First, let me express my gratitude to all of you for allowing me to serve as the President of the Southern Association for Vascular Surgery. Today, I will explore the state of vascular surgery education, including my personal view of the strengths and weaknesses. Then, I will review the aviation training model and, finally, offer a few thoughts on ways to improve vascular training. As we begin this journey, I would remind you that our education system is critical to our success as a specialty, and that each of us has a stake in the outcome.
When peripheral artery disease (PAD) affects the infrapopliteal vessels alone or in addition to the more proximal vessels, limb-threatening ischemia and tissue loss often occur. In the United States, between 150,000 and 300,000 cases of critical limb ischemia (CLI) are diagnosed each year.1 Within 1 year of diagnosis, 30% of CLI patients will have had a major amputation, and 25% will have died; at 3 years, the mortality rate is 60%, predominantly due to ischemic cardiovascular disease.2
Critical limb ischemia (CLI) is the “terminal” or “endstage” presentation of peripheral artery disease, defined by the presence of rest pain and/or tissue loss for at least 2 to 4 weeks that can be attributed to occlusive arterial disease. The diagnosis is clinical in nature. The presenting symptoms have been classified as Fontaine stages III and IV or Rutherford-Becker 4, 5, and 6, and the European Consensus Conference has also included the need for analgesia for more than 2 weeks or ischemic tissue loss with an ankle pressure of < 50 mm Hg as part of the definition.1 Anatomically, CLI is characterized by multilevel and multivessel infrainguinal and tibial arterial stenoses and occlusions that create a severe imbalance between supply and demand of oxygen in the affected tissues, compromising their viability and threatening limb loss. It is estimated that 1.5 million patients in Europe and 2 million patients in the United States older than 50 years of age manifest symptoms of CLI. Although CLI encompasses < 5% of all cases of peripheral artery disease, its prognosis is poor: the 1-year mortality and major amputation rates range from 20% to 50%.2-4
Purpose: To assess the feasibility and diagnostic performance of time-resolved computed tomographic (CT) angiography in the detection and classification of endoleaks after endovascular aortic aneurysm repair (EVAR) in high-risk patients.
Each year, critical limb ischemia (CLI) develops in 500 to 1,000 patients in a Western population of 1 million people. The disease is associated with 5-year mortality rates of ≥ 50%1,2 and an estimated cost of 2.7 billion dollars in 2007.3 Meanwhile, the rapid proliferation of new technologies has left the vascular specialist with an array of potential therapies to treat peripheral arterial disease (PAD), often without rigorous outcome data or cost-effectiveness information to guide responsible treatment decisions.
Patients suffering from critical limb ischemia (CLI) with nonhealing wounds are among the most complicated to treat. Limb loss is a potentially devastating event in a person’s life, often resulting in profound physical, psychological, and vocational consequences.1 Patients with CLI frequently exhibit multiple comorbidities requiring a specialized multidisciplinary team for optimal medical management. Improved awareness of the need for limb preservation has given rise to a concept, similar to that of wound care centers, that is increasingly referred to as a limb salvage or amputation prevention program. In 2009, Metro Health Hospital instituted an evidence-based amputation prevention approach that has evolved into StAMP (Stamping Out Amputation One Limb at a Time), an amputation prevention program. The implementation of a team approach led to a systematic process for patient screening, evaluation, treatment, and follow-up, with the collective goal of achieving the best patient outcomes.
Objectives: This study sought to investigate the feasibility and safety of percutaneous management of vascular complications after transcatheter aortic valve implantation (TAVI).
Purpose: To review emerging evidence regarding the use of bare metal (BMS) vs. drug-eluting stents (DES) in the treatment of infrapopliteal occlusive disease.
There is always room for improvement—medicine should never be about complacency. The “promise of the new” should always be a driving force in any discipline. This is how we progress. However, most of us are complacent and are happy to do what we do as long as it is working. Vein specialists need to admit that although we are doing quite well in the treatment of superficial venous disease (axial disease, branch varicosities, and spider veins/telangiectasias), there is work yet to be done. Albert Einstein said, “I do my best thinking when I’m bored.” We may feel bored with our current treatment options because they more or less enable us to achieve good results and satisfied patients. Also, we have been using them for more than 10 years. Perhaps now is the time to do our best thinking. I believe that in each area of superficial venous disease, there is room for improvement.
Objectives: This paper sought to report the outcomes of patients who are considered unfit for urgent surgical repair of ascending aortic dissections (AADs) who were treated using a novel endovascular repair strategy.
Objectives: This study sought to determine the relationship between vascular disease in different arterial territories and advanced age.
Purpose: To investigate the ionizing radiation dose, image quality, and diagnostic performance of computed tomographic (CT) angiography of the peripheral arteries with three different CT angiographic acquisition protocols, with use of pretreatment digital subtraction angiography (DSA) as the reference standard.
OBJECTIVE. The location, number, size, and configuration of intimal tears in aortic dissection have important therapeutic and prognostic implications. Planning of procedures to treat complications of aortic dissection may require precise delineation of the intimal tears. The purpose of this article is to illustrate the ability of MDCT using multiplanar image reformatting and virtual angioscopy to depict the location and appearance of intimal tears and fenestrations within dissection flaps in cases of thoracic aortic dissection.
Background: Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events.
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