Audible Bleeding

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The Vascular Surgery Podcast

  • 45 minutes 50 seconds
    ChatGPT/LLM in Vascular Surgery

    This episode of Audible Bleeding features Drs. Adam Johnson and Jeniann Yi, members of the Society for Vascular Surgery Health Information Technology Committee, to discuss the application of large language models in vascular surgery with two experts in the field, Dr. Andrew Gonzalez and one of his collaborators, Shantanu Dev.  The episode promises a conversation exploring machine learning and large language models with insights from the guests' diverse expertise in vascular surgery, health informatics, and artificial intelligence.

     

    Dr. Andrew Gonzalez, an assistant professor in vascular surgery at Indiana University School of Medicine and also an SVS HITC committee member, has clinical and research interests in peripheral arterial disease and artificial intelligence applications for amputation prevention.

     

    Shantanu Dev, a computer science PhD student at Ohio State, focusing on multimodal modeling for clinical applications in AI. Shantanu worked at PWC for eight years in their AI R&D division and co-owns Satsong Digital Health, an AI company addressing healthcare inequities and quality of care.

     

    Relevant links:

     

    Co-Hosts:

     

    Dr. Jennian Yi is an Assistant Professor of Surgery at the University of Colorado.

    Dr. Adam Johnson is an Assistant Professor of Surgery at Duke University, and editor at Audible Bleeding.

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    20 May 2024, 1:48 am
  • 37 minutes 51 seconds
    JVS Author Spotlight - Pillado, Coleman, and Lal

    Audible Bleeding editor Wen (@WenKawaji) is joined by 5th year general surgery resident Richa Kalsi (@KalsiMD) from University of Maryland Medical Center, 4th year general surgery resident Nitin Jethmalani from New York Presbyterian Hospital-Weill Cornell, JVS (@JVascSurg) editor Dr. Forbes (@TL_Forbes) and JVS-VL (@jvsvl) editor Dr. Bush (@ruthlbush) to discuss two great articles in the JVS family of journals regarding chronic pain and resident burnout and SFJ reflux and its implication in C2 and C3 chronic venous insufficiency. This episode hosts Dr. Pillado (@drpillado), Dr. Coleman (@ColemanDM_vasc) and Dr. Lal. 

     

    Articles:

     

     

     

    Show Guests:

    • Dr. Coleman: Professor of Surgery at Duke University and Division Chief of Vascular and Endovascular Surgery at Duke University Medical Center.

    • Dr. Pillado: vascular surgery resident at Northwestern Hospital in Chicago, IL 

    • Dr. Lal: Professor of Surgery at the University of Maryland, Professor of neurology at Mayo clinic, and professor of biomedical engineering at George Mason University. and Director of Center for Vascular Research at University of Maryland Medical Center

     

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    6 May 2024, 1:24 am
  • 30 minutes 57 seconds
    JVS CIT Editorials and Abstracts - April 2024

    In this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by members of our SVS Social Media Ambassadors and Editor in Chief of JVS CIT, Dr. Matthew Smeds.

     

    Readers:

    Matthew Smeds (@mattsmeds)

    Christopher DeHaven (@ChrisDeHavenPSU)

    Ethan Vieira

    Litton Whittaker

    Nicholas Schaper

    Nishi Vootukuru (@Nishi_Vootukuru)

     

    Editorials:

    Accomplishments and goals: Review of 2023 and previous of 2024 for the Journal of Vascular Surgery Cases, Innovations, and Techniques.

     

    The enduring success of the DRIL technique and new advances in dialysis access.

     

    Abstracts:

    Intraprocedural application of a peripheral blood flow monitoring system during endovascular treatment for femoropopliteal disease.

     

    Thoracic outlet syndrome: single-center experience on the transaxillary approach with the aid of the TRIMANO Arthrex arm.

     

    Inferior vena cava hemangioma resected using a novel Toumai robotic surgical platform.

     

    Surgical release of anterior tibial artery entrapment with associated popliteal artery entrapment.

     

    Revisiting Heinz-Lippman disease as a complication of chronic venous insufficiency.

     

    Utilization of coronary computed tomography angiography and computed tomography-derived fractional flow reserve in a critical limb-threatening ischemia cohort.

     

    A rare case of Bannayan-Riley-Ruvalcaba syndrome with concurrent arteriovenous malformation.

     

    Autologous and synthetic pediatric iliofemoral reconstruction: A novel technique for pediatric iliofemoral artery reconstruction.

     

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    30 April 2024, 9:27 pm
  • 1 hour 6 minutes
    Social Deprivation in Vascular Surgery

    In this episode Abena Appah-Sampong (@abenasamp) and Leana Dogbe (@leanadogbe) partner with Vaiva Dabravolskaite ([email protected]) from ESVS to host an episode discussing social deprivation in vascular surgery. Dr. Tara Mastracci and Dr. Olamide Alabi join us to offer insights into how social deprivation drives disparities in outcomes and steps to how we can shift practice paradigms to better address our patient needs.

     

    Dr. Tara Mastracci (@aorticsurgeon) is a vascular surgeon with over 15 years of experience treating and managing complex aortic pathologies. She is currently working at St. Bartholomew’s Hospital in London, UK, on the Cardiothoracic Team doing complex aortic surgery. On top of her clinical duties, Dr. Mastracci is dedicated to studying the social and non-clinical factors influencing vascular outcomes. 

     

    Dr. Olamide Alabi (@OAlabiMD) is an Associate Professor of Surgery in the Department of Surgery at Emory University School of Medicine. Her clinical effort focuses on the full scope of vascular disease for patients at Emory University Hospital and the Atlanta VA HealthCare System, however, her academic portfolio and funded research is focused primarily on the intersection of peripheral artery disease, quality, and health equity. 

     

    References:

    • Social Deprivation and the Association With Survival Following Fenestrated Endovascular Aneurysm Repair/2021 https://www.annalsofvascularsurgery.com/article/S0890-5096(21)00872-4/fulltext

    • Is social deprivation an independent predictor of outcomes following cardiac surgery? An analysis of 240,221 patients from a national registry. BMJ/2015 https://bmjopen.bmj.com/content/5/6/e008287.long  

    • Survival Disparity Following Abdominal Aortic Aneurysm Repair Highlights Inequality in Ethnic and Socio-economic Status/ https://www.ejves.com/article/S1078-5884(17)30521-X/fulltext
    • Nash, D., McClure, G., Mastracci, T. M., & Anand, S. S. (2022). Social deprivation and peripheral artery disease. Canadian Journal of Cardiology, 38(5), 612-622.

    • Vart, P., Coresh, J., Kwak, L., Ballew, S. H., Heiss, G., & Matsushita, K. (2017). Socioeconomic status and incidence of hospitalization with lower‐extremity peripheral artery disease: atherosclerosis risk in communities study. Journal of the American Heart Association, 6(8), e004995.

    • Henry, A. J., Hevelone, N. D., Belkin, M., & Nguyen, L. L. (2011). Socioeconomic and hospital-related predictors of amputation for critical limb ischemia. Journal of vascular surgery, 53(2), 330-339.

    • Demsas, F., Joiner, M. M., Telma, K., Flores, A. M., Teklu, S., & Ross, E. G. (2022, June). Disparities in peripheral artery disease care: A review and call for action. In Seminars in vascular surgery (Vol. 35, No. 2, pp. 141-154). WB Saunders.

     

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    25 April 2024, 3:17 pm
  • 38 minutes 48 seconds
    JVS Author Spotlight - McDermott and Chan

    Join Audible Bleeding team Matthew Chia, Nitin Jethmalani, and Leana Dogbe and editors from the JVS family of publications Thomas Forbes and Gale Tang as we discuss two of the latest highlights in vascular research. First, we welcome Mary McDermott, MD to discuss the discordance between patient-reported outcomes and objective PAD measures in the latest episode of the JVS.  The episode finishes with a stimulating discussion with Alex Chan, PhD to discuss the effect of nicotine on angiogenesis in a murine model of PAD.

    Articles:

    Discordance of patient-reported outcome measures with objectively assessed walking decline in peripheral artery disease by McDermott et al. https://doi.org/10.1016/j.jvs.2023.12.027

    Chronic nicotine impairs the angiogenic capacity of human induced pluripotent stem cell-derived endothelial cells in a murine model of peripheral arterial disease by Chan et al. https://doi.org/10.1016/j.jvssci.2023.100115

    Related Articles:

    Clinical characteristics and response to supervised exercise therapy of people with lower extremity peripheral artery disease by Patel et al. https://doi.org/10.1016/j.jvs.2020.04.498

    Effects of supervised exercise therapy on blood pressure and heart rate during exercise, and associations with improved walking performance in peripheral artery disease: Results of a randomized clinical trial by Slysz et al. https://doi.org/10.1016/j.jvs.2021.05.033 

    Show Guests:

    Mary McDermott, MD is the Jeremiah Stamler Professor of Medicine and Preventive Medicine at the Feinberg School of Medicine at Northwestern Medicine.  Among her many accolades and titles, she serves as deputy editor of the Journal of the American Medical Society, and has an extensive career focused on improving our understanding of peripheral arterial disease.  

    Alex Chan, PhD is a researcher who studied regenerative medicine and cell therapeutics as a postdoctoral fellow in the lab of Dr. Ngan Huang, PhD at the Stanford Cardiovascular Institute.

     

    23 April 2024, 4:43 am
  • 57 minutes 31 seconds
    How to Heal a Heel: Lessons From the Malvern Diabetic Foot Conference

    In today’s episode, Dr. Rachael Forsythe (@ROForsythe), consultant vascular surgeon at NHS Lothian, leads a fictional case-based discussion with leaders in managing diabetic foot ulcers. Joining the conversation are Professor Andrew Boulton, Mr. Patrick Coughlin, Dr. David Armstrong, Dr. Dane Wukich, and Dr. Edgar Peters.

    Professor Boulton is a professor of medicine at Manchester University in England and is co-chair of the Malvern  Diabetic Foot Conference meeting. He served as president of numerous distinguished societies, including the International Diabetes Federation.

    Dr.  Coughlin (@Coughlin_pa) is a consultant vascular surgeon in Leeds, England. He is a very active member of the Vascular Society of Great Britain and Ireland Council and has a special academic and clinical interest in peripheral artery disease.

    Dr. Armstrong (@DGArmstrong) is a podiatric surgeon and professor of surgery at Keck School of Medicine of the University of California and director of the Southwestern Academic Limb Salvage Alliance. Dr. Armstrong is very well known for his work on amputation prevention, the diabetic foot and wound healing.

    Dr. Wukich (@DaneWukich) is a professor and chair of the Department of Orthopedics at the University of Texas, Southwestern and Medical Director of Orthopedic Surgery at UT Southwestern University Hospitals. Dr. Wich has an interest in foot and ankle surgery, including the management of diabetes-related complications.

    Dr. Edgar Peters is an associate professor of internal medicine, infectious diseases, and acute medicine at Amsterdam University Medical Centers, Dr. Peter's main interest is infection of the musculoskeletal system, particularly in patients with diabetes and is the Scientific Secretary of the International Symposium on the Diabetic Foot. 

     

    Malvern Diabetic Foot Conference info:

    https://www.facebook.com/MalvernDiabeticFootConference/

    https://eu.eventscloud.com/website/8151/

     

    If this episode was of interest to you, please take a listen to this Transatlantic Series episode where we speak with the authors of the SVS, ESVS, and IWGDFU joint guidelines on the management of peripheral arterial disease (PAD) in patients with diabetes. 

     

    Articles, resources, and societies referenced in the episode:

    DF Blog. “Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review @bradspellberg @lacuscmedcenter @usc,” January 1, 2022. https://diabeticfootonline.com/2022/01/01/oral-is-the-new-iv-challenging-decades-of-blood-and-bone-infection-dogma-a-systematic-review-bradspellberg-lacuscmedcenter-usc/.

    Gariani, Karim, Truong-Thanh Pham, Benjamin Kressmann, François R Jornayvaz, Giacomo Gastaldi, Dimitrios Stafylakis, Jacques Philippe, Benjamin A Lipsky, and Lker Uçkay. “Three Weeks Versus Six Weeks of Antibiotic Therapy for Diabetic Foot Osteomyelitis: A Prospective, Randomized, Noninferiority Pilot Trial.” Clinical Infectious Diseases 73, no. 7 (October 5, 2021): e1539–45. https://doi.org/10.1093/cid/ciaa1758.

    Li, Ho-Kwong, Ines Rombach, Rhea Zambellas, A. Sarah Walker, Martin A. McNally, Bridget L. Atkins, Benjamin A. Lipsky, et al. “Oral versus Intravenous Antibiotics for Bone and Joint Infection.” New England Journal of Medicine 380, no. 5 (January 31, 2019): 425–36. https://doi.org/10.1056/NEJMoa1710926.

    Magliano, Dianna, and Edward J. Boyko. IDF Diabetes Atlas. 10th edition. Brussels: International Diabetes Federation, 2021.

    Østergaard, Lauge, Mia Marie Pries-Heje, Rasmus Bo Hasselbalch, Magnus Rasmussen, Per Åkesson, Robert Horvath, Jonas Povlsen, et al. “Accelerated Treatment of Endocarditis—The POET II Trial: Ration

    ale and Design of a Randomized Controlled Trial.” American Heart Journal 227 (September 2020): 40–46. https://doi.org/10.1016/j.ahj.2020.05.012.

    Price, Patricia. “The Diabetic Foot: Quality of Life.” Clinical Infectious Diseases 39 (2004): S129–31.

    Sharma, S., C. Kerry, H. Atkins, and G. Rayman. “The Ipswich Touch Test: A Simple and Novel Method to Screen Patients with Diabetes at Home for Increased Risk of Foot Ulceration.” Diabetic Medicine: A Journal of the British Diabetic Association 31, no. 9 (September 2014): 1100–1103. https://doi.org/10.1111/dme.12450.

    Shin, Laura, Frank L. Bowling, David G. Armstrong, and Andrew J.M. Boulton. “Saving the Diabetic Foot During the COVID-19 Pandemic: A Tale of Two Cities.” Diabetes Care 43, no. 8 (August 1, 2020): 1704–9. https://doi.org/10.2337/dc20-1176.

    Tone, Alina, Sophie Nguyen, Fabrice Devemy, Hélène Topolinski, Michel Valette, Marie Cazaubiel, Armelle Fayard, Éric Beltrand, Christine Lemaire, and Éric Senneville. “Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study.” Diabetes Care 38, no. 2 (February 1, 2015): 302–7. https://doi.org/10.2337/dc14-1514.

    Wukich, Dane K., Katherine M. Raspovic, and Natalie C. Suder. “Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death.” Foot & Ankle Specialist 11, no. 1 (February 2018): 17–21. https://doi.org/10.1177/1938640017694722.

    21 April 2024, 3:50 pm
  • 27 minutes 37 seconds
    International Society for Women Vascular Surgeons

    Audible Bleeding editor Wen (@WenKawaji) is joined by 5th integrated vascular resident Yang (@YangYang_MD) and Moira 3rd year medical student discussing the International Society for Women Vascular Surgeons and Women’s Vascular Summit with Dr. Linda Harris. 

    Show Guests:

    • Dr. Linda Harris: Dr. Harris joined University of Buffalo in 1995 and currently sits as Professor of Surgery with tenure in the Department of Surgery. She is also the Program Director for the Vascular Fellowship and Vascular Residency Programs. She is the president of the international society for women vascular surgeons.

     

    SVS Women's section episodes 

     

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    12 April 2024, 9:55 am
  • 52 minutes 59 seconds
    SVS Outpatient Vascular Verification Program

    In this episode of Audible Bleeding, editor Dr. Adam Johnson is joined by General Surgery PGY-3 Sasank Kalipatnapu, MS2 Nishi Vootukuru, along with Dr. Anton Sidawy, MD, and Dr. William Schutze to discuss the nuances of the recently launched Society for Vascular Surgery (SVS) Outpatient Verification Program, in collaboration with the American College of Surgeons.

    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 will also cover the broad steps that need to be taken by a facility looking to become verified and will also show the value added by being verified by this joint ACS/SVS Vascular Verification program.

     

    Dr. Anton Sidawy, MD, MPH, FACS is the Lewis B. Saltz Chair and Professor of Surgery at George Washington School of Medicine, Washington DC. He is the chair of the Vascular Verification Program steering committee and oversees the development and implementation of inpatient and outpatient vascular verification programs.

     

    Dr. William Patrick Shutze is a Vascular Surgeon from Texas Vascular Associates in Plano, TX, and Chair of the Outpatient Committee. He is also the secretary for the Society for Vascular Surgery and is also the chair of the Communications Committee. He has led the efforts with the implementation of the recently launched Outpatient Verification Program.

     

    Relevant links:

     

    Co-Hosts:

    Dr. Adam Johnson is an Assistant Professor of Surgery at Duke University and editor at Audible Bleeding.

    Dr. Sasank Kalipatnapu is a PGY-3 General Surgery resident at UMass Chan Medical School, Worcester, MA.

    Nishi Vootukuru is a 2nd-year medical student at Rutgers NJMS University, Newark, NJ.

     

    25 March 2024, 9:12 pm
  • 41 minutes 18 seconds
    Robotic Vascular Surgery Part 1

    Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year general surgery resident Ryan Ellis discussing robotic vascular surgery with Dr. Judith Lin (@JudithLin4) and Dr. Petr Stadler. Dr. Lin and Dr. Stadler will share their personal journey in robotic vascular surgery, cases they have done, and what think the future looks like.  This is part one of our robotic vascular series. Our next episode will feature Dr. Lumsden and Dr. Bavare from Houston Methodist. 

    Show Guests:

    • Dr. Judith Lin: professor and chief of vascular surgery in the Department of Surgery at Michigan State University’s College of Human Medicine

    • Dr. Petr Stadler: Professor of Surgery, Head of Vascular Surgery Department, Na Homolce Hospital, Prague, Czech Republic

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    13 March 2024, 8:16 pm
  • 35 minutes 31 seconds
    JVS Author Spotlight - Maldonado and Guzman

    Audible Bleeding editor Wen (@WenKawaji) is joined by second year medical student Nishi (@Nishi_Vootukuru), 3rd year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes) and JVS-CIT associate editor Dr. O’Banion (@limbsalvagedr) to discuss two great articles in the JVS family of journals regarding endovascular management of acute limb ischemia and ultrasound-based femoral artery calcification score. This episode hosts Dr. Thomas Maldonado (@TomMaldonadoMD) and Dr. Raul J. Guzman, the authors of the following papers:

     

    Articles:

     

     

     

    Show Guests:

    • Dr. Thomas Maldonado is the Schwartz - Buckley endowed professor of surgery in the Vascular Division at New York University Langone Medical Center in New York,  Co-Director of Center for Complex Aortic Disease

    • Dr. Raul J. Guzman is the Donald Guthrie Professor of Vascular Surgery, Chief of Division of Vascular Surgery at Yale New Haven Hospital. He is also Surgeon-in-Chief of Vascular Surgery, Heart and Vascular Center for the Yale New Haven Health System. ([email protected])

     

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    3 March 2024, 8:45 pm
  • 27 minutes 24 seconds
    Holding Pressure: Carotid Endarterectomy

    Authors:

     Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California

    Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program

    Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center

     

    Resources: 

    • Rutherford’s 10th Edition Chapters: 88, 89, and 91

    • Houston Methodist CEA Dissection Video:

    Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ

    Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w

     

    Outline:

     1. Etiology of Carotid Artery Stenosis

    • Risk factors: advanced age, tobacco use, hypertension, diabetes.

    • Atherosclerosis as the primary cause.

    1. Development of Atherosclerotic Disease and Plaque Formation

      • LDL accumulation in arterial walls initiating plaque formation.

      • Inflammatory response, macrophage transformation, smooth muscle cell proliferation.

      • Role of turbulent blood flow at carotid bifurcation in plaque development.

    1. Clinical Features of Carotid Artery Stenosis

      • Asymptomatic nature in many patients.

      • Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit.

      • Carotid bruit as a physical finding, limitations in diagnosis.

    1. Importance of Evaluating CAS

      • Assessing stenosis severity and stroke risk.

      • Revascularization benefits dependent on stenosis severity.

    1. Classification of Stenosis Levels

      • Clinically significant stenosis: ≥ 50% narrowing.

      • Moderate stenosis: 50%–69% narrowing.

      • Severe stenosis: 70%–99% narrowing.

    1. Stroke Risk Associated with Carotid Stenosis

      • Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis.

    1. Diagnosis and Screening

      • No population-level screening recommendation.

      • Screening for high-risk individuals as per SVS guidelines.

      • Carotid Duplex Ultrasound as primary diagnostic tool.

      • Additional tools: CT angiography, Magnetic Resonance Angiography.

      • Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4.

    1. Revascularization Criteria

      • Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively.

      • Asymptomatic Patients: 70% stenosis, considering life expectancy.

    1. Surgical Indications and Contraindications

      • Indications: symptomatic patients, life expectancy considerations.

      • Contraindications: Stenosis

    27 February 2024, 9:19 pm
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