20 episodes

The Retrograde Approach is a vascular surgery podcast made by two Australian vascular surgeons, that explores our speciality in detail. We discuss current issues, themes and topics in vascular surgery and its related fields including interventional radiology, angiography, medicine and surgery.

Supported by the Australian and New Zealand Society of Vascular Surgery (www.anzsvs.org.au)

The Retrograde Approach Dr Sam Farah and Dr Yogeesan Sivakumaran

    • Health & Fitness
    • 4.7 • 14 Ratings

The Retrograde Approach is a vascular surgery podcast made by two Australian vascular surgeons, that explores our speciality in detail. We discuss current issues, themes and topics in vascular surgery and its related fields including interventional radiology, angiography, medicine and surgery.

Supported by the Australian and New Zealand Society of Vascular Surgery (www.anzsvs.org.au)

    Episode 20: The Diabetic Foot

    Episode 20: The Diabetic Foot

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

    • 51 min
    Episode 19: Asymptomatic Carotid Artery Disease

    Episode 19: Asymptomatic Carotid Artery Disease

    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...

    • 57 min
    Episode 18: Thoracic Outlet Syndrome feat. Dr Gert Frahm-Jensen

    Episode 18: Thoracic Outlet Syndrome feat. Dr Gert Frahm-Jensen

    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.

    • 1 hr 30 min
    Episode 17: Early Career Development feat. Dr Nedal Katib

    Episode 17: Early Career Development feat. Dr Nedal Katib

    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.

    • 1 hr 9 min
    Episode 16: Radiation Safety

    Episode 16: Radiation Safety

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

    • 53 min
    Episode 15: Hyperhidrosis and thorascopic sympathectomy feat. Dr Edward Travers

    Episode 15: Hyperhidrosis and thorascopic sympathectomy feat. Dr Edward Travers

    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.

    • 1 hr 2 min

Customer Reviews

4.7 out of 5
14 Ratings

14 Ratings

越秀少爷 ,

Excellent topics for Fellowship Exam

As a General Surgical Trainee, I’ve learned so much about Vascular Surgery from this podcasts. And for exam purposes, I’ve also learned consultant answers to those exam questions. Thanks very much, Sam and Yogi.

Fei Chang Hao!!!

Nedal Katib ,

An Amazing Effort

Excellent topics and great discussion. Well done Sam and Yogi! Keep up the good work.

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