Clamp & Flow

By Roy Saade

[Clamp & Flow @ClampandFlow]

https://t.co/GcdSi6PQ0r

Spent the last 2 months editing this video. Learned a lot making it.

This one is for all the Residents and Med Students who need a clear, step-by-step refresher on Above-Knee Fem-Pop Bypass with PTFE.

Things I covered:
1-Longitudinal vs transverse incision for femoral artery Exposure.
2- Dissecting the CFA in a fibrotic field
3-Popliteal artery segments.
4- Medial vs lateral exposure of the "P1" popliteal artery.
5-How to tunnel. Superficial vs deep tunneling.
6- How to bevel a graft.
7-Optimal arteriotomy size....
and much more.

If this can help even a handful of trainees, it was worth every hour 😁. #VascularSurgery #MedEd

[Clamp & Flow @ClampandFlow]

Splenic Artery Aneurysms: Three Advanced Cases
https://t.co/FkdTmA3M9a

[Clamp & Flow @ClampandFlow]

Giant left subclavian artery aneurysm. Not something you'll see every day, or every year... Consent taken as always. #VascularSurgery

[Clamp & Flow @ClampandFlow]

@docpark When the in-situ vein splits, we follow the segment where the valvulotome has passed (usually the larger, straighter one) and ligate the other.

[BehindTheKnife @BehindTheKnife]

Intern Bootcamp #1

[Clamp & Flow @ClampandFlow]

We’d like to thank Pr. Franco Grego and the organizing committee of the #VIPConference for an amazing meeting.
Meeting vascular surgeons from Italy, Europe, the US, and beyond, in historic #Padua, was extraordinary.
The quality of the topics and discussions was truly stimulating.

[Clamp & Flow @ClampandFlow]

The congress wrapped up fittingly on Saint Anthony of Padua’s Feast Day.
A beautiful ending to an inspiring few days where history, medicine, and community came together.

[Clamp & Flow @ClampandFlow]

This is me sewing my first (~2 cm) patch angioplasty at #VIPConference in Padova.
Just saying: Good thing this wasn’t a live case. 😅

[sandeep raj pandey @drsandeeprpande]

VIP congress 🇮🇹 16-25 with Prof @benstarnesmd @HimVaSc Prof Ben 🇺🇸 & Prof Ben 🇸🇬 confirmed fr HimVaS chapter 2

[Clamp & Flow @ClampandFlow]

Ever looked at a carotid angiogram and thought:
“Which one’s the ICA, which one’s the ECA?”

Quick rule of thumb:
ECA -> early branches in the neck-> looks like a tree.
ICA -> no branches until it’s inside the skull

#MedEd #Radiology

[Clamp & Flow @ClampandFlow]

Crescendo TIA. Worsens. Stroke-in-evolution. Rushed to CEA. Note the Unclamped ICA, and good backflow.

[Clamp & Flow @ClampandFlow]

If the clot persists or TIAs continue, CEA is the treatment of choice; not observation.
Hold heparin for 4–6 hours, then proceed urgently.
🧠 You’re not watching the clock, you’re racing it.
#VascularSurgery #StrokeCare #FOAMed

[Clamp & Flow @ClampandFlow]

A 70yo man presents to ER with 3 TIAs in 12 hours. Duplex US shows a snake-like clot flapping in the carotid bulb. CTA shows no brain bleed.
That’s a crescendo TIA with a free-floating thrombus (FFT).
🚨 1 in 5 will stroke within 48h. #MedTwitter #NeuroTwitter

[Clamp & Flow @ClampandFlow]

🧠 Playbook:
– Start IV heparin + DAPT + high-intensity statin.
– No thrombolytics (you’ll just spray the clot into the MCA)
– BP 120–140
– Repeat CTA in 24h → if clot remains, stenosis ≥50%, or persistant TIAs-> OR
#Stroke #NeuroTwitter

[Genival Vidal dos Santos @GenivalVid98027]

Aorto Caval Fistula plus AAA and iliacs!!
@AortaSurg @PenseAorta @AortaEd @THINK__AORTA @walter_boim @VascularForum @PipeCabreraV @Dr_Ma_of_PUMC @Lazybonesradio1 @CelestinoGutirr @OckeReis @cvirendo @UMNVascularSurg @UK_Aorta @CleClinicHVTI @GAEscobarMD @ErbenYoung

[Genival Vidal dos Santos @GenivalVid98027]

Aorto Caval Fistula plus AAA and iliacs!!
@AortaSurg @PenseAorta @AortaEd @THINK__AORTA @walter_boim @VascularForum @PipeCabreraV @Dr_Ma_of_PUMC @Lazybonesradio1 @CelestinoGutirr @OckeReis @cvirendo @UMNVascularSurg @UK_Aorta @CleClinicHVTI @GAEscobarMD @ErbenYoung

[Clamp & Flow @ClampandFlow]

📸 From Rutherford: Pledgeted sutures for robust closure of the fistula.
The aortic & IVC walls are often fused: take both in transaortic bites.

🧭 If feasible:
#EndoFirst → EVAR ± covered IVC stent (fearing IVC thrombus).
📍Monitor closely for endoleaks.

#VascSurg #MedEd #AAA

[Clamp & Flow @ClampandFlow]

🚨 Clinical Vignette:
Patient with known AAA. Presents hypotensive with flank pain. Rushed to OR for open repair. Aorta & iliacs clamped. On opening the sac—massive gush of blackish blood.

What’s the diagnosis? What’s your next step?

#VascularSurgery.#SurgicalEducation

[Clamp & Flow @ClampandFlow]

🛠️ Management pearls:
1️⃣ Apply immediate digital pressure or packing on bleeding source within the sac.
2️⃣ Identify the fistula (likely posterior aortic wall to IVC).
3️⃣ Prioritize Fistula/IVC control: it’s usually more life-threatening than lumbar retrograde bleed.
4️⃣ Perform transaortic repair: suture IVC defect from within sac using non-absorbable sutures.
5️⃣ Once stable, oversew lumbar arteries and proceed with graft placement.

Teamwork, suction, and rapid decision-making are key.
#OpenSurgery #SurgicalEducation #VascSurg