The Audible Bleeding team is here at the annual EVS meeting in Charleston, SC. We wanted to share with you some of the attendees' experiences in their own words!

Join Audible Bleeding team Matthew Chia, Nitin Jethmalani, and Leana Dogbe and editors from the JVS family of publications Thomas Forbes and Gale Tang as we discuss two of the latest highlights in vascular research. First, we welcome Mary McDermott, MD to discuss the discordance between patient-reported outcomes and objective PAD measures in the latest episode of the JVS.  The episode finishes with a stimulating discussion with Alex Chan, PhD to discuss the effect of nicotine on angiogenesis in a murine model of PAD. Articles: Discordance of patient-reported outcome measures with objectively assessed walking decline in peripheral artery disease by McDermott et al. https://doi.org/10.1016/j.jvs.2023.12.027 Chronic nicotine impairs the angiogenic capacity of human induced pluripotent stem cell-derived endothelial cells in a murine model of peripheral arterial disease by Chan et al. https://doi.org/10.1016/j.jvssci.2023.100115 Related Articles: Clinical characteristics and response to supervised exercise therapy of people with lower extremity peripheral artery disease by Patel et al. https://doi.org/10.1016/j.jvs.2020.04.498 Effects of supervised exercise therapy on blood pressure and heart rate during exercise, and associations with improved walking performance in peripheral artery disease: Results of a randomized clinical trial by Slysz et al. https://doi.org/10.1016/j.jvs.2021.05.033  Show Guests: Mary McDermott, MD is the Jeremiah Stamler Professor of Medicine and Preventive Medicine at the Feinberg School of Medicine at Northwestern Medicine.  Among her many accolades and titles, she serves as deputy editor of the Journal of the American Medical Society, and has an extensive career focused on improving our understanding of peripheral arterial disease.   Alex Chan, PhD is a researcher who studied regenerative medicine and cell therapeutics as a postdoctoral fellow in the lab of Dr. Ngan Huang, PhD at the Stanford Cardiovascular Institute.  

Audible Bleeding editor Wen (@WenKawaji) is joined by 3rd year general surgery resident Ryan Ellis discussing robotic vascular surgery with Dr. Judith Lin (@JudithLin4) and Dr. Petr Stadler. Dr. Lin and Dr. Stadler will share their personal journey in robotic vascular surgery, cases they have done, and what think the future looks like.  This is part one of our robotic vascular series. Our next episode will feature Dr. Lumsden and Dr. Bavare from Houston Methodist.  Show Guests: Dr. Judith Lin: professor and chief of vascular surgery in the Department of Surgery at Michigan State University’s College of Human Medicine Dr. Petr Stadler: Professor of Surgery, Head of Vascular Surgery Department, Na Homolce Hospital, Prague, Czech Republic Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.  

Audible Bleeding editor Wen (@WenKawaji) is joined by second year medical student Nishi (@Nishi_Vootukuru), 3rd year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes) and JVS-CIT associate editor Dr. O’Banion (@limbsalvagedr) to discuss two great articles in the JVS family of journals regarding endovascular management of acute limb ischemia and ultrasound-based femoral artery calcification score. This episode hosts Dr. Thomas Maldonado (@TomMaldonadoMD) and Dr. Raul J. Guzman, the authors of the following papers:   Articles:   Safety and efficacy of mechanical aspiration thrombectomy at 30 days for patients with lower extremity acute limb ischemia by Dr. Maldonado and colleagues. An ultrasound-based femoral artery calcification score by Dr. Raul Guzman and colleagues.     Show Guests: Dr. Thomas Maldonado is the Schwartz - Buckley endowed professor of surgery in the Vascular Division at New York University Langone Medical Center in New York,  Co-Director of Center for Complex Aortic Disease Dr. Raul J. Guzman is the Donald Guthrie Professor of Vascular Surgery, Chief of Division of Vascular Surgery at Yale New Haven Hospital. He is also Surgeon-in-Chief of Vascular Surgery, Heart and Vascular Center for the Yale New Haven Health System. ([email protected])   Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.  

Audible Bleeding editor Matt Chia (@chia_md) is joined by Nishi Vootukuru (@Nishi_Vootukuru)  and Lili Sadri (@lilisadri) are joined by Drs. Joel Ramirez, James Iannuzzi, and James Pavel Kibrik to discuss their latest publications in the JVS family of journals.  Along with insight from JVS Assistant Editor Dr. Paul Dimuzio and JVS-VL Editor-in-Chief Dr. Ruth Bush (@RuthLBush), hear about the latest trends in AAA repair and the value of postoperative duplex after venous thermal ablation.  Don't miss it! Articles: Decreasing prevalence of centers meeting the Society for Vascular Surgery abdominal aortic aneurysm guidelines in the United States, by Ramirez et al. Value and limitations of postoperative duplex scans after endovenous thermal ablation, by Kibrik et al. Additional Links: Factors associated with ablation-related thrombus extension following microfoam versus radiofrequency saphenous vein closure, by Chin et al. Outcomes of a single-center experience in eliminating routine postoperative duplex ultrasound screening after endovenous ablation, by Woodhouse et al. Show guests: Joel Ramirez, MD - Integrated Vascular Surgery Resident at the University of California, San Francisco James C. Iannuzzi, MD MPH - Assistant Professor, Division of Vascular and Endovascular Surgery at the University of California, San Francisco Pavel Kibrik, DO - Graduate of New York Institute of Technology Osteopathic School of Medicine and current vascular surgery researcher at the NYU Langone School of Medicine  Ruth Bush, MD JD MPH FACS - Professor of Vascular Surgery and Associate Dean of Educational Affairs at the University of Texas, Medical Branch and Editor-in-Chief of the Journal of Vascular Surgery Venous and Lymphatic Disorders

Audible Bleeding editors Matt (@chia_md) and Gowri (@GowriGowda11) are joined by 3rd year General Surgery resident Sasank Kalipatnapu (@ksasank), 2nd year medical student Nishi Vootukuru (@Nishi_Vootukuru), JVS editor-in-chief Dr. Thomas Forbes (@TL_Forbes), and JVS-VL Associate Editor Dr. Meryl Logan (@ProleneQueen), to discuss two great articles in the JVS family of journals regarding treatment of asymptomatic carotid artery disease and comparison of venous insufficiency treatment via radiofrequency ablation and microfoam ablation. This episode hosts Dr. Robert Chang, Dr. Stephanie Talutis, and Dr. Juan Carlos Jimenez, the authors of the following papers:    Articles: JVS: A comparative effectiveness study of carotid intervention for long-term stroke prevention in patients with severe asymptomatic stenosis from a large integrated health system by Chang et al.  JVS-VL: Comparison of outcomes following polidocanol microfoam and radiofrequency ablation of incompetent thigh great and accessory saphenous veins by Talutis et al.    Additional article discussed for JVS-VL: Adjunctive techniques to minimize thrombotic complications following microfoam sclerotherapy of saphenous trunks and tributaries by Jimenez et al.   Show Guests: Dr. Robert Chang – Assistant Chair of Vascular Surgery, Adjunct Investigator, KP Division of Research Northern California Dr. Stephanie Talutis - Assistant Professor of Vascular Surgery, Tufts Medical Center Dr. Juan Carlos Jimenez, Clinical Professor of Surgery, Director, Gonda Venous Center, Vice-Chair for Justice, Equity, Diversity, and Inclusion at UCLA   Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

In this episode, we explore the role of vascular surgeons in oncologic surgery. We will be discussing the nuances of vascular involvement in oncologic resection, common practices, and future directions of this collaborative surgical culture.   Dr. Adam Beck (@AWBeckMD) is a vascular surgeon and Professor of Surgery at the University of Alabama at Birmingham where he serves as the Director of the Division of Vascular Surgery and Endovascular Therapy, holds the Holt A. McDowell, Jr, MD Endowed Chair in Vascular Surgery and serves as the Director of Quality and Associate Chief Medical Quality Officer for the UAB Cardiovascular Institute. Dr. Beck completed his general surgery residency training and a surgical oncology research fellowship at the University of Texas-Southwestern Medical Center. He trained in vascular surgery at the Dartmouth-Hitchcock Medical Center and then completed a fellowship in advanced endovascular techniques, including branched and fenestrated endografts for aortic aneurysmal disease, at the University Medical Center of Groningen in The Netherlands. You can learn more about Dr. Adam Beck here.   Dr. Xavier Berard (@XavierBerardMD)  is a French vascular surgeon and serves as a Consultant in the Department of Vascular Surgery and Professor of Vascular and Endovascular Surgery in Bordeaux University Hospital in Bordeaux, France. He is board certified from the French College of Vascular and Endovascular Surgeons and from the European Society for Vascular and Endovascular Surgery. He has also completed a PhD in Vascular Biomaterials and has built a library of educational video content. He works closely with Institut Bergonié Bordeaux Cancer Center for sarcomas. You can see educational videos and learn more about Dr. Xavier Berard here   Dr. Sharif Ellozy (@SharifEllozy)  is a vascular surgeon at the New York-Presbyterian/Weill Cornell Medical Center where he serves as Associate Professor of Clinical Surgery in the Division of Vascular and Endovascular Surgery, and Program Director of the Vascular Surgery Fellowship program. He is also one of the founders of Audible Bleeding. He is readily involved in oncologic resection at the Memorial Sloan Kettering Cancer Center and works closely with surgical oncologists on operative cases that have vessel involvement.   Authors/Interviewers: Dr. Sree Kanna, MD - McGill, Montreal (@VulnerableAorta) Dr. Nakia Sarad, DO, MS - New York-Presbyterian/Queens - Weill Cornell, New York (@NakSaradDO)   Editors: Morgan Gold, MD,CM candidate - McGill, Montreal (@MorganSGold) Ezra Schwartz, MD,CM, MS, MMSc-Med Ed candidate - Harvard, Boston (@EzraSchwartz10)   Helpful Resources:   To learn more about sarcoma resections, check out the Schwarzbach papers on lower extremity sarcomas and retroperitoneal sarcomas   Click here to learn more about the NCCN Guidelines on Resectability of Pancreatic Cancers   Click here to learn more about IVC Reconstruction Techniques in Oncologic Surgery   Video of IVC Leiomyosarcoma Reconstructions here (courtesy of Dr. Berard)   Click here to learn more about the Renal Cell Carcinoma Mayo Staging System Click here to find the original article on the Shamblin Classification for Carotid Body Tumors   Check out this review paper on Oncovascular Surgery    Check out this paper on spiral endografts here Video of spiral saphenous vein graft technique here (courtesy of Dr. Berard)   What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding   Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.  

Drs. Kush Sharma and Ashraf Mansour review vascular disease affecting the upper extremity.  Originally published on Jan 29, 2021. Vascular Surgery Exam Prep Ebook - Upper Extremity Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Nicole Rich, Adam Johnson, and Kevin Kniery review cerebrovascular. Vascular Surgery Exam Prep Ebook - Cerebrovascular Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Adam and Matt introduce the new exam prep curriculum and accompanying e-book. Vascular Surgery Exam Prep E-Book Vascular Surgery Exam Prep Curriculum Calendar What other topics would you like to hear about? Let us know more about you and your thoughts about our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

We are excited to have Dr. Robert Molnar, Dr. Anil Hingorani, and Dr. Edward Arous to discuss the SVS Sub-Section on Outpatient & Office Vascular Care (SOOVC). In 2018, the SVS created a new membership section for clinicians who work in outpatient and office vascular care centers. The section’s mission is to establish a forum where members can work to advance the care of patients with vascular disease in outpatient settings by enhancing SVS efforts in education, advocacy, quality practice, ethics and research. Since its start, the section has grown to more than 130 members. It is now a subsection of the SVS Community Practice Section (SVSCPS).    Dr. Robert Molnar has practiced with the Michigan Vascular Center since 1998. He completed his undergraduate studies at the University of Notre Dame, his medical degree at the Medical College of Ohio, his General Surgery at Michigan State University and his Vascular Fellowship at Vanderbilt University. He serves as the chair of the SVS Community Practice Section and is on the SVS executive Board. One of his main interests is in high quality outpatient vascular care, especially in the OBL space.   Dr. Anil Hingorani has been practicing vascular surgery in Brooklyn, New York since 1998. He completed his undergraduate studies at Rensselaer Polytechnic Institute and graduated medical school from Albany Medical college. He performed his general surgery residency at St. Luke’s Roosevelt Medical center at Columbia University and his vascular fellowship at Maimonides Medical Center. He serves as the chair of the Subsection  for Outpatient and Office Vascular Care. He is affiliated with NYU Langone in Brooklyn New York   Dr. Edward Arous received his medical degree from the University of Massachusetts Medical School, his master’s in public health from the Harvard School of Public Health, and completed his residency in vascular surgery at the University of Massachusetts Medical School. Prior to joining The Vascular Care Group, Dr. Arous was an Assistant Professor of Vascular and Endovascular Surgery at the University of Massachusetts Medical School and the Director of the Limb Preservation Center.  Learn more about the SOOVC here: SVS SOOVC webpage  Learn more about the SVS Clinical Practice Section here: SVS Community Practice Section webpage   What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding   Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Audible Bleeding editors Matt Chia and Wen Kawaji are joined by JVS Assistant Editor Dr. Paul Dimuzio and JVS Editor-in-Chief Dr. Thomas Forbes to discuss a recent article in the JVS.  They’re joined by Dr. Elizabeth Andraska, the first author of the paper discussing long-term followup after EVAR, available now in the August 2022 issue of the JVS.  Find out how this paper can have an immediate impact on your patients, and hear insights directly from Dr. Andraska in this exciting episode!   Link to “Longer follow-up intervals following endovascular aortic aneurysm repair are safe and appropriate after marked aneurysm sac regression” by Andraska et al.: https://doi.org/10.1016/j.jvs.2022.01.079    Show Guests: Dr. Elizabeth Andraska (@eandraska) is in her sixth year of training in the integrated vascular surgery residency at the University of Pittsburgh. She has a Masters in Clinical Research from the University of Michigan and has completed two years of dedicated research time at the University of Pittsburgh. She is excited to pursue a career in academic vascular surgery.   Previous episode with Dr. Elizabeth Andraska on Getting Started with Basic Science in Vascular Surgery: https://www.audiblebleeding.com/getting-started-in-basic-science/    Previous episode with Dr. Thomas Forbes and Dr. Ron Dalman on the next chapter of the JVS: https://www.audiblebleeding.com/2022/06/14/interview-with-the-incoming-editors-of-the-jvs/    JVS Host Introductions: Dr. Paul Dimuzio (@pdimuziomd) is the William M. Measey Professor of Surgery, Director of the Division of Vascular and Endovascular Surgery at Thomas Jefferson University Hospital and Co-Director of the Jefferson Vascular Center in Philadelphia, as well as being one of the new Assistant Editors for the JVS. Dr. Thomas Forbes (@TL_Forbes) is the Surgeon-in-Chief and James Wallace McCutcheon Chair of the Sprott Department of Surgery at the University Health Network, Professor of Surgery at the University of Toronto, as well as being one of the new Editors-in-Chief for the JVS.   Audible Bleeding Host Introductions:  Dr. Wen Kawaji (@WenKawaji) is a general surgery resident at Medstar Health in Baltimore, MD. She is passionate about vascular, trauma, and critical care and recently completed a burn/surgical critical care fellowship at Johns Hopkins. Wen has been a loyal audible bleeding fan throughout residency and is excited to learn from and work with the podcast team. In her spare time, she enjoys traveling, food adventures, and puzzles. Dr. Matthew Chia (@chia_md) is in his final year of the integrated vascular surgery program at Northwestern University.  He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research at Northwestern.    Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Join us as we cover VAM 2022! (#VAM22) Today we caught up with Dr. Sharee Wright (@DrASW6) who was a moderator of the Medical Student Program: How to Success as a Vascular Surgery Residency Applicant.  We also met some medical student attendees to see how their experiences has been so far.  Stay tuned for more coverage of #VAM22 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.  

As the official journal of the Society for Vascular Surgery, the Journal of Vascular Surgery (JVS) aims to be the premier journal of medical, endovascular, and surgical care of vascular disease. This year, JVS transitions to a new executive board headed by Dr. Ron Dalman (Executive Editor) and Dr. Thomas Forbes (Editor-in-Chief). Many thanks to our outgoing executive board led by Dr. Peter Gloviczki and Dr. Peter Lawrence!   In this episode, Imani and Sharif sit down with the incoming Executive Editor and Editor-in-Chief, Dr. Dalman and  Dr. Forbes. We discuss their transition into their new roles, their goals for the journal, and how they hope to grow academic publishing in the era of social and digital media.   Come to the JVS Special Session at VAM on Thursday, June 16th, 2022 at 1:30 PM EDT. Submit ideas/topics for the session here.   If you want to submit an article to JVS.    Follow JVS on Twitter!   What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected].

We are very excited to bring you the top papers from the 2022 Society for Clinical Vascular Surgery meeting. This episode features 3 papers, discussed by the primary author with commentary provided by Dr. Caron Rockman, President of the SCVS, Professor of Surgery at NYU, and program director of Vascular Surgery training programs. Vice-President Dr. Ashraf Mansour, Professor and Chair of Surgery at Michigan State University, and Dr. Jean Bismuth, SCVS Secretary, from Houston, Texas. Clinical Presentation, Operative Management and Long-term Outcome of Rupture Following Previous Abdominal Aortic Aneurysm Repair Discussed by: Dr. Indrani Sen Authors: Indrani Sen, Irina Kanzafarova, Jennifer Yonkus, Bernardo Mendes, Jill Colglazier, Fahad Shuja, Randall DeMartino, Manju Kalra, Todd Rasmussen Utilization of Thromboelastography with Platelet Mapping Assay to Predict Graft Thrombosis in Lower Extremity Revascularization Discussed by: Dr. Monica Majumdar Authors: Monica Majumdar MD MPH, Zach M Feldman MD, Imani McElroy MD, Natalie Sumetsky MS, Harold D Waller MD, Srihari Lella MD, Ryan P Hall MD, Young Kim MD, Kathryn Nuzzolo BS, Amanda Kirshkaln MS, David Chang PhD MPH MBA, Jessica Cardenas PhD, Eric Grabowski MD, Rushad Patell MD, Matthew Eagleton MD, Anahita Dua MD MS MBA  Outcomes Of Upper Extremity Vs. Transfemoral Access For Fenestrated-branched Endovascular Aortic Repair (FB-EVAR) Discussed by: Dr. Khalil Chamseddin Authors: ​​Khalil Chamseddin MD, Carlos H. Timaran MD, Gustavo S. Oderich MD, Emanuel R. Tenorio MD, PhD, Mark A. Farber MD, F. Ezequiel Parodi MD, Darren B. Schneider MD, Andres Schanzer MD, Adam W. Beck MD, Matthew P. Sweet MD, Sara L. Zettervall MD, Bernardo Mendes MD , Matthew J. Eagleton MD, on behalf of the U.S. Aortic Research Consortium Follow us on twitter at: @audiblebleeding Dr. Amanda Fobare: @amandafobare Dr. Caron Rockman: @CaronRockman Dr. Jean Bismuth: @Jean Bismuth Dr. Indrani Sen: @IndraniSenvasc Dr. Monica Majumdar: @Monica_Majumdar

In this month’s episode of our JVS Editor’s Choice series, Adam and Wen discuss the Journal of Vascular Surgery: Venous and Lymphatic Disorders Editors' Choice articles for May 2022 with the Senior Editor, Dr. Peter Lawrence. Submit your questions here for the JVS VAM Session Video Summary of the Articles Articles Discussed: Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. Dr Quinones-Bladrich’s paper on IVC Leiyomyosarcoma Editor's Choice--Ten-year follow-up of a randomized controlled trial comparing saphenofemoral ligation and stripping of the great saphenous vein with endovenous laser ablation (980 nm) using local tumescent anesthesia. Severity of disease and treatment outcomes of anterior accessory great saphenous veins compared with the great saphenous vein. CME--Comparative analysis of the results of cyanoacrylate ablation and radiofrequency ablation in the treatment of venous insufficiency. JVS Journal Club Website If you enjoy our content, please contribute to Support Audible Bleeding! Help us improve through our ALL NEW Listener Survey! Follow us on Twitter: @AudibleBleeding Credits: Guest: Peter Lawrence Authors: Yasong Yu and Wen Kawaji Editor: Adam Johnson

In 2021, the SVS approved a membership section dedicated to vascular surgeons in the first 0-10 years of practice. The mission of the Young Surgeons Section (YSS) of the SVS is to foster and accelerate the learning and career development of SVS members within their first ten years in clinical practice. We are excited to have Dr. Chelsea Dorsey and Dr. Leigh Ann O’Banion to discuss the evolution of the YSS, their plans for the upcoming VAM, and how people can get involved.   Dr. Chelsea Dorsey (@MdDorsey) is an Associate Professor of Surgery in the Section of Vascular Surgery at the University of Chicago and serves as the Vice Chair of Diversity, Equity and Inclusion in the Department of Surgery.  In keeping with her medical education interests, she was recently appointed the Associate Dean for Medical Student Academic Advising and Advancement at the Pritzker School of Medicine. She currently sits on a number of regional and national committees focused on surgical education and also serves on the SVS Communications and Appointments Committee.  In January of this year, she was formally appointed the Chair of the newly formed SVS Young Surgeons Section.     Dr. Leigh Ann O'Banion (@limbsalvagedr) is an Assistant Professor of Vascular Surgery at UCSF Fresno, where she also completed her general surgery residency. She did her fellowship in vascular surgery at UCSF, graduated in 2017 and then returned to UCSF Fresno as an attending. She has a busy clinical practice with a focus on limb salvage and outcomes of vascular amputees and shares a passion for mentoring the next generation of vascular trainees. She is on the steering committee of the Young Surgeons Section of the SVS.   Young Surgeon Section  page on the SVS website   What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding   Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.  

In this episode, we are fortunate to hear three interviews from guest experts in the field discussing occupational hazards in vascular surgery. We cover physical pain and discomfort with Dr. Max Wohlauer, radiation safety with Dr. Melissa Kirkwood, and pregnancy and radiation with Dr. Venita Chandra.  Show Guests: Dr. Max Wohlauer (@doctormaxw) is an assistant professor at the University of Colorado School of Medicine, as well as an associate program director of their residency and fellowship.  He founded the Vascular Surgery COVID-19 Collaborative (VASCC, https://medschool.cuanschutz.edu/surgery/divisions-centers-affiliates/vascular/research/vascc/vascc).  He obtained his medical degree from the Albany Medical College and completed general surgery residency at the University of Colorado followed by vascular surgery fellowship at the Cleveland Clinic. Audible Bleeding with Dr. Samuel Money on Ergonomics in Surgery: https://www.audiblebleeding.com/money-ergonomics/  Physical discomfort, professional satisfaction, and burnout in vascular surgeons: https://doi.org/10.1016/j.jvs.2018.11.026  Physical pain and musculoskeletal discomfort in vascular surgeons: https://doi.org/10.1016/j.jvs.2020.07.097  Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force: https://doi.org/10.1016/j.jvs.2020.10.065  Dr. Melissa Kirkwood is an associate professor at the UT Southwestern Medical Center and chief of the division of vascular surgery. She completed her medical degree at Yale University School of Medicine, followed by a general surgery residency at The University of Chicago, and vascular surgery fellowship at the University of Pennsylvania Medical Center. One of her major research interests is radiation dose control and novel technology for decreasing radiation exposure. Dual fluoroscopy with live-image digital zooming significantly reduces patient and operating staff radiation during fenestrated-branched endovascular aortic aneurysm repair: https://doi.org/10.1016/j.jvs.2020.05.031  Disposable, lightweight shield decreases operator eye and brain radiation dose when attached to safety eyewear during fluoroscopically guided interventions: https://doi.org/10.1016/j.jvs.2021.11.067  Radiation brain dose to vascular surgeons during fluoroscopically guided interventions is not effectively reduced by wearing lead equivalent surgical caps: https://doi.org/10.1016/j.jvs.2017.12.054    Dr. Venita Chandra (@ChandraVenita) is a clinical associate professor at Stanford University as well as the program director for vascular surgery residency and fellowship. She obtained her medical degree from the University of Chicago followed by general surgery residency and vascular surgery fellowship at Stanford University. She also completed a technology development fellowship in the Stanford Biodesign Program. She is part of the SVS Wellness Task Force and has an interest in radiation safety in pregnancy. Monitoring of fetal radiation exposure during pregnancy: https://doi.org/10.1016/j.jvs.2013.01.052 Incidence of Infertility and Pregnancy Complications in US Female Surgeons: https://doi.org/10.1001/jamasurg.2021.3301   Host Introductions: Dr. Matt Chia (@chia_md) is in his 6th year in the integrated vascular surgery program at Northwestern University. He obtained his medical degree from the University of Illinois College of Medicine, and also holds a Master’s in Health Services and Outcomes Research from Northwestern.    Dr. Jessie Ho (@JessieHo_) is in her 4th year general surgery resident at Northwestern University. She obtained her medical degree from the Texas A&M College of Medicine, and is completing a Master’s in Clinical Investigation at Northwestern.   Authors: Matt Chia, MD, MS, Jessie Ho, MD, Janhavi Patel, BMSc Editor: Matt Chia, MD Reviewers: Sharif Ellozy, MD, Adam Johnson, MD

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship. In this episode, Imani talks with Dr. Eric Pillado about his experiences thus far in training, finding comfort in being himself, and his ambitions in addressing health disparities in Latin-X and Spanish-speaking populations.  Dr. Pillado (@drpillado) is an integrated vascular trainee at McGaw Medical Center of Northwestern University.  To read Dr. Pillado’s perspective piece “Being Queer Without Proximal or Distal Control”.  To learn more about The Surgical Outcomes & Quality Improvement Center (SOQIC) and the SECOND Trial. What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected].

Holding Pressure AKA/BKA Shownotes   Name of Surgery: Above Knee Amputation/Below Knee Amputation   Authors: Dominique Dockery, MS3, Alpert Medical School of Brown University Robert Patterson, MD, FACS, Alpert Medical School of Brown University/Providence Surgical Care Group   Editor:  Yasong Yu   Reviewer: Ryan Meyer   Core Resources: Rutherford's Vascular and Endovascular Therapy 9th Edition Chapters 104, 105, 111, 112 Anson and McVeigh’s Surgical Anatomy   Additional Resources: Article Explaining WIfI (https://www.jvascsurg.org/article/S0741-5214(13)01515-2/fulltext)  Links to Apps for CLTI Calculators (https://vascular.org/news-advocacy/society-vascular-surgery-launches-mobile-apps-staging-chronic-limb-threatening)  Callander Technique Original Article (https://jamanetwork.com/journals/jama/article-abstract/1155011) Logan, Meryl Simon & Bush, Ruth L. Vascular surgeons are health disparities doctors. JVS. Vol 74; Issue 5p1437. November 2021.    Underlying disease featured in episode: Peripheral arterial disease (PAD)/chronic limb threatening ischemia (CLTI) Pathophysiology/etiology Blockage of the arteries supplying blood to the lower limbs usually secondary to atherosclerosis Affects an estimated 8-12 million Americans Associated with smoking, diabetes, hypertension, obesity CLTI is more severe form of PAD (up to 20% of PAD patients)- associated with rest pain, ischemia ulceration, or gangrene Patient presentation Varies based on disease progression and prior intervention Ranges from asymptomatic to major tissue loss Often have patients with intermittent claudication, rest pain, or wounds/ulceration Patients can be classified using Rutherford scale or WIfI classification Diagnosis Ankle-brachial index is diagnostic (1.3) Often obtain CTA with run-off to visualize vessels prior to angiogram Angiogram to plan intervention Surgical treatment  Revascularization: either endovascular (angioplasty vs stenting) or open (bypass based on targets with either vein or graft) Amputation: after failed revascularization or irreversible/severe ischemia with no revascularization options Minor (toe/foot) vs major (below knee/through knee/above knee)   Indications for surgery:  acute ischemia: for irreversible ischemia, for severe ischemia with no revascularization options, or following unsuccessful attempts at revascularization chronic ischemia: failure of revascularization, lack of suitable conduit or target arteries, severe patient comorbidities, poor functional status, or extensive gangrene or infection such that foot salvage is not possible foot infection severe traumatic injury lower extremity skeletal or soft tissue malignancy   Preop Preparation: linking the patient with a prosthetist prior to surgery is ideal and helps with surgical planning, addressing patients’ fears and concerns, determining level of amputation (pulses/blood flow, level of infection, etc.)   Surgical steps with relevant images:  Below the knee amputation (posterior flap technique): Create a hemi-circular incision anteriorly (generally about 1 handbreadth below the tibial tuberosity that goes from just anterior to the fibula to an equidistant portion of the other side) and a long posterior flap  Cut through the muscles of the anterior compartment (muscle bundle on the lateral side of the tibia) and expose the anterior tibial artery and vein- ligate and suture ligate Using a periosteal elevator, which is something like a chisel, strip the periosteum proximally from the tibia and divide the tibia with an oscillating saw. Then strip the periosteum and attachments of the fibula at this level and divide either with the saw or a bone shear.  Use an amputation knife to create the posterior flap along the skin and fascia incision lines (fashion it to make sure it will reach anteriorly without muscle bulk/tension). The remaining tibial vessels are then identified and individually suture ligated. Identify the tibial nerve, bluntly dissect it quite proximally and divide it with electrocautery.  After hemostasis has been established, remove a wedge of bone from the anterior portion of the tibia so that that doesn’t provide a pressure point on the prosthesis and resect the fibula 1-2 centimeters above the line of tibial transection with a rib cutter to be sure that the fibula doesn’t wear against the prosthesis laterally and create an ulceration or painful protrusion. Loosely approximate the posterior flap to the anterior fascia with several interrupted Vicryl sutures and then carefully re-approximate the skin with vertical mattress sutures of Prolene using a Keith needle to avoid traumatizing the skin with forceps.    Above knee amputations (Callander technique): Does not cut across any muscle bellies but is purely dividing all muscular attachments through the tendinous insertions. It is similar to a through the knee amputation, but it involves dividing the femur immediately above the flare of the condyle with curved anterior and posterior fish mouth type flaps that again allow division without the trauma of muscular transection.   Postoperative care: knee immobilizer post-operatively after BKA to reduce risk of contractures, non–weight bearing on the stump until the fitting of a prosthesis 4 to 6 weeks after surgery, close follow up with vascular surgeon   Complications: primary healing fails in 20% to 30% of patients and approximately 1 in 5 patients undergoing BKA need a higher-level amputation due to wound problems   Top Asked Questions:   What ankle-brachial index is diagnostic of peripheral arterial disease?   Less than 0.9, severe PAD is less than 0.4. An ABI greater than 1.3 or 1.4 is considered non-diagnostic and further workup is indicated.   What is the Rutherford classification for peripheral arterial disease?   0- asymptomatic, 1- mild claudication, 2- moderate claudication, 3- severe claudication, 4- ischemic rest pain, 5- minor tissue loss, 6- major tissue loss    Which amputation level requires more energy to ambulate with a prosthesis?    Above knee amputations require 50-70% more energy than below knee amputations What are the compartments of the lower leg, and which major vessels and nerves are in each compartment?   Anterior- anterior tibial artery and vein, deep peroneal nerve Lateral- superficial peroneal nerve Deep posterior- posterior tibial artery and vein, peroneal artery and vein, tibial nerve Superficial posterior- mostly musculature

We are very excited to have Dr. Kellie Brown, the current Vice-Chair of the Vascular Surgery Board, and Dr. Malachi Sheahan, the Vice-Chair Elect, to pull back the curtain on how the VSB serves the public and the vascular surgery community at large while defining our specialty. They discuss the history of the VSB, provide some insight into board examination development, and clarify the process of Continuous Certification Assessment. They also discuss the new nomination process adopted this year by the VSB, and how interested people can get more involved.    Dr. Kellie Brown is Professor of Surgery and Radiology in the Division of Vascular and Endovascular Surgery at The Medical College of Wisconsin, and the Chief of Vascular Surgery at the Zablocki VA Medical Center. She is the Program Director for the Vascular Surgery Fellowship at the Medical College of Wisconsin.    Dr. Malachi Sheahan is Professor of Surgery and Chair of Vascular and Endovascular Surgery and Program Director for the Vascular Surgery Integrated Residency and Fellowship at LSU Health Sciences Center in New Orleans.    Vascular Surgery Continuous Certification Assessment VSB Update - Spring 2021 What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding   Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Have you ever wondered how physicians create new medical technology or how they receive funding for creating new medical products? Five entrepreneurs, who have developed medical products and received funding, will share the process of developing a company and the different types of funding. This webinar is presented by the SVS Health Information Technology Committee. Webinar Faculty: Anahita Dua, MD, MS, MBA - Asst. Prof., Harvard Medical School Sophia Khan, MD - Asst. Prof., UTHealth; CEO & Founder, Voythos AI Pratap Khanwilkar, PhD, MBA - Vice-President, InCube Labs Dave Kuraguntla, MD - Founder & CEO, Alio Hari Radhakrishnan, MD - Co-Chief Executive Officer, Decisio Health, Inc. Moderators: Judith Lin, MD, MBA - Prof. & Chief, Vascular Surgery, Michigan State University College of Human Medicine Shivprasad Nikam, MD, MBA - Vascular Surgeon, Geisinger; President & CEO, Mundaii Join us on May 4 for the next HITC Webinar - New Technologies in Vascular Surgery. Register Here

As part of the Race & Representation (R&R) Series, we are doing spotlights on vascular trainees and faculty that identify as racial/ethnic minorities underrepresented in medicine (URiM), who have been historically excluded from the field. We hope to amplify these voices as examples of the unique challenges faced by URiMs within vascular surgery and as a source of inspiration and mentorship.  In this episode, Imani talks with Dr. Garietta Falls about her journey to vascular surgery and the lessons she learned along the way.  Dr. Falls (@drgfalls) is an assistant professor at Case Western Reserve School of Medicine and also serves as the director of the vascular lab at Metro Health in Cleveland, Ohio.  For more information on the Midwestern Vascular Society For more information on the goals and objectives of the SVS DEI Committee  What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

Adam and Farooq discuss Journal of Vascular Surgery Editor’s Choice articles for April 2022 with the Senior Editor, Dr. Peter Lawrence. Video Summary of the Articles Articles Discussed Treatment of carotid stenosis in asymptomatic, non-octogenarian, standard risk patients with stenting versus endarterectomy trials. Predictors of mortality in nonagenarians undergoing abdominal aortic aneurysm repair: Analysis of the National Surgical Quality Improvement Program dataset. Hospital-based delays to revascularization increase risk of postoperative mortality and short bowel syndrome in acute mesenteric ischemia. Outcomes of carotid artery stenting in patients with radiation arteritis compared with those with atherosclerotic disease. JVS Journal Club Website If you enjoy our content, please contribute to Support Audible Bleeding! Help us improve through our ALL NEW Listener Survey! Follow us on Twitter: @AudibleBleeding Credits: Guest: Peter Lawrence Authors: Adam Johnson and Farooq Usmani Editor: Adam Johnson Reviewers: Shivik Patel

Holding Pressure and Vascular Origin Stories: History of Hemodialysis Access   In this crossover episode of Holding Pressure and Vascular Origin Stories Gowri and Marlene explore the history of hemodialysis access, the creation of arteriovenous fistulas and prosthetic grafts. During this episode Gowri interviews Dr. Appell- the surgeon who created the first AV fistula for hemodialysis access and Marlene interviews Dr. Schanzer about his experience with early hemodialysis access and the development of the distal revascularization and interval ligation procedure.  Below you can find a picture of the first Teflon shunt used for hemodialysis, The Artificial Kidney Center Admission and Policy Committee (aka ‘God Squad’), evolution of early A-V shunts and Drs. James E Cimino, Kenneth Appell, Michael J. Brescia.    Links to other podcasts on bioethics and finance of hemodialysis and the God Squad: Beside Rounds: Episode 26 The God Squad   Freakonomics: Is dialysis a test case of medicare for all? References: [1] Klaus Konner. History of vascular access for haemodialysis. Nephrol Dial Transplant (2005) 20: 2629–2635.   [2]  B.H. Scribner, R. Buri, J.E.Z. Caner, R. Hegstrom, J.M. Burnell. Preliminary report on the treatment of chronic uremia by means of intermittent hemodialysis. Trans Am Soc Artif Intern Organs 1960; 6: 114–12.   [3]  Wayne Quinton, David Dillard, and Belding H. Scribner Authors. Cannulation of Blood Vessels for Prolonged Hemodialysis. Transactions of the ASA10, 1960, Vol. 6, pp. 104–107.   [4] Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966; 275: 1089–1092   [5] Cimino JE, Brescia MJ. The early development of the arteriovenous fistula needle technique for hemodialysis. ASAIO J 1994; 40: 923–927   [6] Scribner. Hemodialysis Using an Arteriovenous Fistula. N Engl J Med 1966;    [7] Baker, L. D., Jr, Johnson, J. M., & Goldfarb, D. (1976). Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis. Transactions - American Society for Artificial Internal Organs, 22, 382–387.   [8] Blagg, CR. Development of ethical concepts in dialysis: Seattle in the 1960s. Nephrology  1998; 4, 235-238   [9] Blagg CR. The Early History of Dialysis for Chronic Renal Failure in the United States: A View From Seattle. World Kidney Forum.   [10] Rettig, RA. Origins of the Medicare Kidney Disease Entitlement: The Social Security Amendments of 1972. Biomedical Politics. Institute of Medicine (US) Committee to Study Decision Making; 1992   [11] Scribner, B. Treatment of Chronic Uremia.    [12] United States Renal Data System. 2020 USRDS Annual Data Report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2020.   [13] Scribner, Belding. A Personalized History of Chronic Hemodialysis. American Journal of Kidney Diseases. Vol XVI No 6. December 1990. pp511-519 Hosts: Marlene Garcia-Neuer (@GarciaNeuer) is a MS4 at THE Ohio State University College of Medicine.   Gowri Gowda (@GowriGowda11)  is an MS3 at Tulane University School of Medicine.    Guests: Dr. Harry Schanzer, Vascular Surgeon Mount Sinai Hospital and Bronx VA (retired)   Dr. Kenneth Appel, General Surgeon, Bronx VA (retired) 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 you want to address the question to (resident, fellow, attending, or someone specific) Send them in writing, or in voice recorded format.    Send them to [email protected]. Also send us any ideas, suggestions, or comments.   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. Please share your feedback through our Listener Survey!   Credits: Author: Marlene Garcia-Neuer, Gowri Gowda Editor: Yasong Yu Reviewers: Sharif Ellozy, Adam Johnson

Holding Pressure AVF/AVG Creation Show Notes Name of Surgery: AVF/AVG Creation   Authors:  Gowri Gowda, Tulane University School of Medicine, MS3 Daniela Medina, Penn State College of Medicine, MS4 Dr. Gerry Victor, LSU Health New Orleans, PGY1   Editor:  Yasong Yu   Reviewers: Amanda Fobare Farooq Usmani   Core Resources: Rutherford's Vascular and Endovascular Therapy 9th Edition Chapter# 175,176,178,179   Additional Resources: Landmark paper:  benefits of regional vs local anesthesia on AV fistula outcomes titled“Effect of regional versus local anesthesia on outcome after arteriovenous fistula creation: a randomized controlled trial”  by Aitken et. al found that regional brachial plexus block anesthesia results in greater vasodilation and increased short-term blood flow was associated with higher primary patency at 3 months compared to local anesthesia.  SVS reporting standards for HA access: reference for surgical dialysis access placement and revision  VSITE Review - Vascular Access   Underlying disease featured in episode Pathophysiology/etiology: Chronic Kidney Disease (CKD) is defined as decreased kidney function (estimated as an eGFR   Pathophysiology: The pathophysiology of CKD is variable based on the underlying condition. Two common etiologies are diabetic nephropathy and hypertensive nephropathy. Diabetic nephropathy is a result of chronic hyperglycemia which results in the glycosylation of the basement membrane and plasma hyperfiltration. This ultimately results in glomerular damage. Hypertensive nephropathy is a result of long standing arterial hypertension and increased capillary hydrostatic pressure in the glomeruli as well as ischemic glomerular damage.  Etiology:  Conditions that can cause chronic kidney disease include diabetic nephropathy, hypertensive nephropathy, glomerulonephritis, and polycystic kidney disease. CKD stage is used to guide the management and risk stratify for major complications of CKD such as all-cause mortality, cardiovascular mortality, and progression of kidney disease. . Appropriate staging includes cause of disease, eGFR level, and category of albuminuria. Decline in kidney function is typically asymptomatic. However, when a patient reaches ESRD (eGFR Epidemiology: With an aging population and a rise in the incidence of diabetes, CKD and ESRD are becoming increasingly prevalent diagnoses in the United States. The prevalence of ESRD reached 746,557 in 2017 with an increase in incidence by 2.3% from 2017 to 2018. Data from the United States Renal Data System reported a rise in ESRD patients receiving hemodialysis from 84,537 to 112,818 between the years of 2000-2018. Medicare spending for ESRD patients increased from $36.1 billion in 2009 to $38.7 billion in 2018.  Patient Presentation Case: Our patient is a 60 year old right-hand dominant female with a past medical history of diabetes, hypertension, hyperlipidemia, and CKD with an eGFR of 20. She has no surgical history and has a family history of heart failure and diabetes. She does not currently work, drinks around 2 glasses of wine a week, and quit smoking 10 years ago. Her current medications include atorvastatin, lisinopril, and aspirin.    Diagnosis History: H&P of a patient referred for access creation should elicit hand dominance and work history because they can affect where the fistula or graft should be positioned. It is especially important to note any previous access procedures, prior central lines, pacemakers,  thoracic surgeries, or other venous system procedures. A history of chronic infections, immunosuppression, skin diseases, history of stroke, and extremity weaknesses may also affect choice of procedure.  Physical Exam and Imaging: discussed in preop assessment section.   Treatment (Medical/Surgical) Non-temporary treatment options include kidney transplantation and dialysis (requires AV Fistula creation, AV graft creation, or peritoneal dialysis access placement).    Indications for surgery: The treatment of choice for ESRD is kidney transplantation as it provides a higher quality of life and a lower mortality risk for patients when compared with dialysis.  Patients who are unable to receive a transplant have a choice between hemodialysis through a hemodialysis catheter, AV Fistula, AV graft, or peritoneal dialysis based on various patient-specific factors.  The SVS’s clinical practice guidelines and the National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (NFK-KDOQI) guidelines align in their recommendation to refer patients to a vascular access surgeon for permanent hemodialysis access when their creatinine drops below 25 mL/min. So for our patient, her GFR of 20 warranted a referral to vascular surgery.   Early access placement, ideally more than 4 months before the initiation of dialysis, decreases the risk of sepsis and death. This has been attributed to a decreased need for the use of central venous catheters for temporary hemodialysis access.   Preop Preparation:  The first step in a successful permanent AV access placement is a thorough preop evaluation. Comorbid conditions impacting access patency rates include age, diabetes, peripheral vascular disease, smoking, hyperparathyroidism, and anemia.  Comorbidities:  Age, Diabetes, and Smoking have been more extensively studied than others. Retrospective observational studies have shown that smoking increases both early and late failure of AV access. ESRD patients who are smokers should be counseled on smoking cessation and referred to a tobacco cessation program before their AV access procedure.  Studies regarding age and its effects have also been largely retrospective observational studies but with conflicting results. A meta-analysis of 13 studies by Lazarides et al. looked at dialysis outcomes in elderly patients and found a higher rate of radiocephalic AV access failure in elderly patients compared with the non elderly. Additionally this analysis found a statistically significant higher rate of brachiocephalic AVF patency compared to radiocephalic access and no statistically significant difference in AVG placement within the elderly population. In conclusion, for elderly patients, upper arm brachial-cephalic AVF or AVG is the preferable access placement site when compared to a distal radial-cephalic AVF.  For patients with DM, studies have suggested an increased long term risk of thrombosis and arterial steal.  Taking inflow as distal as possible decreases the risk of steal syndrome.    Surgical steps (relevant images can be found in Rutherford Chapter 175):   Autogenous Access Steps    The selected artery and vein are identified and dissected.  The distal end of the vein is transected. Side branches are identified and ligated to maximize flow into the vein and prevent delayed maturation. Prior to clamping the artery, systemic heparin may be considered. Alternatively, the artery may be clamped and flushed with heparinized saline.  An arteriotomy of  4 to 6 mm is made. Limiting the length decreases the incidence of arterial steal  An end to side AV anastomosis between the end of the vein and side of the artery is performed using a 6-0 or 7-0 monofilament nonabsorbable (prolene) suture. The anastomosis is flushed just prior to completion. An end to side vs side to side anastomosis has been shown to decrease the risk of venous hypertension.  After the anastomosis is completed, remaining side venous branches are identified and ligated through the main incision. Depending on practice style, stable incisions may be done to ligate additional venous branches not accessible through the main incision. This final step increases flow into the main venous segment and promotes maturation.    Autogenous Access with a Transposition   If a transposition is required, a one-stage or two-stage technique may be utilized. The benefit of a one-stage technique is the need for only one procedure. The benefit of the two stage procedure is being able to assess whether the vein will mature and be usable. Two stage procedures are recommended for small veins If a two stage procedure is selected, the first stage consists of creating the arterio-venous fistula.  The second stage , the transposition,  is performed 4 to 6 weeks later. A superficial tunnel is created. The venous limb of the fistula is transected and passed through the tunnel. A new anastomosis is created between the two ends of the venous limb of the fistula.  Alternatively, a superficialization of the fistula may be performed. The vein is exposed, side branches ligated, and the vein is mobilized superficially by approximating the subcutaneous tissue below the vein. The vein is transected and mobilized proximal to the anastomosis. A tunnel is created in the subcutaneous tissue. The vein is then passed through the tunnel and once again    Prosthetic Access   A 6 mm PTFE graft is the graft of choice for an AV graft creation. A tapered graft (4-6mm) should be considered to decrease risk of steal The artery and vein selected for use are identified and dissected.  Subcutaneous tunnel is created using Gore Sheath, the Noon, or the Kelly-Weck tunneler.  The graft is first anastomosed to the vein in an end-to side fashion using a 6-0/7-0 monofilament suture. The venotomy should ideally be made to optimize venous outflow and prevent any turning or twisting of the vein. Systemic heparin is administered to prevent arterial occlusion. The inflow artery is clamped and arterial anastomosis is completed in a similar fashion. Unlike the autogenous access procedure, the arteriotomy does not need to be strictly limited to 4 to 6 mm as the graft size will limit arterial steal.   Postoperative care: Postop Care and Evaluation of fistulas and grafts revolve around assessing maturation AV fistulas generally can take up to 12 weeks to mature whereas AV grafts are ready in 2 weeks.  Patients who receive an AV fistula should be assessed by the vascular surgeon 2 weeks post-op, for patency and any early surgical complications such as infection, nerve compression, ischemia, steal syndrome, or extremity swelling.  Around 4-6 weeks, the fistula should be evaluated for maturity by using a duplex ultrasound to assess diameter, depth, flow through the fistula, and length of access.  Physical examination for maturity should include feeling for a thrill and pulse, evaluation of the body with the optimal length being 6 to 10 cm, and evaluation of the depth ideally within 1 cm of the skin surface.    Patency: Primary patency is the interval from time of access placement to any intervention required to maintain or reestablish patency.  Primary assisted patency is the interval time from access placement to maintenance of access patency and includes surgical or endovascular interventions needed to maintain functionality of a patent access as long as it is not occluded.  Once a conduit gets occluded, you move on to measuring secondary patency, which is the interval time from time of access placement to access abandonment. To learn more about this, listeners can check out the section  “time of measurement of patency” in the SVS reporting standards for hemodialysis access. The DOPPS study indicated an improvement in AVG primary patency with calcium channel blockers, AVG secondary patency with aspirin, decreased AVG primary patency with warfarin, and improvement in AVF secondary patency with ACE inhibitors.    Complications: There are a multitude of complications that can arise and affect the patency of the AV fistula or graft. In fact, a large portion of the rise in costs during the transition from CKD to ESRD can be attributed to hospitalizations for AV access failures, revision procedures, repeated access placements, and thrombectomies.  Primary AVF failure is defined as an AVF that fails within three months of use or has never been usable for dialysis. Radio-cephalic fistulas have the highest failure rate and are commonly caused by anatomic problems or lesions that were preexisting or arose after the procedure. Thrombosis: Hemodynamic changes and flow disturbances can cause intimal hyperplasia primarily at the outflow anastomosis in an AVG and anywhere along the outflow vein in an AVF. Another factor that can contribute to intimal hyperplasia is repeated puncture of the fistula or graft. Intimal hyperplasia can ultimately lead to stenosis and thrombosis.  Infection: Infection is the second most common cause of loss of access patency, accounting for 20% of cases. Some of the risk factors for infection include the presence of AV grafts, diabetes, increased age, and repeated cannulation. Pseudoaneurysm: Repeated cannulation in the same area of access can result in the formation of a pseudoaneurysm which is a disruption of the vessel wall with a collection of blood contained by fibrous tissue. Pseudoaneurysms have a risk of rupture and infection. Dialysis Access Steal Syndrome: Due to the increased blood flow through the AV access, there can develop a decrease in blood flow to the distal extremity. Clinical features of steal syndrome include hand pain, diminished sensory or motor function, or coolness. Risk factors include previous access procedures, diabetes, PAD, CAD, a history of steal syndrome, and female gender. Steal syndrome can lead to permanent neurological damage to the extremity if not dealt with in an expeditious manner. Venous Hypertension: Venous HTN commonly occurs due to central venous stenosis primarily caused by chronic endothelial trauma from a previous catheter placement. Venous HTN impacts access patency and function and can lead to severe edema. Top Asked Questions:   What are the rules of 6’s?  The rule of 6s is an easy way to evaluate the maturity of a fistula. Six weeks after the AV fistula is created, the fistula should be able to support a blood flow of 600ml/min, be at a maximum of 6mm from the surface, and have a diameter greater than 6mm   What are the indications for choosing an AV graft vs. an AV fistula vs a temporary catheter? Indications for choosing AVF: Preferred over AVGs due to their superior patency rates if the patient's vascular anatomical characteristics such as diameter and depth are deemed appropriate through physical examination and vascular mapping via ultrasound. Less chances of infection compared to AVGs and temporary catheter.    Indications for choosing AVGs:  Once native fistulas in the non dominant arm have been exhausted you move on to the consideration of AVGs.  If a patient’s vascular anatomy is inadequate for AVF placement. If a patient requires an expedited catheter removal, AVGs can be considered to avoid longer maturation time of AVF  Older age and smaller vein size have been associated with appropriateness of using AVG or AVF    Indications for choosing temporary catheters include the following:  Patient is in need of dialysis but has not yet received an AVF/AVG or their AVF/AVG is not ready for use  AVF/AVG/Peritoneal Dialysis with complications and temporarily not able to be utilized  Patient requires dialysis but has a transplant confirmed in Acute need of dialysis without indications for permanent HA access placement   How long do AV Fistulas and AV grafts typically last?  Autogenous AV access has better primary and secondary patency rates compared to prosthetic AV access (refer to patency paragraph #9 above for definitions of patency).    Patency Measure Autogenous Access AV graft 1-year Primary Patency 43%-85% 40%-54% 2-year Primary Patency 40%-69% 18%-30% 1- year Secondary Patency  46%-90% 59%-65% 2-year Secondary Patency 62%-75% 40%-60% Apart from an AV Graft and AV Fistula, what is another method of permanent dialysis?    Peritoneal dialysis (PD) is an alternative method of dialysis that utilizes the peritoneum as a membrane for fluid dissolution and exchange. PD is as effective as hemodialysis access (HA) with the only absolute contraindication being a lack of peritoneal membrane. However, there are other factors to consider when choosing between PD and HA for dialysis access. Medical considerations include previous peritoneal scarring, adhesions, or hernias. Additionally, because PD is performed by the patient and not in a dialysis center, it is vital to assess any patient specific factors (physical, social, environmental) that could prevent them from adhering to their dialysis regimen.  When working up a patient for dialysis access, PD should be considered as a potential option. If a patient is deemed suitable for PD, it can provide a much higher quality of life than HA. PD can be performed from the home relieving the patient of visits to a dialysis center multiple days during the week. PD can also be performed overnight while the patient is asleep and does not require needle sticks.    References:    Misskey, J., & Hsiang, Y. (2015). The First Arteriovenous Fistula: A History of Hemodialysis Access and a Forgotten Pioneer. In Journal of Vascular Surgery (Vol. 61, Issue 6, p. 81S). Elsevier BV. https://doi.org/10.1016/j.jvs.2015.04.156   Polo JR. Kenneth Charles Appell, M.D.: the surgeon who performed the first radiocephalic fistulas for hemodialysis. Am Surg. 2006 Feb;72(2):172-3. PMID: 16536251.   Annual data report. USRDS. (n.d.). Retrieved February 21, 2022, from https://adr.usrds.org/2020/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities    Chopra, V. Central venous access devices and approach to device and site selection in adults. In T. Post (Ed.). UpToDate, Waltham, MA (accessed on February 20, 2022): UpToDate.   Oliver, M., Quinn, R. Approach to the adult patient needing vascular access for chronic hemodialysis. In T. Post (Ed.). UpToDate, Waltham, MA (accessed on February 20, 2022): UpToDate.   Woo, K. Arteriovenous fistula creation for hemodialysis and its complications. InUpToDate. UpToDate, Waltham, MA. (Accessed on February 22, 2022)    Woo, K. Arteriovenous graft creation for hemodialysis and its complications. In T. Post (Ed.),UpToDate. UpToDate, Waltham, MA. (Accessed on February 22, 2022).   Aitken, E., Jackson, A., Kearns, R., Steven, M., Kinsella, J., Clancy, M., & Macfarlane, A. (2016). Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial.Lancet (London, England),388(10049), 1067–1074. https://doi.org/10.1016/S0140-6736(16)30948-5   Lazarides, M. K., Georgiadis, G. S., Antoniou, G. A., & Staramos, D. N. (2007). A meta-analysis of dialysis access outcome in elderly patients.Journal of vascular surgery, 45(2), 420–426. https://doi.org/10.1016/j.jvs.2006.10.035   Pisoni, R. L., Gillespie, B. W., Dickinson, D. M., Chen, K., Kutner, M. H., & Wolfe, R. A. (2004). The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology.American journal of kidney diseases : the official journal of the National Kidney Foundation,44(5 Suppl 2), 7–15. https://doi.org/10.1053/j.ajkd.2004.08.005   Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, Miller A, Scher L, Trerotola S, Gregory RT, Rutherford RB, Kent KC. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002 Mar;35(3):603-10. doi: 10.1067/mva.2002.122025. PMID: 11877717.   —----------------------------------------------   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 you want to address the question to (resident, fellow, attending, or someone specific) Send them in writing, or in voice recorded format.    Send them to [email protected]. Also send us any ideas, suggestions, or comments.   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.    

Soni and Wen discuss the Journal of Vascular Surgery Venous and Lymphatics March Editors' Choice articles with the Editor-in-Chief, Dr. Peter Gloviczki. Video Summary of the Articles Articles Discussed: Institutional trends over a decade in catheter-directed interventions for pulmonary embolism. Contemporary rates of inferior vena cava filter thrombosis and risk factors. Pregnancy after iliac vein stenting for pelvic venous insufficiency. A multicenter randomized controlled trial of cyanoacrylate closure and surgical stripping for incompetent great saphenous veins. JVS Journal Club Website If you enjoy our content, please contribute to Support Audible Bleeding! Help us improve through our ALL NEW Listener Survey! Follow us on Twitter: @AudibleBleeding Credits: Guest: Peter Gloviczki Authors: Soni Nag, Wen Kawaji Editor: Adam Johnson Reviewer: Eilidh Gunn and Matthew Chia

The Society for Vascular Surgery was founded on July 3rd, 1946 at the Fairmount Hotel in San Francisco, California by thirty-one vascular surgeons looking to improve the field. In August 2021, the SVS kicked off a year-long celebration of its 75th anniversary. As part of this celebration, the SVS Foundation will be hosting the "Cheers to 75 Years Gala" in Boston on June 17th. This fundraiser will allow the SVS Foundation to make even greater progress in accomplishing its mission of optimizing the vascular health and well-being of patients and the public through support of research.    To discuss the upcoming gala and the SVS Foundation, we have three guests with us today:    Dr. Ronald Dalman, MD, DFSVS, Past President of the SVS, is here with us today in his role as Chair of the Gala Committee. @RLDalmanMD   Dr. Venita Chandra is an Associate Professor of Surgery and the Program Director for the vascular surgery fellowship at Stanford.  She is here today in her role as co-Chair of the Gala Committee. @ChandraVenita   Dr. Peter Lawrence is Wiley Barker Professor and Chief of the Division of Vascular and Endovascular Surgery at UCLA and Senior Editor of the Journal of Vascular Surgery.  He joins us today in his role as the Chair of the SVS Foundation.   Listen to the SVS Foundation episode, April 3rd, 2021 Listen to the VISTA Program episode, May 3rd, 2021    Want to donate to the auction? Contact Rupa Brosseau at [email protected]   What other topics would you like to hear about? Let us know more about you and what you think of our podcast through our Listener Survey or email us at [email protected]. Follow us on Twitter @audiblebleeding   Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

In this month’s episode of our JVS Editor’s Choice series, Soni and Wen discuss Journal of Vascular Surgery March’s Editor’s Choice articles with the Editor-in-Chief, Dr. Peter Gloviczki Video Summary of the Articles Articles Discussed: Perioperative outcomes of carotid endarterectomy and transfemoral and transcervical carotid artery stenting in radiation-induced carotid lesions. (CME Article) Incidence, predictive factors, and outcomes of intraprocedure adverse events during fenestrated-branched endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms. Dr Schanzer Editorial: Fenestrated and branched endografts are transformational but we haven't made it to the top of the mountain yet Timing of endovascular repair impacts long-term outcomes of uncomplicated acute type B aortic dissection Percutaneous arteriovenous fistula creation with the 4F WavelinQ EndoAVF System. JVS Journal Club Website If you enjoy our content, please contribute to Support Audible Bleeding! Help us improve through our ALL NEW Listener Survey! Follow us on Twitter: @AudibleBleeding Credits: Guest: Peter Gloviczki Authors: Soni Nag, Wen Kawaji Editor: Adam Johnson Reviewers: Chris Audu and Fanny Alie-Cusson

In this month’s episode of our JVS Editor’s Choice series, Yasong and Wen discuss Journal of Vascular Surgery February’s Editor’s Choice articles with the Senior Editor, Dr. Peter Lawrence   Video Summary of the Articles   Articles Discussed: Surgeon volume and established hospital perioperative mortality rate together predict for superior outcomes after open abdominal aortic aneurysm repair (CME and Editor's Choice Article) Intraoperative blood pressure lability carries a higher risk of headache after carotid endarterectomy Early outcomes of t-Branch off-the-shelf multibranched stent graft in urgent and emergent repair of thoracoabdominal aortic aneurysms Predictors of outcome in diabetic patients undergoing infrapopliteal endovascular revascularization for chronic limb-threatening ischemia   JVS Journal Club February 2022 JVs Journal Club Website   If you enjoy our content, please contribute to Support Audible Bleeding!   Help us improve through our ALL NEW Listener Survey!   Follow us on Twitter: @AudibleBleeding   Credits: Guest: Peter Lawrence Authors: Yasong Yu, Wen Kawaji Editor: Yasong Yu Reviewers: Eilidh Gunn  

Travel/Research Scholarships for Medical Students National Meetings: Vascular and Endovascular Surgery Society (VESS) and Vascular Annual Meeting Date: 6/15-18, 2022 in Boston Hosting organizations: Society for Vascular Surgery (SVS), and VESS Available scholarships for students SVS General Surgery Resident/Medical Student Travel Scholarship Includes: A financial award to be used toward the cost of travel expenses during the period of the Vascular Annual Meeting, Complimentary meeting registration. Opportunity to participate in a mock interview practice session Application: Demographic information and Statement of interest in written or video form Deadline: 3/9 4pm EST Link   SVS Diversity Medical Student Travel Scholarship Same deadline and process as above but for medical students who are part of minority group based on gender or ethnicity Link   VESS Winter Date: 2/23-26, 2023 in Whistler, Canada Host: VESS Available scholarships for students 2022 VESS Next Generation Student Mentor Program To introduce medical students from around the country to the dynamic specialty of vascular surgery. To embrace the students and make them feel part of the fellowship atmosphere of the VESS annual meeting. To provide opportunities for meaningful interaction between the students and vascular surgery residents, fellows, and young faculty in attendance. The VESS will provide each student in attendance a $1,500 scholarship to defray the cost of travel to the meeting. Deadline: to be determined, but applications will open this summer Link    VRIC (Vascular Research Initiative Conference) Emphasizes the exchange of basic and translational vascular science  Date: 5/11/2022 in Seattle Host: SVS Available scholarships for students Vascular Research Initiatives Conference Trainee Award Award of 1,000 dollars for any trainee from pre-medical students all the way to fellows to present their research at VRIC conference Top-scoring abstracts submitted to the VRIC by trainees will be considered for the award. Deadline: past but should be recurrent Link   The Venous Symposium (Virtual) Date: 4/21-4/23 Abstract submission open until 3/24 Available scholarship for students Venous Symposium Physician-in-Training Scholarship Tuition for the 2022 Venous Symposium Virtual on Thursday, April 21 – to Saturday, April 23, 2022 On-demand access to the educational program and exhibit hall for an entire year Course materials and access to presentations online Deadline: no specific deadline, but reviewed regularly Link   VENOUS2022: Date: 2/23-26 in Orlando Hosting Organization: American Venous Forum (AVF)   SCVS 49th Annual symposium Date: 3/19-23 in Las Vegas Host: Society of Clinical Vascular Surgery (SCVS)   —--------------------------------------------------------------------------------------------------------------------------------------- SVS Foundation Student Research Fellowship Aimed to stimulate laboratory and clinical vascular research by undergraduate college students and medical school students registered at universities in the United States and Canada. Includes: a $3,000 award and a two-year complimentary subscription to the Journal of Vascular Surgery. Application: Needs SVS member as sponsor, and a letter of support from the sponsor Have a research plan and fill out a research plan instruction and form (Download here) Submit NIH style Biosketch and CV for both the student and sponsoring member Deadline: February 14, 2022 Link    Resources Getting Started Using the VQI for Research Getting Started with Basic Science Research   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 you want to address the question to (resident, fellow, attending, or someone specific) Send them in writing, or in voice recorded format.    Send them to [email protected]. Also send us any ideas, suggestions, or comments.   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.

In this month’s episode of our JVS Editor’s Choice series, Ryan discusses Journal of Vascular Surgery December’s Editor’s Choice articles with the Editor-in-Chief of the JVS, Dr. Peter Gloviczki. Video Summary of the Articles Articles Discussed: The Influence of Socioeconomic Status on Outcomes of Lower Extremity Arterial Reconstruction (CME and Editor’s Choice Article) A more proximal landing zone is preferred for thoracic endovascular repair of acute type B aortic dissections Outcomes of intramural hematoma involving the ascending aorta and extending into the descending thoracic aorta The Natural History of Large Abdominal Aortic Aneurysms in Patients without Timely Repair   JVS Journal Club January JVs Journal Club Website   If you enjoy our content, please contribute to Support Audible Bleeding!   Help us improve through our ALL NEW Listener Survey!   Follow us on Twitter: @AudibleBleeding   Credits: Guest: Peter Gloviczki Authors: Ryan Meyer, Andrew Lazar Editor: Yasong Yu Reviewers: Yasong Yu

In this month’s episode of our JVS Editor’s Choice series, Yasong and Gowri discuss January’s Editor’s Choice articles in the Journal of Vascular Surgery Venous and Lymphatic issue with the Senior Editor, Dr. Peter Lawrence   Dr. Lawrence’s Video Summary of the Articles Articles Discussed: Iliac Vein Stenting is Safe When Performed in an Office Based Lab Setting (CME Article of the Month) A randomized controlled trial to evaluate the safety and efficacy of transluminal injection of foam sclerotherapy compared to ultrasound-guided foam sclerotherapy during endovenous catheter ablation in patients with varicose veins The clinical significance of ultra-high D-dimer levels The economic impact of infection requiring hospitalization on venous leg ulcers   If you enjoy our content, please Support Audible Bleeding!   Help us improve through our ALL NEW Listener Survey!   Follow us on Twitter: @AudibleBleeding   Credits: Guest: Dr. Peter Lawrence Authors: Yasong Yu, Gowri Gowda Editor: Yasong Yu Reviewers: Eilidh Gunn

Vascular Origin Stories is a podcast series that explores the fun and engaging stories that shaped vascular surgery. In today’s episode, we will explore the different materials used to try and repair and bridge aortic gaps. We’ll see attempts to treat aortic aneurysms with ligation, banding, and occlusion. How Albert Einstein’s abdominal aortic aneurysm was treated with cutting edge 1940s technology: cellophane.  And how a young surgical research fellow, a stray suture, perseverance, and fast sewing machine skills ushered in the modern era of fabric grafts. For images and references, check our website here. Host:   Marlene (@GarciaNeuer ) is a 4th-year medical student at THE Ohio State College of Medicine.  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. Credits: Author: Marlene Garcia-Neuer Editor: Yasong Yu Reviewers: Adam Johnson and Sharif Ellozy Music from Kinemesis_Music , ArtSlop Flodur, Brolefilmer, Nesrality, JuliusH  from Pixabay

In today’s episode, Dr. Alaska Pendleton and Dr. Anahita Dua discuss vascular lab pearls for your VSITE exam and the RPVI.    Dr. Alaska Pendleton is a third year resident in the Integrated Vascular Surgery Residency at the Massachusetts General Hospital completing  her  second year of research. Dr. Anahita Dua is an Assistant Professor at Harvard Medical School and a vascular surgeon at the Massachusetts General Hospital. She is also director of the Vascular Laboratory and co-director of the Peripheral Arterial Disease Center there.   Episode created by Alaska Pendleton MD and Anahita Dua MD. Edited by Matthew Smith MD PhD Reviewed by Sharif Ellozy MD   If you enjoy our content, please contribute to Support Audible Bleeding! Help us improve through our Listener Survey! Follow us on Twitter: @AudibleBleeding

In this month’s episode of our JVS Editor’s Choice series, Yasong and Ryan discuss Journal of Vascular Surgery December’s Editor’s Choice articles with the Senior Editor of the JVS, Dr. Peter Lawrence.   Dr. Lawrence’s Video Summary of the Articles Articles Discussed: Cost-Effectiveness of TransCarotid Artery Revascularization versus Carotid Endarterectomy (Editor’s Choice Article) Predictors of Clinical Outcome of Fenestrated and Branched Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms in an Italian Multicenter Registry Claudicating Patients with Peripheral Artery Disease have Meaningful Improvement in Walking Speed after Supervised Exercise Therapy (CME Article of the Month) Outcomes of Bypass and Endovascular Interventions for Advanced Femoropopliteal Disease in Patients with Premature Peripheral Artery Disease JVS Journal Club December JVs Journal Club Website   If you enjoy our content, please contribute to Support Audible Bleeding!   Help us improve through our ALL NEW Listener Survey!   Follow us on Twitter: @AudibleBleeding   Credits: Guest: Peter Lawrence Authors: Ryan Meyer, Yasong Yu Editor: Yasong Yu Reviewers: Eilidh Gunn, Andrew Lazar