Audible Bleeding Powered by the SVS
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Audible Bleeding is a resource for trainees and practicing vascular surgeons, focusing on interviews with leaders in the field, board preparation, and dissemination of best clinical practices and high impact innovations in vascular surgery.
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Robotic Vascular Surgery Part 1
Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year general surgery resident Ryan Ellis discussing robotic vascular surgery with Dr. Judith Lin (@JudithLin4) and Dr. Petr Stadler. Dr. Lin and Dr. Stadler will share their personal journey in robotic vascular surgery, cases they have done, and what think the future looks like. This is part one of our robotic vascular series. Our next episode will feature Dr. Lumsden and Dr. Bavare from Houston Methodist.
Show Guests:
Dr. Judith Lin: professor and chief of vascular surgery in the Department of Surgery at Michigan State University’s College of Human Medicine
Dr. Petr Stadler: Professor of Surgery, Head of Vascular Surgery Department, Na Homolce Hospital, Prague, Czech Republic
Follow us @audiblebleeding
Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.
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JVS Author Spotlight - Maldonado and Guzman
Audible Bleeding editor Wen (@WenKawaji) is joined by second year medical student Nishi (@Nishi_Vootukuru), 3rd year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes) and JVS-CIT associate editor Dr. O’Banion (@limbsalvagedr) to discuss two great articles in the JVS family of journals regarding endovascular management of acute limb ischemia and ultrasound-based femoral artery calcification score. This episode hosts Dr. Thomas Maldonado (@TomMaldonadoMD) and Dr. Raul J. Guzman, the authors of the following papers:
Articles:
Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia by Dr. Maldonado and colleagues.
An ultrasound-based femoral artery calcification score by Dr. Raul Guzman and colleagues.
Show Guests:
Dr. Thomas Maldonado is the Schwartz - Buckley endowed professor of surgery in the Vascular Division at New York University Langone Medical Center in New York, Co-Director of Center for Complex Aortic Disease
Dr. Raul J. Guzman is the Donald Guthrie Professor of Vascular Surgery, Chief of Division of Vascular Surgery at Yale New Haven Hospital. He is also Surgeon-in-Chief of Vascular Surgery, Heart and Vascular Center for the Yale New Haven Health System. (raul.guzman@yale.edu)
Follow us @audiblebleeding
Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.
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Holding Pressure: Carotid Endarterectomy
Authors:
Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California
Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program
Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center
Resources:
Rutherford’s 10th Edition Chapters: 88, 89, and 91
The North American Symptomatic Carotid Endarterectomy
Asymptomatic Carotid Atherosclerosis Study
Audible Bleeding’s eBook chapter on cerebrovascular disease
Houston Methodist CEA Dissection Video:
Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ
Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w
Outline:
1. Etiology of Carotid Artery Stenosis
Risk factors: advanced age, tobacco use, hypertension, diabetes.
Atherosclerosis as the primary cause.
Development of Atherosclerotic Disease and Plaque Formation
LDL accumulation in arterial walls initiating plaque formation.
Inflammatory response, macrophage transformation, smooth muscle cell proliferation.
Role of turbulent blood flow at carotid bifurcation in plaque development.
Clinical Features of Carotid Artery Stenosis
Asymptomatic nature in many patients.
Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit.
Carotid bruit as a physical finding, limitations in diagnosis.
Importance of Evaluating CAS
Assessing stenosis severity and stroke risk.
Revascularization benefits dependent on stenosis severity.
Classification of Stenosis Levels
Clinically significant stenosis: ≥ 50% narrowing.
Moderate stenosis: 50%–69% narrowing.
Severe stenosis: 70%–99% narrowing.
Stroke Risk Associated with Carotid Stenosis
Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis.
Diagnosis and Screening
No population-level screening recommendation.
Screening for high-risk individuals as per SVS guidelines.
Carotid Duplex Ultrasound as primary diagnostic tool.
Additional tools: CT angiography, Magnetic Resonance Angiography.
Handling of Imaging Modalities
Ultrasound: Noninvasive, cost-effective, potential overestimation of stenosis.
CTA: Fast, high resolution, contrast exposure risks.
MRA: Contrast-free plaque analysis, possible overestimation of stenosis.
Angiography: Gold standard, expensive, stroke risk.
Assessing Degree of Stenosis via CDUS
Parameters for 50-69% stenosis: Peak Systolic Velocity (PSV) 125-229 cm/sec, End Diastolic Velocity (EDV) 40-100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio 2-4.
Parameters for 70-99% stenosis: PSV ≥ 230 cm/sec, EDV > 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4.
Revascularization Criteria
Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively.
Asymptomatic Patients: 70% stenosis, considering life expectancy.
Surgical Indications and Contraindications
Indications: symptomatic patients, life expectancy considerations.
Contraindications: Stenosis Medical Management for All CAS Patients
Lifestyle changes, high-intensity statin therapy, antiplatelet therapy.
Decision Factors for Surgical Approaches
TCAR, stenting, endarterectomy: situational preferences.
Carotid Endarterectomy: Surgical Procedure
Incision along anterior border of sternocleidomastoid muscle.
Electrocautery through platysma muscle and subcutaneous tissues.
Protecting the great auricular nerve, dividing the external jugular vein.
Retracting sternocleidomastoid muscle, exposing carotid sheath.
Dissecting internal jugular vein, ligating facial vein.
Avoiding injury to the vagus nerve, dissecting the common carotid artery.
Identifying and mobilizing the hypoglossal nerve, addressing the external carotid artery.
Extending disse -
Transatlantic Series with the ESVS: Intersocietal PAD Guidelines
Welcome to the Transatlantic series, a co-production of Audible Bleeding (a publication of the SVS) and the ESVS podcast. In today’s episode, we explore the intersocietal guidelines on peripheral arterial disease in patients with diabetes and foot ulcers authored by the International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS), and the Society for Vascular Surgery (SVS).
Dr. Robert Fitridge is a Professor of Vascular Surgery at University of Adelaide in Australia. He is a member of the IWGDF and is also a member of the steering committee for the Global Vascular Guideline on the management of Chronic Limb-threatening Ischaemia.
Dr. Vivienne Chuter is a Professor in the Department of Podiatry at Western Sydney University and Honorary Professor in the School of Health Science at The University of NewCastle. She is a member of the IWGDF. She has published extensively on diabetic foot disease and leads a clinically based research program focusing on the prevention and management of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and for non-Indigenous Australians.
Dr. Nicolaas Schaper is an emeritus professor of Endocrinology at Maastricht University Hospital in the Netherlands. Dr. Schaper was the coordinator of the European diabetic foot research consortium, Eurodiale. He is Chair of the 2023 Diabetic Foot Symposium (ISDF 2023) and is Chair of the IWGDF.
Dr. Joseph L. Mills is a Professor of Vascular Surgery at Baylor in Houston, Texas. He is a member of the IWGDF. Dr. Mills is a leader in the vascular surgery global community, has served as president of the Peripheral Vascular Surgery Society, and is currently a member of the Surgery Residency Review Committee of the ACGME.
Further reading and links:
The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer.
Global vascular guidelines for CLTI
Best-CLI
Engaging patients and caregivers to establish priorities for the management of diabetic foot ulcers
A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial
Release of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary
Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases
Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events
Low-Dose Aspirin for the Primary Prevention of Cardiovascular Disease in Diabetic Individuals: A Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis
Diabetes, Lower-Extremity Amputation, and Death
Outcomes in patients with chronic leg wounds in Denmark: A nationwide register‐based cohort study
Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia
Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review.
Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review.
Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review. -
International Vascular Surgery: Dr. PC Gupta (India)
In today’s episode, Dr. Sharif Ellozy, Gowri Gowda, Ezra Schwartz, and Kundanika Lakkadi interview Dr. Premchand “PC” Gupta, a vascular surgeon in India.
Dr. Gupta is the clinical director of vascular and endovascular surgery and vascular interventional radiology at the Care Hospitals in Hyderabad, India. He is President of the Vascular Society of India and Vice President of the World Federation of Vascular Societies. He is actively involved in research, sits on numerous editorial boards and has had many publications and awards.
Dr. Gupta received his medical degree from the Armed Forces Medical College in Pune, India and completed his MS in Surgery at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. He completed his vascular surgery fellowship at Nagoya University School of Medicine, Japan. Dr. Gupta pursued additional training in carotid surgery at the University of North Carolina at Chapel Hill as well as in complex aortic surgery at Houston Methodist Hospital.
Twitter:
Dr. PC Gupta (@pcvasc)
Dr Sharif Ellozy (@sharifellozy)
Dr. Ezra Schwartz (@ezraschwartz10)
Dr. Gowri Gowda (@gowrigowda11)
Kundanika Lakkadi (@kundanikalakka1)
Articles, resources, and societies referenced in the episode:
Indian healthcare system summary
George R, Gupta PC. Vascular Surgery in India - the Challenge and the Promise.
Indian Journal of Vascular and Endovascular Surgery
Vascular Society of Kerala
Vascular Society of India and Vascular Society of India Annual Conference (VSICON)
Aortic Rupture in the Indian Context
Indian National Vascular Day and Amputation Free India and Walkathon
Vascular Awareness In India: What More Needs to be Done
CDC Disinfection & Sterilization Guide -
JVS Author Spotlight - Ramirez, Iannuzzi, and Kibrik
Audible Bleeding editor Matt Chia (@chia_md) is joined by Nishi Vootukuru (@Nishi_Vootukuru) and Lili Sadri (@lilisadri) are joined by Drs. Joel Ramirez, James Iannuzzi, and James Pavel Kibrik to discuss their latest publications in the JVS family of journals. Along with insight from JVS Assistant Editor Dr. Paul Dimuzio and JVS-VL Editor-in-Chief Dr. Ruth Bush (@RuthLBush), hear about the latest trends in AAA repair and the value of postoperative duplex after venous thermal ablation. Don't miss it!
Articles:
Decreasing prevalence of centers meeting the Society for Vascular Surgery abdominal aortic aneurysm guidelines in the United States, by Ramirez et al.
Value and limitations of postoperative duplex scans after endovenous thermal ablation, by Kibrik et al.
Additional Links:
Factors associated with ablation-related thrombus extension following microfoam versus radiofrequency saphenous vein closure, by Chin et al.
Outcomes of a single-center experience in eliminating routine postoperative duplex ultrasound screening after endovenous ablation, by Woodhouse et al.
Show guests:
Joel Ramirez, MD - Integrated Vascular Surgery Resident at the University of California, San Francisco
James C. Iannuzzi, MD MPH - Assistant Professor, Division of Vascular and Endovascular Surgery at the University of California, San Francisco
Pavel Kibrik, DO - Graduate of New York Institute of Technology Osteopathic School of Medicine and current vascular surgery researcher at the NYU Langone School of Medicine
Ruth Bush, MD JD MPH FACS - Professor of Vascular Surgery and Associate Dean of Educational Affairs at the University of Texas, Medical Branch and Editor-in-Chief of the Journal of Vascular Surgery Venous and Lymphatic Disorders
Customer Reviews
Great Podcast
Big fan of BTK and just recently started tuning into Audible Bleeding after having had the opportunity to collaborate with this group for a podcast episode.
Great example of how to build partnerships amongst colleagues and other relevant professional socieities and journals.
The best place for vascular surgery on the internet!
Gotta love what these guys are doing! Great collaborations with the SVS, the JVS, faculty, and trainees all across the world. 💯 would recommend to a friend.
Comprehensive yet concise
This podcast covers vascular surgery from multiple angles, reviewing new research and controversies, interviewing leaders and legends in the field and providing up-to-date didactics for vascular surgeons in training. It’s an essential resource for keeping up with the dynamic field.