Category: open aneurysm surgery
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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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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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Debranch First! or Why Haven’t We Done This All Along for Thoracoabdominal Aortic Aneurysms?
Context Despite all the advances in endovascular repair of thoracoabdominal aortic aneurysms, no data shows their superiority in the mid to long term compared to open repair. That is why branched stent graft programs occur hand-in-hand with robust open surgical programs, to offer durable open solutions to younger healthier patients while mitigating risk in older […]
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When You Pay Your Own Way, You Chose Value
The patient is an active man in his 60’s with a history of hypertension who had known about a right common iliac artery aneurysm for several years and had come for an opinion. He was asymptomatic of pain. He had a prior splenic artery aneurysm embolization about a decade prior to presentation.. CT scan showed […]
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Innovating Our Way Out of Not Having Enough Vascular Surgeons
Innovating Our Way Out of Not Having Enough Vascular Surgeons This year’s SVS meeting featured a sobering assessment about the vascular manpower deficit affecting North America at the E. Stanley Crawford Critical Issues Forum, moderated by Dr. Michel Makaroun, MD, president-elect of the SVS. 35-45% of practicing vascular surgeons plan on retiring in the next […]
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Video Presentation: Removing Stent Grafts and It’s Implications for Putting Them In
This was presented at Dia De La Patología Aortíca Marbella organized by Dr. Fernando Gallardo. Here is the link.
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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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Never Stop Following Stent Grafts -Type IV endoleak causing slow growth in 12 year old stent graft
The patient had undergone EVAR for bilateral common iliac artery aneurysm with the original Gore Excluder stent graft a dozen years before with coil embolization and extension to the external iliac on the larger side and femoral to internal iliac artery bypass on the other side. A coagulopathy, one of the clotting factor deficiencies, […]
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Ruptured Thoracoabdominal Aortic Aneurysm In 88 Year Old -a survival
The patient, an active 88 year old man, was transferred from an outside institution after a CT scan revealed a 9cm thoracoabdominal aortic aneurysm on workup of sudden onset back pain. On transfer, his blood pressure was stable but low in the 90’s. On arrival, his blood pressure dropped into the 60’s but responded to […]
A Surgeon's Notes 