Audible Bleeding

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/

Dr.Todd Albert is Albert is Surgeon-in-Chief, Chief Medical Officer and Korein-Wilson Professor of Orthopedic Surgery at Hospital for Special Surgery.

https://www.hss.edu/physicians_albert-todd.asp

 

Dr. Sheeraz Qureshi is an Associate Attending Orthopedic Surgeon at Hospital for Special Surgery and Associate Professor of Orthopedic Surgery at Weill Cornell Medical College.

https://www.hss.edu/physicians_qureshi-sheeraz.asp

 

Dr. Peter Connolly is an Associate Professor of Surgery in the Division of Vascular and Endovascular Surgery at Weill Cornell Medical College.

https://weillcornell.org/pconnolly

 

 Spine Surgery Resources

 

(27:40) Minimally Invasive Instruments – Aesculap Mitral Valve Set

https://www.aesculapusa.com/assets/base/doc/DOC917_Valve_XS_Brochure.pdf

 

(29:15) New Instrument Dr.Ellozy Mentions

https://vascsurg.me/2017/07/29/in-medicine-we-can-all-be-real-world-innovators/

 

Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. https://www.ncbi.nlm.nih.gov/pubmed/27683674

 

Anterior lumbar spine surgery: a systematic review and meta-analysis of associated complications.

https://www.ncbi.nlm.nih.gov/pubmed/?term=25728552

 

Vascular injury in elective anterior lumbosacral surgery. 

https://www.ncbi.nlm.nih.gov/pubmed/20407353

 

Anterior Lumbar Interbody Fusion with and Without an ‘access Surgeon’.

https://www.ncbi.nlm.nih.gov/pubmed/27669042

Dr. Thomas Forbes is a professor of surgery and RJ Elliot Chair and Division Head of Vascular Surgery at the University of Toronto (@UofTVascular), and the program director of the Advanced Aortic Surgery Fellowship at the University of Toronto. He is also an associate editor of the Journal of Vascular Surgery and the chair of the Document Oversight Committee of the Society for Vascular Surgery. He joins us to discuss the application of new technologies in vascular
surgery, insight into Canadian vascular surgery, vascular surgical training, subspecialization and regionalization, personalized medicine, and the personality of the vascular surgeon.

(0:20) Full biography: https://surgery.utoronto.ca/content/thomas-forbes

(5:57) Dr. Wayne Johnson - Founding Chair in the Division of Vascular Surgery at the University of Toronto Division, founder of the Canadian Society for Vascular Surgery: https://www.uhn.ca/PMCC/media/Globe_Mail/Pages/forefather_vascular_surgery_Canada_globe-2016.aspx

(7:28) Dr. Jim May of the Royal Prince Alfred Hospital, Australia, one of the early pioneers of endovascular surgery: http://sydney.edu.au/medicine/people/academics/profiles/james.may.php

(8:27) “Iliac on a stick”; terminology for removing devices of the time: https://bit.ly/2SvtXaW

(10:08) A model approach that allows Canadian surgeons to implement new technologies in practice: The PMCC Innovation Committee, co-founded by a vascular surgeon, Dr. Barry Rubin: https://www.uhn.ca/PMCC/media/Globe_Mail/Pages/Peter-Munk-Cardiac-Centre-Innovation-Committee-2017.aspx

(11:28) Recent FDA proposed changes to device approval process spark fears of dangers of rapid device adoption: https://vascularnews.com/us-fda-plan-shakeup-of-its-510k-clearance-programme/

(13:44) Regionalization of fenestrated endovascular device practice patterns: https://www.ncbi.nlm.nih.gov/pubmed/29843567

(19:08) Advanced Aortic Surgery fellowship at the University of Toronto: https://surgery.utoronto.ca/fellowships-division-vascular-surgery

(29:55) Centers of Excellence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516836/pdf/12913_2017_Article_2340.pdf

(31:26) SVS Clinical Practice Guideline: https://vascular.org/research-quality/guidelines-and-reporting-standards/clinical-practice-guidelines

(33:18) Leapfrog initiative: http://www.leapfroggroup.org/about

(33:23) The Volume Pledge: https://www.healthleadersmedia.com/clinical-care/surgical-specialization-may-trump-volume-measure-quality

(35:31) “Personalized vascular surgery”: https://www.mdedge.com/vascularspecialistonline/article/106142/vascular-surgery-its-personal

(38:43) Dr. Forbes on heart health: “Let’s be more active”: https://www.youtube.com/watch?v=KhhW_E9cAr4

(40:28) Vascular surgeons are the firefighters of the surgery world: https://bit.ly/2G7UFF5

(42:51) MEGS: The Montefiore endovascular grafting system: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421179/figure/f1-2/?report=objectonly

Malachi Sheahan, MD, professor 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 chats with us about mentorship, his role in developing the fundamentals of vascular surgery curriculum, burnout and surgeon wellness, his experiences during Katrina, and his thoughts on the #ThisIsOurLane controversy.

 

(0:25) Full Biography: http://www.lsuhn.com/healthnews/Malachi-Sheahan-MD

(2:39) Jim Menzoian: https://health.uconn.edu/find-a-provider/physician/Menzoian-James

(3:11) Larry Hollier: https://www.medschool.lsuhsc.edu/surgery/faculty_detail.aspx?name=hollier_larry

(3:48) Robert Batson: https://www.medschool.lsuhsc.edu/surgery/faculty_detail.aspx?name=batson_robert

(7:57) How young vascular surgeons who are interested in academia can get involved:

• VESS - http://vesurgery.org/vess-special-programs
• SCVS - http://symposium.scvs.org/Young-Surgeons/
• APDVS - https://vascular.org/apdvs/residents-fellows

(11:30) Fundamentals of Vascular Surgery: https://www.jvascsurg.org/article/S0741-5214(18)30798-5/pdf

(15:22) Mission Rehearsal research

• https://www.ejves.com/article/S1078-5884(16)30647-5/pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362978/pdf/vhrm-11-195.pdf

(21:28) Burnout links and wellness

• How EMRs contribute to burnout: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687935/pdf/189e1405.pdf
• SVS effort to recognize burnout: https://vascular.org/news-advocacy/tackling-burnout-special-report-part-1

(27:46) Providing care in the aftermath of Hurricane Katrina

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1863583/pdf/tacca118000069.pdf
• https://www.chron.com/news/hurricanes/article/Trapped-hospital-workers-kept-most-patients-alive-1502571.php
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1681680/

(33:31) Dr. Sheahan’s editorial about gun violence, “It’s Time for Us to Talk About Guns”: https://www.mdedge.com/vascularspecialistonline/article/154467/its-time-us-talk-about-guns

Dr. Sheahan’s other Vascular Specialist editorials: https://www.mdedge.com/vascularspecialistonline/editor