Browder, Melissa Hammrick, Jacob E Wood, Federico Parodi, Luigi Pascareella, Mark Farber, William Marston

Neurologic Outcomes of Carotid and Other Emergent Interventions for Ischemic Stroke over Six Years with Analysis Enhanced by Machine Learning

Discussed by: Dr. P. Andrew Rivera, Ochsner Health, New Orleans, LA
Authors: P Andrew Rivera, Bethany Jennings, Jeffrey Burton, Aaron Hayson, Faith Mason, Jaron Pettis, Adam Berenson, Sam Money, Waldemar C Sternbergh III, Daniel Fort, Hernan A Bazan

Effect of Timing of TEVAR after Type B Aortic Dissection in the SVS VQI Post-approval Project for Dissection

Discussed by: Dr. Adam Beck, UAB, Birmingham AL
Authors: Adam W Beck, Grace Wang, Joseph Lombardi, Rodney White, Jack Cronenwett, John Kern, Richard P Cambria, Ali Azizzadeh

Follow us on Twitter @audiblebleeding

Dr. Amanda Fobare: @amandafobare
Dr. Adam Beck: @AWBeckMD
Dr. Hernan Bazan: @HernanBazanMD
Dr. Katherine McGinigle: @KateMcGinigleMD
Dr. Caitlin Hicks: @CaitlinWHicks
Dr. Wen Kawaji: @WenKawaji

In this month’s episode of our JVS Editor’s Choice series, Yasong and Wen discuss Journal of Vascular Surgery February’s Editor’s Choice articles with the Senior Editor, Dr. Peter Lawrence

Video Summary of the Articles

Articles Discussed:

Surgeon volume and established hospital perioperative mortality rate together predict for superior outcomes after open abdominal aortic aneurysm repair (CME and Editor's Choice Article)
Intraoperative blood pressure lability carries a higher risk of headache after carotid endarterectomy
Early outcomes of t-Branch off-the-shelf multibranched stent graft in urgent and emergent repair of thoracoabdominal aortic aneurysms
Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia

JVS Journal Club February 2022

JVs Journal Club Website

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Credits:

Guest: Peter Lawrence

Authors: Yasong Yu, Wen Kawaji

Editor: Yasong Yu

Reviewers: Eilidh Gunn

Travel/Research Scholarships for Medical Students

National Meetings:

Vascular and Endovascular Surgery Society (VESS) and Vascular Annual Meeting

Date: 6/15-18, 2022 in Boston

Hosting organizations: Society for Vascular Surgery (SVS), and VESS
Available scholarships for students

SVS General Surgery Resident/Medical Student Travel Scholarship
Includes: A financial award to be used toward the cost of travel expenses during the period of the Vascular Annual Meeting, Complimentary meeting registration. Opportunity to participate in a mock interview practice session
Application: Demographic information and Statement of interest in written or video form
Deadline: 3/9 4pm EST
Link

SVS Diversity Medical Student Travel Scholarship

Same deadline and process as above but for medical students who are part of minority group based on gender or ethnicity
Link

VESS Winter

Date: 2/23-26, 2023 in Whistler, Canada

Host: VESS

Available scholarships for students

2022 VESS Next Generation Student Mentor Program
To introduce medical students from around the country to the dynamic specialty of vascular surgery.
To embrace the students and make them feel part of the fellowship atmosphere of the VESS annual meeting.
To provide opportunities for meaningful interaction between the students and vascular surgery residents, fellows, and young faculty in attendance.
The VESS will provide each student in attendance a $1,500 scholarship to defray the cost of travel to the meeting.
Deadline: to be determined, but applications will open this summer
Link

VRIC (Vascular Research Initiative Conference)

Emphasizes the exchange of basic and translational vascular science

Date: 5/11/2022 in Seattle

Host: SVS

Available scholarships for students

Vascular Research Initiatives Conference Trainee Award
Award of 1,000 dollars for any trainee from pre-medical students all the way to fellows to present their research at VRIC conference
Top-scoring abstracts submitted to the VRIC by trainees will be considered for the award.
Deadline: past but should be recurrent
Link

The Venous Symposium (Virtual)

Date: 4/21-4/23

Abstract submission open until 3/24

Available scholarship for students

Venous Symposium Physician-in-Training Scholarship
Tuition for the 2022 Venous Symposium Virtual on Thursday, April 21 – to Saturday, April 23, 2022
On-demand access to the educational program and exhibit hall for an entire year
Course materials and access to presentations online
Deadline: no specific deadline, but reviewed regularly
Link

VENOUS2022:

Date: 2/23-26 in Orlando

Hosting Organization: American Venous Forum (AVF)

SCVS 49th Annual symposium

Date: 3/19-23 in Las Vegas

Host: Society of Clinical Vascular Surgery (SCVS)

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SVS Foundation Student Research Fellowship

Aimed to stimulate laboratory and clinical vascular research by undergraduate college students and medical school students registered at universities in the United States and Canada.

Includes: a $3,000 award and a two-year complimentary subscription to the Journal of Vascular Surgery.
Application:
Needs SVS member as sponsor, and a letter of support from the sponsor
Have a research plan and fill out a research plan instruction and form (Download here)
Submit NIH style Biosketch and CV for both the student and sponsoring member
Deadline: February 14, 2022
Link

Resources

Getting Started Using the VQI for Research

Getting Started with Basic Science Research

Calling all medical students

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year

Who you want to address the question to (resident, fellow, attending, or someone specific)

Send them in writing, or in voice recorded format.

Send them to HoldingPressure.AudibleBleeding@gmail.com. Also send us any ideas, suggestions, or comments.

Please share your feedback through our Listener Survey!

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this month’s episode of our JVS Editor’s Choice series, Ryan discusses Journal of Vascular Surgery December’s Editor’s Choice articles with the Editor-in-Chief of the JVS, Dr. Peter Gloviczki.

Video Summary of the Articles

Articles Discussed:

The Influence of Socioeconomic Status on Outcomes of Lower Extremity Arterial Reconstruction (CME and Editor’s Choice Article)
A more proximal landing zone is preferred for thoracic endovascular repair of acute type B aortic dissections
Outcomes of intramural hematoma involvingÂ the ascending aorta and extending into the descending thoracic aorta
The Natural History of Large Abdominal Aortic Aneurysms in Patients without Timely Repair

JVS Journal Club January

JVs Journal Club Website

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Help us improve through our ALL NEW Listener Survey!

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Credits:

Guest: Peter Gloviczki
Authors: Ryan Meyer, Andrew Lazar
Editor: Yasong Yu
Reviewers: Yasong Yu

In this month’s episode of our JVS Editor’s Choice series, Yasong and Gowri discuss January’s Editor’s Choice articles in the Journal of Vascular Surgery Venous and Lymphatic issue with the Senior Editor, Dr. Peter Lawrence

Dr. Lawrence’s Video Summary of the Articles

Articles Discussed:

Iliac Vein Stenting is Safe When Performed in an Office Based Lab Setting (CME Article of the Month)
A randomized controlled trial to evaluate the safety and efficacy of transluminal injection of foam sclerotherapy compared to ultrasound-guided foam sclerotherapy during endovenous catheter ablation in patients with varicose veins
The clinical significance of ultra-high D-dimer levels
The economic impact of infection requiring hospitalization on venous leg ulcers

If you enjoy our content, please Support Audible Bleeding!

Help us improve through our ALL NEW Listener Survey!

Follow us on Twitter: @AudibleBleeding

Credits:

Guest: Dr. Peter Lawrence
Authors: Yasong Yu, Gowri Gowda
Editor: Yasong Yu
Reviewers: Eilidh Gunn

Vascular Origin Stories is a podcast series that explores the fun and engaging stories that shaped vascular surgery.

In today’s episode, we will explore the different materials used to try and repair and bridge aortic gaps. We’ll see attempts to treat aortic aneurysms with ligation, banding, and occlusion. How Albert Einstein’s abdominal aortic aneurysm was treated with cutting edge 1940s technology: cellophane. And how a young surgical research fellow, a stray suture, perseverance, and fast sewing machine skills ushered in the modern era of fabric grafts.

For images and references, check our website here.

Host:

Marlene (@GarciaNeuer ) is a 4th-year medical student at THE Ohio State College of Medicine.

Please share your feedback through our Listener Survey!

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Credits:

Author: Marlene Garcia-Neuer

Editor: Yasong Yu

Reviewers: Adam Johnson and Sharif Ellozy

Music from Kinemesis_Music , ArtSlop Flodur, Brolefilmer, Nesrality, JuliusH from Pixabay

In today’s episode, Dr. Alaska Pendleton and Dr. Anahita Dua discuss vascular lab pearls for your VSITE exam and the RPVI.

Dr. Alaska Pendleton is a third year resident in the Integrated Vascular Surgery Residency at the Massachusetts General Hospital completing her second year of research. Dr. Anahita Dua is an Assistant Professor at Harvard Medical School and a vascular surgeon at the Massachusetts General Hospital. She is also director of the Vascular Laboratory and co-director of the Peripheral Arterial Disease Center there.

Episode created by Alaska Pendleton MD and Anahita Dua MD.

Edited by Matthew Smith MD PhD

Reviewed by Sharif Ellozy MD

If you enjoy our content, please contribute to Support Audible Bleeding!

Help us improve through our Listener Survey!

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In this month’s episode of our JVS Editor’s Choice series, Yasong and Ryan discuss Journal of Vascular Surgery December’s Editor’s Choice articles with the Senior Editor of the JVS, Dr. Peter Lawrence.

Dr. Lawrence’s Video Summary of the Articles

Articles Discussed:

Cost-Effectiveness of TransCarotid Artery Revascularization versus Carotid Endarterectomy (Editor’s Choice Article)
Predictors of Clinical Outcome of Fenestrated and Branched Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms in an Italian Multicenter Registry
Claudicating Patients with Peripheral Artery Disease have Meaningful Improvement in Walking Speed after Supervised Exercise Therapy (CME Article of the Month)
Outcomes of Bypass and Endovascular Interventions for Advanced Femoropopliteal Disease in Patients with Premature Peripheral Artery Disease

JVS Journal Club December

JVs Journal Club Website

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Credits:

- Guest: Peter Lawrence
- Authors: Ryan Meyer, Yasong Yu
- Editor: Yasong Yu
- Reviewers: Eilidh Gunn, Andrew Lazar

Join live for the next SVS HITC webinar on Surgeon innovator: Startups, Entrepreneurship and Venture Capital on Dec 15, 2021 at 6PM EST where 5 entrepreneurs, who have developed medical products and received funding, will share the process of developing a company and the different types of funding.

Register and join us on Dec. 15: https://bit.ly/31AZ0Mp

Today’s episode is a recording of the SVS Healthcare Information Technology Committee (HITC) Webinar, Artificial Intelligence in Vascular Surgery originally held on Thursday, July 22, 2021. The SVS HITC has invited a number of speakers to explore ways you should be using AI in your practice today and get a glimpse of what will be coming around the corner.

Speakers

"Brief Overview of AI in Vascular Surgery" - Sharon Kiang, MD (@Sharon_Kiang_MD), Associate Professor of Surgery, Loma Linda University
"Current Application of AI Technology in Vascular Surgery" - David Kuraguntla, DO, Founder and CEO of Alio (@WeAreAlio)
"Machine Learning and Policy" - Paula Shireman, MD, MBA, Professor of Surgery, University of Texas Health Science Center at San Antonio
"Future of AI in Vascular Surgery" - Alan Lumsden, MD (@AlanLumsdenMD) Chair of Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center

Moderators

Uwe Fischer, MD - Assistant Prof. of Surgery, Vascular Division, Yale School of Medicine
Judith Lin, MD - (@Judithlin4) Chair of SVS HITC and Professor of Surgery, Chief of Vascular Surgery, Michigan State University

References

Fischer UM, Shireman P, and Lin J. Current applications of artificial intelligence in vascular surgery. Seminars in Vascular Surgery. Available online Oct 27, 2021.

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Credits:

Author: SVS HITC
Editor: Adam Johnson

Mr. Mohamed Barkat and Mr. Nick Greaves discuss what trainees should know about the evaluation and management of thoracoabdominal aneurysms with Mr. Michael Jenkins.

Mr. Michael Jenkins MD FRCS qualified in 1989 and trained in surgery at Charing Cross, University College London, the Royal Brompton, and Royal Free hospitals and was awarded the Gold medal at FRCS. He was appointed as a consultant vascular surgeon at St Mary’s Hospital, Imperial College Healthcare NHS Trust, and Chelsea and Westminster hospitals in 2001. Mr. Jenkins was the Director of AAA screening in Northwest London from 2011-2018. He is currently President of the Vascular Society of Great Britain and Ireland and was chair of the Circulation Foundation 2016-18 and a past President of the British Society of Endovascular Therapy. He was the Director of the Major Trauma Centre at St Mary’s Hospital, 2010-16

He developed both a local and a national tertiary referral practice for thoracoabdominal aortic aneurysm and dissection.

Resources

Crawford Classification
ESVS recommendation of management of Thoracic aortic pathologies
Open Repair of Thoracoabdominal Aortic Aneurysm: Step-by-Step
https://www.circulationfoundation.org.uk
https://www.bset.co.uk/
https://www.vascularsociety.org.uk/
Yale Vascular Review Podcast Episode 1: Thoracoabdominal Aneurysms

Host Introductions

Mr. Mohamed Barkat (@mo_barkat) is a vascular trainee in the Northwest of England and is the Vascular Society Affiliate representative for the Rouleaux Club
Mr. Nick Greaves is a consultant Vascular Surgeon at Manchester Royal Infirmary with a specialist interest in open aortic surgery.

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Credits:

Authors: Rachael Forsythe, Mohamed Barkat
Editors: Sharif Ellozy, Leanna Erete

Andrew Nickinson and Aminder Singh discuss what vascular trainees should know about venous disease with Mr. Manj Gohel. This podcast is aimed at preparing UK vascular trainees for the Fellowship of Royal College (FRCS) vascular examination but should apply to any vascular surgery exams.

Mr. Manj Gohel MD FRCS FEBVS (@ManjGohel) is a consultant vascular and endovascular surgeon at Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. He is also an Honorary Senior Lecturer at Imperial College, London, and the honorary secretary of the Royal Society of Medicine’s Venous Forum.

Mr. Gohel has a specialist interest in venous disease and has been actively involved in venous research for over 15 years, speaking regularly at national and international conferences. He spearheaded the landmark EVRA and ESCHAR trials and has recently co-chaired the European Society of Vascular Surgery Venous Thrombosis Guidelines.

Hosts:

Mr. Andrew Nickinson (@AndrewNickinson)is a vascular specialty trainee in the Wessex Deanery and the SAC representative for the Rouleaux Club.
Mr. Aminder Singh (@AminderASingh)is an NIHR Academic Clinical Fellow in Vascular Surgery at the University of Cambridge, a Vascular trainee in East of England and European/Venous representative for the Rouleaux Club.

Selected papers:

Gohel et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial BMJ 2007; 335(7618)
Gohel et al; EVRA Trial Investigators. A Randomized Trial of Early Endovenous Ablation in Venous Ulceration. NEJM. 2018; 378(22):2105-2114.
Kakkos et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. EJVES. 2021 Jan;61(1):9-82.
Vedantham et al. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. NEJM. 2017;377(23):2240-2252.
Brittenden et al. A randomized trial comparing treatments for varicose veins. NEJM. 2014;371(13):1218-27.

Please share your feedback through our Listener Survey!

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Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Credits:

Authors: Andrew Nickinson, Aminder Singh
Editor: Leanna Erete
Reviewers: Adam Johnson, Rachael Forsythe

In this month’s episode of our JVS Editor’s Choice series, Yasong and Andrew discuss November’s Editor’s Choice articles in the Journal of Vascular Surgery Venous and Lymphatic issue with the Editor in Chief, Dr. Peter Gloviczki.

Dr. Gloviczki’s Video Summary of the Articles

Articles Discussed:

Early thrombosis after iliac stenting for venous outflow occlusion is related to disease severity and type of anticoagulation (Editors Choice and CME Article of the Month)
Catheter-based interventions versus medical and surgical approaches in acute pulmonary embolism
Stratification of pelvic venous reflux in patients with pelvic varicose veins
Utility of the 50% stenosis criterion for patients undergoing stenting for chronic iliofemoral venous obstruction

Other discussed articles:

The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders
Shaking Our Foundations

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Help us improve through our ALL NEW Listener Survey!

Follow us on Twitter: @AudibleBleeding

Credits:

Guest: Dr. Peter Gloviczki
Authors: Yasong Yu, Imani McElroy
Editor: Yasong Yu
Reviewers: Eilidh Gunn, Andrew Lazar

In the second episode of our medical student series, Holding Pressure, Marlene and Megan sit down with Kirthi, Paulina, and Alexandra to discuss some of their advice on interviewing for residency. They also revisited excerpts from an episode published December 2020 titled “Advice for Applicants to the Integrated Vascular Surgery Residency,” where Dr. Chelsea Dorsey from University of Chicago, Dr. Murray Shames from University of South Florida, and Dr Arash Fereydooni, who was a PGY1 at Stanford integrated vascular program at the time, gave us their take on the entire application process (Link to full episode below).

Guests:

Kirthi Bellamkonda (@kirthisb) is a PGY-1 at the Vascular Surgery Integrated Residency Program at Dartmouth-Hitchcock Medical center. She graduated from Yale School of Medicine, and also holds a bachelor’s degree from University of Illinois at Chicago, as well as a masters degree from University of Oxford.

Paulina Villanueva is a PGY-1 at the Vascular Surgery Integrated Residency Program at THE Ohio State University Hospital Wexner Medical Center. She graduated from Charles Drew/UCLA School of Medicine, and also holds a bachelor’s degree in Neuroscience from UCLA, as well as a masters degree from California State Polytechnic University in Biological Sciences.

Alexandra Gobble is a PGY-2 at the Vascular Surgery Integrated Residency Program at THE Ohio State University Hospital Wexner Medical Center. She graduated from University of Washington School of Medicine, and also holds a bachelor’s degree in Material and Biomaterials Engineering from the New Mexico Institute of Mining and Technology .

Related Contents

Advice for Applicants to the Integrated Vascular Surgery Residency - complete episode from which sound clips were extracted

So You’ve Matched into Vascular...Now What (Part 1) - featuring Kirthi as a medical student

“It’s Time to End the Interview” - Dr. Malachi Sheahan’s take on the modern interview process for surgical trainees

More Medical Student Content

Hosts:

Marlene Garcia-Neuer (@GarciaNeuer) is a MS4 at THE Ohio State University College of Medicine.

Megan Tenet (@megantenet) is a MS4 at Georgetown University School of Medicine

Calling all medical students!

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year
Who you want to address the question to (resident, fellow, attending, or someone specific)
Send them in writing, or in voice recorded format.

Send them to HoldingPressure.AudibleBleeding@gmail.com. Also send us any ideas, suggestions, or comments.

Please share your feedback through our Listener Survey!

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Credits:

Authors: Yasong Yu, Marlene Garcia-Neuer, Megan Tenet

Editor: Yasong Yu

Reviewers: Christopher Audu, Amanda Fobare

In this month’s episode of our JVS Editor’s Choice series, Yasong, Andrew, and Ajay discuss Journal of Vascular Surgery November’s Editor’s Choice articles with the Editor in Chief of the JVS, Dr. Peter Gloviczki.

Dr. Gloviczki’s Video Summary of the Articles

Articles Discussed:

Intraoperative consultation of vascular surgeons is increasing at a major American trauma center
Effects of supervised exercise therapy on blood pressure and heart rate during exercise, and associations with improved walking performance in peripheral artery disease: Results of a randomized clinical trial
Preoperative risk score accuracy confirmed in a modern ruptured abdominal aortic aneurysm experience (CME Article of the Month)
Evaluation of the Gore TAG thoracic branch endoprosthesis in the treatment of proximal descending thoracic aortic aneurysms

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Credits:

Guest: Peter Gloviczki
Authors: Andrew Lazar, Ajay Menon
Editor: Yasong Yu
Reviewers: Eilidh Gunn, Ryan Meyer

In today's episode, Adham Elmously and Matt Spreadbury discuss diagnosis and management of type B aortic dissections with Drs Einar Brevik and Joseph Lombardi.

An outline can be found on our website

References

Lombardi et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020 Jan;71(3): P723-747
Lombardi JV et al. STABLE II Investigators. STABLE II clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design. J Vasc Surg. 2020 Apr;71(4):1077-1087.

Authors:

Dr. Adham Elmously (@elmouslyMD) is a second-year vascular surgery fellow at the New York-Presbyterian Cornell/Columbia Program in New York, NY.
Dr. Matthew Spredbury (@mattspreadbury) is a second-year vascular surgery resident at Haukeland University Hospital in Bergen, Norway.

Guests:

Dr. Joseph Lombardi (@VascSurgMD) is the Professor and Chief of Vascular Surgery at Cooper University Hospital in Camden, New Jersey, and the PI on the STABLE I and STABLE II trials.
Dr. Einar Brevik (LinkedIn) is a consultant vascular surgeon and the previous president of the Norwegian Society of Vascular Surgery.

Editor: Matt Smith

Reviewers: Adam Johnson and Matt Chia

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Vascular Surgery Origins is a podcast series that explores the fun and engaging stories that shaped vascular surgery.

In today’s episode we will explore the search for the ‘spark of life’ to reanimate man, and how it inspired innovative arterial anastomosis techniques and frankensteinian operations. Specifically, I’ll talk about our understanding of circulation from Greeks and Galen to our modern knowledge brought to us by William Harvey, as well as other electrifying attempts at reanimation. Hear how Robert Abbe proved vascular circulation was critical for limb-replantation and how his friendship with a novelist inspired the future father of vascular surgery Alexis Carrel. Finally, I will explore how Drs. Carrel and Guthrie mastered arterial- anastomosis and opened the floodgates to major arterial repair, limb-replantation and organ transplantation, even if some of their experiments seem a little frankensteinian.

Host: Marlene (@GarciaNeuer ) is a 4th year medical student at THE Ohio State College of Medicine.

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Credits:

Author: Marlene Garcia-Neuer

Editor: Yasong Yu

Reviewers: Sharif Ellozy and Adam Johnson

We are excited to introduce the first episode of our new series, Vascular Surgery History. This podcast series will explore the fun and engaging stories that shaped vascular surgery.

Today’s episode will focus on early vascular surgeons, including Dr. Robert Liston, John Hunter, Lambert Hallowell, and Astley Cooper and their success and failures.

Sources and further reading:

[1] A History of Vascular Surgery. Steven G Friedman. Blackwell Publishing. 2005

[2] The Greatest Benefit to Mankind. A Medical History of Humanity. Roy Porter. Norton and Company 1997.

[3] Time me, gentlemen! The Bravado and Bravery of Robert Liston. Adrew J Jones, Robert

Nesbit Jr, Steven Holsten. American College of Surgeons, Poster Competition 2016 CC201

Host: Marlene (@GarciaNeuer ) is a 4th year medical student at THE Ohio State College of Medicine.

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Credits:

Author: Marlene Garcia-Neuer

Editor: Yasong Yu

Reviewers: Sharif Ellozy

Dr. Gregorio Sicard is Professor Emeritus of Surgery and Emeritus Chief of Vascular Surgery at Washington University School of Medicine in St. Louis. He trained in general surgery at the Barnes Hospital, Washington University School of Medicine, and completed the first Transplantation Fellowship there. He eventually became the Chief of Vascular Surgery and Chief of General Surgery at Washington Hospital. He founded the Vascular surgery fellowship there in 1983. He is a former President of the Society of Vascular Surgery, and recipient of the 2018 Society for Vascular Surgery Lifetime Achievement Award. He was a pioneer in the retroperitoneal approach to the aorta, and is regarded as a master aortic surgeon by his peers. He has a legacy of trainees who have gone on to assume leadership roles in Vascular Surgery.

Dr. Frank Caputo is an Associate Professor of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He is also the Vascular Surgery Director of the Aorta Center, Program Director of the Vascular Surgery Training Programs. His clinical interests include complex open and endovascular repair of thoracic, thoracoabdominal and abdominal aortic aneurysms, management of thoracic dissection, endovascular and open repair of failed endografts. Dr. Caputo earned his medical degree from the University of Medicine and Dentistry New Jersey, Newark, NJ, where he also served his surgical residency and two years as a National Institutes of Health research fellow. He completed his fellowship in vascular surgery at Barnes-Jewish Hospital of Washington University, St. Louis, Mo. where he served as administrative fellow. He joined the Cleveland Clinic medical staff in 2018.

Sicard, Gregorio A, Jeffrey M Reilly, Brian G Rubin, Robert W Thompson, Brent T Allen, M.Wayne Flye, Kenneth B Schechtman, Patricia Young-Beyer, Carey Weiss, and Charles B Anderson. "Transabdominal versus Retroperitoneal Incision for Abdominal Aortic Surgery: Report of a Prospective Randomized Trial." Journal of Vascular Surgery 21.2 (1995): 174-83.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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In this episode of our monthly JVS series, Farooq, Ajay, and Yasong discuss the latest Editor’s Choice articles with the Senior Editor, Dr. Peter Lawrence

Trends in the Use of Cerebrospinal Drains and Outcomes Related to Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair and Complex Endovascular Aortic Repair in the Vascular Quality Initiative Database (Editor’s Choice Article)
Late Outcomes After Endovascular and Open Repair of Large Abdominal Aortic Aneurysms (CME Article of the Month)
Evaluation of Revascularization Benefit Quartiles using the Wound, Ischemia, and Foot Infection Classification System for Diabetic Patients with Chronic Limb-Threatening Ischemia
Revascularization for Asymptomatic Carotid Artery Stenosis Improves Balance and Mobility

Video Summary of Papers Above

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Credits:

Guest: Dr. Peter Lawrence
Authors: Farooq Usmani, Ajay Menon
Reviewers: Jacob Schwartzman, Andrew Lazar
Editor: Yasong Yu

Welcome back to our series on Landmark Papers in Vascular Surgery. In this episode, Jacob, Amanda, and Matt sit down with Dr. William Jordan to discuss arguably one of the most landmark papers in the field, the NASCET trial.

Dr. Jordan is the John E. Skandalakis Chair of Surgery, and Professor and Chief of the Division of Vascular Surgery and Endovascular Therapy at the Emory University School of Medicine in Atlanta, Georgia. He completed his medical degree at Emory, followed by a general surgery residency at the University of Alabama at Birmingham and a vascular surgery fellowship at Emory. He serves on the editorial board of the JVS family of publications and for several other journals. He is the immediate past president of the Society of Clinical Vascular Surgery, and among many contributions to research in vascular surgery in general, he has published extensively on the treatment of carotid disease. Dr. Jordan, thanks for your leadership of the specialty, and for joining us to discuss NASCET.

The NASCET Trial is the “North American Symptomatic Carotid Endarterectomy Trial,” originally published in the New England Journal of Medicine in 1991. Below are links to the original manuscript as well as several additional related publications:

Original Manuscript
Trial Methodology
Long-Term Followup and 50-69% Stenosis Data

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We are excited to be introducing the first episode of our new series, Holding Pressure. The contents are geared towards medical students to introduce them to the field of vascular surgery. In this episode, we have a group of distinguished medical students who are leaders or founders of Vascular Surgery Interest Group at their respective medical schools to talk about their experiences.

Guests:

Tara Zielke (@ZielkeTara) is a 3rd year medical student and the president of VSIG at Loyola University School of Medicine

Dominique Dockery (@domdoc_) is a 3rd year medical student and the president and founder of VSIG at the Warren Alpert Medical School of Brown University

Ali Hakimi is a 3rd year medical student and the co-president of VSIG and MS3 at University of Colorado School of Medicine

Brian Leoce (@leocebm) is a 3rd year medical student and the president and founder of VSIG at Rutgers New Jersey Medical School.

Hosts:

Yasong (@YasongYuMD) is a 4th year general surgery resident at Rutgers New Jersey Medical School. He completed his medical degree at SUNY Downstate College of Medicine.

Imani (@iemcelroy) is a 5th-year general surgery resident at the Massachusetts General Hospital. She completed her medical degree at the Charles R. Drew/UCLA Medical Education Program and also holds a Master’s in Public Health from the Harvard T.H. Chan School of Public Health.

Resources

SVS VSIG Website, including access to VSIG Toolkit

SVS Develop My Training Career

Calling all medical students

Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.

Include the following

Your name, school, and year
Who you want to address the question to (resident, fellow, attending, or someone specific)
Send them in writing, or in voice recorded format.

Send them to HoldingPressure.AudibleBleeding@gmail.com. Also send us any ideas, suggestions, or comments.

Imani’s episodes on Race and Representation in Medicine

The Historical Relationship Between Black America, Medicine, and Research: Deconstructing Barriers and Optimizing Care

One Year Later - Moving Forward with Intentionality in Efforts to Combat Systemic Racism in Healthcare

Matt’s Interview with Dr. Aulivola and others at VAM21

#VAM21 Highlight, Part 4 - Jason Lee and VESS, Bernadette Aulivola and Cassius Ochoa Chaar on Outreach & Max Wohlauer on Occupational Hazard in Vascular Surgery

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Credits:

Authors: Yasong Yu, Imani McElroy

Editor: Yasong Yu

Reviewers: Sharif Ellozy, Matthew Chia

In this installment of the Race and Representation Series, we discuss how to implement effective change to combat systemic racism within healthcare at national, regional, and local levels. Our guests, Dr. Albert Sam and Dr. Bryan Fisher describe their practices and how they have been champions of healthcare equity within both the private and academic settings.

Show Guests:

Dr. Albert Sam is a specialty care physician board-certified in vascular and endovascular surgery. Prior to joining Inova he was in private practice in Middletown, CT, and was the founder and director of the Middlesex Health multidisciplinary limb preservation program. He previously served as the Chief of Vascular Surgery at Baton Rouge General Hospital as well as at the Tulane Heart & Vascular Institute in New Orleans. In addition to becoming one of the first physicians nationally to be board certified in general surgery, vascular surgery, and endovascular medicine, he has served as a principal investigator for numerous national and international vascular clinical trials, including the NIH stroke trials CREST and CREST-2.

Dr. Bryan Fisher, Sr. (@amputationsuck) is a board-certified vascular surgeon and a member of The Surgical Clinic in Nashville, TN. He completed his general surgery residency at the Ohio State University and his vascular fellowship at Vanderbilt University. He serves as the Chief of Vascular Surgery, Director of Wound Care, and co-Director of the Center for Limb Preservation.

PAD Task Force Call to Action
National Minority Quality Forum

Host Introductions:

Dr. Imani E. McElroy (@iemcelroy) is a 5th-year general surgery resident at the Massachusetts General Hospital. She completed her medical degree at the Charles R. Drew/UCLA Medical Education Program and also holds a Master’s in Public Health from the Harvard T.H. Chan School of Public Health.

Dr. Andrew Gonzalez (@DrAGonzMD) is an attending physician at Indiana University. He received his medical degree, Master’s of Public Health, and an undergraduate degree from the University of Illinois at Chicago and his Juris Doctorate from the John Marshall Law School.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

Follow us on Twitter @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

VAM21 Highlight, Part 4 - Jason Lee and VESS, Bernadette Aulivola and Cassius Ochoa Chaar on Outreach, and Max Wohlauer on Occupational Hazard in Vascular Surgery

Directly from the Vascular Annual Meeting in 2021 in San Diego, here’s a taste of some of the great things that are happening at this year’s VAM. Hear perspectives from some first-time VAM attendees, as well as speakers, moderators, and other leaders in the field.

In this episode, we hear three different interviews with four different guests. We covered the Vascular and Endovascular Surgical Society with Dr. Jason Lee, Resident and Student Programming with Dr. Bernadette Aulivola and Dr. Cassius Ochoa Chaar, and occupational hazards for vascular surgeons with Dr. Max Wohlauer. Stay tuned for followup episodes on these and other topics from VAM!

Show Guests:

Dr. Jason Lee is the President of the Vascular and Endovascular Surgical Society, in addition to being the chief of vascular surgery for Stanford Medicine. He has held multiple leadership roles within many professional societies, having completed his medical degree at the University of California San Diego, general surgery residency at the Harbor-UCLA Medical Center, and vascular surgery fellowship at Stanford.
- Join the VESS (@VESurgery): https://vesurgery.org/my-vess/why-join-vess/
- VESS Annual Winter Meeting: https://vesurgery.org/meetings/winter/
- VESS Virtual Residency Fair: https://vesurgery.org/virtual-residency-fair/
Dr. Bernadette Aulivola (@BAulivolaMD) is the chief of vascular surgery at Loyola University in Chicago, Illinois, and chaired the resident and student outreach committee for VAM21. She completed her medical degree at the Washington University School of Medicine, general surgery residency at Rush University Medical Center and Cook County Hospital in Chicago, and vascular surgery fellowship at the Beth Israel Deaconess Medical Center.
Dr. Cassius Ochoa Chaar is an associate professor of vascular surgery at the Yale School of Medicine in New Haven, Connecticut, and was vice chair of the resident and student outreach committee for VAM21. He completed his medical degree and master’s of science at the American University of Beirut, followed by general surgery residency at Yale, and vascular surgery fellowship at the University of Pittsburgh Medical Center.
- Join the SVS as a Medical Student: https://vascular.org/about/membership/medical-student
- Join the SVS as a General Surgery Resident: https://vascular.org/membership/candidate/general-surgery-resident
- Find a mentor in the SVS Mentor Match Program: https://vascular.org/career-tools-training/develop-my-training-career/mentor-match-program
Dr. Max Wohlauer (@doctormaxw) is an assistant professor at the University of Colorado School of Medicine, as well as an associate program director of their residency and fellowship. He founded the Vascular Surgery COVID-19 Collaborative (VASCC, https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/vascular/research/vascc/vascc). He obtained his medical degree from the Albany Medical College and completed general surgery residency at the University of Colorado followed by vascular surgery fellowship at the Cleveland Clinic.
- Audible Bleeding with Dr. Samuel Money on Ergonomics in Surgery: https://www.audiblebleeding.com/money-ergonomics/
- Physical discomfort, professional satisfaction, and burnout in vascular surgeons: https://doi.org/10.1016/j.jvs.2018.11.026
- Physical pain and musculoskeletal discomfort in vascular surgeons: https://doi.org/10.1016/j.jvs.2020.07.097
- Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force: https://doi.org/10.1016/j.jvs.2020.10.065

Host Introductions:

Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research from Northwestern.

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In this month’s episode of our JVS - VL Editor’s Choice series, Jacob, Andrew, and Ryan discuss September’s selected articles with Senior Editor of the JVS, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

A comparison of cyanoacrylate glue and radiofrequency ablation techniques in the treatment of superficial venous reflux in CEAP 6 patients (CME and Editor’s Choice)
Endovenous laser ablation of incompetent great saphenous veins with 1470-nm laser using bare tip and radial fibers results in similar short-term outcomes
Pelvic venous insufficiency secondary to iliac vein stenosis and ovarian vein reflux treated with iliac vein stenting alone
Clinical outcomes of venous self-expanding stent placement for iliofemoral venous outflow obstruction

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Credits:

Guest: Dr. Peter Lawrence
Authors: Andrew Lazar, Ryan Meyer
Reviewer: Imani McElroy
Editor: Jacob Schwartzman

In this episode of our monthly JVS series, Jacob, Philip, and Yasong discuss the latest Editor’s Choice articles with Editor-in-Chief, Dr. Peter Gloviczki.

Popliteal scoring assessment for vascular extremity injuries in trauma study (CME and Editor’s Choice)
A population-based study of post-endovascular aortic repair rupture during 15 years
Long-term safety and efficacy of angioplasty of femoropopliteal artery disease with drug-coated balloons from the AcoArt I trial
A health insurance claims analysis on the effect of female sex on long-term outcomes after peripheral endovascular interventions for symptomatic peripheral arterial occlusive disease

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Credits:

Guest: Dr. Peter Gloviczki
Authors: Philip Lettieri, Yasong Yu
Reviewers: Eilidh Gunn, Shivik Patel
Editor: Jacob Schwartzman

Directly from the Vascular Annual Meeting in 2021 in San Diego, here’s a taste of some of the great things that are happening at this year’s VAM. Hear perspectives from some first-time VAM attendees, as well as speakers, moderators, and other leaders in the field.

In this episode, we hear from Dr. Carlos Bechara and Dr. William Shutze on the new SVS Surgical Coaching Program. We discuss the basics of the program and get a first hand look at what a coach and mentee interaction will look like as Dr. Bechara provides Dr. Shutze with his perspective and advice on a common non-clinical problem.

Show Guests:

Dr. Carlos Bechara (@cfbechara) is a professor of Vascular Surgery and Endovascular Therapy at Loyola University Medical Center in Chicago, Ill. He is also the Co-Medical Director of Vascular Surgery and the Program Director of the Vascular Surgery Fellowship. Dr. Bechara has a focus on aortic disease and is part of the first cohort of surgical coaches. He completed medical school at American University of the Caribbean, general surgery residency at Tulane and Baylor University and vascular fellowship at Baylor University.
Dr. William P. Shutze is a vascular surgeon with Texas Vascular Associates in Plano, Tx. He has served numerous roles for the Society of Vascular Surgery and the Southern Vascular Outcomes Network. He is past president of the Texas Vascular and Endovascular Society and will be the chair of the 2021-2022 SVS Clinical Practice Council. He went to medical school at the Baylor College of Medicine, general surgery residency at the University of Alabama Birmingham, and vascular surgeryfellowship at Baylor University.

SVS Surgical Coaching for Vascular Surgeons: https://surgicalcoaching.org/svs/

Email: info@surgicalcoaching.org
Phone: (608) 301-5156
Surgical Coaches are SVS members and practicing vascular surgeons. The program is open to all active SVS members in good standing.

Host Introductions:

Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research from Northwestern.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Directly from the Vascular Annual Meeting in 2021 in San Diego, here’s a taste of some of the great things that are happening at this year’s VAM. Hear perspectives from some first-time VAM attendees, as well as speakers, moderators, and other leaders in the field.

In this episode, we hear from Dr. Alan Dardik on the brand-new JVS: Vascular Science journal, which is the latest addition to the JVS family of publications. We discuss the frontiers of vascular physiology, the scope of basic science beyond the wet lab, and his favorite articles from the journal to date.

Show Guests:

Dr. Alan Dardik (@adardik) is a surgeon-scientist, and a professor of Surgery (Vascular) and of Cellular and Molecular Physiology at the Yale School of Medicine. He leads the NIH-funded and VA-funded Dardik lab to study the healing and function of blood vessels and blood vessel substitutes used to treat patients with vascular disease, and is the editor of the JVS: Vascular Science journal. He completed his MD/PhD, general surgery residency, and vascular surgery fellowship all at the Johns Hopkins University.

Relevant Resources:

JVS: Vascular Science: https://jvsvs.org/
- Inaugural issue cover article: https://doi.org/10.1016/j.jvssci.2020.09.004
- JVS: VS May 2021 webinar: https://www.youtube.com/watch?v=xaByfdcOxRU
Dardik Lab webpage: https://medicine.yale.edu/lab/dardik/
- Cyclosporine and AVF article: https://doi.org/10.1161/ATVBAHA.120.315875
Vascular Research Initiatives Conference (VRIC): https://vascular.org/meetings/vascular-research-initiatives-conference-vric
Previous Audible Bleeding Basic Science Episode: https://www.audiblebleeding.com/getting-started-in-basic-science/

Host Introductions:

Dr. Chris Audu (@ChrisAuduMD) is in his 5th year of training in the integrated vascular surgery residency at the University of Michigan. His research studies the role of chromatin modifying enzymes on wound healing pathways as well as learning the details of high throughput experimentation in discovering novel acid-amine organic reactions for vascular-focused, medicinal chemistry. He is currently F32 funded and was recently awarded the 2020 VESS Resident Research Award.
Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research at Northwestern.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Directly from the Vascular Annual Meeting in 2021 in San Diego, here’s a taste of some of the great things that are happening at this year’s VAM. Hear perspectives from some first-time VAM attendees, as well as speakers, moderators, and other leaders in the field. In this episode, we hear from Dr. Donald Baril, who moderated one of the most popular Wednesday afternoon sessions titled “Positioning Vascular Surgeons for Success as Community Leaders in Vascular Disease.” We also hear from the chair of the SVS Public and Professional Outreach (PPO) committee, Dr. Benjamin Pearce. We talk about the re-launch of the SVS Branding Toolkit, complete with a contest to win a years’ worth of SVS membership dues!

Show Guests:

Dr. Donald Baril (@DonaldBaril) is an associate professor of surgery at the Cedars-Sinai Medical Center in Los Angeles, California. He completed medical school at the Ohio State University, general surgery residency at the Mount Sinai school of medicine, and vascular surgery fellowship at the University of Pittsburgh.
Dr. Benjamin Pearce (@hawkeyebjp) is the William D. Jordan, Jr. Endowed Professor in Vascular Surgery and Endovascular Therapy at the University of Alabama in Birmingham. He completed medical school at the University of Texas, general surgery residency at the University of Chicago, and vascular surgery fellowship at the University of Alabama in Birmingham. He is the director of both their integrated residency and traditional fellowship.

Relevant Resources:

SVS Valuation Resources: https://vascular.org/career-tools-training/branding-valuation/valuation
- Sg2 Report on the Value of Vascular Surgery: https://vascular.org/sites/default/files/SVS_value_vascular_surgery_CS_v1.2.pdf
- Report from the SVS Vascular Surgery Valuation Work Group: https://doi.org/10.1016/j.jvs.2020.05.056
SVS Branding Toolkit Contest:
- Login to the SVS Branding toolkit (https://vascular.org/career-tools-training/branding-valuation) to customize a flier for your practice and download it. Email your customized file to communications@vascularsociety.org to be entered in a drawing for free membership dues for 2022!
- Use the materials in the toolkit to promote the vascular specialty and your practice.
- Complete the questionnaire (https://www.surveymonkey.com/r/SVSBrandingContest) for a chance to win free registration to VAM 2022 or a $250 social media campaign in your local area run by SVS staff (your choice!). Prizes will be given for the most creative use of the branding toolkit and most effective use of the branding toolkit.

Host Introductions:

Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research at Northwestern.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Matt Chia, Chris Audu, and Elizabeth Andraska sit down with Drs. Kevin Southerland, Karen Ho, and Andrea Obi for a panel discussion introducing basic science in vascular surgery and some tips on getting started and obtaining funding for your research.

Dr. Kevin Southerland (@kwsoutherland) is an assistant professor of surgery at Duke. He is a co-investigator of an NIH U01 grant to study the 4D nucleome of muscle regeneration in ischemia-induced damage and repair and was selected to be the 2021 Wylie Scholar to study transcriptional dynamics and heterogeneity of macrophages in CLTI.

Dr. Karen Ho is the John Marquardt Clinical Research Professor of Vascular Surgery at Northwestern. She was recently awarded an R01 grant from the NHLBI to study the meta-organismal pathways that impact susceptibility to arterial restenosis after vascular surgery.

Dr. Andrea Obi (@AndreaObiMD) is an assistant professor of Vascular Surgery at the University of Michigan, a recipient of the 2019 Wylie Scholar award for young investigators in vascular surgery, an NIH K08 awardee and, most recently, the recipient of the SVS Foundation/ACS Mentored Clinical Scientist Research Development Award (a K08 matching grant) to study the role of myeloid epigenetic regulation on venous thrombus resolution.

Relevant Resources for Research and Funding:

SVS Research Opportunities in Vascular Surgery
AVAS award:
AVF/Jobst research grant
AHA research grant
VESS award
SAAS award
SUS award
AAS award
Vascular Cures/Wylie Scholar program
NIH F32 Award
Burroughs Wellcome Postdoctoral Grants
HHMI Research Grants
NIH RePORTER

Host Introductions:

Dr. Chris Audu (@ChrisAuduMD) is in his fifth year of training in the integrated vascular surgery residency at the University of Michigan. His research studies the role of chromatin-modifying enzymes on wound healing pathways as well as learning the details of high throughput experimentation in discovering novel acid-amine organic reactions for vascular-focused, medicinal chemistry. He is currently F32 funded and was recently awarded the 2020 VESS Resident Research Award.
Dr. Elizabeth Andraska (@eandraska) is in her fifth year of training in the integrated vascular surgery residency at the University of Pittsburgh. She is T32 funded by the National Institutes of Health and is currently a Burroughs Wellcome Foundation fellow. She is studying the role of platelet-neutrophil complexes in immunothrombosis.
Dr. Matt Chia (@chia_md) is in his 6th of 7 years in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine and also holds a Master’s in Health Services and Outcomes Research at Northwestern.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Matt Chia and Andy Lazar sit down with Drs. Leila Mureebe, Jeff Siracuse, and Philip Goodney for a panel discussion introducing the VQI and some practical tips on getting started with vascular health services research.

Dr. Leila Mureebe (@leils) is an associate professor of surgery in the division of vascular and endovascular surgery at the Duke University School of Medicine. She completed her medical degree and general surgery residency at the Medical College of Pennsylvania, a vascular research fellowship at Harvard Longwood, and her vascular surgery fellowship at Yale. She also holds dual master’s degrees in public health from the UNC and in management and clinical informatics from Duke.

Dr. Jeff Siracuse is an associate professor of surgery and radiology at the Boston University School of Medicine. He completed his medical degree at the New York Medical College, followed by a general surgery residency at Beth Israel Deaconess, a vascular research fellowship at Harvard Longwood, and a vascular surgery fellowship at the New York-Presbyterian programs. He also holds an MBA from Boston University and has extensive experience with the VQI data, including being the medical director and regional RAC chair for the Vascular Study Group of New England.

Dr. Philip Goodney is a professor of surgery and the associate chair for research at the Dartmouth-Hitchcock Medical center. He received his medical degree from the University of Connecticut, followed by a general surgery residency and vascular surgery fellowship at Dartmouth. He completed a special fellowship in outcomes research with the VA Outcomes Group in White River Junction, Vermont, while also receiving a Master’s Degree in Evaluative Clinical Sciences. Among the many key positions he holds in our field, he is the current chair for the national VQI Research Advisory Committee or RAC.

Previous Episode - Dr. Jack Cronenwett with the origin story of the VQI

Relevant Links:

Current SVS Regional Quality Groups
Previously approved VQI projects
Submit a RAC Proposal + Deadlines
JAMA Surgery guide to the VQI
SVS Research Opportunities in Vascular Surgery

Host Introductions:

Dr. Lazar (@Lazar_surgery) is a general surgery resident at Morristown Medical Center in New Jersey and completed his second year of vascular surgery research at Columbia University, where - among other projects - he has focused on using the VQI to look at insurance and health disparities.
Dr. Chia (@chia_md) is in his 5th of 7 years in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine and also holds a Master’s in Health Services and Outcomes Research at Northwestern.

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In this episode of our monthly JVS series, Jacob, Yasong, and Joshua discuss the latest Editor’s Choice articles with Senior Editor, Dr. Peter Lawrence.

Epidemiology of endovascular and open repair for abdominal aortic aneurysms in the United States from 2004 to 2015 and implications for screening (CME and Editor’s Choice)
Fenestrated-branched endovascular aortic repair is a safe and effective option for octogenarians in treating complex aortic aneurysm compared with nonoctogenarians
The majority of major amputations after resuscitative endovascular balloon occlusion of the aorta are associated with preadmission trauma
Impact of impaired ambulatory capacity on the outcomes of peripheral vascular interventions among patients with chronic limb-threating ischemia

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We are very excited to bring you our new series on Landmark Papers in Vascular Surgery!

We are proud to start off with the IMPROVE trial, and for that we welcome Professor Janet Powell, Professor of Vascular Biology & Medicine at Imperial College, London and Chief Investigator of the IMPROVE Trial.

Professor Powell studied medicine in the USA (after obtaining a PhD in Biophysics in London), before returning to Britain where she completed clinical training in pathology, specialising in cardiovascular risk. Initially her research interests were confined to the laboratory but soon extended from bench (vascular biology) to bedside (clinical trials). She has been integral to all of the key UK trials in abdominal aortic aneurysm management, including the UK Small Aneurysms Trial, the EVAR-1 and EVAR-2 trials and of course, the IMPROVE Trial. In recognition of her outstanding contribution to research in vascular surgery, she was recipient of the Lifetime Achievement Award at the Vascular Society of Great Britain and Ireland Annual Scientific Meeting in 2012, and is honoured with a named lectureship at the annual European Society of Vascular Surgery conference, called the Janet Powell Lecture in Evidence-Based Vascular Surgery.

The IMPROVE Trial is the “Immediate Management of Patients with Rupture: Open Versus Endovascular Repair,” originally published in the British Medical Journal in 2014. Below are links to the original manuscript as well as several additional related publications:

Original Manuscript
One-Year Outcomes
Three-Year Outcomes
Observations Regarding Clinical Care (2014)
Re-intervention Data (2018)

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In this episode, Imani and Reginald discuss with Dr. Backhus and Dr. Goodney the historical implications of the longstanding poor relationship between the Black community and the medical community, and its effect on current practices and patient care in vascular surgery. They also explore the role of research in creating demonstrable changes in practice to aid in ameliorating this relationship.

Leah Backhus, MD, MPH, FACS (@leahbackhusmd) practices at Stanford Hospital and is Chief of Thoracic Surgery at the VA Palo Alto, where she focuses on thoracic oncology and minimally invasive surgical techniques. She is also Co-Director of the Thoracic Surgery Clinical Research Program and has grant funding through the Veterans Affairs Administration and NIH. Her current research interests are in imaging surveillance following treatment for lung cancer and cancer survivorship. She is a member of the National Lung Cancer Roundtable of the American Cancer Society serving as Chair of the Task Group on Lung Cancer in Women. She also serves on the Board of Directors of the Society of Thoracic Surgeons. As an educator, Dr. Backhus is the Associate Program Director for the Thoracic Track Residency and is the Chair of the ACGME Residency Review Committee for Thoracic Surgery.

Phillip Goodney MD, MS (@DartmthSrgHSR) is a vascular surgeon, health services researcher, Vice-Chair of Research in the Department of Surgery, Director of the Center for the Evaluation of Surgical Care at Dartmouth (CESC), and Co-Director of the VA Outcomes Group at Veterans Affairs Medical Center in White River Junction, Vermont. His research interests include outcomes assessment using both quantitative and qualitative methods, clinical trials, patient preferences, and shared decision making. He received a Career Development Award from the National Heart, Lung, and Blood Institute in 2010, the Lifeline Research Award from the Society for Vascular Surgery (SVS), and research funding from VA HSR&D, PCORI, FDA, and others. He was elected to the American Surgical Association in 2016 and serves on multiple editorial boards of surgical, cardiovascular, and health services journals.

Background

The U.S. Public Health Service Syphilis Study at Tuskegee
American Eugenics and Forced Sterilization
The Story of Henrietta Lacks
Johns Hopkins NP Colonoscopy Training

Additional Resources:

Warren et al. (2020) “Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community.” NEJM, 383(22)
Blanchard et al.(2020) “A Sense of Belonging.” NEJM, 383(15): 1409–1411
Armstrong et al. (2007) “Racial/Ethnic Differences in Physician Distrust in the United States.” AJPH. 97(7): 1283–1289.
DeShazo, Richard D. (2020) The Racial Divide in American Medicine: Black Physicians and the Struggle for Justice in Health Care. University Press of Mississippi.
Jacobs et al. (2006) “Understanding African Americans’ Views of the Trustworthiness of Physicians.” JGIM. 21(6): 642–647
Frakt, Austin. (2020) “Bad Medicine: The Harm That Comes From Racism.” The New York Times.
Tweedy, Damon. (2016) Black Man in a White Coat: a Doctor's Reflections on Race and Medicine. Picador,
Armstrong et al. (2013) “Prior Experiences of Racial Discrimination and Racial Differences in Health Care System Distrust.” Medical Care. 51(2): 144–150
Greenwood et al. (2018) “Patient–physician gender concordance and increased mortality among female heart attack patients” PNAS. 115(34): 8569-8574.
SVS Foundation VISTA Program

Host Introductions

Imani McElroy, MD, MPH (@IEMcElroy) is a general surgery resident at the Massachusetts General Hospital in Boston, MA.
Reginald Nkansah, MD (@NkansahReginald) is a first-year vascular surgery resident at the University of Wahington in Seattle, WA.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Black Man in a White Coat: A Doctor's Reflections on Race and Medicine

In this episode of our monthly JVS series, Jacob, Yasong, and Andrew discuss the latest Editor’s Choice articles with Editor-in-Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Update on workforce diversity in vascular surgery (Editor’s Choice)
Society for Vascular Surgery femoral runoff score is associated with limb-based patency after aortofemoral bypass (CME)
Primary mechanism of stroke reduction in transcarotid artery revascularization is dynamic flow reversal
Comparison of surgical versus percutaneously created arteriovenous hemodialysis fistulas

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In this month’s episode of our JVS - VL Editor’s Choice series, Jacob, Joshua, and Andrew discuss July’s selected articles with Editor-in-Chief of the JVS, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Risk factors for acute kidney injury after pharmacomechanical thrombolysis for acute deep vein thrombosis (Editor’s Choice and CME)
Hypersensitivity reaction after cyanoacrylate closure of incompetent saphenous veins in patients with chronic venous disease: A retrospective study
The randomized, controlled ATLANTIS trial of aquatic therapy for chronic venous insufficiency
Adjunctive techniques to minimize thrombotic complications following microfoam sclerotherapy of saphenous trunks and tributaries

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This year marks the 75th Anniversary of the Society for Vascular Surgery. This year's Vascular Annual Meeting will also be a very welcome return to in-person meetings after the pandemic. Sharif and Fanny chat with the co-Chairs of the Program Committee for the VAM, Dr. Andy Schanzer and Dr. Matt Eagleton, to give us a preview.

Dr. Andres Schanzer is a Professor of Surgery and Chief of the Division of Vascular and Endovascular Surgery at the University of Massachusetts Memorial Medical Center and University of Massachusetts Medical School in Worcester, Massachusetts, with a secondary appointment as Professor of Quantitative Health Sciences. He serves as the Director of the UMass Memorial Heart and Vascular Center and is the founding Director of the UMass Memorial Center for Complex Aortic Disease. He serves as the national principal investigator for the United States Fenestrated and Branched Endograft Research Consortium. This is his first year as co-Chair of the Program Committee for the Vascular Annual Meeting of the Society for Vascular Surgery.

Dr. Matthew Eagleton is the chief of the Division of Vascular and Endovascular Surgery at Massachusetts General Hospital and co-director of the Fireman Vascular Center leading a multi-disciplinary team interested in the management of vascular disease. Dr. Eagleton’s clinical and research interests are focused on the pathobiology and endovascular treatment options for complex aortic disease. Dr. Eagleton has served in a variety of national organizations including the Vascular and Endovascular Surgical Society and the Society for Vascular Surgery. This year, he is completing his tenure as Chair of the Program Committee for the Vascular Annual Meeting of the Society for Vascular Surgery.

Dr. Fanny Alie-Cusson is joining us today for her first interview as part of the Audible Bleeding family. She is an Assistant Professor of Vascular Surgery at the University of Pittsburgh Medical Center.

Click here to register for VAM21

See the VAM21 program here

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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In this episode of our monthly JVS series, Jacob and James discuss the latest Editor’s Choice articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Characterization of syndromic, nonsyndromic familial, and sporadic type B aortic dissection (CME and Editor’s Choice)
Outcomes after transfemoral carotid artery stenting stratified by preprocedural symptom status
Long-term symptom improvement and health-related quality of life after operative management of median arcuate ligament syndrome

The 4th article for this month, Sex-related disparities in intervention rates and type of intervention in patients with aortic and peripheral arterial diseases in the National Inpatient Sample Database, is discussed in a separate “Meet-the-Author” episode with first author Dr. Katharine McGinigle. Check it out here.

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We are excited to share our discussion with Dr. Carmen Johnson and Dr. Ronald Fairman from the Food and Drug Administration on the approval processes and the post-market surveillance of medical devices.

Dr. Carmen Gacchina Johnson is the Assistant Director, Vascular & Endovascular Devices at the Food and Drug Administration. She has a Ph.D. in Bioengineering and has been with the FDA since 2012. Her area of expertise is in cardiovascular devices.

Dr. Ronald Fairman is an Emeritus Professor of Surgery and former Chief of the Division of Vascular Surgery at the University of Pennsylvania, as well as a former President of the Society for Vascular Surgery. He is speaking to us today in his role as Medical Officer on the Vascular and Endovascular Devices Team (VEDT)

A History of Medical Device Regulation & Oversight in the United States

MedWatch Forms for FDA Safety Reporting

Virtual two-day meeting of the CDRH Circulatory System Devices Panel of the Medical Devices Advisory Committee in Quarter4 of 2021

To sign up for news about device approvals, recalls, and other FDA actions and announcements, we recommend subscribing to CDRH News.

Leadership Development Program Applications are open and due by July 16, 2021

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Matt Chia and Ali Irshad sit down with Drs. Meryl Simon Logan and Sree Kanna in part 2 of our series for newly-matched vascular residents embarking on their next stage of training.

Show Guests:

Dr. Meryl Simon Logan (@ProleneQueen) is a staff vascular surgeon at the Olin E. Teague Central Texas Veteran’s Health Care System in Temple, Texas, as well as holding an adjunct assistant professorship at Texas A&M. She currently holds the rank of Major in the U.S. Air Force, as well as chairs the SVS Social Media Committee. She completed an integrated residency in vascular surgery at the University of California in Davis and received her medical degree from the Drexel University College of Medicine in Philadelphia.
Dr. Sree Kanna (@VulnerableAorta) is finishing his intern year in vascular surgery at McGill University in Montreal, Quebec. Originally from Kuala Lumpur in Malaysia, he completed his medical training at the Dalhousie Medical School in Halifax, Nova Scotia. He has an interest in aortic surgery and surgical outcomes in indigenous populations, and on his days off describes himself as an experimental cook and a horror movie addict.

Relevant Links:

VSITE Information: https://www.absurgery.org/default.jsp?certvsite
SVS VESAP 5: https://vascular.org/career-tools-training/vesap5
Vascular SCORE Curriculum: https://www.surgicalcore.org/public/curriculum#vascsurg
SVS Research Opportunities in Vascular Surgery: https://vascular.org/research-quality/research-opportunities

If you missed it, check out "So You've Matched into Vascular...Now What? (Part 1).

Host Introductions:

Dr. Irshad (@AIrshad_MD) is an assistant professor at the University of Connecticut in Hartford. He completed his integrated vascular surgery residency at the Houston Methodist Hospital, earned his medical degree from the University of Massachusetts in Worcester. He has special interests in medical innovation, novel devices, complex aortic disease, and diagnostic imaging.
Dr. Chia (@chia_md) is in his 5th of 7 years in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine and is obtaining a Master’s in Health Services and Outcomes Research at Northwestern. He is part of the Vascular SECOND trial team at the Surgical Outcomes and Quality Improvement Center and is an avid podcast fan.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Adam and Dr. Sheahan join Miss Eilidh Gunn and Dr. Steven Yule to discuss human factors engineering, coaching, and the Non-technical Skills for Surgeons (NOTSS) taxonomy and how they can be applied to improving vascular surgery.

Professor Steven Yule (@NOTSS_lab) is the Chair of Behavioural Sciences at the University of Edinburgh, Associate Professor at Harvard, and Director of Non-Technical Skills at the Royal College of Surgeons of Edinburgh. He is a Human Factors scientist and organizational psychologist. He is internationally recognized for his research on non-technical skills, patient safety, and simulation in surgery. His interests are in peer and computer assessments of surgical performance from video, safety in low and middle-income contexts, surgical coaching, sabermetrics, and astronaut training for long-duration spaceflight. He is also currently the program Director for MSc Patient Safety and Clinical Human Factors at Edinburgh University.

To Learn More about NOTSS:

RCSEd Let’s Talk Surgery Podcast: Performance Project
Enhancing Surgical Performance: A Primer on Non-technical Skills
NOTSS Handbook
Non-technical Skills for Surgeons RCSEd Website
Non-Technical Skills for Surgeons Website (notss.org)
The future training of non-technical skills for surgeons (NOTSS) - YouTube

Relevant links

Moulton CA, Regehr G, Mylopoulos M, MacRae HM. Slowing down when you should: a new model of expert judgment. Acad Med. 2007 Oct;82(10 Suppl):S109-16.
Hu YY, Peyre SE, Arriaga AF, et al. Postgame analysis: using video-based coaching for continuous professional development. J Am Coll Surg. 2012;214(1):115-124.
Sudol NT, Guaderrama NM, Honsberger P, et al. Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists. JAMA Surg. 2021 May 1;156(5):e210265.
CIEHF White Paper: Human Factors for Health Care and Social Care
Ariadne Labs

Co-hosts

Miss Eilidh Gunn (@eil1_g) is currently a PhD candidate in Clinical Surgery at the University of Edinburgh. Her research interests are human factors, non-technical skills and surgical coaching.
Dr. Mal Sheahan is a regular contributor to the podcast, editor for Vascular Specialist and co-chair of the SVS wellness taskforce overseeing their new initiative in peer coaching.

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Enhancing Surgical Performance: A Primer in Non-technical Skills

In this episode of our monthly JVS series, Jacob, Matt, and Yasong discuss the latest Editor’s Choice articles with Editor-in-Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Validation of the Global Limb Anatomic Staging System in first-time lower extremity revascularization (Editor’s Choice)
Comparison of open- and closed-cell stent design outcomes after carotid artery stenting in the Vascular Quality Initiative (CME)
Endovascular interventions for claudication do not meet minimum standards for the Society for Vascular Surgery efficacy guidelines
Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair

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In this “Meet the Authors” Episode, Jacob and Matt Chia sit down with Dr. Katharine McGinigle to discuss her upcoming article in the June issue of the JVS titled, “Sex-related disparities in intervention rates and type of intervention in patients with aortic and peripheral arterial diseases in the National Inpatient Sample Database.”

Dr. McGinigle is an assistant professor of surgery at the University of North Carolina School of Medicine, where she also is the surgical director of the enhanced recovery after surgery program. She completed her medical degree, master’s of public health, and general surgery residency all at UNC, along with a fellowship in vascular surgery at Duke University.

Sign up for the SVS Journal Club on June 9, 2021 to discuss this paper further!

Relevant Links:

Article: Sex-related disparities in intervention rates and type of intervention in patients with aortic and peripheral arterial diseases in the National Inpatient Sample Database

Previous Audible Bleeding episode with Melina Kibbe

Frank J. Veith International Society: How to Promote Women in Vascular Surgery Webinar

In this month’s episode of our JVS - VL Editor’s Choice series, Jacob, Farooq, and Robin discuss May’s selected articles with Senior Editor of the JVS, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

Predictors of intracranial hemorrhage in patients treated with catheter-directed thrombolysis for deep vein thrombosis
A retrospective comparison of thrombectomy followed by stenting and thrombectomy alone for the management of deep vein thrombosis with May-Thurner syndrome
Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins
Propofol administration during catheter-directed interventions for intermediate-risk pulmonary embolism is associated with major adverse events

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Matt Chia and Ali Irshad sit down with Drs. Regina Husman and Kirthi Bellamkonda to answer your questions from Twitter about how newly-matched vascular residents can set themselves up for success in their residency.

Show Guests:

Dr. Regina Husman (@reginahusman) is a first-year integrated vascular surgery resident at the University of Texas Health Science Center at Houston. She is originally from Jakarta, Indonesia, and earned her medical degree at UCLA. She is interested in pursuing research in hemodialysis access complications and innovative endovascular techniques in treating peripheral arterial disease.
Dr. Kirthi Bellamkonda (@kirthisb) is finishing her 4th year of medical school at Yale and is the incoming integrated vascular intern at Dartmouth. She is passionate about using medical innovation to increase access to vascular care and spent her research time in medical school developing low-cost vascular tools with Butterfly Network.

Relevant Links:

APDVS Course List
Audible Bleeding Episode on Vascular Decision Making Book
Methodist Intern Bootcamp

Host Introductions:

Dr. Ali Irshad (@AIrshad_MD) is an assistant professor at the University of Connecticut in Hartford. He completed his integrated vascular surgery residency at the Houston Methodist Hospital, earned his medical degree from the University of Massachusetts in Worcester. He has special interests in medical innovation, novel devices, complex aortic disease, and diagnostic imaging.
Dr. Matt Chia (@chia_md) is in his 5th of 7 years in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine and is obtaining a Master’s in Health Services and Outcomes Research at Northwestern. He is part of the Vascular SECOND trial team at the Surgical Outcomes and Quality Improvement Center and is an avid podcast fan.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Adam, Robin, and Dr. Forbes sit down with Drs Eldrup-Jorgensen and Nelson to discuss in detail the SVS Foundation’s newest initiative, the VISTA program, and one of the first funded pilot projects.

Jens Eldrup-Jorgensen, MD is a professor of surgery at Tufts University and Maine Medical Center and medical director for the Society of Vascular Surgery for the Vascular Quality Initiative. He is the innovative force behind the development of the Vascular Volunteers Improve Service to All Program, also known as VISTA.
Peter Nelson, MD (@prn19) is the Professor and Chief of Vascular Surgery, Mary Louise Todd Chair in Cardiovascular Research, OU College of Medicine and leads one of the first funded pilot projects working with indigenous communities in Oklahoma.

Relevant Links:

Vascular Volunteers Improve Service to All (VISTA) Program

Co-host introductions

Thomas Forbes, MD (@TL_forbes) is a professor of surgery and RJ Elliot Chair and Division Head of Vascular Surgery at the University of Toronto and was our 4th guest on the podcast and has been a major supporter of our work and will be joining our team more regularly.
Robin Osofsky, MD (@OsofskyRobin) is a general surgery resident at the University of New Mexico who is interested in applying for vascular surgery.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this episode of our monthly JVS series, Jacob, Kate, and Philip discuss the latest Editor’s Choice articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Association between surgeon case volume and years of practice experience with open abdominal aortic aneurysm repair outcomes (Editor’s Choice)
Lipoprotein(a) levels and risk of abdominal aortic aneurysm in the Women's Health Initiative
Safety of vascular interventions performed in an office-based laboratory in patients with low/moderate procedural risk
Temporary intravascular shunt use improves early limb salvage after extremity vascular injury (CME)

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Rachael and Francesca discuss with Mr. Jonathan Boyle and Aminder vascular surgery registries in the UK, how they contribute to device safety and lessons learned from the Nellix experience.

Mr. Jonathan Boyle MD FRCS graduated from the University of Leicester in 1991, completed a Doctor of Medicine postgraduate research degree in 2000, and was appointed as a consultant vascular surgeon in Cambridge University Hospitals NHS Trust in 2002, where he was Clinical Lead for Vascular Surgery from 2014-17.

He has held numerous national and international leadership roles. Amongst others, he is Vice President of the Vascular Society of Great Britain and Ireland (VSGBI), Past President of the British Society for Endovascular Therapy, and Section Editor of the European Journal of Vascular and Endovascular Surgery.

During his roles as Clinical Lead for the UK’s National Vascular Registry (NVR) and Chair of the VSGBI Audit and Quality Improvement Committee, he led the development of the Peripheral Artery Disease Quality Improvement Framework and, more recently, has introduced the incorporation of device-specific information into the NVR. Under his leadership, the NVR team won the HQIP Team of the Year 2020 award in recognition of their “outstanding work on registry device capture, quality improvement and a rapid response to COVID-19”. He has also worked closely with Medicines and Healthcare products Regulatory Agency on failing vascular devices.

Aminder Singh MBBS is an Academic Clinical Fellow at the University of Cambridge and vascular surgery specialty trainee in the East of England, currently undertaking research investigating the development of stem cell models to characterize aortopathy variants. He is the venous and European rep on the Rouleaux Club Executive Committee.

Co-host: Francesca Guest MBChB is a vascular surgery specialty trainee on the South West England training program, currently working in Exeter. She is the Association for Surgeons in Training (ASiT) rep on the Rouleaux Club Executive Committee.

Resources:

UK Vascular Services Quality Improvement Programme (including the National Vascular Registry): https://www.vsqip.org.uk
Vascular Society of Great Britain and Ireland: https://www.vascularsociety.org.uk
UK National Joint Registry: https://www.njrcentre.org.uk/njrcentre/
British Society for Endovascular Therapy: https://www.bset.co.uk

Relevant papers:

Singh AA, Benaragama KS, Pope T, Coughlin PA, Winterbottom AP, Harrison SC, Boyle JR. Progressive Device Failure at Long Term Follow Up of the Nellix EndoVascular Aneurysm Sealing (EVAS) System. Eur J Vasc Endovasc Surg. 2021 Feb;61(2):211-218. doi: 10.1016/j.ejvs.2020.11.004. Epub 2020 Dec 7
Singh AA, Boyle JR. Introduction of New Medical Devices: Lessons Learned From Experience With Endovascular Aneurysm Sealing. J Endovasc Ther. 2020 Feb;27(1):160-162.
Singh AA, Boyle JR. Readmission and Re-intervention are Better Measures of EVAR Quality. Eur J Vasc Endovasc Surg. 2020 Oct;60(4):518. doi: 10.1016/j.ejvs.2020.08.011

Erratum: In the original publication, Mr. Singh stated that the Nellix device had been approved by the FDA. This is incorrect and this device is still considered investigational in the USA. The audio has been updated to reflect this correction.

April 12th, 2021

APDVS Lifetime Achievement in Education Award Winner, Dr. Jack Cronenwett: History of the APDVS, the vascular integrated residency, and the VQI

Dr. Jack Cronenwett was recently awarded the first Lifetime Achievement in Education Award from the Association for Program Directors in Vascular Surgery (APDVS). We are very excited to have Dr. Cronenwett join us to give us his perspective on the history of the APDVS, the Vascular Integrated Residency, and the Vascular Quality Initiative.

Dr. Cronenwett is an Active Emeritus Professor of Surgery at the Geisel School of Medicine at Dartmouth, in Lebanon, New Hampshire. He was Chair of the section of Vascular Surgery at Dartmouth-Hitchcock Medical Center from 1984 to 2007. He is a past president of the Society for Vascular Surgery, as well as the New England Society for Vascular Surgery. He served as the medical director for the vascular surgery study group of New England from 2002 to 2014, and was the medical director of the SVS Patient Safety Organization (also known as the Vascular Quality Initiative) at its creation in 2011.

He is also a past member of the Residency Review Committee for Surgery for the ACGME.

In that role, he developed the first program requirements for integrated residency for the RRC, and in 2007, Dartmouth was one of the first three programs to create an integrated vascular residency.

He is editor emeritus of the Journal of Vascular Surgery and the seventh and eighth additions of Rutherford's Vascular Surgery. He is the current editor of Vascular Decision Making.

In 2016, Dr. Cronenwett received the lifetime achievement award of the society for vascular surgery. He is the inaugural recipient for the 2021 APDVS lifetime achievement award.

Dr. Joseph Mills Sr. article, "Vascular surgery training in the United States: A half-century of evolution"

Dr. Cronenwett's 2019 John Homans Lecture, "Why should I join the Vascular Quality Initiative"

Vascular Specialist Online: APDVS honors Jack L. Cronenwett with inaugural Lifetime Achievement in Education Award

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at AudibleBleeding@vascularsociety.org.

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Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Through a collaboration with the WISER podcast, Dr. Amanda Fobare and Dr. Vivian Wang sit down with Dr. Shipra Arya to discuss her path to Vascular Surgery and her research on frailty. Dr. Shipra Arya (@ShipraAryaMD) graduated from All India Institute of Medical Sciences, one of the most prestigious medical schools in India. At that time, she was the only woman pursuing a career in Surgery. She went on to the Harvard School of public health to earn an MPH. Following her time in Boston, she completed her general surgery residency at Creighton, followed by a Vascular Surgery Fellowship at the University of Michigan (@UMichSurgery). She was on faculty at Emory University (@EmorySurgery) before joining faculty at Stanford University (@stanfordvasc). Her love for vascular surgery shines through in this interview. We enjoyed discussing her research in frailty, and her tips and tricks for balancing a busy career and her family life. WISER: https://wiserpodcast.com/ Follow us at: @wiserpodcast and @audiblebleeding Hosts: Amanda Fobare (@amandafobare), Vivian Wang (@vwang323), Virginia Wang (@VirginiaWang20) Editor/Producer: Vivian Wang Artwork: Virginia Wang Music: "Borough" and "Plate Glass" by Blue Dot Sessions

Adam, Robin, and Dr. Forbes sit down with Drs Lawrence, Nelson, and Eldrup-Jorgensen to discuss the Society for Vascular Surgery Foundation and introduce one of its newest initiatives, the VISTA program.

Peter Lawrence, MD is Wiley Barker Professor and Chief of the Division of Vascular and Endovascular Surgery at UCLA and senior editor of the Journal of Vascular Surgery. He joins us today in his role as the Chair of the SVS Foundation.
Peter Nelson, MD (@prn19) is the Professor and Chief of Vascular Surgery, Mary Louise Todd Chair in Cardiovascular Research, OU College of Medicine, and Chair of the Foundation Development Committee of the SVS Foundation.
Jens Eldrup-Jorgensen, MD is a professor of surgery at Tufts University and Maine Medical Center and medical director for the Society of Vascular Surgery for the Vascular Quality Initiative. He is the innovative force behind the development of the Vascular Volunteers Improve Service to All Program, also known as VISTA.

Donate to the SVS Foundation here.

Relevant Links:

SVS Foundation
SVS Foundation 2020 Annual Report
Vascular Volunteers Improve Service to All (VISTA) Program

Co-host introductions

Thomas Forbes, MD (@TL_forbes) is a professor of surgery and RJ Elliot Chair and Division Head of Vascular Surgery at the University of Toronto and was our 4th guest on the podcast and has been a major supporter of our work and will be joining our team more regularly.
Robin Osofsky, MD (@OsofskyRobin) s a general surgery resident at University of New Mexico who is interested in applying for vascular surgery.

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Dr. Julie Duke and Dr. Mia Miller sit down to discuss AAAs for the VSITE and board review.

Click here to access the episode outline on our website.

Miss Rachel Bell MS FRCS qualified from the UMDS in 1994 and trained in London and the South East Thames rotation. She was appointed as a consultant at Guy’s & St. Thomas’ in 2005. She was the clinical lead for vascular surgery from 2008-2016 and helped lead the reconfiguration of vascular services across South East London. She became the Clinical Director of Cardiovascular Services at Guys and St Thomas’s and the Vascular Network Director for South East London. After 15 years in London, she relocated back to the North East and is now based at the Freeman Hospital in Newcastle. Nationally she is the current President of the British Society of Endovascular Therapy, Chair of the Circulation Foundation, and President-Elect of the Vascular Society of Great Britain and Ireland. Her clinical interests include aortic aneurysm repair, open thoracoabdominal aneurysm repair, and the surgery and management of vascular graft infection. She is also interested in sustainable and innovative healthcare system improvement, staff wellbeing and prevention of burnout. Co-host: Lauren Shelmerdine is a Vascular Trainee in the North East of England currently doing research and is the Circulation Foundation representative for the Rouleaux Club. She enjoys exploring with her two huskies and living sustainably. Resources: * Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC) * British Society of Endovascular Therapy * Circulation Foundation * The Vascular Society for Great Britain and Ireland

Please DM @leanna_erete on Twitter with any feedback

In this month’s episode of our JVS - VL Editor’s Choice series, Jacob, Valeria, and Aakanksha discuss March’s selected articles with Editor in Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Long-term outcomes following use of a composite Wallstent-Z stent approach to iliofemoral venous stenting (Editor’s Choice)
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative (CME)
Three-year follow-up results of the prospective European Multicenter Cohort Study on Cyanoacrylate Embolization for treatment of refluxing great saphenous veins
Correlation of disease comorbidity with prescribed treatment among insured U.S. lymphedema patients

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March 20th, 2021

“VSIG Live!’ with Drs. Ben Pearce, Loay Kabbani, and Jonathan Bath

The Association of Program Directors in Vascular Surgery Recruitment of Medical Student and Residents Committee will present a free informational webinar, ‘VSIG Live!’, at 6pm CST on Thursday, March 25th, 2021. The intent of ‘VSIG Live!’ is to allow all U.S. medical students to experience a Vascular Surgery Interest Group meeting and learn more about Vascular Surgery, even in the absence of a local chapter.

The webinar will highlight:

What is a Vascular Surgeon
A Day in the Life of a Vascular Surgeon
Options for vascular surgery training
Interesting presentations from current trainees highlighting the diversity of vascular cases
How to start a VSIG at your institution

Register here for VSIG Live!

Dr. Benjamin Pearce is an Associate Professor of Surgery and the Program Director for the Vascular Surgery Integrated Residency and Fellowship Programs at the University of Alabama School of Medicine.

Dr. Loay Kabbani is an Associate Professor of Surgery and Program Director for the Vascular Surgery Fellowship at the Henry Ford Hospital, Wayne State University. He is also co-chair of the Recruitment of Medical Student and Residents Committee for the APDVS.

Dr. Jonathan Bath, MD is an Assistant Professor of Surgery and the Program Director for the Vascular Surgery Fellowship at the University of Missouri School of Medicine. He is co-chair of the Recruitment of Medical Student and Residents Committee for the APDVS.

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In this episode of our monthly JVS series, Jacob, Tomaz, and Soni discuss the latest Editor’s Choice articles with Editor in Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

High prevalence of abdominal aortic aneurysms in patients with lung cancer
Timing of repair of blunt thoracic aortic injuries in the thoracic endovascular aortic repair era
Technical approach, outcomes, and exposure-related complications in patients undergoing anterior lumbar interbody fusion
Anatomic suitability for commercially available percutaneous arteriovenous fistula creation systems

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Dr. Barend Mees joins us to discuss the upcoming 24th European Vascular Course, and how they are adapting surgical simulation to virtual education. Dr. Mees is a consultant Vascular & Endovascular Surgeon in the department of Vascular Surgery at MUMC+ in Maastricht. He currently is Associate Professor and Deputy Head of the department of Vascular Surgery. His clinical area of interest is the endovascular treatment of complex aortic disease and peripheral arterial disease. He is the research coordinator of the department of Vascular Surgery and has obtained a PhD in Vascular Biology from Erasmus MC, INSERM (U689, Paris) and Max-Planck Institute (Bad Nauheim, Germany). His main research focus areas are vascular biology, tissue engineering and training in innovative endovascular techniques.

Dr. Mee is the inventor of the MAZE Box, a novel hands-on training simulator for Endovascular Surgery and tutor for Vascular International. Dr. Mees is an examiner of the UEMS FEBVS examination since 2017. He is organizer of the I-MEET congress and course director of the European Vascular Course. He has been Secretary of the Dutch Society for Vascular Surgery since 2018.

European Vascular Course - March 7-8, 2021

Watch the MAZE box in action!

MAZEBox website

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Mr. Neil Hopper MB BCh BSc MD FRCS is a Consultant Vascular Surgeon at the Royal Cornwall Hospital in Truro, South West England. He grew up in Swansea and went to medical school in Cardiff (94-2000), where he graduated top of his year (Cardiff Medical Society Prize). He intercalated in anatomical sciences (first-class honors 96-97). He became a junior doctor with the intention of following a career in palliative care but enjoyed his surgical house job so much he switched to surgery. He considered cardiothoracic surgery but switched to general surgery. As a registrar, he really enjoyed vascular and therefore became a vascular surgeon. In April 2019, he became unwell and lost both legs below the knee. He returned to work in October 2019 (paperwork and clinics) and resumed full duties with full on-call in February 2020. He has recently become a clinical lecturer in Anatomy for the University of Exeter. Since his illness, he has discovered an interest in exercise and loves nothing more than going on trike rides with his family. He is 44 years old, married to Rachel, and has 2 children, Harry (7) and Evie (11). Follow Mr. Hopper * Twitter: @neilhop76 * Instagram: @bionicsurgeon * YouTube * Blog: https://www.bionicsurgeon.net/blog

Additional Links * Lecture at The Vascular Societies’ Annual Scientific Meeting 2020 * Interview with Medscape * Article on Bravest Briton 2020 award * 19th Coolest Person in Cornwall 2020 * British Society of Rehabilitation Medicine * BACPAR (British Association of Chartered Physiotherapists in Amputee Rehabilitation) * The Limbless Association * Steel Bones (Charity for Civilian Amputees) * Limb Power * Blesma (Charity for Limbless Veterans) * Freetrike Rehab Cycling * Prosthetic companies that supply NHS patients + Blatchford Prosthetics + Össur + Ottobock

UK training terms * F1 = Intern straight out of medical school * House jobs = Intern rotations * Senior House Officer (SHO) = Junior Resident * Registrar (Reg) = Senior Resident * Consultant = Attending * DGH = District General Hospital

Professor Chris Imray is a consultant vascular, renal transplant and trauma surgery at the University Hospitals Coventry & Warwickshire NHS Trust in Coventry, UK. He is also an Honorary Professor at Warwick Medical School, Coventry and Exeter Universities and immediate Past President of the Vascular Society of Great Britain and Ireland.

Professor Imray has combined his love of mountaineering with clinical vascular surgery - he is involved in a number of polar medicine societies and is a world expert on the management of frostbite and non-freezing cold injuries. He has conducted research into hypoxia and ischemia at altitude and has published extensively.

His personal accomplishments include a wide range of expeditions across the globe, from the sea cliffs of the Outer Hebrides in Scotland to the volcanoes of Chile and, most notably, to the summit of Everest.

Useful links:

Selected papers about altitude / extreme medicine:

Femoral stabs at 8400m with the lowest recorded ABGs: Grocott et al. Arterial blood gases and oxygen content in climbers on Mount Everest. N Engl J Med. 2009 Jan 8;360(2):140-9.
Transcranial Doppler at 8000m, with novel insights: Wilson et al Cerebral artery dilatation maintains
cerebral oxygenation at extreme altitude and in acute hypoxia--an ultrasound and MRI study. J Cereb Blood Flow Metab. 2011 Oct;31(10):2019-29.
Novel insights from Everest (8000m) confirmed:
- Sagoo et al. The use of MR to investigate the potential mechanisms involved in the development of high altitude cerebral oedema. J Cereb Blood Flow Metab. 2016 Jan 8. pii
- Wilson et al. The cerebral venous system and anatomical predisposition to high altitude headache. Annals of Neurology 2013
- Wilson and Imray. The Cerebral Venous System and
  Hypoxia. J Appl Physiol. 2015 Aug 20:jap.00327.2015.
The effect of altitude on the brain: Wilson et al. The cerebral effects of ascent to high altitudes. Lancet Neurol. 2009 Feb;8(2):175-91.
Women are at least as strong as men on hyper-endurance events: Hattersley et al. A comparison of the metabolic effects of sustained strenuous activity in polar environments on men and women. Sci Rep. 2020 Aug 17;10(1):13912.
Evidence-based guidelines on the management of frostbite:
- McIntosh et al. Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness Environ Med. 2019 Jul 17. pii: S1080-6032(19)30097-3.
- Handford et al. Frostbite: a practical approach to hospital management. Extrem Physiol Med. 2014 Apr 22;3:7.
Collaborative teamwork gives the best results: Fisher et al. Pedicled Abdominal Flaps for Enhanced Digital Salvage After Severe Frostbite Injury. Wilderness Environ Med. 2019 Mar;30(1):59-62.

Other useful resources

Information on the management of frostbite:
https://www.thebmc.co.uk/how-to-get-expert-frostbite-advice
Oxford Handbook of Wilderness and Expedition Medicine: https://oxfordmedicine.com/view/10.1093/med/9780199688418.001.0001/med-9780199688418
Media appearances by Prof Imray:
- Radio: http://news.bbc.co.uk/today/hi/today/newsid_9722000/9722707.stm
- Television: BBC Panorama: Horizon Doctors in the death zone: http://www.bbc.co.uk/sn/tvradio/programmes/horizon/broadband/tx/everest/
Polar medicine / extreme environment and research organisations:
- https://worldextrememedicine.com/products/courses/polar-medicine/polar-medicine-norway/
- https://www.rgs.org/in-the-field/advice-training/expedition-medicine-(1)/committee-members/
- https://www.rgs.org/in-the-field/advice-training/resources-for-expeditions/global-polar-altitudemetabolic-research-registr/
- https://bmrescouk.wordpress.com
- https://www.xtreme-everest.co.uk/Scientific-Strategy-Group

The Vascular and Endovascular Research Network (VERN) COVER Study (COVID-19 Vascular sERvice Study): https://vascular-research.net/projects/cover-study-covid-19-vascular-service-study/

To learn more about The Rouleaux Club, visit http://rouleauxclub.com

February 17th, 2021

We are very excited to have three guests on the podcast to discuss the new Society for Vascular Surgery Learning Management System.

Dr. Kellie Brown is a Professor of Surgery and Radiology in the Division of Vascular and Endovascular Surgery at The Medical College of Wisconsin and the Chief of Vascular Surgery at the Zablocki VA Medical Center. She is the Program Director for the Vascular Surgery Fellowship at the Medical College of Wisconsin. She is the Chair of the Education Committee for the Society for Vascular Surgery.

Dr. Rabih Chaer is a Professor of Surgery in the Division of Vascular Surgery at the University of Pittsburgh, as well as the Program Director for the Vascular Integrated Residency and the Chief of Vascular Surgery at UPMC Presbyterian. He is the Chair of the Education Council for the Society of Vascular Surgery.

Lisa Cohen is the Director of Education and Professional Development for the Society of Vascular Surgery. She is currently the Co-Chair of the Medical Specialty Society Section of the Alliance for Continuing Education in the Health Professions.

Log on to the SVS Education portal here.

Submit your feedback on the SVS Education portal here: education@vascularsociety.org

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Dr. Todd Rasmussen is a Colonel in the United States Air Force and is a Professor of Surgery and Associate Dean of Research at the Uniformed Services University of the Health Sciences and an attending vascular surgeon at Walter Reed National Military Medical Center. Dr. Rasmussen has been deployed numerous times to Iraq and Afghanistan and cared for many traumatic vascular injuries at Walter Reed Medical Center. Through his experience and research, he has become one of the foremost leaders in the management of vascular trauma and recently published the third edition of Rich’s Vascular Trauma.

Dr. Marlin “Wayne” Causey is a Lieutenant Colonel in the US Army and the Chief of Vascular Surgery at Brooke Army Medical Center.

Dr. Kevin Kniery is a vascular surgeon at Brooke Army Medical Center.

Seminal Papers in Blunt Thoracic Aortic Injury

AAST 1997 Paper: https://pubmed.ncbi.nlm.nih.gov/9095103/
AAST 2008 Paper: https://pubmed.ncbi.nlm.nih.gov/18545103/
JVS 2011 Paper: https://pubmed.ncbi.nlm.nih.gov/20974523/
Timing of repair of BTAI JVS 2020: https://www.jvascsurg.org/article/S0741-5214(20)31575-5/fulltext

Dr. Ben Starnes’ podcast on Behind The Knife on BTAI: https://bit.ly/2LuycWq

Mr. Paul Blair graduated Queens University Medical School in 1982, became consultant vascular surgeon and director of trauma at the Royal Victoria Hospital in Belfast, Northern Ireland, in 1995, and subsequently rose to the clinical director for vascular and plastic surgery at the Royal Victoria Hospital and president of the Vascular Society of Great Britain and Ireland in 2014/2015. He has an international reputation and is widely published in carotid body tumor surgery and vascular trauma, in addition to having a very busy clinical practice. He has recently retired from the National Health Service but continues to work clinically and is the public health lead for the Northern Ireland AAA screening program.

Useful links:

Further reading on the Northern Ireland Troubles: Bardon, Jonathan. A History of Ulster. Newtownards, Blackstaff Press, 2005.
Earnshaw JJ. The Indication for Elective Repair of Abdominal Aortic Aneurysm Should Be Reviewed. Eur J Vasc Endovasc Surg. 2021 Jan;61(1):7-8. doi: 10.1016/j.ejvs.2020.09.001. Epub 2020 Sep 12. PMID: 32933823.
Barros D’Sa A. Twenty five years of vascular trauma in Northern Ireland. BMJ 1995;310:1. PMID: 7827542

To learn more about the Rouleaux Club, visit: http://rouleauxclub.com/

Complete our Listener Survey and support our work!

A History of Ulster

February 2nd, 2021

The Society for Vascular Surgery has created a branding tool kit which is available exclusively and at no cost to SVS members. It is designed to help vascular surgeons communicate our role in comprehensive vascular care. We are excited to have Dr. Joseph Mills on to discuss the genesis and development of the branding initiative, as well as Dr. Linda Harris and Dr. Kathryn Bowser to discuss its implementation in their practices. To learn more, register here for the upcoming Branding Toolkit Town Hall (Thursday, Feb. 4th, 2021, at 6pm CST)

Branding and Valuation Tools

How to Use the Branding Tool Kit Platform

View the September 17th Town Hall: Putting the New SVS Branding Toolkit to Use

Dr. Bowser's website

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In this episode of our monthly JVS Arterial Editor’s Choice series, Jacob, Yasong, and Aakanksha discuss the latest articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

The value of the modern vascular surgeon to the health care system: A report from the Society for Vascular Surgery Valuation Work Group (Editor’s Choice)
Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair (CME)
Performance of Viabahn balloon-expandable stent compared with self-expandable covered stents for branched endovascular aortic repair
Increased mortality with paclitaxel-eluting stents is driven by lesion length

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Kush Sharma and Ash Mansour of Michigan State University sit down to discuss Upper extremity arterial pathology for the VSITE and board review.

January 20th, 2021

Become a JVS Intern!

We are excited to announce a fantastic educational opportunity for vascular trainees! The Journal of Vascular Surgery is initiating an internship program geared at both senior integrated vascular residents and vascular fellows. The program is designed for those who have an interest in learning the JVS Journals review and editorial process. The goals of the program are to teach the next generation of vascular surgeons how to be good reviewers of clinical and basic scientific research papers and to diversify the reviewer pool to better reflect practitioners in the field, and the patients we care for. Interns will be mentored by senior editorial staff throughout the process and will be expected to review a select number of papers and produce at least one co-authored commentary.

Application: Interested residents, fellows should email the following items to jmcewan@vascularsociety.org, attention Dr. Ulka Sachdev, by February 1, 2021.

Curriculum vitae
Recommendation letter from a clinical or research mentor highlighting the applicant’s potential to contribute to the goals of the journals review process
A statement of interest (not to exceed 500 words) which highlights the applicant’s career goals and commitment to dissemination of knowledge across a broad spectrum of experiences
A statement from either the program director or Chief of the Division affirming that the trainee has adequate time to fulfill the goals of the program

Full details of the program can be found here.

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January 18th, 2021

Dr. Sachdev-Ost graduated from medical school at Icahn School of Medicine in New York City, where she stayed to complete both her general surgery residency and vascular surgery fellowship. During her residency she also completed 2 research years in basic science at Mount Sinai and Rockefeller University studying platelet-leukocyte interactions in vascular disease. She then went on to UPMC in 2006 as a surgeon-scientist, where she also secured an independent R01 grant in 2018. Dr. Sachdev heads a research lab that focuses on the role of Toll-like receptors in angiogenesis and muscle regeneration. She is currently the site chief of vascular surgery at Magee Women’s Hospital, the associate program director of the vascular surgery residency and fellowship at UPMC and was recently appointed as an associate editor for clinical research focused on diversity, equity and inclusion at JVS.

Useful links:

Dr. Sachdev-Ost Editorial “Moving ahead”: https://www.jvascsurg.org/article/S0741-5214(20)32361-2/fulltext

Recruiting women to vascular surgery and other surgical specialties: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2812%2901613-8

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Dr. Bajakian and Dr. Katib discuss part two of Peripheral Arterial Occlusive Disease (PAOD) focusing on Chronic Limb Threatening Ischemia

Happy New Year! In this month’s episode of our JVS - VL Editor’s Choice series, Jacob discusses January’s selected articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

A randomized controlled noninferiority trial comparing radiofrequency with stripping and conservative hemodynamic cure for venous insufficiency technique for insufficiency of the great saphenous vein (CME)
Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery (Editor’s Choice)
Results of polidocanol endovenous microfoam in clinical practice
Randomized clinical trial of radiofrequency-induced thermotherapy combined with transilluminated powered phlebectomy versus high ligation and stripping for the treatment of lower limb varicose veins

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Happy holidays everyone! In this month’s episode of our JVS - Arterial Editor’s Choice series, Jacob discusses January’s selected articles with Editor-in-Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Evaluating the prevalence of abdominal aortic aneurysms in the United States through a national screening database (Editor’s Choice)
The benefit of deferred carotid revascularization in patients with moderate-severe disabling cerebral ischemic stroke (CME)
Meaningful change in 6-minute walk in people with peripheral artery disease
Outcomes of rotational atherectomy in complex lesions of the superficial femoral artery

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Drs. Tracci, Sideman, Connolly, and Mattos, representing the Society for Vascular Surgery (SVS) Policy and Advocacy Council, Government Relations Committee (GRC), and the Political Action Committee (PAC), join Adam Johnson and Nicole Rich to discuss how they became involved and specifically their work regarding the United States Centers for Medicare & Medicaid Services (CMS) Payment Reforms that will go into effect in January 2021.

The updated physician fee schedule will substantially alter the Evaluation and Management (E/M) Codes that physicians use to bill for office-based services provided to Medicare patients. Our panelists detail how these changes will decrease reimbursement for surgical procedures, impact the field of vascular surgery, and the importance of surgeon involvement in the advocacy process.

Panel Members

Dr. Megan Tracci (@MeganTracci) is an associate professor of surgery at the University of Virginia (UVA) Health in Charlottesville, VA, and the chair of the SVS government relations committee (GRC).
Dr. Matthew Sideman (@UTHSAvascular) is an associate professor of surgery at UT Health San Antonio in San Antonio, TX, and is the chair of the SVS Policy and Advocacy Council, as well as the SVS Representative to the RVS Update Committee (RUC).
Dr. Peter Connolly (@phcvascular) is an associate professor of surgery at Weill Cornell Medical College in New York City, NY, and co-chair of the SVS Political Action Committee (PAC).
Dr. Mark Mattos is a self-employed vascular surgeon, the program director for the vascular surgery fellowship at Michigan Vascular Center in Flint, MI, and co-chair of the SVS Political Action Committee (PAC).

Learn more about Payment Reform:

SVS Town Hall: Financial Implications of Impending Payment Reform
SVS 2021 Medicare Physician Fee Schedule One-Pager
SVS Advocacy Resources for Members
Surgical Care Coalition
Vascular Specialist: Advocating for our Members
CMS Newsroom Factsheet: Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2021

Get involved in Policy and Advocacy through the SVS:

Voter Voice: Contact Congress via the SVS
SVS Virtual Coding & Reimbursement Workshop
SVS Vascular Surgery Trainee Advocacy Travel Scholarship
SVS Councils & Committees

This episode is the first of our series working with the SVS political organizations. Future topics may include coronavirus response legislation, student debt, prior authorization, and red tape reduction.

What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our listener survey or AudibleBleeding@vascularsociety.org.

With the interview season underway amidst a pandemic, we sought out advice for students applying to the integrated vascular surgery residency from three experts.

Dr. Chelsea Dorsey was recently on the podcast discussing recruitment and retention of under-represented minorities at all levels. Dr. Dorsey attended medical school at the University of Chicago Pritzker School of Medicine, and completed an integrated vascular surgery residency at Stanford University. She serves as Director of Preclinical Advising in the medical school - a role that allows her to have significant facetime with 1st and 2nd year students. Of note, she also serves as Director of the MS3 Surgical Simulation Course and was recently nominated to the Academy of Distinguished Medical Educators at the University. She currently sits on a number of regional and national education committees, including the SVS, COVERS, and MVSS.

Dr. Murray Shames (@MurrayShames) is the current President of the Association for Program Directors in Vascular Surgery, as well as the Division Chief of Vascular Surgery and former Program Director at the University of South Florida. His teaching experience includes developing models for the Fundamentals of Vascular Surgery and Fundamentals of Endovascular Surgery courses. He has been the course Co-Director for the Introduction to Academic Vascular Surgery Course in Tampa since 2012, and has served as an instructor/preceptor to dozens of residents since coming back to USF in 2002.

Dr. Arash Fereydooni (@Arash_Fere) is currently one of the first-year integrated vascular surgery residents at Stanford University. Dr. Fereydooni completed a BS and MS in Molecular, Cellular and Developmental Biology at Yale. He then received his medical degree in 2020 from Yale School of Medicine where he did a Howard Hughes Medical Institute Fellowship under the mentorship of Dr. Alan Dardik. He currently serves on the Student Education committees of SVS and VESS. In 2019, he started the annual SVS Integrated Vascular Surgery Match webinar.

Nominate someone for the SVS Excellence in Community Service Award!

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The Journal of Vascular Surgery has been piloting online journal clubs and would like to open them up to a broader audience. Two JVS Editors join us to discuss this innovative approach to critically reviewing impactful research in vascular surgery and how to get involved.

Paul DiMuzio, MD (@pdimuziomd)- Assistant editor of the Journal of Vascular Surgery and the Director of the Division of Vascular and Endovascular Surgery at Jefferson Health in Philadelphia, PA.
Misty Humphries, MD (@mhumphriesmd) - on the editorial board of the Journal of Vascular Surgery and Associate Professor of Surgery at UC Davis in Sacramento, CA.

Click here to sign up to host a monthly journal club in 2021

Click here to register for the December virtual journal club (Wed 12/16/2020 9pm Eastern on Zoom)

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In this month’s episode of our JVS - Arterial Editor’s Choice series, Jacob and our newest team member, Aakanksha Gupta, discuss December’s selected articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

Surgical management of pediatric renin-mediated hypertension secondary to renal artery occlusive disease and abdominal aortic coarctation (CME)
Extended screening guidelines for the diagnosis of abdominal aortic aneurysm (Editor’s Choice)
Natural history of acute pediatric iliofemoral artery thrombosis treated with anticoagulation
Midterm results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System, technical recommendations, and an algorithm for maintenance

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November 18th, 2020

Audible Bleeding Joins the SVS Family of Publications!

The Audible Bleeding team is proud to announce that we are joining the Society for Vascular Surgery (SVS) family and will be a formal publication of the vascular society. Three leaders in the SVS join us to discuss the goals and process for this transition.

Ken Slaw, PhD (@almostyoda) is a first time guest on the podcast and the executive director of the SVS.
Ron Dalman, MD (@stanfordvasc) is a returning guest, president of the SVS and chief of vascular surgery at Stanford health care.
Amy Reed, MD is a returning guest, chair of the communications committee, and chief of vascular surgery at the University of Minnesota.

We want to learn more about how the vascular surgery community uses podcasts and how we can improve - Click here to fill out our Listener Survey 2.0

Let us know if you want to give more detailed feedback and be more involved by leaving your email at the end of the survey.

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In this month’s episode of our JVS - Arterial Editor’s Choice series, Jacob, Tomaz and Soni discuss November’s selected articles with Editor-in-Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Adverse cardiac events after vascular surgery are prevalent despite negative results of preoperative stress testing (Editor’s Choice and CME)
Lumbar drain complications in patients undergoing fenestrated or branched endovascular aortic aneurysm repair: Development of an institutional protocol for lumbar drain management
Stroke rate after endovascular aortic interventions in the Society for Vascular Surgery Vascular Quality Initiative
External validation of the Vascular Quality Initiative prediction model for survival in no-option chronic limb-threatening ischemia patients

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November 16th, 2020

Debate: Who Should Manage Vascular Trauma?

Today’s debate is inspired by the recent opinion piece published in the Annals of Surgery, Beyond the Crossroads: Who Will be the Caretakers of Vascular Injury Management? : Annals of Surgery

This episode is a collaboration between Audible Bleeding, Behind The Knife, and Trauma ICU Rounds. Subscribe to all 3 on any podcasting platform!

Vascular Surgery

Dr. Benjamin Starnes is a Professor of Vascular Surgery, Chief of the Division of Vascular Surgery and Vice Chair of the Department of Surgery for UW Medicine. Additionally he is a former military surgeon with combat experience.

Dr. Westley Ohman is an Assistant Professor of Vascular Surgery at Barnes-Jewish Hospital which is a level 1 trauma center where he is routinely involved in the care of complex vascular trauma.

Trauma Surgery

Dr. Tanya Zakrison is an Associate Professor of Surgery and a Trauma and Acute Care Surgeon at the University of Chicago medical center, which is a level 1 trauma center.

Dr. Matthew Martin is a Professor of Surgery at Scripps Medical Center in San Diego, a former Army Surgeon who is recognized as a leader in trauma care, and has served on 5 combat deployments.

Moderators

Dr. Dennis Kim is an Associate Professor of Surgery and an Acute Care and Trauma Surgeon at UCLA School of Medicine and is the host of the podcast Trauma ICU rounds

Dr. Kevin Kniery is a Vascular Surgeon at Brooke Army Medical Center.

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In our next installment of the bi-monthly JVS-Venous/Lymphatic series, Jacob discusses the November 2020 editor’s choice articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins (Editor’s Choice and CME)
- Link to original VeClose trial
The clinical relevance of anterior accessory great saphenous vein reflux
The biomechanical impact of hip movement on iliofemoral venous anatomy and stenting for deep venous thrombosis
Interim results of bleomycin-polidocanol foam sclerotherapy as a highly efficient technique for venous malformations

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November 9th, 2020

Vascular Decision Making: Medical, Endovascular and Surgical

We are excited to interview the editors of the newly released textbook, Vascular Decision Making: Medical, Endovascular and Surgical. They discuss the process of editing a textbook and what makes this resource unique. They also describe the novel app that they have developed to go along with the textbook.

Jack Cronenwett is Emeritus Professor of Surgery at the Dartmouth-Hitchcock Medical

Center. He has served as President of the Society for Vascular Surgery and Editor of the

Journal of Vascular Surgery. In 2001 he developed and then served as Medical Director

of the SVS Vascular Quality Initiative, which now includes over 700 hospitals that share

clinical data to improve vascular healthcare. In 2016 he received the Society for Vascular

Surgery Lifetime Achievement Award.

Alik Farber is Chief of the Division of Vascular and Endovascular Surgery at Boston Medical Center and Professor of Surgery and Radiology at Boston University School of Medicine. Dr. Farber obtained his medical degree from Harvard Medical School. He completed a residency in general surgery at Massachusetts General Hospital, a vascular surgery fellowship at Dartmouth-Hitchcock Medical Center and an endovascular surgery fellowship at the Southern Illinois School of Medicine. Dr. Farber is currently a National Co-Chair of the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial.

Erica Mitchell is a board certified Vascular and Endovascular Surgeon with additional fellowship training in Interventional Radiology. She received her medical degree from the University of Colorado and completed general surgery residency and interventional radiology training at the University of Colorado Health Science Center. She completed her vascular surgery fellowship at Oregon Health & Science University where she served as Professor of Surgery, Program Director for Vascular Surgery, and Vice- Chair for Quality for the Department of Surgery until 2018. Dr. Mitchell practices vascular and endovascular surgery while currently enrolled in a Master of Health care and Delivery program at Dartmouth College. She enthusiastically supports surgical resident wellness and is the Founder of the virtual platform The Doc Pod, that provides a forum for confidential peer support. As of the new year, she will be transitioning to Memphis, Tennessee, where she will be Professor Surgery, University of Tennessee, and Medical Director for Vascular and Endovascular Surgery at Regional One Hospital in Memphis

Link to sample application chapter on endoleak management:

https://zingtree.com/host-gallery.php?gallery_id=180&persist_names=Restart&persist_node_ids=45

Link to Sample chapters via Amazon.com (click the “look inside” button)

https://www.amazon.com/Vascular-Decision-Making-Jack-Cronenewett/dp/1975115813

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Vascular Decision Making: Medical, Endovascular, Surgical

In this latest installment of our JVS collaboration, Jacob and Soni discuss the October Editor’s Choice articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

Retrograde open mesenteric stenting should be considered as the initial approach to acute mesenteric ischemia
Safety and feasibility of transradial infrainguinal peripheral arterial disease interventions
Arterial reconstruction with human bioengineered acellular blood vessels in patients with peripheral arterial disease

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October 28, 2020

Why a Career in Vascular Surgery with Dr. Bernadette Aulivola

In partnership with Behind the Knife and the Association of Program Directors in Vascular Surgery

Episode Notes

Today, we have the first in a two-part series of episodes that we are developing in conjunction with the Association of Program Directors in Vascular Surgery and the Behind the Knife podcast on the reasons why one should pursue a career in Vascular Surgery

Dr. Bernadette Aulivola is a Professor of Vascular Surgery and Endovascular Surgery and the Division Director of Vascular Surgery at Loyola University Medical Center

Vascular Surgeon: Bernadette Aulivola, MD, FACS

Check out Behind the Knife here: Behind the Knife: Home or on any podcast platform.

Find a Vascular mentor here: Mentor Match Program

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Alex Forsyth and Dr. Sarah Carlson Discuss Acute Limb Ischemia. Alex Forsyth is a 4th year medical student at Boston University She’s a cofounder of the Vascular surgery student interest group and is exciting to be applying to Integrated Vascular surgery programs this season

Dr. Sarah Carlson is an assistant Professor of Vascular Surgery at Boston University where she practices at the Boston VA Medical Center. She completed her general surgery training at Beth Israel Deaconess in Boston followed by a fellowship in Vascular Surgery at Dartmouth-Hitchcock Medical center in new Hampshire.

In our next installment of the bi-monthly JVS-Venous/Lymphatic series, Tomaz and Soni discuss the September 2020 editor’s choice articles with Editor-in-Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Acute superior mesenteric venous thrombosis results in high rates of readmission and morbidity
A prospective safety and effectiveness study using endovenous laser ablation with a 400-μm optical fiber for the treatment of pathologic perforator veins in patients with advanced venous disease (SeCure trial)
Volume control of the lower limb with graduated compression during different muscle pump activation conditions and the relation to limb circumference variation
Role of an age-adjusted D-dimer cutoff level in the diagnosis algorithm of lower limb deep venous thrombosis in outpatients

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In this latest installment of our JVS collaboration, Soni and Tomaz discuss the September Editor’s Choice articles with Editor-in-Chief of the Journal of Vascular surgery, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

The impact of age on in-hospital outcomes after transcarotid artery revascularization, transfemoral carotid artery stenting, and carotid endarterectomy
Rapid increase in hybrid surgery for the treatment of peripheral artery disease in the Vascular Quality Initiative database
Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic aneurysm repair
Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch

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Dr. Brigitte Smith (@Brig13Smith1)is an assistant professor of surgery in the Division of Vascular Surgery at the University of Utah, School of Medicine in Salt Lake City, Utah. She is also the program director for the vascular surgery fellowship and Vice-Chair of Education for the department of surgery. She received her MD and completed an integrated vascular surgery residency at the University of Wisconsin. Join us for our conversation on how we can innovate in the areas of quality and safety education for our vascular surgery trainees.

She has already many achievements in surgical education with a grant for her research from the NBME Stemmler Medical Education Research Fund, named associate editor for surgical education with the Annals of Surgery Open team, winner of the Association for Surgical Education Linnea Hauge Outstanding Educational Scholar award, and recently selected to lead the American College of Surgeons (ACS) NSQIP Quality in Training Initiative (QITI).

Additional Reading

Six Steps to Engage Residents in Quality Improvement Education
Crossing the quality chasm
SQUIRE 2.0 website

Relevant Publications

Pender T, Boi L, Urbik VM, Glasgow R, Smith BK. Implementation and Evaluation of a Novel High-Value Care Curriculum in a Single Academic Surgery Department. J Am Coll Surg. 2020 Oct 3:S1072-7515(20)32331-0.
Purnell SM, Wolf L, Millar MM, Smith BK. A National Survey of Integrated Vascular Surgery Residents' Experiences With and Attitudes About Quality Improvement During Residency. J Surg Educ. 2020;77(1):158-165.
Smith BK, Davies MG, Harris IB. The Current State of the 0+5 Integrated Vascular Surgery Residency Training Paradigm: A Scoping Review of the Literature. J Surg Educ. 2019;76(4):990-1004.
Smith BK, Greenberg JA, Mitchell EL. The evolving integrated vascular surgery residency curriculum. Ann Vasc Surg. 2014;28(7):1761-1768.
Huffman EM, Anderson TN, Choi JN, Smith BK. Why the Lab? What is Really Motivating General Surgery Residents to Take Time for Dedicated Research [published online ahead of print, 2020 Aug 4]. J Surg Educ. 2020;S1931-7204(20)30268-3

Dr. Hazim J. Safi earned his medical degree at the University of Baghdad and completed his general surgery internship at Medical City Teaching Hospital in Baghdad and St. James Hospital in London, England. He completed his general surgery followed by his cardiothoracic residency at Baylor College of Medicine in Houston, studying under Dr. Michael DeBakey and Dr. Stanley Crawford. Dr. Safi is a professor and the founding chairman of the department of Cardiothoracic and Vascular Surgery at McGovern Medical School at UTHealth in Houston and chief of cardiothoracic and vascular surgery at Memorial Hermann Heart & Vascular Institute. Throughout his almost 50 year career, he has co-authored 30 book chapters and 200 scientific articles, and he is credited with the innovation and development of internationally recognized surgical techniques that have dramatically improved patient outcomes in aortic surgery.

Dr. Bruce Tjaden Jr earned a Bachelor of Arts degree from Boston University and attended medical school at the University of Kansas. He then completed his surgery residency at the Department of Surgery at the University of Kansas Hospital, and a vascular surgery fellowship at the University of Texas – Houston Health Science Center / Memorial Hermann Hospital under Dr. Hazim Safi and Dr. Ali Azizzadeh. Dr. Tjaden then joined Dr. Safi’s Department of Cardiothoracic and Vascular Surgery and practiced as an academic vascular surgeon at Memorial Hermann as well as surrounding Houston hospitals. He is now an Assistant Professor of Vascular and Endovascular Surgery at Cooper University Hospital in Camden, New Jersey and he has a particular interest in the management of aortic dissection and thoracic endovascular aortic repair.

A Time for All Things: The Life of Michael E. Debakey https://www.amazon.com/Time-All-Things-Michael-DeBakey/dp/0190073942

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A Time for All Things: The Life of Michael E. DeBakey

Dr. Nedal Katib from the Prince of Wales University Hospital and St. Vincent's Hospital in Sydney, Australia, and Dr. Danielle Bajakian from the Columbia University Medical Center in New York, NY discuss intermittent claudication and medical management of peripheral artery occlusive disease.

Script by: Dr. Nedal Katib

In our next installment of the JVS Editor’s choice series, Soni and Adam discuss the JVS August Editor’s Choice articles with Senior Editor, Dr. Peter Lawrence.

Articles Discussed:

Risk Factors and Safe Contrast Volume Thresholds for Post-contrast Acute Kidney Injury after Peripheral Vascular Interventions https://bit.ly/2y3pcRi
Learning curve of fenestrated and branched endovascular aortic repair for pararenal and thoracoabdominal aneurysms https://bit.ly/2zAu152
CME, PR, Editor's Choice. Endovascular Repair of Ruptured Abdominal Aortic Aneurysm is Superior to Open Repair: Propensity Matched Analysis in the Vascular Quality Initiative https://bit.ly/2zDtEa1

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Dr. Ross Naylor (MBChB MD FRCS) is Professor of Vascular Surgery at the Leicester Vascular Institute, Leicester UK. He is a past President of the Vascular Society of Great Britain and Ireland and a past Editor in Chief of the European Journal of Vascular and Endovascular Surgery. He has authored 600 publications and book chapters, co-edited three textbooks of Vascular Surgery and his work has been cited over 17,000 times. He has just recently retired from clinical practice and we were lucky enough to interview him about his career and insights in carotid surgery.

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July 26th, 2020

Representation Matters: Recruitment and Retention of URM to Vascular Surgery

In this second episode from our series on race and representation in medicine, we focus on the challenges of recruitment and retention of racial and ethnic minority groups that are underrepresented in medicine (URM) to vascular surgery. We are very pleased to have with us a number of guests at different levels of training to discuss their experiences and insights.

Dr. Chelsea Dorsey is faculty in the Section of Vascular Surgery at the University of Chicago and serves as the Director of the UChicago Vein Clinic and Ambulatory Medical Director for Cardiac, Vascular, and Thoracic Surgery. She is a graduate of the Pritzker School of Medicine, where she developed an interest in health care inequalities. In addition, she volunteered her time helping pipeline programs and outreach activities in the community geared toward increasing the number of underrepresented minorities in the medical field. After completing her Vascular Surgery training at Stanford University as the first woman and first African American accepted into the training program, she returned as faculty at the University of Chicago Medicine. She serves as Director of Preclinical Advising in the medical school. She has served on the BSD Faculty Diversity Committee since 2017 and was recently appointed Chair of the Diversity, Equity, and Inclusion Steering Committee in the Department of Surgery.

Dr. Elsie Ross is a vascular surgeon and research scientist in the Division of Vascular Surgery at Stanford University. She graduated from Stanford University School of Medicine in 2011 and completed her vascular surgery integrated residency at Stanford University School of Medicine in 2018. During her residency, she completed a two-year post-doctoral fellowship in biomedical informatics. Her current research focuses on using machine learning and electronic health records for early disease identification, precision medicine, and evaluating opportunities to engage in patient education beyond the clinic. She is a Fulbright Scholar and a Soros Fellow, and is a recipient of the Young Investigators Award from the Association for Academic Surgery, as well as the Junior Faculty Award from the Society of University Surgeons.

Dr. Joel L. Ramirez, MD, is the inaugural UCSF Integrated Vascular Surgery resident. He completed his undergraduate education at the University of California, Irvine, and received his medical degree from the UCSF School of Medicine, graduating with Distinction in Clinical and Translation Research, and as a member of Alpha Omega Alpha. Dr. Ramirez conducted an NIH-funded pre-doctoral research fellowship between his third and fourth years of medical school with the UCSF Division of Vascular and Endovascular Surgery. In 2018, he was awarded first place for the Western Vascular Society Robert Hye Memorial Best Resident Presentation Award, for his research reporting on long term outcomes of endovascular aortic aneurysm repair. Dr. Ramirez has been the recipient of numerous other research fellowships, awards, and honors, including the American Medical Association Foundation Physicians of Tomorrow Award, the Society for Vascular Surgery Foundation Student Research Fellowship for two consecutive years, the American Heart Association Student Scholarship in Cardiovascular Disease, and the Association for Academic Surgery Senior Medical Student Award, among many others.

Dr. Ronald Dalman is the Walter C. and Elsa R. Chidester Professor and Chief of Vascular Surgery at Stanford University. He is also the current President of the Society for Vascular Surgery. Dr. Dalman earned his medical degree at the University of Michigan and completed surgical training at the University of Washington (Seattle) and his vascular fellowship at the Oregon Health and Sciences University. Dr. Dalman joined Stanford directly out of training and has led the vascular program since 2005. He is a member of the Vascular Surgery Board, American Board of Surgery, and a past member of the Residency Review Committee for Surgery, ACGME. At Stanford Health Care he serves as Co-Director and Chief Quality Officer for the Cardiovascular Service Line. At the School of Medicine, Dr. Dalman is a Steering Committee and founding member of the Cardiovascular Institute (CVI). Dr. Dalman's research laboratory studies the pathophysiology of abdominal aortic aneurysm (AAA) disease, and is actively engaged in identifying and validating new treatment measures for AAA.

Additional Resources:

Dr. Dorsey’s presentation from the VESS paper session at the SVSOnline-

Update on Workforce Diversity in Vascular Surgery: What has changed in 20 years?

https://cdmcd.co/RqbR89

Perceptual and Structural Facilitators and Barriers to Becoming a Surgeon: A Qualitative Study of African-American and Latino Surgeons Ulloa et al. Acad Med. 2018 September ; 93(9): 1326–1334. doi:10.1097/ACM.0000000000002282 https://pubmed.ncbi.nlm.nih.gov/29742613/

Structural Solutions for the Rarest of the Rare: Underrepresented-Minority Faculty in Medical Subspecialties Kemi M. Doll, M.D., and Charles R. Thomas, Jr., M.D. N Engl J Med 2020; 383:283-285 DOI: 10.1056/NEJMms2003544

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In our next installment of the JVS-Venous/Lymphatic series, Jacob discusses the July 2020 editor’s choice articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

Radiofrequency and laser vein ablation for patients receiving warfarin anticoagulation is safe, effective, and durable (CME)
The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology
Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers
In-hospital outcomes of catheter-directed thrombolysis versus anticoagulation in cancer patients with proximal deep venous thrombosis

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In our next installment of the JVS Editor’s choice series, Jacob discusses the JVS July Editor’s Choice articles with Senior Editor, Dr. Peter Lawrence.

Dr. Lawrence YouTube Video

Articles Discussed:

The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms
Five-year survival following endovascular repair of ruptured abdominal aortic aneurysms is improving (CME)
Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access
Implications of early failure of isolated endovascular tibial interventions

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Dr. Matthew Chia (@chia_md)is an integrated vascular surgery resident at Northwestern Feinberg School of Medicine. He is currently in his research years working on a T32 NIH grant and has been involved with the vascular surgery extension of the SECOND trial under the mentorship of Dr. Karl Bilimoria and Dr. Dawn Coleman.

Dr. Dawn Coleman (@ColemanDM_vasc) is an associate professor of surgery at the University of Michigan and is the Program Director of the Integrated Vascular Surgery Residency Program and Fellowship. She is a returning guest and spoke with us previously about her amazing work with the SVS Wellness Taskforce, for which she is chair.

Important Links

http://www.thesecondtrial.org/
second@northwestern.edu
Northwestern Vascular Surgery Scientist Training Program

Further Reading

Bilimoria KY, Chung JW, Hedges LV, et al. National Cluster-Randomized Trial of Duty-Hour Flexibility in Surgical Training. N Engl J Med 2016;374:713-27
Hu Y-Y, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med 2019;381:1741-52.
Khorfan R, Yuce TK, Love R, et al. Cumulative Effect of Flexible Duty-hour Policies on Resident Outcomes: Long-term Follow-up Results From the FIRST Trial. Ann Surg 2020;271:791-8.
Zhang LM, Ellis RJ, Ma M, et al. Prevalence, Types, and Sources of Bullying Reported by US General Surgery Residents in 2019. JAMA 2020;323:2093-5.
Davila VJ, Meltzer AJ, Hallbeck MS, Stone WM, Money SR. Physical discomfort, professional satisfaction, and burnout in vascular surgeons. J Vasc Surg 2019;70:913-20.e2.

Dr. Matthew Edwards and Dr. Cullen McCarthy from Wake Forrest School of Medicine discuss management of Renal Vascular diseases

Script by Dr. Cullen McCarthy

June 22nd, 2020

Race and Representation in Medicine: Addressing Implicit Bias in the Workplace

In light of the events unfolding across the country over the past few weeks, The Society for Vascular Surgery's Diversity Equity and Inclusion Task Force and the Wellness Task Force sponsored a webinar around race in America and its impact on our field. We at Audible Bleeding thought this was an excellent start, and we would hope to keep the conversation going. As such, this will be the first in a series of episodes on race and representation in medicine. Today we would like to discuss the challenges of addressing implicit bias in the workplace. We are very pleased to have with us a number of guests at different levels of training to discuss their experiences and insights.

Dr. Vincent Rowe is a Professor of Surgery at the Keck School of Medicine of USC. He is the Program Director of the Vascular Surgery Residency. He earned his medical degree from the University of Southern California School of Medicine, and trained in general surgery at Kaiser Permanente Medical Center in Los Angeles. He subsequently completed a two-year Vascular Surgery Fellowship at the University of Tennessee Medical Center in Knoxville Tennessee.

Dr. Olamide Alabi is an Assistant Professor of Surgery in the Division of Vascular Surgery and Endovascular Therapy at the Emory University School of Medicine. She received her medical degree from the University of Nebraska College of Medicine, trained in general surgery at Loma Linda University Medical Center in Southern California, and completed a fellowship in Vascular Surgery at Oregon Health and Science University.

Dr. Nina Bowens is an Assistant Professor in Surgery, UCLA School of Medicine, and a member of the Division of Vascular and Endovascular Surgery at Harbor-UCLA. She earned her medical degree at Weill Cornell Medical College and trained in general surgery at the University of Pennsylvania. She completed her Vascular Surgery fellowship at the New York Presbyterian Hospital.

Dr. Osarumen Okunbor is a graduate of Meharry Medical College, completed his General surgery at Louisiana State University in New Orleans, and will be starting his Vascular Surgery fellowship at University of Washington in Seattle.

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Listen on Apple Podcasts, Spotify, or stream on their website

Dr. Victoria Teodorescu (Dr. T) grew up in New Jersey but really claims Nebraska as her home. Her summers as a child in Nebraska were spent chasing after cows, swimming in the irrigation ditches, and finding snakes in the backyard. Dr. T’s road to medicine definitely wasn’t straight. She knew she loved science and math, but Dr. T remembers that “the girls in my high school hadn’t been expected to do much of anything and even if you really want to do something with your life, there is no guidance.”

She attributes her guidance and determination to the women in her family who had the fortunate opportunity to graduate from college back in the 1920s. After graduating from college at NYU, Dr. T took on different jobs including working on Wall Street and even joining the Fashion Institute, before medicine called her home.

Dr. T recounts the people that tried to discourage her on her road to medicine, including her own program director who had told her that “women with children don’t belong in surgery.” Despite all the obstacles, Dr T was able to become Chief of Vascular Surgery at Bronx VA Medical Center where she instituted a diabetic foot clinic to combat emergency amputations for foot infections.

Dr. T joined Emory School of Medicine in 2016 and is currently an associate professor of surgery in the Division of Vascular Surgery and Endovascular Therapy.

Hosts: Amanda Fobare, Deema Elcoufi

Editor: Patience Timi

Producer: Alex Speak

In this latest installment of our JVS collaboration, Jacob discusses the June Editor’s Choice articles with Editor-in-Chief of the Journal of Vascular surgery, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Population-based long-term outcomes of open versus endovascular aortic repair of ruptured abdominal aortic aneurysms (CME and Editor’s Choice)
Hemodynamic events during carotid stenting are associated with significant periprocedural stroke and adverse events
Prospective nonrandomized study to evaluate cone beam computed tomography for technical assessment of standard and complex endovascular aortic repair
A randomized controlled trial of drug-coated balloon angioplasty in venous anastomotic stenosis of dialysis arteriovenous grafts

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May 25th, 2020

Cerebrovascular Trauma with Dr. Todd Rasmussen

Episode 4 of 6 for our Vascular Trauma series.

Kevin and Nicole discuss the management of ceberbrovascular trauma, primarily blunt and penetrating injuries to the carotid and vertebral arteries.

Dr. Rasmussen is a Colonel in the United States Air Force and is a Professor of Surgery and Associate Dean of Research at the Uniformed Services University of the Health Sciences and an attending vascular surgeon at Walter Reed National Military Medical Center.

Dr. Rasmussen has been deployed numerous times to Iraq and Afghanistan and cared for many traumatic vascular injuries at Walter Reed Medical Center. Through his experience and research, he has become one of the foremost leaders on the management of vascular trauma and recently published the third edition of Rich’s Vascular Trauma.

EAST Blunt Cerebrovascular Injury Guidelines

https://www.east.org/education/practice-management-guidelines/blunt-cerebrovascular-injury

Check out Rich’s Vascular Trauma

https://www.elsevier.com/books/richs-vascular-trauma/9781455712618

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We discuss aortopathies and arteriopathies with Dr. Anna Ohlsson and Dr. Sherene Shalhub from the University of Washington.

Review Script by Anna Ohlsson, MD

May, 13th, 2020

Dr. Sam Money joins us to discuss the importance of ergonomics in vascular surgery. Dr. Money completed his surgical residency at SUNY Downstate and trained in vascular surgery at the Ochsner clinic in New Orleans. He remained at Ochsner Clinic for 15 years where he rose through the ranks to be Division Head of Vascular Surgery. He then moved to the Mayo Clinic in Arizona where he served as professor and Chairman of the Department of Surgery. Currently, he serves as chair of Surgery and associate medical director for surgery at Ochsner Medical institutions. He has served in numerous leadership positions including presidency of the society for clinical vascular surgery, the southern association of vascular surgery and the vascular and endovascular society.

Articles from this episode:

Impact of procedure type and equipment on surgeon discomfort:

https://www.journalacs.org/article/S1072-7515(20)30125-3/fulltext

Wearable devices to measure ergonomic risks:

https://jamanetwork.com/journals/jamasurgery/fullarticle/2762518

Ergonomic issues in Vascular Surgery:

https://www.jvascsurg.org/article/S0741-5214(18)30800-0/fulltext

Survey of Ergonomic Injuries (male sex and long case time in surgical oncology):

https://www.sciencedirect.com/science/article/abs/pii/S1072751516314971

Randomized ergonomics study:

https://journals.lww.com/annalsofsurgery/Citation/2019/12000/A_Preventive_Program_for_Work_related.10.aspx

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May 11, 2020

In our next installment of the bi-monthly JVS-Venous/Lymphatic series, Jacob discusses the May 2020 editor’s choice articles with Editor-in-Chief, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

The 2020 update of the CEAP classification system and reporting standards (Editor’s Choice)
Spine stabilization is a risk factor for the development of pelvic iliac vein lesions (CME)
Comparison of computed tomography venography and intravascular ultrasound in screening and classification of iliac vein obstruction in patients with chronic venous disease
Impact of ligation versus repair of isolated popliteal vein injuries on in-hospital outcomes in trauma patients

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May 7th, 2020

In this latest installment of our JVS collaboration, Jacob discusses the May Editor’s Choice articles with Editor-in-Chief of the Journal of Vascular surgery, Dr. Peter Gloviczki.

Dr. Gloviczki YouTube Video

Articles Discussed:

Economic burden and clinical impact of preoperative opioid dependence for patients undergoing lower extremity bypass surgery (Editor’s Choice)
Risk factors associated with microembolization after carotid intervention (CME)
Five-year results of endovascular abdominal aortic aneurysm repair with the Ovation abdominal stent graft
Fenestrated endovascular repair for diseases involving the aortic arch

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May 3rd, 2020

We have a special announcement for our third year medical students out there thinking about Vascular Surgery as a career choice. Joining us today is Dr. David Rigberg, Program Director for the Vascular Surgery Integrated Residency and Fellowship at UCLA and Chair of the Resident and Student Outreach Committee (RSOC) of the Society for Vascular Surgery.

He will be discussing an upcoming webinar for medical students entitled “Vascular Surgery Match 2021: All Questions Answered”. This event is sponsored by the Society for Vascular Surgery (SVS), The Vascular and Endovascular Surgery Society (VESS), and the Association of Program Directors in Vascular Surgery (APDVS).

This webinar is specially designed for 3rd year medical students with an interest in vascular surgery and will focus on the 2021 Match in 0-5 Vascular Surgery Residency Programs. They will try to address all your FAQ’s, including the impact of Sub-I cancellations, interviews, and best advice for moving forward. Please plan to attend!

When: Wednesday, May 13, 2020 05:00 PM Eastern Time (US and Canada)

Register in advance for this meeting:

https://us02web.zoom.us/meeting/register/tZEtdO6vqjIvGdV28wAHeFbHUgou5EeAvuEt

After registering, you will receive a confirmation email containing information about joining the meeting.

Dr. Matthew Wooster's advice for medical students interested in pursuing vascular surgery

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Dr. Sammy Siada and Dr. Rafael Malgor from the University of Colorado sit down to discuss Angioaccess details, decision making and complications.

Review Script by Sammy Siada