When I lecture to interventionalists (cough, cardiologists), I often end with some variation on the following:
1. The common femoral artery is the left main of the leg, so why would you ever leave a stent across the LCX?
2. Claudication is like stable angina, so is it okay to intervene on a long LAD CTO for stable angina?
3. Gangrene and ulceration are like STEMI and Non-STEMI, only you can’t take the dressing down on an infarcted heart three times a day and wash away the debris.
4. If a LIMA to LAD isn’t a failure and lasts many years beyond the best stents, how is a femoral to tibial bypass a failure?
5. Why is that [insert technology] is a failure in the coronary circulation but the latest and greatest thing in the peripheral circulation?
6. Reversible ischemia is well demonstrated in the foot by lifting it off the bed and watching the color change. It’s too bad for vascular surgeons we can’t build a giant white box around this test and have have the hospital build a center around it.
7. The ABI is a great test of cardiac risk, not so much for peripheral vascular disease.
8. Hybrid revascularization works for the legs in the same way it works for the heart -you maximize the hand that you are dealt.
9. The nitinol throne is not won without some cost.
10. One day, in the far future, someone will dig up an ancient human that is more nitinol, stainless, steel, and chromium, than bone, from the mitral valve out to the fingers and toes.
A Surgeon's Notes 