Audible Bleeding

Kim Hodgson, MD is the David Sumner endowed Chair of vascular and endovascular surgery at Southern Illinois University School of Medicine in Springfield, Ill. and is the current president of the Society for Vascular Surgery.  He received his medical degree at the University of Pennsylvania, did his general surgery residency at Albany medical college and vascular surgery fellowship at the Southern Illinois University. He has over 100 peer-reviewed publications, 40 book chapters and has been the PI on numerous clinical trials.  He was the inaugural editor of VESAP and co-editor in chief of the second and third editions of VESAP. Dr. Hodgson served on the Vascular Surgery Board and recently presented as the SVS representative at the multidisciplinary panel for the Circulatory system devices and medical devices advisory committee as part of the FDA oversight into paclitaxel devices in PAD.

These are the opinions of Dr. Hodgson and do not necessarily represent a formal stance by the SVS. 

Updates from The FDA Circulatory System Devices Panel Meeting, June 19-20th, 2019:

• US FDA Panel Reviews Paclitaxel Device Data: No Recommendations Issued as More Work is Needed. VascularNews.com. June 20, 2019.
• FDA Letter to Health Care Providers, UPDATE: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality. FDA.gov. June 20, 2019.
• FDA Executive Summary, Circulatory System Devices Panel Meeting, Paclitaxel-Coated Balloon and Paclitaxel-Eluting Stent Late Mortality Panel, June 19-20, 2019

Next steps:

• Society for Vascular Surgery’s VQI Adds New Analysis to Paclitaxel Device Discussion. VascularNews.com. June 14, 2019.
• The problems with Target Lesion Revascularization (TLR) as an endpoint. Vascular Specialist. January 25, 2015.

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Dr. Michael Conte is a professor of surgery and co director of the UCSF Heart and Vascular center and chief of the division of Vascular and Endovascular Surgery.

Dr. Conte is the lead author on the Global vascular guidelines on the management of chronic limb-threatening ischemia just published in the Journal of Vascular Surgery in June 2019.

Article link

https://www.jvascsurg.org/article/S0741-5214(19)30321-0/fulltext

To access the SVS that includes WIFI Calculator search in iTunes Store or Google Play for "SVS iPG". It is free and full of useful information and calculators to use in everyday practice.

Dr. Dawn Coleman is an Associate Professor of Surgery at The University of Michigan, and she is the Program Director of the Integrated Vascular Surgery Residency Program and Fellowship. She is the Chair of The SVS Wellness Task Force, and discusses the results of the vascular surgery burnout survey on today’s podcast.  

https://www.mdedge.com/vascularspecialistonline/article/202031/mixed-topics

Episode 1 of 3 from our time at VAM 2019

Dr. Joseph Lombardi is a Professor of Surgery at Cooper Medical School and Head of The Division of Vascular and Endovascular Surgery at Cooper University. He is the PI of the Stable II Trial on endovascular treatment of Acute, Complicated Type B Aortic Dissection with a Composite graft design.

Stable I Trial

https://www.ncbi.nlm.nih.gov/pubmed/22169668

Stable II Trial

https://www.jvascsurg.org/article/S0741-5214(16)00633-9/fulltext

 SVS/STS Dissection Classification System

Please see Audible Bleeding’s Twitter feed for an animation of the new classification system.

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Audible Bleeding is excited to announce our new collaboration with the Journal of Vascular Surgery. We aim to present high impact articles in a digestible audio format and provide insights into their broader context and how the research developed through interviews with the journal editors and highlighted authors. Our guests on this episode are Journal of Vascular Surgery Editors, Dr. Peter Gloviczki and Dr. Peter Lawrence to introduce this collaboration and discuss their session at the upcoming #VAM19.

B4: CRITICAL ISSUES FOR AUTHORS AND REVIEWERS

• A joint session of JVS/EJVES/JAMA Surgery
• Friday, June 14, 2019
• 6:30 - 8:00 am

Dr. Peter Gloviczki is the Editor-in-Chief of the Journal of Vascular Surgery.  He completed his general surgery and vascular training at Semmelweis University in Budapest, Hungary, at St. Michel and St. Joseph Hospitals in Paris, France, and at the Mayo Clinic in Rochester, MN, where he joined faculty and then became Chair of the Division of Vascular and Endovascular Surgery from 2000-2010.  He is a Past President of the SVS and WFVS, as well as numerous other national and regional vascular societies. He has over 400 peer-reviewed publications, and he has edited seven textbooks, including multiple editions of Rutherford’s Vascular Surgery. 

Dr. Peter Lawrence is the Senior Editor of the Journal of Vascular Surgery.  He completed his general surgery and vascular training at Columbia-Presbyterian Medical Center in New York, spent his early career at the University of Utah but now serves as the Chief of Vascular Surgery and the Bergman Chair in Vascular Research at University of California Los Angeles. He is a Past President of the SVS and SVS Foundation.  Dr. Lawrence is committed to medical education as seen by his involvement in the National Board of Medical Examiners and the American Boards of Surgery and Vascular Surgery. He has served on the editorial board or as a selected reviewer for eleven medical journals. 

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Michel S. Makaroun, MD is a professor of surgery and the chair of vascular surgery at the University of Pittsburgh Medical Center.  He is the current president of the Society for Vascular Surgery and has been the president of almost every major vascular surgery organization, including the WFVS, SCVS, Eastern Vascular Society and the APDVS.  He received his medical training at the American University in Beirut and completed his vascular surgery training at the University of Pittsburgh. He is an expert in the endovascular repair of aortic and carotid disease.

SVS Vascular Annual Meeting 2019:

• Highlights
• Programming for vascular residents and fellows
• Programming for medical students and general surgery residents

Vascular Surgery Workforce:

• The national shortage of vascular surgeons
• E. Stanley Crawford Critical Issues Forum at 2018 VAM

 Benefits of SVS membership:

•  SVS Member Benefits
•  SVS Patient Safety Organization - VQI
•  Getting involved: SVS Councils and Committees

 Branding Campaign for Vascular Surgery:

• SVS: Branding Your Practice to Referring Physicians
• Branding vascular surgery should start with Why. Manish Mehta. Journal of Vascular Surgery. 69(5): 1333-1341. May 2019.
• Vascular surgery is the best-kept secret in medicine and my thoughts on how we can change that. Alan M. Dietzek. Journal of Vascular Surgery. 69(1): 5-14. January 2019.

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Dr. Warren Gasper is the Chief of Vascular Surgery at the San Francisco VA, an assistant professor of vascular surgery at UCSF, and the president of the Northern California Vascular Society. He did his general surgery residency and vascular surgery fellowship at UCSF. He is the principal investigator in multiple NIH-funded clinical trials studying interventions for PAD, broadening the application of MRA imaging in vascular surgery, and treatment of para-visceral and thoracic aortic aneurysms with fenestrated endografts.

Dr. Ahmed Shalabi ([email protected], LinkedIn) is the Chief of Vascular Anesthesia at UCSF, where he is an associate professor of anesthesia and perioperative care. He did his residency in anesthesia at the Alexandria University Hospital in Egypt and has pursued advanced training in pediatric anesthesia at the University of Lille in France, in transplantation anesthesia at UCSF, and in transesophageal echocardiography at UCLA. He discovered his passion for doing anesthesia for complex open and endovascular cases and is a member of the Center for Aortic Excellence at UCSF, where he has developed a Vascular Anesthesia Quality Improvement Database.

Dr. Leigh Ann O'Banion ([email protected]) 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 mentoring the next generation of vascular trainees. She is currently enrolling patients in a prospective study focused on improving the multidisciplinary system of care for patients who undergo amputations.

• Anesthesia in acute aortic syndrome:
  • Review Article: Anesthesia for vascular emergencies. Ellard L and Djaiani G. Anaesthesia. 68 (Suppl. 1), 72-83. 2013
• Outcomes for EVAR under sedation / local:
  • Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm. IMPROVE trial investigators. British Journal of Surgery. 101(3): 216-224. 2014
  • Decreased mortality with local versus general anesthesia in endovascular aneurysm repair for ruptured abdominal aortic aneurysm in the Vascular Quality Initiative database. Faizer R et al. Journal of Vascular Surgery. S0741-5214(18)32551-5. 2019
  • Local anesthesia for percutaneous endovascular abdominal aneurysm repair is associated with fewer pulmonary complications. Van Orden K et. al. Journal of Vascular Surgery. 68(4) 1023-1029. 2018
  • Type of Anesthesia for Endovascular Abdominal Aortic Aneurysm Repair. Armstrong RA et. al. Journal of Cardiothoracic and Vascular Anesthesia. 33: 462-471. 2019
• Renoprotection:
  • Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. Weisbord SD et. al. New England Journal of Medicine. 378(7): 603-614. 2018
  • Mannitol for the Prevention of Peri-Operative Acute Kidney Injury: Systematic Review. Waskowski J et. al. European Journal of Vascular and Endovascular Surgery. In press. 2019
• Spinal cord protection guidelines for thoracic aortic work:
  • 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease. Hiratzka LF et. al. Circulation. 121(13): e266-369. 2010
  • Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European Association for Cardio-Thoracic Surgery. Etz CD et. al. European Journal of Cardio-Thoracic Surgery. 47: 943-957. 2015
• Perioperative coronary artery revascularization and antiplatelet bridging:
  • Coronary-Artery Revascularization before Elective Major Vascular Surgery. McFalls EO et. al. New England Journal of Medicine. 351(27) 2795-804. 2004
  • Bridging antiplatelet therapy with cangrelor in patients with recent intracranial stenting undergoing invasive procedures: a prospective case series. Godier A. British Journal of Anaesthesia. In press. 2019
• Rapid ventricular pacing for aortic arch work:
  • Rapid Ventricular Pacing for Landing Zone Precision During Thoracic Endovascular Aortic Arch Repair: A Case Series. Bokoch MP et. al. Journal of Cardiothoracic and Vascular Anesthesia. 31: 2141-2146. 2017

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

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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