Podcasts about endovascular

The effectiveness of endovascular treatment (EVT) in cases of acute ischaemic stroke caused by distal medium vessel occlusion (DMVO) is still unclear. A study in the JNNP assessed the safety and effectiveness of EVT in comparison to the best medical management for DMVO. Podcast host Dr. Saima Chaudhry¹ spoke to some of the paper's authors, Dr. Adam Dmytriw², Dr. Vivek Yedavalli³ and Dr. Hamza Salim³.   Read the paper: Endovascular therapy versus best medical management in distal medium middle cerebral artery acute ischaemic stroke: a multinational multicentre propensity score-matched study   1. Warren Alpert Medical School, Brown University, Rhode Island, USA 2. Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA 3. Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA Please subscribe to the show on Apple Podcasts, Spotify or find it on your platform of choice. Your feedback and reviews are very appreciated. Follow JNNP on twitter: @JNNP_BMJ

In this interview, Drs. Scali and Spratt discuss how the historical norms are being challenged for connective tissue disease patients (CTD) and endovascular repair.

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from January 11-17, 2025.

Today we are going to discuss another Editor's Choice article from the European Journal for Vascular and Endovascular Surgery (EJVES). The title is: Association of Pedal Acceleration Time With Healing and Amputation Free Survival in Patients With Ulceration and Gangrene by Odette Hart et al from The University of Auckland and Waikato Hospital in Hamilton, New Zealand. The article was published as an Editor's choice in the European Journal of Vascular and Endovascular surgery in October 2024. Shownotes:Editor's Choice – Association of Pedal Acceleration Time With Healing and Amputation Free Survival in Patients With Ulceration and GangreneHart, Odette et al.European Journal of Vascular and Endovascular Surgery, Volume 68, Issue 4, 490 - 497https://www.ejves.com/article/S1078-5884(24)00471-4/fulltext

Contributor: Aaron Lessen MD Educational Pearls: Aortic injury occurs in 1.5-2% of patients who sustain blunt thoracic trauma Majority are caused by automobile collisions or motorcycle accidents Due to sudden deceleration mechanism accidents Clinical manifestations Signs of hypovolemic shock including tachycardia and hypotension, though not always present Patients may have altered mental status Imaging Widened mediastinum on chest x-ray, though not highly sensitive CT is more sensitive and specific, and signs of thoracic injury include an intimal flap, aortic wall outpouching, and aortic contour abnormalities In hemodynamically unstable or otherwise unfit for CT patients, transesophageal echocardiogram may be used Four types of aortic injury (in order of ascending severity) I: Intimal tear or flap II: Intramural hematoma III: Pseudoaneurysm IV: Rupture Management Hemodynamically unstable: immediate OR for exploratory laparotomy and repair Hemodynamically stable: heart rate and blood pressure control with beta-blockers Minor injuries are treated with observation and hemodynamic control Severe injuries may receive surgical management Some patients benefit from delayed repair An endovascular aortic graft is a surgical option Mortality 80-85% of patients die before hospital arrival 50% of patients that make it to the hospital do not survive References Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma [published correction appears in J Trauma Acute Care Surg. 2015 Feb;78(2):447]. J Trauma Acute Care Surg. 2015;78(1):136-146. doi:10.1097/TA.0000000000000470 Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53(1):187-192. doi:10.1016/j.jvs.2010.08.027 Osgood MJ, Heck JM, Rellinger EJ, et al. Natural history of grade I-II blunt traumatic aortic injury. J Vasc Surg. 2014;59(2):334-341. doi:10.1016/j.jvs.2013.09.007 Osman A, Fong CP, Wahab SFA, Panebianco N, Teran F. Transesophageal Echocardiography at the Golden Hour: Identification of Blunt Traumatic Aortic Injuries in the Emergency Department. J Emerg Med. 2020;59(3):418-423. doi:10.1016/j.jemermed.2020.05.003 Steenburg SD, Ravenel JG, Ikonomidis JS, Schönholz C, Reeves S. Acute traumatic aortic injury: imaging evaluation and management. Radiology. 2008;248(3):748-762. doi:10.1148/radiol.2483071416 Summarized by Jorge Chalit, OMS3 | Edited by Meg Joyce & Jorge Chalit Donate: https://emergencymedicalminute.org/donate/  

Surgical arteriovenous fistula (AVF) creation has been a mainstay of dialysis care for multiple decades. What does it take to break into such an established space with a new endovascular medical device? In this episode of the BackTable Podcast, Dr. Jeffrey Hull discusses the challenging journey of developing the Ellipsys system for endovascular AVF creation. --- CHECK OUT OUR SPONSOR Medtronic ClosureFast https://www.medtronic.com/closurefast6f --- SYNPOSIS We trace Dr. Hull's path from the device's initial conception in 2006, through the first-in-human cases in 2013, to regulatory approval and acquisition by Medtronic in 2020. Dr. Hull highlights the roles of key business mentors, the importance of multidisciplinary collaboration with vascular surgery and nephrology, and the impact of investment. He also shares valuable insights on the benefits of having competitors and selecting a well-thought-out exit strategy. Additionally, we explore deep vein arterialization (DVA) as another application of endovascular AVF creation in the context of peripheral arterial disease. --- TIMESTAMPS 00:00 - Introduction 03:05 - The Birth of the Percutaneous AV Fistula Creation 15:04 - First-in-Human Cases 17:58 - Navigating the Startup Journey 21:52 - Identifying Mentors and Investors 27:33 - Competition and Criticism 36:43 - Regulatory Hurdles 44:45 - Acquisition by Medtronic 49:14 - Deep Vein Arterialization for Peripheral Arterial Disease 54:40 - Final Thoughts and Advice --- RESOURCES Avenu Medical: https://avenumedical.com/ Gracz KC et al. Proximal forearm fistula for maintenance hemodialysis (1977): https://pubmed.ncbi.nlm.nih.gov/839655/ Hull JE et al. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access (2018): https://pubmed.ncbi.nlm.nih.gov/29275056/ Endovascular Today- Update on Percutaneous AV Fistula Creation (2015): https://evtoday.com/articles/2015-june/update-on-percutaneous-av-fistula-creation Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art (2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353338/

Surgical arteriovenous fistula (AVF) creation has been a mainstay of dialysis care for multiple decades. What does it take to break into such an established space with a new endovascular medical device? In this episode of the BackTable Podcast, Dr. Jeffrey Hull discusses the challenging journey of developing the Ellipsys system for endovascular AVF creation. --- SYNPOSIS We trace Dr. Hull's path from the device's initial conception in 2006, through the first-in-human cases in 2013, to regulatory approval and acquisition by Medtronic in 2020. Dr. Hull highlights the roles of key business mentors, the importance of multidisciplinary collaboration with vascular surgery and nephrology, and the impact of investment. He also shares valuable insights on the benefits of having competitors and selecting a well-thought-out exit strategy. Additionally, we explore deep vein arterialization (DVA) as another application of endovascular AVF creation in the context of peripheral arterial disease. --- TIMESTAMPS 00:00 - Introduction 03:05 - The Birth of the Percutaneous AV Fistula Creation 15:04 - First-in-Human Cases 17:58 - Navigating the Startup Journey 21:52 - Identifying Mentors and Investors 27:33 - Competition and Criticism 36:43 - Regulatory Hurdles 44:45 - Acquisition by Medtronic 49:14 - Deep Vein Arterialization for Peripheral Arterial Disease 54:40 - Final Thoughts and Advice --- RESOURCES Avenu Medical: https://avenumedical.com/ Gracz KC et al. Proximal forearm fistula for maintenance hemodialysis (1977): https://pubmed.ncbi.nlm.nih.gov/839655/ Hull JE et al. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access (2018): https://pubmed.ncbi.nlm.nih.gov/29275056/ Endovascular Today- Update on Percutaneous AV Fistula Creation (2015): https://evtoday.com/articles/2015-june/update-on-percutaneous-av-fistula-creation Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art (2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353338/

 In this episode, Miguel and Lucas dive into the details of an intriguing case involving a patient with a lower extremity ischemia, possibly exacerbated by a prior COVID infection and cardiovascular risks. The conversation covers the challenges and nuances of managing stenosis and plaque buildup in peripheral arteries, with an emphasis on using cutting-edge techniques such as atherectomy and drug-coated balloons. Key Discussion Points: Patient Case Overview: The patient, a relatively healthy golfer with a history of prothrombotic events post-COVID, faced intermittent claudication and severe stenosis. The team walks through the case's progression and their decision-making process. Medical Optimization Challenges: The hosts highlight the common issue of failed conservative treatments like medication and exercise programs. Miguel discusses the frustrations patients face when optimization fails, leading to pressure on surgeons for more aggressive interventions. Endovascular Techniques Explored: Imaging Insights: The importance of ultrasound and IVUS (Intravascular Ultrasound) in guiding procedural decisions is emphasized, especially in identifying the type of plaque (soft vs. calcified) and the need for debulking. Atherectomy vs. Laser vs. Drug-Coated Balloon: Miguel shares his preference for the RotorX atherectomy device over other methods like laser, citing its versatility in treating soft plaque, clot, and stenosis. Lucas offers his perspective on alternative approaches. Case Reflection: The episode's dramatic twist occurs when a previously undetected lesion surfaces, prompting a reassessment of the procedure and further interventions. Patient Outcome: After a successful intervention with the RotorX device and a drug-coated balloon, the patient returned to golfing, demonstrating the real-world impact of these complex procedures. Humor & Hot Takes: Throughout the episode, Miguel and Lucas share lighthearted moments, including "dad jokes" and banter about their experiences in the medical field, making this technical conversation engaging for both seasoned professionals and learners. Key Takeaways: The importance of thorough imaging in vascular procedures. Why atherectomy devices, when used correctly, can be game-changers in treating challenging cases. How to balance conservative management with more aggressive interventions when dealing with peripheral artery disease.

A 60-ish year-old client with a history of surgery for aortic aneurysm insists—INSISTS—that his 21-year-old massage therapist work with him, in spite of his new onset severe leg pain. What are the practitioner's options in this literally life-or-death scenario? This story, that looks cut-and-dried on the surface, is more complex than it appears. Plus, we get to talk about bulges in the aorta, bleeding ruptures, migrating devices, new surgical innovations, and much much more. Listen in to find out how it all turns out. Resources: Pocket Pathology: https://www.abmp.com/abmp-pocket-pathology-app Ameli, F.M. et al. (1987) ‘Etiology and management of aorto-femoral bypass graft failure', The Journal of Cardiovascular Surgery, 28(6), pp. 695–700. Choi, E. et al. (2021) ‘Risk Factors for Early and Late Iliac Limb Occlusions of Stent Grafts Extending to the External Iliac Artery after Endovascular Abdominal Aneurysm Repair', Annals of Vascular Surgery, 70, pp. 401–410. Available at: https://doi.org/10.1016/j.avsg.2020.06.028. Daye, D. and Walker, T.G. (2018) ‘Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management', Cardiovascular Diagnosis and Therapy, 8(Suppl 1), pp. S138–S156. Available at: https://doi.org/10.21037/cdt.2017.09.17. Endovascular repair of complex aortic aneurysms - Mayo Clinic (no date). Available at: https://www.mayoclinic.org/medical-professionals/cardiovascular-diseases/news/endovascular-repair-of-complex-aortic-aneurysms/mac-20429867 (Accessed: 31 July 2024). Ivancev, K. and Vogelzang, R. (2020) ‘A 35 Year History of Stent Grafting, and How EVAR Conquered the World', European Journal of Vascular and Endovascular Surgery, 59(5), pp. 685–694. Available at: https://doi.org/10.1016/j.ejvs.2020.03.017. Modern History of Aortic Surgery, by Hazim J. Safi, MD | McGovern Medical School (no date). Available at: https://med.uth.edu/cvs/2020/08/25/modern-history-of-aortic-surgery-by-hazim-j-safi-md/ (Accessed: 31 July 2024). Park, K.-M. et al. (2017) ‘Long Term Outcomes of Femorofemoral Crossover Bypass Grafts', Vascular Specialist International, 33(2), pp. 55–58. Available at: https://doi.org/10.5758/vsi.2017.33.2.55. Sponsors: Anatomy Trains: www.anatomytrains.com  MassageBook: www.massagebook.com Elements Massage: www.elementsmassage.com/abmp

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 authors.   Readers: Shourya Verma (@shourya__verma) Nabeeha Khan (@Nabeeha_Khan_) Miguel Fernandez (@MGfernandez21) Amit Chaudhary (@VascularKGMU) Dr. Jayer Chung (@Jayer_Chung)   Hosts: Nishi Vootukuru (@Nishi_Vootukuru) John Culhane (@Johnculhanemd)   Editorials (E) and Abstracts (A):   E- Arteries of fibromuscular dysplasia tell a sympathetic story A- Transcarotid arterial revascularization is feasible and safe with concomitant inferior vena cava occlusion A- Surgical anteriorization of the left common iliac vein results in improved venous outflow and quality of life for May-Thurner syndrome E- Longer is better, discussing length of coverage and timing of intervention in type B aortic dissection A-Endovascular repair of ascending aortic pathologies in patients unfit for open surgery: Case series and literature review A-Improved gait parameters following surgical revascularization in patients with intermittent claudication A- Totally percutaneous endovascular renal allograft salvage for common iliac artery pseudoaneurysm A- Early results of transcatheter electrosurgical aortic septotomy for endovascular repair of chronic dissecting aortoiliac aneurysms E- Impact of the infrapopliteal bypass with distal arteriovenous fistula and distal cuffs in the management of small arterial disease     Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Dr. Linda Chu discusses predictors of intestinal resection-free survival in patients with acute arterial mesenteric ischemia with Dr. Lorenzo Garzelli and Dr. Maxime Ronot.   Predictors of Survival Without Intestinal Resection after First-Line Endovascular Revascularization in Patients with Acute Arterial Mesenteric Ischemia. Garzelli et al. Radiology 2024; 311(3):e230830.

A 70 year old healthy female is referred to you with a 5.7 cm abdominal aortic aneurysm. As an astute clinician you are aware that current guidelines support surgical repair for her AAA. What if there was new data to suggest this patient may not benefit from repair? What would be the optimal size threshold that she would benefit from AAA repair? Tune into this episode of Behind the Knife, where the vascular surgery subspecialty team discusses a paper that challenges current size threshold guidelines for AAA repair.  Hosts:  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan and the Program Director of the Integrated Vascular Surgery Residency Program as well as the Vascular Surgery Fellowship Program at the University of Michigan. Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Drew Braet is a PGY-5 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives - Review the current size threshold guidelines for surgical repair of abdominal aortic aneurysms - Understand the limitations of the aforementioned guidelines - Understand the methodology, findings, limitations, and clinical applications of the manuscript “Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration.” References 1.    Columbo JA, Scali ST, Jacobs BN, et al. Size thresholds for repair of abdominal aortic aneurysms warrant reconsideration. Journal of Vascular Surgery. 2024;79(5):1069-1078.e8. doi:10.1016/j.jvs.2024.01.017 https://pubmed.ncbi.nlm.nih.gov/38262565/ 2.    Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044 https://pubmed.ncbi.nlm.nih.gov/29268916/ 3.    Wanhainen A, Van Herzeele I, Bastos Goncalves F, et al. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. European Journal of Vascular and Endovascular Surgery. 2024;67(2):192-331. doi:10.1016/j.ejvs.2023.11.002 https://pubmed.ncbi.nlm.nih.gov/38307694/ 4.    The UK Small Aneurysm Trial Participants, Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms.  Lancet 1998;352 (9141) 1649- 1655 https://pubmed.ncbi.nlm.nih.gov/9853436/ 5.    Lederle  FAWilson  SEJohnson  GR  et al. Aneurysm Detection and Management Veterans Affairs Cooperative Study Group, Immediate repair compared with surveillance of small abdominal aortic aneurysms.  N Engl J Med 2002;346 (19) 1437- 1444 https://pubmed.ncbi.nlm.nih.gov/12000813/ 6.    United Kingdom EVAR Trial Investigators; Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010 May 20;362(20):1872-80. doi: 10.1056/NEJMoa0911056. Epub 2010 Apr 11. PMID: 20382982. https://pubmed.ncbi.nlm.nih.gov/20382982/ 7.    Lederle FA, Johnson GR, Wilson SE, Ballard DJ, Jordan WD Jr, Blebea J, Littooy FN, Freischlag JA, Bandyk D, Rapp JH, Salam AA; Veterans Affairs Cooperative Study #417 Investigators. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002 Jun 12;287(22):2968-72. doi: 10.1001/jama.287.22.2968. PMID: 12052126. 8.    Lancaster EM, Gologorsky R, Hull MM, Okuhn S, Solomon MD, Avins AL, Adams JL, Chang RW. The natural history of large abdominal aortic aneurysms in patients without timely repair. J Vasc Surg. 2022 Jan;75(1):109-117. doi: 10.1016/j.jvs.2021.07.125. Epub 2021 Jul 26. PMID: 34324972. https://pubmed.ncbi.nlm.nih.gov/34324972/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

 In this episode of the "Life of Flow Podcast," we have the privilege of hosting Dr. Marta Lobato, a renowned expert in endovascular limb salvage and retrograde access. Dr. Lobato shares her extensive knowledge and experience from her work at the boutique BTA unit in Bilbao, Spain. This episode dives deep into technical discussions, offering invaluable insights for medical professionals and enthusiasts alike.

In this week's podcast, Neurology Today's editor-in-chief discusses data on the effectiveness of rescue therapies when endovascular thrombectomy fails, how first-seizure clinics reduce hospitalizations, and AI's use in sleep neurology.

Founded in 2017, XCath is a dynamic startup at the cutting edge of revolutionary medical robotics, nanorobotics and materials science. The company develops next-generation endovascular robotic systems and steerable guidewires to treat life-threatening conditions like cerebrovascular disorders.  With strategically located campuses in Houston, Texas – home to the world's largest medical center – and Pangyo, South Korea, often referred to as the Silicon Valley of Korea, XCath is committed to bringing its innovative solutions to patients around the world. CEO Eduardo Fonseca joins this episode to share how their family of engineers is making this a reality, with a value driven culture, and space-edge approach. After recently performing the world's first public telerobotic mechanical thrombectomy at Abu Dhabi Global Healthcare Week, it's clear that the XCath team is helping pave the way for widescale implementation of robotic surgical tools. Eduardo outlines how the team is building on this momentous landmark to tackle the eye-watering statistics associated with stroke, a conversation that is sure to leave you informed and inspired.

Founded in 2017, XCath is a dynamic startup at the cutting edge of revolutionary medical robotics, nanorobotics and materials science. The company develops next-generation endovascular robotic systems and steerable guidewires to treat life-threatening conditions like cerebrovascular disorders.  With strategically located campuses in Houston, Texas – home to the world's largest medical center – and Pangyo, South Korea, often referred to as the Silicon Valley of Korea, XCath is committed to bringing its innovative solutions to patients around the world. CEO Eduardo Fonseca joins this episode to share how their family of engineers is making this a reality, with a value driven culture, and space-edge approach. After recently performing the world's first public telerobotic mechanical thrombectomy at Abu Dhabi Global Healthcare Week, it's clear that the XCath team is helping pave the way for widescale implementation of robotic surgical tools. Eduardo outlines how the team is building on this momentous landmark to tackle the eye-watering statistics associated with stroke, a conversation that is sure to leave you informed and inspired.

En este programa participan:- Juan Antonio García Carmona, neurólogo del Hospital Santa Lucía y profesor de Farmacología de la UCAM- Sergio Cánovas, jefe de Cirugía Cardiovascular del Hospital Virgen de la Arrixaca, Vicepresidente de la Sociedad Española de Cirugía Cardiovascular y Endovascular para pasar a ser presidente dentro de 2 años.- Laura Cánovas, ginecóloga del Hospital Virgen de la Arrixaca.- José Manuel Ferrández, catedrático de Arquitectura de Computadores de la Universidad Politécnica de Cartagena.

Dr. Dan Ackerman and Dr. Silja Räty discuss the outcomes of patients with basilar artery occlusion treated with intravenous thrombolysis (IVT) only and compares IVT with endovascular thrombectomy.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209249 

Dr. Dan Ackerman talks with Dr. Silja Räty about the outcomes of patients with basilar artery occlusion treated with intravenous thrombolysis (IVT) only and compares IVT with endovascular thrombectomy. Read the related article in Neurology. This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information. Disclosures can be found at Neurology.org.

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 3 Years: ⁠⁠⁠⁠⁠⁠https://blog.feedspot.com/medical_billing_and_coding_podcasts/⁠⁠⁠⁠⁠⁠ I'd love your continued support of this content-rich, value-add podcast to help you succeed in the business of medicine: ⁠⁠⁠⁠⁠⁠https://podcasters.spotify.com/pod/show/sonal-patel5/support⁠⁠⁠⁠⁠⁠ Sonal's 12th Season starts up and Episode 2 features a Newsworthy update on the OIG Work Plan for April 2024. Sonal's Trusty Tip and compliance recommendations focus on supplemental documentation necessary for lower extremity endovascular procedures. Spark inspires us all to reflect on collaboration based on the inspirational words of Helen Keller. Thanks to Advanced Coding Services: Website:⁠ ⁠https://advancedcodingservices.com/⁠⁠ Paint The Medical Picture Podcast now on: Spotify for Podcasters: ⁠⁠⁠⁠⁠⁠https://podcasters.spotify.com/pod/show/sonal-patel5⁠⁠⁠⁠⁠⁠ Spotify: ⁠⁠⁠⁠⁠⁠https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X⁠⁠⁠⁠⁠⁠ Apple Podcasts: ⁠⁠⁠⁠⁠⁠https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177⁠⁠⁠⁠⁠⁠ Google Podcasts: ⁠⁠⁠⁠⁠⁠https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8zMGYyMmZiYy9wb2RjYXN0L3Jzcw==⁠⁠⁠⁠⁠⁠ Amazon Music: ⁠⁠⁠⁠⁠⁠https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast⁠⁠⁠⁠⁠⁠ Breaker: ⁠⁠⁠⁠⁠⁠https://www.breaker.audio/paint-the-medical-picture-podcast⁠⁠⁠⁠⁠⁠ Pocket Casts: ⁠⁠⁠⁠⁠⁠https://pca.st/tcwfkshx⁠⁠⁠⁠⁠⁠ Radio Public: ⁠⁠⁠⁠⁠⁠https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw⁠⁠⁠⁠⁠⁠ Find Paint The Medical Picture Podcast on YouTube: ⁠⁠⁠⁠⁠⁠https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A⁠⁠⁠⁠⁠⁠ Find Sonal on LinkedIn:⁠ ⁠⁠⁠⁠⁠https://www.linkedin.com/in/sonapate/⁠⁠⁠⁠⁠⁠ And checkout the website: ⁠⁠⁠⁠⁠⁠https://paintthemedicalpicturepodcast.com/⁠⁠⁠⁠⁠⁠ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: ⁠⁠⁠⁠⁠⁠PaintTheMedicalPicturePodcast@gmail.com⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/sonal-patel5/message Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities. Episodes originally aired from 2016 to 2021. Originally released: May 16, 2019 It would be an understatement to say that endovascular thrombectomy has revolutionized acute stroke management. As of 2018, the American Heart Association recommends treatment up to 24 hours after time last seen normal for select patients. This week on the BrainWaves podcast, Dr. Tudor Jovin--PI for the DAWN and REVASCAT clinical trials--summarizes the history of thrombectomy trials and what it is about our current strategies that have breathed new life into a technique that has historically fizzled. Produced by James E Siegler and Jesse Thon. Music courtesy of Cuicuitte, Coldnoise, Medyn, Jon Watts, Lee Rosevere, and Mystery Mammal. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter (now X) @brainwavesaudio for the latest updates to the podcast. REFERENCES Campbell BC, Majoie CB, Albers GW, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol 2019;18(1):46-55. Erratum in: Lancet Neurol 2019 Mar;18(3):e2. PMID 30413385Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387(10029):1723-31. PMID 26898852Gross BA, Jadhav AP, Jankowitz BT, Jovin TG. The ongoing revolution in thrombectomy: expanding inclusion criteria to larger cores. World Neurosurg 2018;120:393-94. PMID 30292027Heit JJ, Wintermark M. Perfusion computed tomography for the evaluation of acute ischemic stroke: strengths and pitfalls. Stroke 2016;47(4):1153-8. PMID 26965849Jadhav AP, Molyneaux BJ, Hill MD, Jovin TG. Care of the post-thrombectomy patient. Stroke 2018;49(11):2801-07. PMID 30355218Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol 2009;30(5):885-92. PMID 19299489Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378(1):11-21. PMID 29129157Román LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018;17(10):895-904. PMID 30264728 We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Editor's Summary by Anthony Charles, MD, MPH, Associate Editor of JAMA, the Journal of the American Medical Association, for the March 12, 2024, issue.

Tune in for a multi-disciplinary panel discussion on the latest real-world data and advanced endovascular strategies for PE management  

Individual Patient-data Pooled Analysis of Endovascular Ultrasound Renal Denervation or a Sham Procedure at 6 Months in the RADIANCE Clinical Trial Program

CardioNerds meet with fellows from The Christ Hospital, Drs. Hanad Bashir, Hyunsoo Chung, and Dalia Aziz to discuss the following case that highlights angioleiomyoma: A 60-year-old woman with a past medical history significant for breast cancer (on tamoxifen) presented as a transfer to our facility for a clot-in-transit. She had initially presented to the outside hospital after progressive dyspnea on exertion and recent syncope. She was found on an echocardiogram to have a right atrial mass spanning into the right ventricle. CTA of the chest and abdomen/pelvis demonstrated extensive thrombus burden spanning from the IVC into the right ventricle. She was transferred to our facility for intervention. Endovascular attempts were unsuccessful, at which point she underwent surgical thrombectomy. Gross examination of the mass revealed a cylindrical shape, homogeneous tan color, rubbery soft tissue, measuring 25.5 cm in length and 2.3 cm in diameter. Histology confirmed the presence of angioleiomyoma. A second, smaller mass (5.2cm long and 4mm in diameter) was removed from under the tricuspid valve, with histology consistent with leiomyoma. Estrogen receptor and progesterone receptor staining were strongly positive, leading to the discontinuation of tamoxifen. Given the presence of uterine fibroids identified on the CT scan, there was concern about a uterine origin. A hysterectomy is planned for her in the near future. Expert commentary is provided by Dr. Wojciech Mazur. Episode audio was edited by student Dr. Adriana Mares. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - The Tall Tail Heart: Angioleiomyoma – The Christ Hospital Pearls - The Tall Tail Heart: Angioleiomyoma – The Christ Hospital Although evaluation of cardiac mass by echocardiography can provide information such as size, location, and morphology, adjunctive cross-sectional imaging may be used depending on the need for further temporal resolution (CT) or tissue characterization via cardiac MRI (CMR). If suspicious for elevated metabolic activity, there should be consideration of FDG-PET. Tamoxifen (a selective estrogen receptor modulator) is an agent used for breast cancer therapy. However, its use has been associated with endometrial hyperplasia, uterine fibroids, endometrial and uterine malignancy. Increased risk of malignancy has been seen more often in post-menopausal women and is dose and time-dependent. Clot in transient is a mobile thrombus, typically within the right heart structures. It is estimated to occur in 4-18% of patients with pulmonary embolism and is associated with elevated morbidity and mortality. Treatment includes surgical embolectomy, endovascular embolectomy, systemic thrombolysis, catheter-directed thrombolysis, or systemic anticoagulation. Angioleiomyoma is a rare benign pericystic tumor that most commonly affects the extremities. There are case reports of other affected sites, including the uterus. Invasion into the cardiac structures is exceedingly rare. The only established treatment for angioleiomyoma is surgical resection. Show Notes - The Tall Tail Heart: Angioleiomyoma – The Christ Hospital Syncope Syncope is a transient loss of consciousness secondary to reduced blood flow to the brain. Often, certain presentations are mislabeled as syncope, such as seizure disorders, posttraumatic loss of consciousness, and cataplexy. An organized diagnostic approach should be used to reduce hospital admissions and medical costs and increase diagnostic accuracy. Syncope can be divided into five general subgroups. 1) Neurally mediated reflex syncope (carotid sinus syndro...

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 With the advent of mechanical thrombectomy, some have argued that using intravenous tissue plasminogen activator for stroke is futile. But is it really? Dr. Sheryl Martin-Schild of Dr. Brain, Inc. joins us for today's episode to discuss whether the thrombectomy has killed tPA. The content in this episode was vetted and approved by Sheryl Martin-Schild. Produced by James E Siegler. Music by Lee Rosevere, Josh Woodward, Kevin McLeod, and Little Glass Men. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Coutinho JM, Liebeskind DS, Slater LA, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: a pooled analysis of the SWIFT and STAR Studies. JAMA Neurol 2017;74(3):268-74. PMID 28097310Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals From the American Heart Association/American Stroke Association. Stroke 2016;47(2):581-641. Erratum in: Stroke 2016;47(11):e262. PMID 26696642Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387(10029):1723-31. PMID 26898852Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995;274(13):1017-25. PMID 7563451National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333(24):1581-7. PMID 7477192Rai AT, Boo S, Buseman C, et al. Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes. J Neurointerv Surg 2018;10(1):17-21. PMID 28062805Saver JL, Gornbein J, Grotta J, et al. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: joint outcome table analysis of the ECASS 3 trial. Stroke 2009;40(7):2433-7. PMID 19498197  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Interview with Zhongrong Miao, MD, author of Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct: A Secondary Analysis of the ANGEL-ASPECT Trial. Hosted by Cynthia E. Armand, MD. Read Transcript Related Content: Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct

Interview with Zhongrong Miao, MD, author of Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct: A Secondary Analysis of the ANGEL-ASPECT Trial. Hosted by Cynthia E. Armand, MD. Read Transcript Related Content:   Alberta Stroke Program Early Computed Tomography Score, Infarct Core Volume, and Endovascular Therapy Outcomes in Patients With Large Infarct

Welcome back Rounds Table Listeners! We are back today with our Classic Rapid Fire Podcast! This week, Dr. Mike Fralick and special guest, Dr. Laiya Carayannopoulos from the Intern at Work Podcast, discuss two recent papers exploring the role of video versus direct laryngoscopy for tracheal intubation and blood pressure management post-endovascular thrombectomy after acute ... The post Episode 74 – Video Laryngoscopy for Intubation and Blood Pressure Management post-Endovascular Thrombectomy first appeared on Healthy Debate. The post Episode 74 – Video Laryngoscopy for Intubation and Blood Pressure Management post-Endovascular Thrombectomy appeared first on Healthy Debate.

Welcome back Rounds Table Listeners! We are back today with our Classic Rapid Fire Podcast! This week, Dr. Mike Fralick and special guest, Dr. Laiya Carayannopoulos from the Intern at Work Podcast, discuss two recent papers exploring the role of video versus direct laryngoscopy for tracheal intubation and blood pressure management post-endovascular thrombectomy after acute ...The post Episode 74 – Video Laryngoscopy for Intubation and Blood Pressure Management post-Endovascular Thrombectomy appeared first on Healthy Debate.

Neurology Today Editor-in-chief Joseph E. Safdieh, MD, FAAN, discusses new research on blood pressure targets for stroke after endovascular therapy, changing policies on CME, and a direct-to-consumer blood test for Alzheimer's disease.

In this episode, we review Resuscitative endovascular balloon occlusion of the aorta (REBOA), notably dissecting the recent Jansen et al trial in JAMA. Shownotes / References:  FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

Endovascular Repair of Thoracoabdominal Aortic Aneurysm Guest: Bernardo C. Mendes, M.D. Hosts: Malcolm R. Bell, M.D. Endovascular treatment of thoracoabdominal aortic aneurysms (TAAA) with fenestrated-branched endovascular aneurysm repair (F/B-EVAR) has gained increasing acceptance in patients with suitable anatomy. These techniques have resulted in superior perioperative outcomes when compared to traditional open repair. Patient selection, meticulous preoperative planning, and proper device design are critical to ensure successful treatment. The field of TAAA repair is constantly evolving with ongoing research and the development of new techniques and devices to further improve patient outcomes. This podcast discusses a review of endovascular TAAA treatment, summarizing some general aspects of device design and clinical features relevant to technical success and excellent long-term outcomes. Topics Discussed: Endovascular vs Open Repair Fenestrated and Branched Stents Potential Complications and what to look for Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Sales in the endovascular space is not just about products; it's about saving lives one catheter at a time. In this episode, Samuel Adeyinka interviews Michael Clark, territory manager atTerumo Interventional Systems. From cath labs to catheters, they uncover the intricacies and rewards of this high-stakes industry. Michael shares his journey in the surgical division, revealing the inner workings of a cath lab, where Interventional Cardiologists navigate intricate procedures from dawn till dusk. Michael walks us through the intensity of these days, where there's no time to pause, let alone eat lunch. Yet, amidst the chaos, he highlights the importance of building relationships with healthcare providers and executing a robust business plan. Michael also touches on the impacts of COVID-19, the significance of pre-case planning, embracing the proximity principle, and more. Join us as we explore the pulse of endovascular med device sales and uncover the heart behind the profession. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/RczDMz Love the show? Subscribe, rate, review, and share! Here's How »   Join the Medical Sales Podcast Community today: evolveyoursuccess.com

Neurology Today Editor-in-chief Joseph E. Safdieh, MD, FAAN, discusses research that assesses the safety of endovascular treatment post-stroke for people with intracranial tumors, the AANEM guideline on IVIG use for neuromuscular disorders, and the latest data on donanemab.

Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia Guest: Fahad Shuja, M.D Hosts: Greg Barsness, M.D. Hello and welcome to the Mayo Clinic Cardiovascular Interviews with Experts podcast. I am Greg Barsness, an interventional and critical care cardiologist at Mayo, and I'm thrilled to be joined here by Dr. Fahad Shuja, Assistant Professor in the Division of Vascular and Endovascular surgery at Mayo Clinic Rochester, Minnesota in the USA. Fahad attended medical school at the Aga Khan University in Pakistan. Topics Discussed in this Episode: Endovascular Therapy Peripheral Arterial Disease Ischemia treatment Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Endovascular 101 Authors: Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California Sukgu Han - Associate Professor of Surgery at the University of Southern California. Co-director of Comprehensive Aortic Center at Keck Hospital of USC. Program Director of the Integrated Vascular Surgery Residency and Vascular Fellowship Editor: Yasong Yu Reviewers: Matt Chia and Kirthi Bellamkonda   Core Resources: Rutherford's Vascular and Endovascular Therapy 10th Edition Chapter#26-28 Additional Resources: Relevant Audible Bleeding episodes Holding Pressure Case Prep - AKA/BKA Journal Review in Vascular Surgery: Introduction to Endovascular Surgery – A Prime Peter A. Schneider, MD and Endovascular Skills - history, personal techniques and updates in the 4th Edition Closure devices:  Angioseal Mynx Proglide Endovascular procedures are minimally invasive techniques used to treat conditions affecting blood vessels, such as aneurysms, stenosis, or occlusions, by accessing the affected vessels through an incision in a peripheral artery and using imaging guidance to navigate catheters and devices through the blood vessels to the treatment site.  Endovascular procedures can be broken down into 4 key steps Establishing arterial access Navigating to target treatment zone or vessel Treating the lesion Closure Basic definition of wire, sheaths, and catheters Wires are thin, flexible metal devices used to navigate through blood vessels and to guide other devices, such as catheters or sheaths, to the target location. They are measured in thousands of an inch A 0.018 wire is 0.018 inch in diameter There are two categories of wires: Flexible and support Flexible wires are soft and hydrophilic. They are considered the “workhorses” because they are useful for navigating through vessels. A common type of wire is called the Glidewire which is  slippery and useful in traveling across tortuous vascular anatomy. Support wire are generally a lot stiffer and not hydrophilic. For that reason they are used to deliver and deploy devices A common type of support wire is called the Lunderquist which is used for the deployment of stent grafts in endovascular aortic repair Catheters are flexible hollow tubes used in conjunction with wires to navigate vascular anatomy Various characteristics include the degree and shape of the taper, the lengths, and the stiffness. They are inserted inside the sheath  Sheaths are hollow tubes of various diameters that are inserted into a blood vessel to provide a pathway for catheters or wires.  They have a one way valve to prevent backflow of arterial blood and a side port that permits aspiration and administration of fluids.  They also come with a dedicated dilator which is used to fill the lumen of the sheath and allows the surgeon to insert the sheath safely into the vessel.  If the wire is the rail and the catheter is the train, the sheath is the ground. Sheaths and catheters sizing Both are measured in French 1 French equals 0.33 mm. French size divided by 3 equals the approximate diameter in millimeters.  Another way to think about Fr is roughly the circumference in mm. Divide by 3 instead of 3.14 to get the diameter Sheaths are defined by their inner diameter (ID) Catheters are defined by their outer diameter (OD) This is because catheters go inside the sheath, so the size of a catheter must be smaller or equal to the size of the sheath for it to fit inside.For example, a 5 Fr sheath can accommodate 5 Fr catheter/devices Of note, the hole in the artery will roughly be 2-4Fr larger than the sheath size. This is important when considering the type of closure that will be used at the end of the procedure.  Step One: Establishing Arterial Access Preop preparation:  During physical exam, make sure there's a palpable femoral pulse to rule out iliofemoral disease Review the CT if available for high femoral bifurcation or presence of vessel disease  Patient positioning on the angio table, depends on the access site of choice. Typical position (for retrograde femoral artery access) is supine, arms tucked.   Alternative access sites (ie. radial, brachial, carotid) may require arms to be out and prepped.   How do you choose arterial access, location? Depends on location of lesion you are trying to treat and complexity of the path from the access site Size of the access vessel and device size must be considered when deciding on the access site The most common is retrograde femoral artery access When would other access points be used? Radial artery, brachial, antegrade femoral access. The goal, target location, and path complexity defines the access point. Arterial puncture Femoral access: Look for pulsatile vessel on the US (vein is medial, artery is lateral; “venous penis”) Usually access at the level of femoral head for common femoral artery Seldinger technique is  used to establish access to a vessel or cavity using needle, wire, catheters, and sheath. E.g. using the micropuncture kit: contralateral arterial CFA access with s 21 gauge needle .018” guidewire is passed through the needle Needle is removed and a short 4 or 5 Fr microcatheter with an inner dilator is passed over the guidewire The dilator and guidewire are removed leaving the catheter in place to maintain access Bigger wire is inserted through the catheter, which is then removed over the wire A sheath is inserted over the wire The overall purpose is to start with smaller arterial puncture and exchange to larger size to minimize complication should the access fail Often, percutaneous closure devices are preloaded at this step.  We will discuss this later.   Step Two:  Navigating to treatment zone or vessel With sheath in place, a guidewire is inserted into the vessel under fluoroscopic guidance. Continuous fluoroscopy is taken with the C-arm during key steps to visualize wire movement The C-arm can be portable or built into the room X rays are emitted from the X-ray generator below the patient And the subsequent image is generated from the image intensifier above the patient Radiation safety:  wear protective gear which is made of lead. In addition, use the tableside lead shield whenever possible minimize use of continuous fluoroscopy whenever possible limit use of magnification, and digital subtraction angiography keep the image intensifier as close to the patient as possible to minimize scattering The C-arm can rotate around the patient to get optimal viewing of the vessels Frequently used terminology: 30 degrees RAO which stands for right anterior oblique, describing the  relationship of image intensifier to the patient Common projections used for lower extremity angiograms Iliacs: 20-30 degrees contralateral anterior oblique Femoralsl: 20-30 degrees ipsilateral anterior oblique Trifurcation and tibials: anatomic anterior-posterior or 20 degrees ipsilateral anterior oblique with feet in neutral supine position Thoracic aorta/distal aortic arch: 30~45 degree LAO Renals: AP maximizing image quality by limiting patient movement and with breath holding and collimating Contrast  Two types of contrasts: Iodinated contrast vs carbon dioxide Iodinated contrast has better resolution but patients can have allergic reactions and are at risk of contrast induced renal injury. Therefore, CO2 is preferred for patients with compromised renal function in which an image is created by transiently displacing blood. The downside is that it has lower image resolution than iodinated contrast, and rare but potentially serious complications of air locking.  Power injection vs manual injection When using power injection, you have control over pressure, the amount of contrast, timing, and rate or rise of injection. It allows for rapid filling of large arteries at high flow rates. Manual injection is more efficient for small vessels since you can control dilution and volume Types of Wires Characteristics: wire tip, stiffness, diameter, and length Guide wires To assist in catheter placement, navigate different arteries, cross lesions, and deliver devices.  The most common sizes used in vascular surgery  Large .035” - generally used for the aorta and iliac. Small .014”/.018” - used for smaller branches like the SFA Length: from 120 to 360cm Based on distance from access site to the lesion Long enough to reach target lesions and beyond (inside pt) and deliver catheters (outside pt) but not too long that it's falling off the table and slowing down exchange Flexible vs stiff/support wires How do you decide which wire to use? Typically, you start with flexible wire inside an angle tip catheter to navigate to the target vessel.  Once you reached and crossed the target vessel, the wire is exchanged to a stiff/support wire, which allows you to deliver common brands and models used that every medical student should know and the settings they are used in? Example answer: Glidewire (Tumero): a floppy wire with a  hydrophilic coating which is useful for navigating stenosis and tortuous vessels and is used in a variety of different vessels. Lunderquist (Cook): it is very stiff and used for endovascular repairs of AAAs Rosen wire: support wire with a J tip with intermediate stiffness. Less stiff than Lunderquist. Used to catheterize visceral and renal arteries. Bentson: starter wire, that's short in length with a very long floppy tip that prevents vessel trauma. Types of Catheters  Main purpose of the catheters Allows to approach the target vessel based on the shape of the catheter Allows wire exchange from flexible to stiff Sizes are based on Fr (4-5) 5 Fr are the most common. Microcatheters are for embolizations (2.5Fr) Nonselective (Angiographic catheter) Common types are omni flush, pigtail, and straight They have multiple side holes along the tip so they can inject high volume of contrast into large blood vessels like the aorta Selective catheters/Guide (shape) catheters Have an end hole only with no side holes so they can cannulate specific branch vessels A variety of lengths and shapes depending on the curvature and tortuosity of the pathway to the target vessel. Catheter with specific shapes can align your vector (the force you are exerting by pushing the wire forward at the access site) to the stenotic lesion. Type of catheter that can be used to cross to the contralateral side at the aortic bifurcation – generally the omni.  Types of sheaths Size range: 4-26Fr (larger available for endografts) Size is decided by the device you have to deliver to the target lesion Length is based on the support required from the procedure. The distance from the access site to the target site determines the length of the sheath required.  Common lengths range from 5 to 110cm What are some of the common sheaths used and for which procedure? For endovascular aortic repairs, Dryseal sheaths range from 12Fr ~ 26Fr with lengths of 33cm to 65cm. For visceral and renal artery intervention, Ansil or Raabi sheaths range from 5Fr to 9Fr, with lengths of 45cm to 90cm. For lower extermity work, Ansil, Raabi, Balkin sheaths ranging from 4Fr to 7Fr with lengths of 45cm to 110cm. Steerable sheaths can actively articulate the shape of the sheath, allow you to navigate and treat more challenging anatomy. Step Three: Treating the lesion The lesion has to be crossed with wire and catheters before treating the lesion. They may require the need to exchange sheath Stent and balloon sizing is measured by diameter in millimeters x length in centimeters Balloons Generally need to exchange wire to stiff support wire through the catheter, then the catheter is exchanged over the wire with the balloon mounted catheter Balloons have a wide variety of diameters and lengths Nominal vs Burst pressures Nominal: pressure is where the balloon will inflate to the labeled diameter Burst: pressure where 99.9% of tested balloons ruptured Typically you inflate to nominal but can go higher depending on the type of lesion Compliant balloon vs a semi-compliant vs non-compliant balloon Most of the time, we use a compliant balloon, but in certain situations where we need high pressure dilation, we use non-compliant balloon.  This has to do with the nature of the lesion and risk of vessel rupture. Additional features  Cutting balloons have microblades on the wall. So the idea is to perform control rupture of calcified atherosclerotic lesions, so that the expansion happens more evenly. Drug coated balloons are coated with paclitaxel to reduce the risk of neo-intimal hyperplasia  So, it is sometimes used in peripheral cases where the surgeons feel that the lesions are more prone to developing neo-intimal hyperplasia or areas that have restenosed.  Stents small mesh-like device made of metal that is used to prop open a blocked or narrow blood vessel. It is inserted through a catheter and deployed at the site of the blockage to improve blood flow and reduce the risk of future blockages.  balloon expandable vs self-expanding stents Balloon expandable Better radial force at the time of deployment More accurate deployment Mounted on balloons, so it is more difficult to track them across tight stenosis. May cause damage to the surrounding tissue due to balloon inflation. Self-expanding Usually more flexible in tortuous vessels More resistant to kinking  Higher risk of migration or dislodgement during deployment Post-dilation is often needed covered stents vs bare metal stents Covered stents Covered by PTFE, polyurethane, or silicone May be more resistant to in-stent restenosis, compared to bare metal stents. useful in ruptured vessel EVAR/TEVAR/FEVAR devices are essentially fancy covered stents.   Step Four: Closure Hole in the artery is outer diameter of the sheath, and is bigger than the sheath size since sheath is measured by inner diameter Manual compression Direct pressure with fingertips Enough pressure without bleeding, but not too much that it cuts off circulation No peeking! Timing depends on sheath size, coagulation status, and vessel health. Closure devices Extravascular plug Angio-seal: sandwiches the arteriotomy with a biodegradable anchor and collagen sponge. https://www.youtube.com/watch?v=XhgAs2SxNjA Mynx: utilized a small balloon to create temporary hemostasis within the artery and covers the outside with a polyethylene glycol sealant. https://www.youtube.com/watch?v=_kcJM1lnQo8 Suture-based Sometimes placed at beginning of the case for large bore access Proglide: https://www.youtube.com/watch?v=Wol22SlEpxE Complications What are the most common complications that you experience and how do you mitigate them? Access site Hematoma, pseudoaneruysm, AV fistula, occlusion,  infection Navigation related Dissection, perforation, thromboembolism Systemic Contrast induced AKI  —----------------------------------------------------------------------------------------------------------------------- Please share your feedback through our Listener Survey! Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

This week: Can little-old-you really make a difference? Hell yes you can.Plus: cheaper insulin, cleaner camping gear, a new (lidless) coffee cup, good news on BetterHelp, and maybe even some paid leave. Here's What You Can Do:⚡️ Help your local farmers sell online — not just at farmer's markets — with GrownBy. ⚡️ Help people worldwide get clean, safe, accessible drinking water with charity: water. ⚡️ Support Dr. Ayana Elizabeth Johnson's Urban Ocean Lab as they write the future of ocean policy.⚡️ Stay ahead of water news with the award-winning Circle of Blue non-profit newsroom ⚡️ Queer student journalists: Apply to be a member of the 2023 Nat'l LGBTQ Journalists' Conference Student PROGRAM, a week-long all-expenses-paid reporting intensive News RoundupHealth & MedicineREI has committed to stop selling products with forever chemicals Eli Lilly will cut insulin prices to $35, should still be regulated There's a new bipartisan push for paid family and medical leave Endovascular thrombectomy will (eventually) save millions of lives ClimateThe Interior Department released guidance on how states can claim

Audible Bleeding editor Matt Chia (@chia_md) is joined by MD/PhD student Rahul Ghosh (@ghoshrx), JVS Assistant Editor Dr. Paul Dimuzio (@pdimuziomd), and JVS-VS Associate Editor Dr. John Curci (@CurciAAA) to discuss two great articles  in the JVS family of journals. This episode hosts Dr. Sanuja Bose (@SanujaBose), Dr. Caitlin Hicks (@CaitlinWHicks), and Dr. Elizabeth Chou  (@LizChou), the authors of the following papers discussing sex disparities in medical management around carotid revascularization and smooth muscle cell pathobiology in carotid atherosclerosis.   Articles: “Females are less likely to receive best medical therapy for stroke prevention before and after carotid revascularization than males” by Bose et al. “Vascular smooth muscle cell phenotype switching in carotid atherosclerosis” by Chou et al.    Show Guests: Dr. Sanuja Bose (@SanujaBose) is a graduate from University of Rochester School of Medicine and Johns Hopkins Bloomberg School of Public Health. She is currently a postdoctoral research fellow in the Department of Vascular Surgery at Johns Hopkins. Dr. Caitlin Hicks (@CaitlinWHicks) is an associate professor of surgery at the Johns Hopkins Department of Vascular and Endovascular surgery and the research director of the multidisciplinary diabetic foot and wound service. Dr. Elizabeth Chou (@LizChou) completed her vascular training at Mass General Hospital in 2022 and is currently a vascular surgeon at Cedars Sinai. Dr. Chou's research interests include translational research in therapeutic outcomes of aortic and peripheral vascular disease and vascular disease amongst under-represented minorities and women.   Listeners may also be interested in our episode about getting started using the VQI for research.    Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.  

Drs. Sammy Siada and Rafael Malgor discuss safe access for endovascular surgery.  Originally published on April 29, 2020.   Vascular Surgery Exam Prep eBook - Endovascular Access Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Drs. Kevin Kniery, Marlin "Wayne" Causey, and Todd Rasmussen discuss endovascular management of vascular trauma, particularly focusing on blunt thoracic aortic injuries.  Originally published on Feb 9, 2021, and was created in collaboration with Behind the Knife: The Premier Surgery Podcast. Vascular Surgery Exam Prep eBook - Trauma: Endovascular Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Interview with Amrou Sarraj, MD, author of Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well: The SELECT Late Study. Hosted by Cynthia E. Armand, MD. Related Content: Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well

In this podcast, JNIS Editor-in-Chief, Dr. Felipe C. Albuquerque, speaks with Dr. Krishna C. Joshi(1) and Dr. Michael Chen(2) about their paper "Endovascular thrombectomy for acute ischemic stroke in patients with cancer: a propensity-matched analysis" - https://jnis.bmj.com/content/14/12/1161. Please subscribe to the JNIS Podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest episodes. Also, please consider leaving us a review or a comment on the JNIS Podcast iTunes page: https://podcasts.apple.com/gb/podcast/jnis-podcast/id942473767 Thank you for listening! This episode was edited by Brian O'Toole. (1) Neurological Surgery, Rush University Medical Center, Chicago (2) Neurological Surgery, Rush University Medical Center, Chicago

Heitham Hassoun, MD, Vice President & Medical Director, Cedars-Sinai InternationalDr. Heitham Hassoun is the Vice President & Medical Director for Cedars-Sinai International in Los Angeles, California. He previously served as Global Medical Director for Johns Hopkins Medicine and was an Associate Professor in the Department of Surgery at The Johns Hopkins University School of Medicine.Dr. Hassoun has a wealth of experience in international patient services, global collaborations and health system development. He was instrumental in the creation of Johns Hopkins Aramco Healthcare, a joint venture between Saudi Aramco and Johns Hopkins Medicine, as well as a number of other institutional management and affiliation agreements throughout the Middle East and Asia. Currently, he aims to expand the global footprint of Cedars-Sinai.Dr. Hassoun maintains a clinical practice in vascular & endovascular surgery and he continues to educate and research in a variety of topics related to global collaborative healthcare and academic medicine. He completed his fellowship training in vascular and endovascular surgery at Northwestern University in Chicago and earned his medical degree at Baylor College of Medicine in Houston.John Marchica, CEO, Darwin Research GroupJohn Marchica is a veteran health care strategist and CEO of Darwin Research Group. He is leading ongoing, in-depth research initiatives on integrated health systems, accountable care organizations, and value-based care models. He is a faculty associate in the W.P. Carey School of Business and the graduate College of Health Solutions at Arizona State University.John did his undergraduate work in economics at Knox College, has an MBA and M.A. in public policy from the University of Chicago, and completed his Ph.D. coursework at The Dartmouth Institute. He is an active member of the American College of Healthcare Executives and is pursuing certification as a Fellow.About Darwin Research GroupDarwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin's client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

Dr. Southerland talks with Dr. Carlos Garcia-Esperon about the association of endovascular thrombectomy with functional outcome in patients with acute stroke with a large ischemic core. Read the full article in Neurology.  This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Dr. Carlos Garcia-Esperon discusses his paper, "Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core". Show references: https://n.neurology.org/content/99/13/e1345 This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.  

Name of Surgery: Endovascular Aortic Aneurysm Repair (Infrarenal)   In today's episode of our Holding Pressure (HP) Series, developed by medical students for medical students, Janhavi and Andrew review the basics of endovascular abdominal aortic aneurysm repair (EVAR). Authors:  Janhavi Nikhil Patel is a third and final year medical student at McMaster University. She previously completed her undergraduate in Physiology from Western University.  Andrew Lazar (@Lazar_andy) is a PGY-4 General Surgery resident at Morristown Medical Center in New Jersey. He completed a T32 research fellowship in vascular surgery at Columbia University. He graduated from Weill Cornell Medicine. Editor: Yasong Yu Reviewers: Imani McElroy and Amanda Fobare Core Resource: Rutherford's Vascular and Endovascular Therapy 9th Edition Chapter#69, 70, 72, 73 Additional Resources: EVAR-1 Trial - Endovascular versus Open Repair of Abdominal Aortic Aneurysm. N Engl J Med, 362 (20) (2010), pp. 1863-1871, Endovascular versus Open Repair of Abdominal Aortic Aneurysm | NEJM OVER Trial - F.A. Lederle, T.C. Kyriakides, K.T. Stroupe, J.A. Freischlag, F.T. Padberg, J.S. Matsumura, et al. Open versus endovascular repair of abdominal aortic aneurysm. N Engl J Med, 380 (2019), pp. 2126-2135. Open versus Endovascular Repair of Abdominal Aortic Aneurysm | NEJM Relevant Audible Bleeding episodes Landmark Papers - IMPROVE VSITE Review - AAA Endovascular Aortic Repair Preoperative Sizing VSITE Review - Vascular Access For a full outline check out our website. Calling all medical students Submit your questions for the mailbag episode! Ask us any question related to vascular surgery, and have it answered on the podcast.  Include the following Your name, school, and year Who do you want to address the question to (resident, fellow, attending, or someone specific) Send them in writing or voice-recorded format.   Send to audiblebleeding@vascularsociety.org. Please share your feedback through our Listener Survey! Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.