Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year medical student Nishi (@Nishi_Vootukuru), JVS editor Dr. Forbes (@TL_Forbes), and JVS social media liaison Dr. Haurani to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Marc Schermerhorn, Dr. Andrew Sanders, Dr. Mitchell Cox and Dr. Junji Tsukagoshi, the authors of the following papers. 

Articles:

• Ten Years of Physician Modified Endografts

• Peri-operative and intermediate outcomes of patients with pulmonary embolism undergoing catheter-directed thrombolysis vs. percutaneous mechanical thrombectomy

Show Guests 

• Dr. Marc Schermerhorn: Chief of vascular and endovascular surgery at Beth Israel Deaconess and professor of surgery, Harvard Medical School 

• Dr. Andrew Sanders: PGY4 general surgery resident at Beth Israel Deaconess 

• Dr. Mitchell Cox: Division chief of vascular surgery and endovascular therapy, program director of the vascular surgery residency program at the University of Texas Medical Branch. 

• Dr. Junji Tsukagoshi: Fourth year vascular surgery resident at the University of Texas Medical Branch in Galveston Texas. 

Follow us @audiblebleeding

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Guest:

Dr. Christian de Virgilio is the Chair of the Department of Surgery at Harbor-UCLA Medical Center. He is also Co-Chair of the College of Applied Anatomy and a Professor of Surgery at UCLA's David Geffen School of Medicine.

He completed his undergraduate degree in Biology at Loyola Marymount University and earned his medical degree from UCLA. He then completed his residency in General Surgery at UCLA-Harbor Medical Center followed by a fellowship in Vascular Surgery at the Mayo Clinic.

Resources: 

• Rutherford Chapters (10th ed.): 174, 175, 177, 178

• Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/

• The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext 

• KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ 

Outline:

1. Steal Syndrome

• Definition & Etiology

  • Steal syndrome is an important complication of AV access creation, since access creation diverts arterial blood flow from the hand.

• Steal can be caused by multiple factors—arterial occlusive disease proximal or distal to the AV anastomosis, high flow through the fistula at the expense of distal arterial perfusion, and failure of the distal arterial networks to adapt to this decreased blood flow. 

• Incidence and Risk Factors

  • The frequency of steal syndrome is 1.6-9%1,2, depending on the vessels and conduit choice

  • Steal syndrome is more common with brachial and axillary artery-based accesses and nonautogenous conduits.

  • Other risk factors for steal syndrome are peripheral vascular disease, coronary artery disease, diabetes, advanced age, female sex, larger outflow conduit, multiple prior permanent access procedures, and prior episodes of steal.3,4 

  • Long-standing insulin-dependent diabetes causes both medial calcinosis and peripheral neuropathy, which limits arteries’ ability to vasodilate and adjust to decreased blood flow.

• Patient Presentation, Symptoms, Grading

  • Steal syndrome is diagnosed clinically. 

  • Symptoms after AVG creation occurs within the first few days, since flow in prosthetic grafts tend to reach a maximum value very early after creation.

  • Native AVFs take time to mature and flow will slowly increase overtime, leading to more insidious onset of symptoms that can take months or years.

  • The patient should have a unilateral complaint in the extremity with the AV access. Symptoms of steal syndrome, in order of increasing severity, include nail changes, occasional tingling, extremity coolness, numbness in fingertips and hands, muscle weakness, rest pain, sensory and motor deficits, fingertip ulcerations, and tissue loss. 

  • There could be a weakened radial pulse or weak Doppler signal on the affected side, and these will become stronger after compression of the AV outflow.

  • Symptoms are graded on a scale specified by Society of Vascular Surgery (SVS) reporting standards:5 

• Workup

  • Duplex ultrasound can be used to analyze flow volumes.

  • A high flow volume (in autogenous accesses greater than 800 mL/min, in nonautogenous accesses greater than 1200 mL/min) signifies an outflow issue. The vein or graft is acting as a pressure sink and stealing blood from the distal artery. A low flow volume signifies an inflow issue, meaning that there is a proximal arterial lesion preventing blood from reaching the distal artery.

  • Upper extremity angiogram can identify proximal arterial lesions.

• Prevention

  • Create the AV access as distal as possible, in order to preserve arterial inflow to the hand and reduce the anastomosis size and outflow diameter. 

  • SVS guidelines recommend a 4-6mm arteriotomy diameter to balance the need for sufficient access flow with the risk of steal.

  • If a graft is necessary, tapered prosthetic grafts are sometimes used in patients with steal risk factors, using the smaller end of the graft placed at the arterial anastomosis, although this has not yet been proven to reduce the incidence of steal. 

• Indications for Treatment

  • Intervention is recommended in lifestyle-limiting cases of Grade II and all Grade III steal cases.

  • If left untreated, the natural history of steal syndrome can result in chronic limb ischemia, causing gangrene with loss of digits or limbs.

• Treatment Options

  • Conservative management relies on observation and monitoring, as mild cases of steal syndrome may resolve spontaneously.

  • Inflow stenosis can be treated with endovascular intervention (angioplasty with or without stent)

  • Ligation is the simplest surgical treatment, and it results in loss of the AV access. This is preferred in patients with repetitive failed salvage attempts, venous hypertension, and poor prognoses.

  • Flow limiting procedures can address high volumes through the AV access.

    • Banding can be performed with surgical cutdown and placement of polypropylene sutures or a Dacron patch around the vein or graft.

    • The Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) technique employs a percutaneous endoluminal balloon inflated at the AVF to ensure consistency in diameter while banding

    • Plication is when a side-biting running stitch is used to narrow lumen of the vein near the anastomosis.

• A downside of flow-limiting procedures is that it is often difficult to determine how much to narrow the AV access, as these procedures carry a risk of outflow thrombosis.

• There are also surgical treatments focused on reroute arterial inflow.

• The distal revascularization and interval ligation (DRIL) procedure involves creation of a new bypass connecting arterial segments proximal and distal to the AV anastomosis, with ligation of the native artery between the AV anastomosis and the distal anastomosis of the bypass. Reversed saphenous vein with a diameter greater than 3mm is the preferred conduit. Arm vein or prosthetic grafts can be used if needed, but prosthetic material carries higher risk of thrombosis. The new arterial bypass creates a low resistance pathway that increases flow to distal arterial beds, and interval arterial ligation eliminates retrograde flow through the distal artery. 

  • The major risk of this procedure is bypass thrombosis, which results in loss of native arterial flow and hand ischemia. Other drawbacks of DRIL include procedural difficulty with smaller arterial anastomoses, sacrifice of saphenous or arm veins, and decreased fistula flow.

• Another possible revision surgery is revision using distal inflow (RUDI). This procedure involves ligation of the fistula at the anastomosis and use of a conduit to connect the outflow vein to a distal artery. The selected distal artery can be the proximal radial or ulnar artery, depending on the preoperative duplex. The more dominant vessel should be spared, allowing for distal arterial beds to have uninterrupted antegrade perfusion. The nondominant vessel is used as distal inflow for the AV access. RUDI increases access length and decreases access diameter, resulting in increased resistance and lower flow volume through the fistula. Unlike DRIL, RUDI preserves native arterial flow. 

• Thrombosis of the conduit would put the fistula at risk, rather than the native artery. 

• The last surgical revision procedure for steal is proximalization of arterial inflow (PAI). In this procedure, the vein is ligated distal to the original anastomosis site and flow is re-established through the fistula with a PTFE interposition graft anastomosed end-to-side with the more proximal axillary artery and end-to-end with the distal vein. Similar to RUDI, PAI increases the length and decreases the diameter of the outflow conduit. Since the axillary artery has a larger diameter than the brachial artery, there is a less significant pressure drop across the arterial anastomosis site and less steal. PAI allows for preservation of native artery’s continuity and does not require vein harvest. 

• Difficulties with PAI arise when deciding the length of the interposition graft to balance AV flow with distal arterial flow.

2. Ischemic Monomelic Neuropathy

• Definition

  • Ischemic monomelic neuropathy (IMN) is a rare but serious form of steal that involves nerve ischemia. Severe sensorimotor dysfunction is experienced immediately after AV access creation.

• Etiology

  • IMN affects blood flow to the nerves, but not the skin or muscles because peripheral nerve fibers are more vulnerable to ischemia.

• Incidence and Risk Factors

  • IMN is very rare; it has an estimated incidence of 0.1-0.5% of AV access creations.6

  • IMN has only been reported in brachial artery-based accesses, since the brachial artery is the sole arterial inflow for distal arteries feeding all forearm nerves.

  • IMN is associated with diabetes, peripheral vascular disease, and preexisting peripheral neuropathy that is associated with either of the conditions.

• Patient Presentation

  • Symptoms usually present rapidly, within minutes to hours after AV access creation.

  • The most common presenting symptom is severe, constant, and deep burning pain of the distal forearm and hand. Patients also report impairment of all sensation, weakness, and hand paralysis.

  • Diagnosis of IMN can be delayed due to misattribution of symptoms to anesthetic blockade, postoperative pain, preexisting neuropathy, a heavily bandaged arm precluding neurologic examination.

• Treatment

  • Treatment is immediate ligation of the AV access. Delay in treatment will quickly result in permanent sensorimotor loss.

3. Perigraft Seroma

• Definition

  • A perigraft seroma is a sterile fluid collection surrounding a vascular prosthesis and is enclosed within a pseudomembrane.

• Etiology and Incidence

  • Possible etiologies include: transudative movement of fluid through the graft material, serous fluid collection from traumatized connective tissues (especially the from higher adipose tissue content in the upper arm), inhibition of fibroblast growth with associated failure of the tissue to incorporate the graft, graft “wetting” or kinking during initial operation, increased flow rates, decreased hematocrit causing oncotic pressure difference, or allergy to graft material.

  • Seromas most commonly form at anastomosis sites in the early postoperative period.

  • Overall seroma incidence rates after AV graft placement range from 1.7–4% and are more common in grafts placed in the upper arm (compared to the forearm) and Dacron grafts (compared to PTFE grafts).7-9

• Patient Presentation and Workup

  • Physical exam can show a subcutaneous raised palpable fluid mass

  • Seromas can be seen with ultrasound, but it is difficult to differentiate between the types of fluid around the graft (seroma vs. hematoma vs. abscess)

• Indications for Treatment

  • Seromas can lead to wound dehiscence, pressure necrosis and erosion through skin, and loss of available puncture area for hemodialysis

  • Persistent seromas can also serve as a nidus for infection.

  • The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines10 recommend a tailored approach to seroma management, with more aggressive surgical interventions being necessary for persistent, infected-appearing, or late-developing seromas.

• Treatment

  • The majority of early postoperative seromas are self-limited and tend to resolve on their own

• Persistent seromas have been treated using a variety of  methods-- incision and evacuation of seroma, complete excision and replacement of the entire graft, and primary bypass of the involved graft segment only.

• Graft replacement with new material and rerouting through a different tissue plane has a higher reported cure rate and lower rate of infection than aspiration alone.9

4. Infection

• Incidence and Etiology

  • The reported incidence of infection ranges 4-20% in AVG, which is significantly higher than the rate of infection of 0.56-5% in AVF.11 

  • Infection can occur at the time of access creation (earliest presentation), after cannulation for dialysis (later infection), or secondary to another infectious source. Infection can also further complicate a pre-existing access site issue such as infection of a hematoma, thrombosed pseudoaneurysm, or seroma.

  • Skin flora from frequent dialysis cannulations result in common pathogens being Staphylococcus, Pseudomonas, or polymicrobial species. Staphylococcus and Pseudomonas are highly virulent and likely to cause anastomotic disruption.

• Patient Presentation and Workup

  • Physical exam will reveal warmth, pain, swelling, erythema, induration, drainage, or pus. Occasionally, patients have nonspecific manifestations of fever or leukocytosis.

  • Ultrasound can be used to screen for and determine the extent of graft involvement by the infection.

• Treatments

  • In AV fistulas:

    • Localized infection can usually be managed with broad spectrum antibiotics. 

    • If there are bleeding concerns or infection is seen near the anastomosis site, the fistula should be ligated and re-created in a clean field.

  • In AV grafts:

    • If infection is localized, partial graft excision is acceptable.

    • Total graft excision is recommended if the infection is present throughout the entire graft, involves the anastomoses, occludes the access, or contains particularly virulent organisms

    • Total graft excision may also be indicated if a patient develops recurrent bacteremia with no other infectious source identified.

    • For graft excision, the venous end of the graft is removed and the vein is oversewn or ligated. If the arterial anastomosis is intact, a small cuff of the graft can be left behind and oversewn. If the arterial anastomosis is involved, the arterial wall must be debrided and ligation, reconstruction with autogenous patch angioplasty, or arterial bypass can be pursued.

References

1. Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and Characteristics of Patients with Hand Ischemia after a Hemodialysis Access Procedure. J Surg Res. 1998;74(1):8-10. doi:10.1006/jsre.1997.5206

2. Ballard JL, Bunt TJ, Malone JM. Major complications of angioaccess surgery. Am J Surg. 1992;164(3):229-232. doi:10.1016/S0002-9610(05)81076-1

3. Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg. 2002;36(2):351-356. doi:10.1067/mva.2002.125848

4. Malik J, Tuka V, Kasalova Z, et al. Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies. J Vasc Access. 2008;9(3):155-166. doi:10.1177/112972980800900301

5. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-610. doi:10.1067/mva.2002.122025

6. Thermann F, Kornhuber M. Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access. 2011;12(2):113-119. doi:10.5301/JVA.2011.6365

7. Dauria DM, Dyk P, Garvin P. Incidence and Management of Seroma after Arteriovenous Graft Placement. J Am Coll Surg. 2006;203(4):506-511. doi:10.1016/j.jamcollsurg.2006.06.002

8. Gargiulo NJ, Veith FJ, Scher LA, Lipsitz EC, Suggs WD, Benros RM. Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008;48(1):216-217. doi:10.1016/j.jvs.2008.01.046

9. Blumenberg RM, Gelfand ML, Dale WA. Perigraft seromas complicating arterial grafts. Surgery. 1985;97(2):194-204.

10. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4):S1-S164. doi:10.1053/j.ajkd.2019.12.001

11. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J Vasc Surg. 2008;48(5):S55-S80. doi:10.1016/j.jvs.2008.08.067

In this special series, core faculty members of the SVS Leadership Development Program, Dr. Manuel Garcia-Toca, Dr. Kenneth Slaw, and Steve Robischon, discuss the program origins, research regarding good leadership, and how to join. 

Manuel Garcia-Toca, MD completed his MD at the Universidad Anahuac in Mexico (1999) and MS in Health Policy at Stanford University (2020). Dr. Garcia-Toca completed his residency in General Surgery at Brown University (2008) and a fellowship in Vascular Surgery at Northwestern University (2010). He will serve within the Department of Surgery in the Division of Vascular Surgery and Endovascular Therapy and the Division of Emory Surgery at Grady based primarily at Grady Memorial Hospital.

Kenneth Slaw, PhD is the executive director of the Society for Vascular Surgeons.  Dr. Slaw received his master's and doctoral degrees in educational psychology from the University of Illinois. He has over 35 years of executive leadership experience in the medical society and philanthropic communities, having served in numerous previous roles, including as president of the American Association of Medical Society Executives, as chairman of the board of Make A Wish Illinois, and as senior staff member at the Academy of Pediatrics, where he assisted in efforts with the Pediatric Leadership Alliance Program, which has provided leadership skill building sessions for approximately 3, 000 physicians.

Steve Robischon, PA-C is a Physician Assistant with the Division of Vascular and Endovascular Surgery at the Medical College of Wisconsin in Milwaukee, Wisconsin, and is also a member of the PA Section Steering Committee.

More about the SVS PA Section

More about the SVS Leadership Program

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovates, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of the SVS Social Media Ambassadors.

Readers:

Nick Schaper (@schapernj)

Nabeeha Khan (@Nabeeha_Khan_)

Hosts:

John Culhane (@JohnCulhaneMD)

Nishi Vootukuru (@Nishi_Vootukuru)

Reference Articles:

The Gore Iliac Branch Endoprosthesis as an alternate aortic main body: Promising results in select patients

A classic article that has never been read in English

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Audible Bleeding editor Wen (@WenKawaji) is joined by 4th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes), JVS-VS associate editor Dr. John Curci (@CurciAAA) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Mota, Dr. Liang and Dr. Weinkauf, authors of the following papers.

Articles:

1. The impact of travel distance in patient outcomes following revascularization for chronic limb-threatening ischemia

2. Serum detection of blood brain barrier injury in subjects with a history of stroke and transient ischemic attack

 Show Guests:

1. Dr. Lucas Mota- third-year general surgery resident at the Beth Israel Deaconess Medical Center

2. Dr. Patrick Liang- assistant professor at Harvard medical school and a practicing vascular surgeon at the Beth Israel Deaconess medical center. 

3. Dr. Weinkauf - assistant professor with the Department of Surgery Division of Vascular and Endovascular Surgery at the University of Arizona College of Medicine 

Follow us @audiblebleeding

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Nishi Vootukuru (@Nishi_Vootukuru) and Dr. Ezra Schwartz (@ezraschwartz10) interview Dr. William Shutze and Dr. Anahita Dua (@AnahitaDua) to discuss the Get a Pulse on PAD Campaign.

The Get a Pulse on PAD initiative (#PulseonPAD), launched in February, 2024, is a patient education and advocacy campaign designed to increase the understanding of peripheral artery disease's risk factors and potential symptoms.  

Dr. Shutze is a vascular surgeon with Texas Vascular Associates in Dallas, Texas and the Secretary of the SVS. Dr. Shutze completed his medical studies at Baylor University after completing general surgery residency at University of Alabama in Birmingham. Dr. Shutze returned to Baylor to complete his vascular fellowship. Dr. Shutze is one of the Get a Pulse on PAD initiative’s chairs and a leading expert in PAD. He has actively published in the field with over 100 abstracts and articles, with his most recent work focusing on prosthetics, and advocating for successful prosthetic referral after amputation. 

Dr. Dua is a vascular surgeon at Mass General Hospital and associate professor at Harvard Medical School. At Mass General, she is the director of the Vascular Lab, co-director of the Peripheral Artery Disease Center and Limb Evaluation and Amputation Program (LEAPP), associate director of the Wound Care Center, director of the Lymphedema Center and director of clinical research for the division of vascular surgery. She serves as the Editor-in-Chief of Journal of Vascular Surgery-Vascular Insights. Dr. Dua completed her undergraduate medical studies at the Aberdeen University School of Medicine in Aberdeen, Scotland. She then completed her general surgery residency at the Medical College of Wisconsin and vascular fellowship at Stanford University Hospital. She holds multiple master’s degrees including degrees in trauma sciences and business administration in healthcare management. She also completed certificate programs at the Massachusetts Institute of Technology in health economics and outcomes research as well as in drug and device development. Dr. Dua is a prolific researcher, researcher, and advocate, with much of her work centered on PAD. She furthers patient care not only through research but through her political work as Founder of the Healthcare for Action political action committee (PAC) and member of the SVS PAC Steering Committee. 

Special thank you to Jacob Soucey (@JacobWSoucy)

Resources:

• https://www.secondscount.org/get-a-pulse-pad

• https://evtoday.com/news/pad-pulse-alliance-survey-highlights-disconnect-in-public-knowledge-of-pad-risks

• Association of Black Cardiologists (ABC)

• Society for Cardiovascular Angiography & Interventions (SCAI)

• Society of Interventional Radiology (SIR)

• CardioVascular Coalition (CVC)

• Outpatient Endovascular and Interventional Society (OEIS)

• https://vascular.org/advocacy/political-action-committee

• https://evtoday.com/articles/2021-may/the-arc-act-fighting-amputation-via-legislation

• https://evtoday.com/articles/2006-may/EVT0506_10.html#:~:text=The%20Screening%20Abdominal%20Aortic%20Aneurysm,screening%20as%20a%20Medicare%20benefit

• CLariTI Study: Natural Progression of High-Risk Chronic Limb-Threatening Ischemia

• Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

•  ARC Act of Congress

• Painkiller: TV Series 

• Congressman Payne 

• SAAAVE Act

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

In this episode of Audible Bleeding, editor Dr. Imani McElroy (@IEMcElroy) is joined by General Surgery PGY-4 Sasank Kalipatnapu(@ksasank) along with Dr.David Rigberg, MD (@drigberg), and Dr. Guillermo Escobar, MD (@GAEscobarMD) to discuss the Society for Clinical Vascular Surgery (SCVS) Rising Seniors / Incoming Fellows Program. This episode brings out a conversation exploring the history behind the development of the program, the current state of the program, and the overwhelming importance of the program in the current day. The episode also provides a broad overview of the content presented in the program and the reasoning behind the talks. 

Guests:

1. Dr. David Rigberg - Professor of Surgery, Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Program Director for the Vascular fellowship and integrated vascular surgery residency at the David Geffen School of Medicine, UCLA, Los Angeles, California

2. Dr. Guillermo Escobar- Associate Professor, Division of Vascular Surgery and Endovascular Therapy, Program Director for the Vascular Surgery Fellowship and Residency at Emory University School of Medicine

Relevant links:

• Rising Seniors / Incoming Fellows Program - Program Details

• SCVS - Fellows & Chief Residents Program

• SCVS - Young Vascular Surgeons Program

To apply for the Rising Seniors / Incoming Fellows Program, go to apply now!

Audible Bleeding team:

1. Dr. Imani McElroy is 1st year vascular surgery fellow at USC/LA and editor at Audible Bleeding

2. Dr. Sasank Kalipatnapu, PGY-4 general surgery resident, Dept of Surgery, UMass Chan Medical School, Worcester, MA

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Audible Bleeding contributor and first year vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by vascular fellow Donna Bahroloomi (@DonnaBahroloomi),  fourth year general surgery resident, Sasank Kalipatnapu (@ksasank), JVS editor-in-chief, Dr. Thomas Forbes (@TL_Forbes), and JVS-CIT editor Dr. Matt Smeds (@mattsmeds) to discuss two great articles in the JVS family of journals. The first article analyzes seven years worth of VQI data on TCAR, CEA, and TF-CAS to elucidate modern management of carotid disease. The second article provides a simple but powerful method of assessing adequacy of revascularization in the management of hemodialysis access-induced distal ischemia. This episode hosts Dr. Marc Schermerhorn (@MarcScherm), Sabrina Straus MS3 (LinkedIn), and Dr. Yana Etkin (@YanaEtkin), authors of these papers.

Articles:

Part 1: “Seven years of the transcarotid artery revascularization surveillance project, comparison to transfemoral stenting and endarterectomy” by Sabrina Straus, Dr. Schermerhorn, and colleagues.

Part 2: “Proximalization of arterial inflow with adjunctive arterial pressure measurements for management of hemodialysis access-induced distal ischemia” by Dr. Etkin and colleagues.

Show Guests:

1. Sabrina Straus BS, 3rd year medical student at UCSD
2. Dr. Marc Schermerhorn, George H.A. Clowes, Jr. Professor of Surgery, Harvard Medical School and Chief of Vascular and Endovascular Surgery, BIDMC
3. Dr. Yana Etkin- Associate Professor of Surgery at the Zucker School of Medicine at Hofstra/ Northwell, Program Director for the Vascular Surgery Fellowship and Integrated Vascular Surgery Residency and Associate Chief of Vascular Surgery

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

Audible Bleeding editor Wen (@WenKawaji) is joined by 1st year vascular surgery fellow Richa Kalsi (@KalsiMD), 3rd year medical student Nishi (@Nishi_Vootukuru), 4th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes), JVS-VLD associate editor Dr. Arjun Jayaraj and JVS social media liaison Dr. Haurani to discuss some of our favorite articles in the JVS family of journals.

This episode hosts Dr. Amy Felsted, Dr. Salvatore Scali, and Dr. Arjun Jayaraj, the authors of the following papers. Dr. Arjun Jayaraj and Dr. Haurani will also spend time discussing a virtual special issue, centered around iliofemoral venous stenting published in the Journal of Vascular Surgery, Venous and Lymphatic Disorders that includes six articles published between August 2023 and May 2024. 

Articles:

• Part 1: A patient-centered textbook outcome measure effectively discriminates contemporary elective open abdominal aortic aneurysm repair quality by Dr. Felsted, Dr. Scali and colleagues. 

• Part 2: Virtual special issues on contemporary role of iliofemoral venous stenting

Show Guests 

• Dr. Amy Felsted (@aefelsted): Completed fellowship at Dartmouth-Hitchcock, Currently an assistant professor of surgery at Boston University School of Medicine and practicing vascular surgeon at the VA in Boston

• Dr. Salvatore Scali: Professor of Surgery at University of Florida Division of Vascular Surgery and Endovascular Therapy, program director of the vascular fellowship at University of Florida.

• Dr. Arjun Jayaraj: Vascular surgeon at the RANE Center in Jackson, Mississippi with a focus on the management of venous and lymphatic diseases, Associate Editor of JVS-VL. 

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovates, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of the SVS Social Media Ambassadors.

Readers:

David Ebertz (@EbertzDavid)

Kori Snider (@KoriSnider)

Nabeeha Khan (@Nabeeha_Khan_)

Hosts:

John Culhane (@Johnculhanemd)

Nishi Vootukuru (@Nishi_Vootukuru)

Reference Articles:

Sutureless endovascular bypass technique in long femoropopliteal occlusions

Follow us @audiblebleeding

Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

*Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.

The Audible Bleeding team (Wen Kawaji and Anh Dang) is here at the annual EVS meeting in Charleston, SC. We wanted to highlight some of the research being presented at the conference by medical students and residents.