@farkomd@XavierBerardMD Low threshold to ligate and divide left renal vein to improve exposure and ensure speedy anastomosis. Very important intraop decision- Either divide the gonadal/adrenal to mobilize the left renal vein or divide the renal vein, can’t do both or left kidney will be in trouble.
@drcostantino1 Needs angio with runoff. Likely common femoral to personal bypass. Sounds like rest pain without wounds so peroneal without direct foot runoff may be suffice to relieve symptoms
The average age of a vascular surgeon in the US is over 55 years. There are not enough new surgeons to replace the coming tsunami of retirements and exits from the workforce.
Surveys by the SVS have confirmed a measurable drift from clinical responsibilities as surgeons age.
In my opinion, the current system is running on residual momentum from times gone by. Increasing medical school enrollment and downstream training positions is a long term fix. There are currently no major initiatives to increase the future output of vascular surgeons in time to span the coming gap.
Access is a problem in rural areas but also beginning to surface in suburban metro areas. It will only get worse in the short term.
I think most of us know what needs to be done. It will take a lot of convincing of those who control the purse to get the ship turned around.
@theblanketdog@AWBeckMD Yes we had one case of high flow Pancreatico duodenal artery aneurysm where our coils failed and aneurysm started filling again once celiac re-occluded. These are very interesting entities related to occluded celiac artery. Our case has MALS.
https://t.co/KULEp0coL8
Philadelphia's 3rd Annual Vascular Resident and Fellow Case Conference! Great job to our general surgery residents representing St. Luke's Vascular!
Dr. Hankspiker, Dr. Stewart, and Dr. Alder #vascular#vascularsurgery
@thesurgerylife@_backtable Any concern that repeated IJ access with 12fr could promote future IJ stenosis / occlusion as some of this patients end up with repeat declots every few months
@yuejianing Retroperitoneal, rifampin soaked Dacron with presewn left renal bypass limb, proximal anastomosis just below left renal and SMA . You can have your GI do an endoscopy to look for AEF.
@farkomd Looks like a Medtronic EVAR- ipsi via right access, contra limb in to the left hypo and Did you laser fen the left ext iliac limb ? Couldn’t see the prior tevar on CTA cuts. Both Hypos should be preserved if possible. Nice Creative solution!
@farkomd Is this some kind of distal aortic
Pseudo after open repair? Plug the left internal iliac. AUI to the left. Plug the right common. Left to right fem fem cross over.
@farkomd Amazing learning experience for fellow to see how an experienced attending surgeon achieves such a perfect exposure of challenging anatomy allowing them to suture effortlessly. They will truly understand this when they perform their first open aorta in practice.