Audible Bleeding

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

1. 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.

2. 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.

3. 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.

4. 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.

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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.

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

1. 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
2. Patient Presentation
   1. 20-50% asymptomatic, rest can be intermittent claudication, rest pain, or tissue loss
   2. claudication=pain or discomfort felt in the legs due to a lack of blood flow, especially during physical activity. 
   3. CLTI=chronic limb threatening ischemia: rest pain lasting greater than 2 weeks or nonhealing ulcers and gangrene
   4. 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
3. Diagnosis
   1. 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 Satsang.ai (www.satsang.ai) 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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Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.