Sharvil Sheth, MD

Division Chief, Vascular Surgery, @stlukesvascular, @mystlukes , passionate about medicine, learning and teaching. All tweets are my personal opinion.

[Sharvil Sheth, MD @sheth_md]

@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.

[Sharvil Sheth, MD @sheth_md]

@farkomd Is it still on the wire? If yes then try to send a snare on that same wire and pull it out through the sheath

[Sharvil Sheth, MD @sheth_md]

@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

[Sharvil Sheth, MD @sheth_md]

@farkomd Agree 💯 no stent

[Sharvil Sheth, MD @sheth_md]

@farkomd avoid putting sheath in tortuous splenic artery. Soft wire and catheter. Sheath in celiac for support.

[Daniel McDevitt MD FACS FSVS @dtmcdevitt]

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.

[Sharvil Sheth, MD @sheth_md]

@docpark Ligate the smaller one.

[Sharvil Sheth, MD @sheth_md]

@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

[St. Luke's Vascular Surgery @StlukesVascular]

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

[Sharvil Sheth, MD @sheth_md]

@StlukesVascular Special thanks to @PennVascular for organizing this fantastic regional conference for our trainees.

[Sharvil Sheth, MD @sheth_md]

@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

[Sharvil Sheth, MD @sheth_md]

@mattsmeds Venaseal entire vein

[Sharvil Sheth, MD @sheth_md]

@yuejianing Sorry I meant proximal below right renal and SMA

[Sharvil Sheth, MD @sheth_md]

@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.

[Sharvil Sheth, MD @sheth_md]

@farkomd @WLGore Do you do rapid pacing during deployment ?

[Sharvil Sheth, MD @sheth_md]

@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!

[Sharvil Sheth, MD @sheth_md]

@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.

[St. Luke's Vascular Surgery @StlukesVascular]

Dr. Singh with a JVS publication 💪💪💪💪 #killingit #mystlukes #vascularfellows https://t.co/il6PAJWWLC

[Sharvil Sheth, MD @sheth_md]

@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.

[Sharvil Sheth, MD @sheth_md]

@gertfrahmjensen @farkomd Nice one! Thanks for sharing will keep in mind. I agree that carotid carotid bypass has its own issues in elderly folks.