PhilipVIR

PRO education, AGAINST showing off

[PhilipVIR @philip_vir]

@RSP516 I have to disagree with this. Arterial access, for a patient needed TIPS for bleeding, just to confirm patency of the SMV is not wise and not based on evidence or clinical observations to my knowledge. It wont change management. Direction of flow is obvious on gentle venous inj.

[PhilipVIR @philip_vir]

SIR, before anyone else, should address this phenomenon. There should be guidelines to control these behaviors.

[PhilipVIR @philip_vir]

I am fed up with “online experts” posting cases just for showing off. When you show a case, u r educating peers with “NEW” techniques/procedures, increasing awareness of the “PUBLIC”, or just simply showing off. Posting similar procedures every day reflects bad you.

[PhilipVIR @philip_vir]

@keithppereira The value of CTA is to localize the source/area of bleeding. In these two cases, the source is known. Disagree with generalizations. Would you do angiography for a lower GI bleed without localization?

[PhilipVIR @philip_vir]

@AndrewNiekampMD @kmadass @Mustapja @IRKhalsa @VISLAMDSCAIP Biopsy

[PhilipVIR @philip_vir]

@DHidlayVIR @stryker_spine @dougbeall Beautiful example of filling the fracture cleft

[PhilipVIR @philip_vir]

@AlanAlperMD @t_intheleadcoat @VenuVadlamudiMD @CHICKVIR @SDhandMD @AgnesSolberg @retoba1 @SeanTutton @LessneVIR @TherealDoctorJ @KutsenkoMD Would do highly selective angio. Of I see a blush and felt safe about it would do PVA 250-350. Would consider ablation and sacroplasty next.

[PhilipVIR @philip_vir]

@AlanAlperMD @t_intheleadcoat @VenuVadlamudiMD @CHICKVIR @SDhandMD @AgnesSolberg @retoba1 @SeanTutton @LessneVIR @TherealDoctorJ @KutsenkoMD Important questions before we answer:
Age? When you say hemangioma, r u referring to the misnomer (cavernous malformation - doubt it based on the images) or a true tumor (hemangioendothelioma). If the later, whats the type and grade? (For example, epithelioid are benign).

[PhilipVIR @philip_vir]

@dougbeall @SIRspecialists @TheStrykerIVS @ASIPP @ASPN_PainNeuro @OsteoporosisNOF Very nice. Just to be clear I meant percutaneous implant like Kiva device to fuse the two.. Have you had prior positive experience for disk space cementing for listhesis 2/2 spondylolysis?

[PhilipVIR @philip_vir]

@IR_Nutt @eccomedcenter @GEHealthcare @aapmHQ @SNM_MI @SIRspecialists Can you do CBCT with it?

[PhilipVIR @philip_vir]

@roblookstein @DHidlayVIR @Dr_Tonnessen @SIR_ECS Disagree with radial access. Long case with 6Fr sheath does not seem like a good idea IMO. I would do femoral with a torqable sheath like tour-guide (not as expensive as everyone thinks). Price difference is < than price of a dropped wire. Safer, better support, and much faster..

[PhilipVIR @philip_vir]

@TheRealDoctorOs Beautiful. More clinical information please?

[PhilipVIR @philip_vir]

@SIRspecialists @SIR_ECS @SIRRFS @JVIRmedia

[PhilipVIR @philip_vir]

With the increasing number of endo-AVF procedures, remember that not every patient who is “fit” for anesthesia is “fit” for AV fistula creation.

>40% of ESRD pts with normal heart function go on to develop HF preserved EF in 2-3 years.

Use ESRD prognosis or mortality scores

[PhilipVIR @philip_vir]

@UMichVIR @IRadNAP Impressive! Can you share the outcome? We know the angiographic improvement doesn’t always mean clinical improvement in frostbite thrombolysis

[PhilipVIR @philip_vir]

@Nishan0603 @farkomd @YashodaHospital @RKTvascular @DevinZarkowsky @Kniery_Bird @DSiddapuram @t_intheleadcoat Confused initially by the flipped image. I would ensure patency of the proximal profunda/SFA. I wouldn’t inject thrombin without a psa sac. Injecting the tract seems like a recipe for disaster. I would personally do prolonged compression under sedation with reversal of heparin

[Osman Ahmed @TheRealDoctorOs]

@philip_vir Good thoughts/points...we addressed a lot of these issues in our paper a while back https://t.co/qjJIxXgei7 @marabi2004

[PhilipVIR @philip_vir]

@TheRealDoctorOs True which is shocking tbh...

[PhilipVIR @philip_vir]

Thoughts? @SIRspecialists @JVIRmedia

[PhilipVIR @philip_vir]

IMHO posting clinical vignette/pictures should be for education purposes or asking for feed back. Service promotion? Should be done by the institution’s account anonymously and professionally. Posting a case “done today” or “live” is violates privacy..