Vascular Surgery - Science topic
Vascular surgery is a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. The specialty evolved from general and cardiac surgery as well as minimally invasive techniques pioneered by interventional radiology.
Questions related to Vascular Surgery
Kindly provide your valuable comments based on your experience with surgical loupes
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#Surgery #Loupes # HeadandNeck #Surgicaloncology #Otolaryngology
According to Dawson and colleagues (2007), some surgical faculty identified some shortcoming of knowledge and skills. Example of these include the choice of catheter, balloon , and stent size. Adequate placing of the sheath was also identified as an issue in training residents.
What do vascular surgical residents struggle most with in their surgical education and training? Do vascular surgical residents and attendings believe that their medical education should be changed from the current standards?
Dawson and colleagues (2007)
My lab is recruiting qualified individuals in the area of thrombosis/platelet biology signaling. No prior experience working with platelets is needed as full training and mentorship will be given. Strong skills in biochemistry, molecular biology, and/or animal models of vascular surgery would be advantageous. The surrounding basic research environment is exceedingly rich with 40 investigators publishing highly impactful studies, and my work at the Cleveland Clinic gives us access to patient data and specimens through institutionally-approved protocols. Our department was ranked #1 for the last 25 years in cardiovascular medicine. Please send me a message if interested.
With development of new grafts many surgeons prefer to do the proximal femoral-to-popliteal bypass with synthetic prosthesis even if saphenous vein is avaliable. I'm looking for evidence-based bibliographic references that can state against this approach.
De Bakey and Cooley did the first successful operation for a visceral artery aneurysm (VAA) in 1953. They are relatively rare and the risk of rupture is associated with high mortality .The majority of patients are asymptomatic prior to rupture and the main indication of elective treatment is size, VAA larger than 2 cm and aneurysms in women of childbearing age is recommended. The goal of treatment is to prevent aneurysm expansion by excluding it from the arterial circulation saving branchs patency and freedom from rupture or reperfusion. Surgery has been considered the treatment of VAA for several decades, but now a days endovascular procedures as embolization or covered stents have increased the treatment options available to comorbid patients not suitable for open repair.
After this operative procedure is performed how come the 'new' arterial surface doesn't form thrombi (or does it)? Shouldn't the exposed non-endothelial surface be highly thromogenic?
I link some studies concerning survival and long term outcomes which clearly prove the benefits od intervention and prove that thrombi formation isn't a rule, but which is in disagreement with the standard thaught mechanism of vascular thrombi formation (exposed subendothelium being highly thrombogenic).
Looking forward to hear some answers, thoughts and ideas from experienced people.
Some time in case of extensive PAD and critical ischemia we need to perform the simultaneous reconstruction of aorto-iliac and femoral-popliteal segment. What is your opinion about the optimal site of proximal anastomosis for femoral-poplieal bypass with reversed saphenous vein? Should vein takes-off from the synthetic graft or from the common femoral (femoral) artery? Some surgeons claimed against the anastomosis between synthetic material and vein.
Data seems to have tremendous variability depending on the source. Vascular Access can be broken down into 3 distinct sub-groups, CVCs, PICC lines and ports (port-a-caths). I am trying to come up with annual procedures for each in the US and ROW.
variation in branching of internal iliac artery radiological OR cadaveric?
General surgeon should begin the reconstruction of the excised portal vein during laparoscopic cholecystectomy or send him to a reference center ?
This 18 year old girl was detected to have Takayasu arteritis with hypertension during evaluation for polyarthralgias. MR angiography revealed her to have severe renal artery stenosis left and left subclavian artery stenosis. Recent literature seems to suggest a higher failure rate and restenosis with stenting rather than with plain angioplasty. This goes contrary to what we see in atherosclerotic coronary artery disease stents have a higher success rates.
The choice of the more appropriate method of SFA recanalizazion represents a very interesting and actual topic. This is particularly relevant in claudicant patients. It is reasonable the use in these cases of a covered Stent ?
- Utilizes algorithmic checklists to minimize data entry and validate data
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Which force is needed to make an implant move/grow through soft tissue? There seems to be a threshold to be overcome by stents (or other implants) to make them grow through tissue. Too low means no growing through. Too high would create lesions. The only reported force I know is from bracelets on the teeth (nearly constant 1-2 N for extraction).
Is there anything known for soft tissue? Ideally for stents in atrial walls? Which biological processes enable this kind of "growing through"? How could i foster it?
I'd be thrilled to hear about your input!
By surgery I mean, high ligation of tributaries along with surgical removal of the long saphenous vein, referred to as 'stripping'. The vein is accesses through the Sapheno-Femoral Junction through a lateral incision at the groin. Thermal ablation refers to the thermal destruction of the Long Saphenous Vein, 'in situ' by means of LASER or Radio Frequency heat induction.
I am working on a specific circular instrument for end to side vascular anastomoses and I am eager to know about other efforts made by my colleagues.
We had reported the case of a 57-year-old male patient with a history of acute amaurosis fugax. Carotid angiography was performed as blood pressure differed between his left and right arms and there was a pan-systolic murmur on the left common carotid artery. Total occlusion of the proximal right brachiocephalic artery and a thrombus occluding 90–99% of the left internal carotid artery were detected by carotid angiogram. We decided to place a graft-covered stent through the lesion first, and contain the plaque and thrombus between the stent and the lumen. Therefore, a graft covered stent (5×13, Direct) was implanted with 12 atm pressure. After removing the distal blockingbased protection system, we opened the selfexpanding stent (7×10×30, Cristallo) (figure 3) and dilated the stent using a post-dilatation balloon5×20, Tarcomgrande).
A self-expanding graft-covered stent was successfully implanted and there were no complications. This case published in BMJ Case Journal “ Covered stents may provide extra protection during carotid artery stenting in high risk patients with an excessive thrombus burden”, Tatli E, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-010258.
However , the patient presented transient ischemic attacks after three years. DSA angiography show 99% instent restenosis in the overleap segment of the both stent.
What are your opinion with this case ?
Can you recommend an intraoperative pressure monitoring technique, either external or intraluminal?
Surgical sites infections in vascular surgery are no less challenging or costly to treat compared with other SSIs. Taking the uniquity of vascular surgical interventions into considerations, are their any guidelines or clear bundles of care (BOC) concerning the prevention of wound infections?
Anybody interested in establishing them?
There is very few data on how to manage these lesions, but the thromboembolic potential seems to be high, namely visceral and renal artery ischemia. Do you think we should preemptive treat these patients?
I'm a doctor in training and and I would like to explore this new type of stent understanding how it works in detail.
I'm developing a project and hope to locate outdated and/or open, unused filters. This is a proof-of concept which is on a tight budget.
Renal artery aneurysms are considered the second most common visceral aneurysm (15-22 %), most common being splenic artery aneurysm (60%). It is more common in females. Most of the lesions are saccular and tend to occur at the bifurcation of main renal artery. Management depends on various factors like age, sex, severity of hypertension, any anticipated pregnancy and aneurysm morphology. Surgical treatment is recommended in aneurysms > 2 cm in size.
Surgical repair is usually durable, and can be performed with low risk. Some physicians have recommended stent grafts to repair popliteal aneurysms. What is your opinion?
In those patients with critical iliac aterosclerotic lesions, limiting claudication, pain at rest, limiting lifestyle and despite medical treatment shows no improvement .
Covered stents can afford a protective mechanism that shields stents from tissue in-growth and may reduce restenosis caused by intimal hyperplasia?
They may offer an improvement in performance in the treatment of more complex iliac disease?
In carotid disease the most important consideration for decision-making regarding an invasive approach is the risk for complications associated with the respective approaches. CEA has been performed for more than 50 years with an established record in both prospective and community-wide trials. CAS is still an evolving procedure, and there are limited data with respect to results across the large numbers of practitioners who could potentially offer the procedure .We believe that CAS could be useful in the treatment of some patients with carotid disease. What is your opinion?
In recent years we`ve preferred the Endovascular Technique for almost all of our patients with clinical indication obviously associated with serious and advanced lesions TASC
C & D as a first Femoral Artery approach as disclosed in TASC II B. I wonder about the experience of our colleagues, vascular and endovascular surgeons.
Generally we do an elective repair of Abdominal Aneurysms when they are > 5,0cm, also as we know, small aneurism can rupture .How to predict AAA rupture Risk of aneurisms < 5,0 cm?
Endovascular abdominal aortic aneurysm repair(EVAR) have many advantages but endoleaks, persistent flow outside the graft or endotension,elevated pressure within the aneurysm sac are the principal reasons for failure of the aneurysm endovascular treatment.
It is usual to encounter pseudoaneurysm of femoral artery of large size due to delayed diagnosis as whole attention in trauma goes initially to bony injury if there is fracture of bones. In this situation either vascular injury is missed or iatrogenic injury of artery may lead to pseudoaneurysm. So, what should be the best mode of intervention in femoral artery pseudoaneurysm.
Aneurysm formation is a known issue with these grafts, but - according to literatur - in only up to 7%. We have observed a lot more at our institution.
Stem cells viability assessment in the therapeutic angiogenesis for CLI.
Do You analyze concentration of CD 133+/34- endothelial progenitor cells
in the bone marrow and in stem cell products before administration in the critically ischemic limb of the patients with critical limb ischemia? Do you examine the viability of the stem cells before their administration to the ischemic limb?
I am actually a bit confused.
I want to find a relationship ( if there is one) between an independent continuous variable and a dependent categorical variable.
e.g. The effect of systolic BP reading ( continuous parametric variable ) on stroke dependent categorical i.e. no stroke event =0, stroke =1. I can't use correlation as both have to be continuous variables. Which test? I use SPSS.
Patient with symptomatic varicose veins, duplex reported: absence of incompetence of the femoral valve before the saphenous femoral union, terminal valve incompetence, preterminal valve incompetence, your plan to follow would be:
1.- surgery: ligation adyacent to saphenous femoral union to the femoral vein, ligation of colaterals then to first divison, close of the cribiform fascia (oval fosse), and stripping
2.- thermal ablation of the saphenous vein(laser or radiofrecuency)
3.- chemical ablation of the saphenous vein (Foam)
4. Ligation the saphenous femoral union and distal foam.
Seconds question: your academic level
Vascular surgeron with 6 years subespeciality training
Phebologist with 2 years od training
Other especiality ( wich.........)
Thanks. ALEJANDRO LATORRE