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

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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

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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. 

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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

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*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. 

In this episode, Sasank Kalipatnapu (@ksasank) and Leana Dogbe (@ldogbe4) sit down with Dr.Joseph Mills(@jmills1955), Dr. Douglas Jones and Dr. Premchand Gupta (@pcvasc) to discuss the origin of the SVS Step Challenge. This episode features a conversation about the history behind the SVS Step challenge and the role of walking in treating peripheral artery disease (PAD). It also covers the origin of “Walkathon”, the Indian equivalent of SVS Step Challenge. 

Dr. Joseph Mills is Professor and Chief of the Division of Vascular Surgery and Endovascular Therapy at Michael E DeBakey Department of Surgery at Baylor College of Medicine in Houston, Texas. He is also the John W. Reid and Josephine L. Reid Endowed Professorship in Surgery and is currently the chair of the SVS Foundation. 

Dr. Douglas Jones is an associate professor of Vascular Surgery at UMass Chan Medical School, Worcester, MA. He currently leads the Limb Preservation Center at UMass Memorial Health. 

Dr. PC Gupta is the clinical director of vascular and endovascular surgery and vascular interventional radiology at the Care Hospitals in Hyderabad, India. He is President of the Vascular Society of India and now President of the World Federation of Vascular Societies.

Relevant links: 

SVS Step Challenge - Home Page - Link to look up the details of the Step Challenge

vascular.org/step2024 - Link to sign up for the Step Challenge 2024

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The Audible Bleeding team is here at the annual EVS meeting in Charleston, SC. We wanted to share with you some of the attendees' experiences in their own words!

In this episode, we discuss the challenges of explanting aortic grafts, the diagnosis and management of infected aortic grafts, as well as tips and tricks for once we're in the operating room.

Interviewers/Editors: Mark Basilious, MD Candidate (@markrbasilious)

Eva Urrechaga, MD (@urrechisme) Sharif Ellozy, MD (@SharifEllozy)

Guests:

Dr. Francis Caputo (@FrankCaputoMD) is an Associate Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, Vascular Surgery Director of the Aorta Center, and Program Director of the Vascular Surgery Training Programs. His clinical interests include complex open and endovascular repair of thoracic, thoracoabdominal, and abdominal aortic aneurysms, management of thoracic dissection, and endovascular and open repair of failed endograft. Dr. Caputo earned his medical degree from the University of Medicine and Dentistry New Jersey, Newark, NJ, where he also served his surgical residency and two years as a National Institutes of Health research fellow. He completed his fellowship in vascular surgery at Barnes-Jewish Hospital of Washington University, St. Louis, MO and joined the Cleveland Clinic medical staff in 2018.   

Dr. Peter Rossi (@peterjrossi) is a Professor of Surgery, Radiology, and Orthopedic Surgery, and Chief of the Division of Vascular and Endovascular Surgery at the Medical College of Wisconsin. His primary research and clinical interests are in complex  “re-do” and revision surgery, including for thoracoabdominal and abdominal aortic aneurysms, carotid artery surgery, and renal and mesenteric arterial disease, as well as vascular reconstruction for complicated soft tissue sarcomas. Dr. Rossi completed medical school at the University of Illinois College of Medicine before completing his general surgery training at the University of Chicago and his vascular surgery training at the Medical College of Wisconsin, where he has been a member of the faculty since 2009. 

Dr. Xavier Berard (@XavierBerardMD)  is a French vascular surgeon who has been a Consultant in the Department of Vascular Surgery and Professor of Vascular and Endovascular Surgery in Bordeaux University Hospital in Bordeaux, France since 2010 and a full Professor of Vascular Surgery at the University of Bordeaux since 2016. He has also completed a PhD in Vascular Biomaterials and in 2010 worked as a research fellow at Lausanne University Hospital in Switzerland. He has been board certified by the French College of Vascular and Endovascular Surgeons since 2008 and by the European Society for Vascular and Endovascular Surgery since 2010. He has served as an examiner for the FEBVS exam since 2014 and as a reviewer for the European Journal of Vascular and Endovascular Surgery since 2016. Additionally, he is a member of the ESVS guidelines writing group for vascular graft infection and AAA.  His personal surgical interests include open surgery of (thoraco)abdominal aneurysms, redo aortic surgery, infections in vascular surgery, EVAR explantation, and biomaterials. He works closely with Institut Bergonié Bordeaux Cancer Center for sarcomas. You can see educational videos and learn more about Dr. Xavier Berard here.

Helpful links and resources:

Video of explantation of infected chimney EVAR with duodenal fistula (courtesy of Dr. Berard)

Video of reimplanting the IMA after explanting an infected graft

Video of explantation of infected graft with suprarenal fixation

Videos of using the syringe technique to remove an aortic stent graft here and here (courtesy of Dr. Berard)

References

1. Kim YW. Aortic Endograft Infection: Diagnosis and Management. Vasc Specialist Int. 2023 Sep 21;39:26. doi: 10.5758/vsi.230071. PMID: 37732343; PMCID: PMC10512004.

2. Papas TT. Patient Selection Is Essential for Explantation of Infected Abdominal Aortic Endografts. Angiology. 2023 Nov 23:33197231218622. doi: 10.1177/00033197231218622. Epub ahead of print. PMID: 37995099.

3. Anagnostopoulos A, Mayer F, Ledergerber B, Bergadà-Pijuan J, Husmann L, Mestres CA, Rancic Z, Hasse B; VASGRA Cohort Study. Editor's Choice - Validation of the Management of Aortic Graft Infection Collaboration (MAGIC) Criteria for the Diagnosis of Vascular Graft/Endograft Infection: Results from the Prospective Vascular Graft Cohort Study. Eur J Vasc Endovasc Surg. 2021 Aug;62(2):251-257. doi: 10.1016/j.ejvs.2021.05.010. Epub 2021 Jun 14. PMID: 34140225.

4. Lumsden AB. Explant of the Aortic Endograft: Today's Solutions, Tomorrow's Problems. Methodist Debakey Cardiovasc J. 2023 Mar 7;19(2):38-48. doi: 10.14797/mdcvj.1176. PMID: 36936357; PMCID: PMC10022536.

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We are excited to bring back part two of our discussion on Robotic Vascular Surgery. Yasong (@yasongyumd) and Eva (@urrechisme) are joined by Dr. Lumsden and Dr. Bavare from Houston Methodist Hospital

Show Guests:

Alan Lumsden: Chair of Cardiovascular Surgery at Houston Methodist and DeBakey Heart and Vascular Center

Charu Bavare: Vascular Surgeon at Houston Methodist and Debakey Heart and Vascular Center

Hosts:

Eva Urrechaga - Vascular fellow at University of Pennsylvania

Yasong Yu - Vascular fellow at University of Chicago

Robotic Vascular Surgery Episode 1 with Dr. Judith Lin and Dr. Petr Stadler

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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 vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by vascular fellow Eva Urrechaga (@urrechisme),  fourth year medical student Leona Dogbe (@ldogbe4), JVS Editor-in-Chief, Dr. Thomas Forbes (@TL_Forbes), and JVS-VS editor Dr. John Curci (@CurciAAA) to discuss two great articles in the JVS family of journals. The first article analyzes amputation trends over 12 years in Oklahoma, and identifies risk factors that can be used to target intervention strategies. The second article explores the role of toll-like receptor 4 in skeletal muscle damage caused by chronic limb-threatening ischemia.  This episode hosts Dr. Kelly Kempe (@KellyKempe) and Dr. Ali Navi (@VascularChap), authors of these two papers.

Articles:

Part 1: “Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions” by Drs. Kempe, Nelson, and colleagues.

Part 2: “Role of toll-like receptor 4 in skeletal muscle damage in chronic limb-threatening ischemia” by Drs. Navi, Tsui, and colleagues.

Show Guests:

Dr. Kelly Kempe: Associate Professor and Vascular Surgery Program Director at the University of Oklahoma in Tulsa, Oklahoma.

Dr. Ali Navi: Consultant Vascular Surgeon at Cambridge University Hospitals, UK.

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.

Authors: 

Sebouh Bazikian - PGY1 at Emory School of Medicine Integrated Vascular Surgery Program

Miguel F. Manzure - vascular surgery attending the University of Southern California Keck School of Medicine involved in complex limb preservation

Core Resources:

• Rutherford Chapters: 107, 108, 109 (Includes further information on anatomy), 112

Additional Resources:

• Relevant trials
• • BEST CLI: https://pubmed.ncbi.nlm.nih.gov/36342173/
  • BASIL 2: https://pubmed.ncbi.nlm.nih.gov/37116524/
• Relevant Audible Bleeding episodes
• • Audible Bleeding Endovascular Basics: https://open.spotify.com/episode/7jDpkhGMauBslk8SBklCyB?si=75f0931773d24b91
  • Audible Bleeding eBook, CLTI Chapter: https://adam-mdmph.quarto.pub/vascular-surgery-exam-prep/clti.html
• Anything else useful
• • WIFI: https://pubmed.ncbi.nlm.nih.gov/24126108/
  • GLASS: https://pubmed.ncbi.nlm.nih.gov/31159978/
  • Monophasic, Biphasic, Triphasic Waveforms: https://pubmed.ncbi.nlm.nih.gov/32667274/

Underlying disease featured in episode - peripheral arterial disease

1. Pathophysiology/etiology
   1. narrowing of peripheral arteries caused by atherosclerotic plaques causing arterial insufficiency distal to the point of occlusion. This reduces oxygen supply to the muscles.
   2. When oxygen demand increases but cannot be met, it leads to an imbalance such as pain and poor wound healing. 
   3. Risks: smoking, diabetes, hypertension, dyslipidemia, and older age
   4. Equal prevalence in men and women, peak incidence age 60-80
   5. Coexists with CAD, DM, stroke, Afib, and renal disease
2. Patient Presentation
   1. 20-50% asymptomatic, rest can be intermittent claudication, rest pain, or tissue loss
   2. claudication=pain or discomfort felt in the legs due to a lack of blood flow, especially during physical activity. 
   3. CLTI=chronic limb threatening ischemia: rest pain lasting greater than 2 weeks or nonhealing ulcers and gangrene
   4. Physical exam: 
      1. decreased skin temperature, less hair on the legs, brittle nails, atrophied muscles, shiny skin, livedo reticularis.
      2. Absent or diminished pulses
      3. Buerger sign
3. Diagnosis
   1. Ankle brachial index: