Category: complications
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EIA pulldown transposition: another way to treat infected common femoral pseudoaneurysm
A surgeon from Nepal posted a case of a ruptured common femoral pseudoaneurysm infected from IV drug abuse on LinkedIn. The comments centered around typical textbook responses which were: Ligate, debride, obturator bypass In situ bypass with femoral vein +/- sartorius flap Rifampin soaked graft or crypreserved allograft Ligate only My preferred treatment is #2, […]
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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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Off the guidelines: type II endoleak can derail the perfect EVAR
Every once in a while, I will make an exception to the SVS guidelines on AAA repair with regard to size at time of repair (link). I have a bunch of excuses. When I trained in 2000-2002 with several giants of vascular surgery, there was some controversy when the first guidelines came out in 2003 […]
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Lifelong surveillance after EVAR -is it worth it?
About ten years ago, I had a patient who came to see me for moderate carotid disease. While his carotid disease was asymptomatic, he also had metastatic colon cancer. With colectomy, cryoablation of liver mets, and chemotherapy, he was in remission. Every 6 to twelve months he had some kind of CT scan with contrast. […]
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Abdominal Stroke Alert!
It is a rare day that passes without the announcement of a stroke alert at CCAD. A reflex arc of activity is initiated, as time becomes the critical metric of success. Patients with strokes have a limited window of time to reverse the effects of the arterial occlusion, and the whole hospital is organized around […]
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Zebras, not horses: popliteal artery entrapment syndrome
Recalling the medical school adage, “when you hear hoofbeats, it’s probably horses, not zebras,” it is critical to think about rarities down on the differential list whenever you come across a patient. Vascular diseases suffer from inadvertent obscurantism arising from its absence from medical school curricula such that common disorders like mesenteric ischemia and critical […]
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Life imitates social media: a ruptured type V thoracoabdominal aortic aneurysm or IT saves a life
It was only last month when I came across a post of an aortic aneurysm in a difficult spot (link) and I couldn’t help chiming in some comments. Reading it now, I sound insufferable, because I wrote, “Depends on etiology and patient risk stratification. Also assuming aneurysm goes to level of SMA and right renal […]
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A lot of people can put in a stent graft, unfortunately only a few can take them out.
I recently had to remove a stent graft for infection and got to thinking about how the number of people who could comfortably and confidently manage that has thinned out in the world through the unintended consequence of the medical device market place. In every surgical specialty over the past twenty years, many open […]
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Exovascularist’s Dilemma: Where Is Our LIMA to LAD
During our daily morning huddles, peopled by cardiologists and cardiac surgeons, one thing impresses me more than anything else. The assembled interventional cardiologists, world class and renown, they who can place a stent in any part of the body, will defer to the unassailable superiority of the LIMA to LAD bypass over any existing intervention. […]
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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.
A Surgeon's Notes 