The Retrograde Approach Dr Sam Farah and Dr Yogeesan Sivakumaran

In this episode, Yogi and Sam provide an overview into foot disorders within diabetic patients.

In this episode we delve into the interesting world of carotid artery disease and discuss our management of patients who are asymptomatic. See Yogi's (amazing) crib notes below:
Why do we care about asymptomatic carotid artery disease?
About 10 to 15% of all first ever stroke patients will experience an unheralded ischaemic, carotid territory stroke following thromboembolism from a previously untreated asymptomatic significant carotid disease

Oxford Vascular Study
Enrolled 2354 consecutive patients including 207 with 50 to 99% carotid stenosis
The ipsilateral stroke rate at 5 years for the patients with 70% to 99% was 14.6% compared with 0% for 50 to 50%) and severe (>70%) stenoses in a population of 23,706 people (mean age of 61 years, 46% male) was 2.0% and 0.5% respectively
Moderate stenosis > 50% found in 4.8% of men and 2.2% of women younger than 70 years
The percentage increase to 12.5% in men and 6.9% in women if patients older than 70 years are considered

Severe asymptomatic stenosis (>70%) indicate that its prevalence ranges from 0% to 3.1% of general population
Seminal Trials
Seminal trials have demonstrated a marginal but definitive benefit for CEA in reducing the risk of stroke after 5 and 10 years when compared with “best medical therapy” alone. However, these studies conducted in the late 1980s and in the 1990s, and since their completion, progress in the medical management of cardiovascular diseases has led to a progressive decrease in the yearly risk of stroke in patients with asymptomatic carotid artery stenosis managed with medical treatment alone.
Veterans Affairs Cooperative Study (VACS) [1983 and 1987]
440 men with asymptomatic >50% carotid stenosis were randomised to CEA plus medical management versus medical management only CEA significantly reduced the combined incidence of ipsilateral neurologic events (stroke or TIA) compared to medical group (8.0% vs. 20.6% respectively)

ACAS
1662 patients with asymptomatic >60% carotid stenosis were randomised to medical therapy versus CEA plus medical therapy
Across the United States and Canada
The study was stopped early, after a median follow up of 2.7 years
Patients in the surgical arm had a 5.1% risk of ipsilateral stroke and preoperative stroke/death over 5 years versus 11.0% risk of ipsilateral stroke in the medical arm for a relative risk reduction of 53%; absolute risk reduction of 5.9%
Recommended CEA for patients aged 3%

ACST-1
3120 patients with asymptomatic >60% carotid stenosis were randomised to either immediate CEA or deferred CEA
Asymptomatic patients were considered those without neurological symptoms during the 6 months preceding enrolment
Patients in the immediate CEA group had a significantly reduced five year and 10 year risk of any stroke and peri-operative stroke/death than the deferred CEA group (5 year, 6.9% vs. 10.9%, 10 year 13.4% vs. 17.9%)
An absolute risk reduction of 5.4% was seen in the rate of any stroke and...

In this exciting episode we are joined by Dr Gert Frahm-Jensen, who is an Australian trained Vascular and Endovascular Surgeon working in the Australian Capital Territory. After attaining his medical degree from the Australian National University he completed specialist training in vascular surgery throughout Victoria, Queensland and the ACT. He has a special interest in the management of thoracic outlet syndrome, and we are very appreciative of his expertise that he shares with us in this episode.

This episode of The Retrograde Approach is proudly supported by The Australian and New Zealand Society for Vascular Surgery (anzsvs.org).
We are excited to welcome Dr Nedal Katib (http://www.specialistvascular.com.au/dr-nedal-Katib/ (http://www.specialistvascular.com.au/dr-nedal-Katib/)). Dr Katib completed his Vascular Surgery Training through the Royal Australasian College of Surgeons, which took him to South Australia, New Zealand and New South Wales. He also completed a further fellowship in Belgium in advanced Endovascular and Minimally Invasive Surgery.
Originally born in Melbourne, his career path has taken him all over the world including Dubai UAE and graduating from the Royal College of Surgeons in Dublin Ireland before returning to Australia to continue his surgical career. During his training he completed his masters in surgical anatomy at Sydney University and his United States Medical Licensing Exams (ECFMG licence). Dr Katib is also the chair of communications for the ANZSVS.

Absorbed dose, effective dose, equivalent dose, air kerma and Marie Curie. In this episode, we dive into radiation safety.

In this special episode, we are joined by Adelaide vascular surgeon Dr Edwards Travers to discuss the sometimes daunting and confusing area of hyperhidrosis management.