Dr. Peter Schneider is Professor of Surgery in the Division of Vascular & Endovascular Surgery at University of California San Francisco. Dr. Schneider received his MD from the Johns Hopkins School of Medicine and completed his general surgery residency and vascular surgery fellowship at the University of California San Francisco.  He was the founding member and chief of the Division of Vascular Surgery at Kaiser Permanente in Hawaii from 1994-2018, the past president of Western Vascular Society and has authored several textbooks including Endovascular Skills, the 4th edition, to be published soon.

In today’s episode, Dr. Schneider discusses the early days of endovascular therapy, updates in the 4th Edition of Endovascular Skills, innovations in critical limb ischemia, techniques he uses in his own practice and some of the recent controversies in vascular surgery.

Further Reading

• Western Vascular Society Presidential Address: The Future of Vascular Surgery
• Edward B. Diethrich, MD at the Arizona Heart Institute
• Cut-film Angiography vs Digital Subtraction Angiography
• Critical Limb Ischemia
• • BEST-CLI Trial
  • WIfI Criteria
  • GLASS Classification
  • Audible Bleeding Paclitaxel Episode
• Follow him: @PSchneiderMD

Relevant Disclosures: Consultant for Surmodics and Medtronic

Support Audible Bleeding!

To support our podcast, please visit: https://www.audiblebleeding.com/support/

Dr. David Rigberg is a clinical professor of surgery in the Division of Vascular and Endovascular Surgery at the UCLA David Geffen School of Medicine and the Program Director for the Vascular Surgery Integrated Residency and Fellowship at UCLA. He is the president of the Southern California Vascular Surgical Society as well as the chair of the SVS Resident and Student Outreach Committee. He serves on faculty for the Medical Student and Resident Simulation Program at the VAM and the annual Cardiovascular Fellows Boot Camp in Houston. He joins us to discuss career development and education in vascular surgery, the satisfaction he gets from his venous work, and the role music plays in his life.

Career development & training:

• Introduction to Academic Vascular Surgery
• SVS Vascular Annual Meeting
• Dr. Malachi Sheahan’s Fundamentals of Vascular Surgery
• Houston Methodist Cardiovascular Fellows Bootcamp
• Cardiovascular Fellows Bootcamp - YouTube channel
• Pacific Northwest Endovascular Course

Vascular Surgery workforce

• Recruitment for vascular disease management struggles to keep up with expected demands on the workforce

 Operative tips & tricks

• Balloon Control of the Suprahepatic Inferior Vena Cava: A Novel Technique for Renal Cell Carcinoma Tumor Thrombus
• Tips and Tricks: Dealing with a troublesome peritoneal dialysis catheter 

This episode is the first in a series produced in collaboration with the Society for Vascular Surgery Young Surgeons Advisory Committee (SVS YSC). This episode will focus on establishing a research lab and setting the groundwork for a productive academic career. Our guests for this episode are two members of the Young Surgeons Advisory Committee, Dr. Mohamed Zayed and Dr. Nicholas Osborne.

Dr. Mohamed Zayed ([email protected]) has been an assistant professor of surgery at Washington University in St. Louis since 2014.  He received his medical degree and Ph.D. in pharmacology from UNC and vascular surgery residency training from Stanford.  He has received many research awards for his translational research, including the Vascular Cures Wylie Scholar, American Surgical Association Foundation Fellow and in 2016 was awarded a K08 career development grant from the NIH, National Heart Lung and Blood Institute.

Dr. Nicholas Osborne ([email protected], @nichosbo) has been an assistant professor of vascular surgery at the University of Michigan in Ann Arbor, Michigan since 2014.  He received his medical degree from Dartmouth and general surgery residency and vascular surgery fellowship at the University of Michigan.  He has received multiple awards for his health services research from the American Heart Association, industry and has submitted a grant through the NIH Department for Health and Human Services.

Resources discussed on the show:

• AAS: https://www.aasurg.org/awards/
• AAS Fall Courses: Grant writing course: https://www.aasurg.org/aas-fall-courses/
• ASC AAS Investigator's Course: https://academicsurgicalcongress.org/sic/
• Wylie Scholars Grant: https://vascularcures.org/wylie-scholar-program-2/
• VESS:  https://vesurgery.org/grants-awards/
• AVF: https://www.veinforum.org/avf-foundation/bsn-jobst-research-grant/
• AHA: https://professional.heart.org/professional/ResearchPrograms/ApplicationInformation/ScientistPrincipalinvestigators/UCM_316962_For-Scientists.jsp
• SVS: https://vascular.org/career-tools-training/awards-and-scholarships
• Association of VA Surgeons: https://www.vasurgeons.org/research-awards.html
• HHMI downloadable book: Making the Right Moves: A Practical Guide to Scientific Management for Postdocs and New Faculty
• Melina Kibbe's book: Success in Academic Surgery: Basic Science

Three main categories of research funding:

1. Institutional microgrants
2. • Internal funding mechanisms through research centers or foundations at your institution: university, VA, etc.
   • SVS
   • Other professional societies' awards: AHA, ADA, VESS, etc.
3. Foundation award
   • K award series: career development grants for early-stage investigators
   • R01: highest level, most coveted
4. NIH funding

Dr. Darren Schneider and Dr. Joseph Mills recently participated in the Vascular Leaders Forum: Drug Elution in Peripheral Artery Disease (PAD): A Critical Analysis from a Multispecialty Consortium on March 1-2, 2019 and take time tell us what they heard and how it has impacted their practice.

Darren Schneider, MD (@VascularMD) is Chief of Vascular and Endovascular Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.  He completed his training and was on faculty at the University of California, San Francisco and has extensive experience in minimally invasive vascular procedures and research interests in the design and development of endovascular devices for the treatment of aortic aneurysm and peripheral arterial diseases. Disclosures: None.

Joseph Mills, MD (@jmills1955) is Professor and Chief of the Division of Vascular Surgery & Endovascular Therapy at the Baylor College of Medicine.  He has held numerous leadership positions in vascular surgery, is co-editor for Rutherford’s Vascular Surgery and is most well known for his work in developing the WIfI wound criteria for critical limb ischemia. Disclosures: None

(04:15) Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

(11:30) FDA UPDATE: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality - Letter to Health Care Providers

(12:30) Coronary stents - SPIRIT trial

Dr. Venita Chandra is an associate professor of Surgery and the associate program director for the vascular surgery fellowship at Stanford.  She completed medical school at the University of Chicago and then did her Residency and fellowship at Stanford where she was asked to stay on as faculty.    Dr. Chandra is also the founder of the Stanford Limb Salvage Initiative called the StEPP program or Stanford Extremity Preservation Program and is going to talk to us today about limb preservation among other things.

(00:20) Venita Chandra, MD full Biography

(02:30) SVS General Surgery Resident/Medical Student Vascular Annual Meeting Travel Scholarship

(03:30)  Stanford Extremity Preservation Program

• Partnerships between podiatrists and vascular surgeons in building effective wound care centers
• The role of interdisciplinary team approach in the management of the diabetic foot
• The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI)

(14:30) “Endovascular Junkie” - Early Bypass versus Endovascular First

(15:30) Early amputation - Partial or major amputation

(18:00) Palliative care and “end-stage” vascular disease

(21:30) Advanced endovascular techniques

• Pedal and alternative access for endovascular procedures
• DES and DCB
• Stents below the knee

(26:00) Education and Standford Vascular Surgery Fellowship and Residency

(29:00) Fellowship vs. Residency - Both are great!

(33:00) Diversity in vascular surgery

• Fetal radiation exposure during pregnancy

(36:30) Dr. Samuel Money Flush Technique

(38:00) Hip Hop BBQ Pandora

Dr. Starnes is a Professor and Chief of the Division of Vascular Surgery and Vice Chair of the Department of Surgery for UW Medicine.  He received his undergraduate degree at Albright College in Reading, PA, his medical degree at Jefferson Medical College in Philadelphia and completed his surgical training at Walter Reed in Washington, D.C.  Prior to accepting his position at UW Medicine, Dr. Starnes spent a total of 15 years in the United States Army serving three combat tours, one in Kosovo and two in Iraq.  

Disclaimer: Dr. Starnes is a co-founder of Aortica corporation where he holds patents and stock options

(0:22)  Academic bio

(0:55) Research interests

• Management of complex aortic aneurysms
• Classification of blunt aortic injury

(1:23)  Western Vascular society

(5:25) Military experience

(17:29) Aortica Corporation

(29:00) Discussion on the widespread use of FEVAR

(33:15) IDE process

(33:58) Starnes FEVAR results prior to obtaining IDE

(38:30) The Bleeding Edge documentary

(38:38) Elizabeth Holmes

(40:25) Fenestrations for everyone!

Dr. Edward Woo is the chairman of the Department of Vascular Surgery at MedStar Health in Washington, DC, and professor of surgery at Georgetown University. He went to medical school, residency and fellowship at the University of Pennsylvania and served on staff as a vascular surgeon before moving to Washington, DC. At MedStar, he grew a division of vascular surgery, interviewing and hiring many surgeons across multiple hospitals.  He gives advice for fellows on how to find a job and negotiate a contract.

Further Reading

• Tips on How to Negotiate a Contract by Julie Freischlag, MD
• Anatomy of a complex physician contract negotiation
• Contract Negotiations - Ten Tips from the Trenches

Dr. Jeffrey Jim is an Associate Professor of Surgery and Program Director, Vascular Surgery Fellowship and Integrated Residency at the Barnes-Jewish Hospital and Washington University in St Louis, Missouri. He takes some time to discuss the basics of TransCarotid Artery Revascularization (TCAR), comparative effectiveness research and drivers of cost in vascular surgery.

Disclosures:

• Consultant for Silk Road Medical (Proctor, Co-Director of National Test Drive: Education courses for physicians)
• Consultant for Medtronic (speaker/educational content)

(0:28) Academic Bio and Video Bio

(4:22) TransCarotid Artery Revascularization

(14:22) Updated data and publications on TCAR

• 1-year outcomes of ROADSTER trial
• Multi-Institution data observational data
• SVS-VQI Registry data

(19:45) Long term outcomes of carotid stenting

(22:00) Masters in Population Health Sciences

(23:10) Cost-effectiveness analyses in Vascular Surgery

(29:30) Predicting future workload and implications for training and SVS comments on vascular surgery workforce

Dr. Gustavo Oderich is originally from Porto Alegre, Brazil and currently the Chair of the Division of Vascular and Endovascular Surgery, Program Director for Vascular Surgery Integrated Residency, Traditional Fellowship and Advanced Aortic Fellowship at the Mayo Clinic in Rochester, MN.  He is a pioneer and expert in branched and fenestrated endovascular devices for the treatment of complex aortic aneurysmal disease and discusses recent innovations, controversies and future directions of this field.

(0:25) - Full Biography and a recent interview in Vascular News

(7:42) - Brachial Access and other advanced techniques for TAAA

(9:38) - Evolution from physician-modified to company-manufactured fenestrated-branched endografts to treat pararenal and thoracoabdominal aortic aneurysms.

(13:30) - In situ fenestration during aortic aneurysm repair

(17:30) - Regulatory, compliance, and legal issues involved with physician-modified devices

(18:20) - Investigational Device Exemption (IDE)

(19:10) - GORE® EXCLUDER® Thoracoabdominal Branch Endoprosthesis (TAMBE)

(24:20) - NICE draft guideline casts shadow over EVAR for unruptured aneurysms and The proposed UK abdominal aortic aneurysm guidelines: A much needed wakeup call

(29:30) - Sexual dysfunction after elective repair of abdominal aortic aneurysms

(31:00) - Techniques that have lead to reduced radiation exposure in F-BEVAR

(36:30) - Peloton

Join us for a VSITE review of cerebrovascular disease!  For more reading, make sure you check out the Updated Societ for Vascular Surgery Guidelines for Management of Extracranial Carotid disease.  Below is a brief outline of topics covered:

1. PRESENTATION AND DIAGNOSIS
   1. What is the definition of crescendo TIAs
   2. Who needs to be screened?
   3. US findings
   4. Other Imaging Modalities
2. MANAGEMENT 
   1. Optimal medical therapy
      1. Timing
      2. Intra-op techniques
      3. Post-op Complications
      4. Long-term Complications and Follow-up
   2. Carotid endarterectomy general principles
   3. Carotid Artery Stenting
   4. Uncommon disease presentations
      1. Occluded Carotid
      2. Vertebrobasilar insufficiency and carotid artery disease?
      3. Tandem lesions in the carotid bulb and carotid siphon
      4. Carotid artery dissection
      5. Simultaneous coronary and carotid disease
3. Prospective Trials - MUST READS
   1. Asymptomatic Carotid Atherosclerosis Study (ACAS)
   2. North American Symptomatic Carotid Endarterectomy Trial (NASCET)
   3. Carotid Revascularization Endarterectomy versus Stenting Trial (CREST)

For full notes, check out our VSITE review website: https://www.audiblebleeding.com/boards-prep-and-vsite/