Category: AIOD
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The Story Should Fit: Repair of a Stent Graft Infection with Aortoiliac Endarterectomy and Bovine Pericardial Graft
One of the greatest surgical texts, Cope’s Early Diagnosis of the Acute Abdomen, is something every surgical resident, vascular or general, should read. The mid-century edition which I owned during my residency, has since been updated, but the central message of the book is this: every complaint or pain the patient has comes from a […]
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Arterial Restoration in CLTI with Remote Endarterectomy (EndoRE).
The patient is a man over 70 years of age who came to the hospital with severe pain of his right foot and leg with walking short distances and at night while recumbent. He had a history of hypertension, diabetes, and coronary artery disease, and several years ago had his left common iliac artery stented. […]
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Incidental Pheochromacytoma
An oldie but a goodie from my first blog, “The Pipes Are Calling” on Medscape. This case came to mind when I recently diagnosed a pheochromacytoma from my clinic -middle aged man with difficult to control hypertension and unilateral renal artery stenosis. One of the most critical lessons learned from medical school, the Columbia University […]
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Arterial Restoration -Something New, Something Old
Something that I recently promised Dr. James S.T. Yao, I will be working to publish on my stent removal and extended remote endarterectomy cases and techniques. Meanwhile, here is a talk.
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The Unclampable: Strategies for Managing a Heavily Calcified Infrarenal Aorta
Leriche Syndrome -one of those disease names that adds to our work in a way that an ICD codes and even the “aortoiliac occlusive disease” fails to describe. When I hear someone described as having Leriche Syndrome, I think about a sad, chain smoking man, unmanned, complaining of legs that cramp up at fifty feet, pulseless. The CT scan will […]
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Salvage: A different approach to graft infections in the groin
The principles of salvage are in rescuing valuable undamaged goods in the setting of catastrophe. This guided me when a patient was flown in from an outside institution to our ICU with a saline soaked OR towel in his right groin -he had had an aorto-bifemoral bypass for aorto-iliac occlusive disease a year prior, but […]
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When both iliac systems are occluded below an abdominal aortic aneurysm: hybrid techniques on the cutting edge
The patient is an 70 year old man referred for evaluation of claudication that occurred at under a block of walking. He reported no rest pain or tissue loss. He smoked heavily up to a pack a day, with congestive heart failure with an ejection fraction of 40%, prior history of myocardial infarction treated with […]
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When good enough is better than perfect: a case of end stage visceral segment aortic occlusive disease
The patient is a woman in her 60’s who self referred for complaint of abdominal pain, weight loss, and rest pain of the lower extremities. She is a 40 pack year smoker and had severe COPD, hypertension, congestive heart failure with mitral regurgitation, chronic kidney disease stage IV, and ischemic rest pain of the legs. […]
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3DVR -Very Helpful in Planning Open Surgical Cases
The images above show a patient with on isolated occlusion of his left common iliac artery. He was young, in his forties, but was a heavy smoker and suddenly developed claudication of his left leg which interfered with his work. He quit smoking and did not progress with exercise. Discussion involving possible stenting was made […]
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EndoRE-ABF -an alternative to the EndoABF which is in turn an alternative to the ABF.
The patient is 70 year old woman with prior history of smoking who developed severe claudication and near rest pain. She was unable to walk more than 50 feet before having to stop due to severe leg pain. On exam, neither femoral artery pulses were palpable. PVR’s (pulse volume recordings) and ABI’s (ankle brachial […]
A Surgeon's Notes 