othman abdul malak

@AmputationSuck @GAEscobarMD @farkomd @ChengaziMD @ReneLizola @t_intheleadcoat @DrJayMohan @JayMathewsMD @kmadass @keithppereira @pparikhxr @SDhandMD This is the way perc until there is a problem and then cutdown until I forget the problem happened #recencybias also I only do perc access in patients I know will be compliant with the 6 hrs with arm flat, and that I know to be reliable if something was to change post discharge

@GAEscobarMD @farkomd @ChengaziMD @ReneLizola @t_intheleadcoat @DrJayMohan @JayMathewsMD @kmadass @keithppereira @pparikhxr @SDhandMD I feel seen! Patient had a neuro deficit from a very small hematoma. I cut down for a while…then went back to perc and holding pressure myself.

Critical RAS with refractory HTN - VS and IR collab with brachial cut down approach - patient was lanky and radial limited lengths. RCFA occluded, Left iliacs tortuous and moderate stenoses. Would you have gone groin first before considering cut down?

@farkomd Those are the things I didn’t know about the patient 😂😂, challenging case was there any occlusive disease as well or pure embolic phenomenon?

@prolenepapi Ceratainly an option. There was a fair amt of clot extending into aorta. Rising lactate and creatinine

Here is the problem, what is your solution?

Just about 1 week away! @FutureVascSurgn @VascularSVS @NextGenVascular sign up to hear more about our training program, meet faculty and residents, and ask questions!

@ahmadhamad4 @PittSurgOnc @OhioStateSurg Iconic, they’re lucky to have you!

From Research Fellow in 2016 to Complex General Surgical Oncology Fellow in 2025 — full circle at UPMC, this time as a family of 3. Grateful for the journey, the mentors, and the privilege to train here. @PittSurgOnc @OhioStateSurg

@Edith_Tz @UPMC_Vascular @HviUpmc @PittSurgery A great family to be a part of! Congratulations!

Sending 4 fabulous vascular surgeons out into the world! Congrats to Bowen Xie, Rohan Kulkarni, Michael Villareal & Maxim Shaydakov🍾🥳💜 Great surgeons but even better humans. You will always be part of our @UPMC_Vascular @HviUpmc @PittSurgery family. Always here for you!

@UPMC_Vascular @APDVS_ @FutureVascSurgn Welcome back rich!! The trainees are lucky to have you there!

Our trainees participate in the Fundamentals of Vascular surgery under the watchful eye of new faculty member Dr. Richard Redlinger @APDVS_ @FutureVascSurgn

@thesurgerylife Awesome thread Eli, most impressive is the q2 call. How often do you use bolt 7 for fempop instead of 12 Fr? 50/50? For compartment syndrome are you only doing rescue fasciotomy or do you still do prophylactic fasciotomy for some depending on ischemia time?

Tweetorial about how i approach Acute Limb Ischemia (ALI): Over the past 9 years with q2 call ive performed hundreds of ALI cases, my approach is endo first using mostly Penumbra for past 7 years with excellent limb salvage over 95% for ALI 1/2a/2b and compartment syndrome 5-10%

@thesurgerylife 😂😂😂😂😂

Is that part of #VAM25 ?

@EricKnauerMD @rbarbosa91 Will never forget when I was an intern one of our HPB surgeons heard me saying it was just a gallbladder. The next 5 mins are permanently seared into my memory.

@rbarbosa91 If it’s “just a gallbladder” might as well be “just a general surgeon”.

Many residents, when asked what they’re going to do after finishing, answer by saying ‘just’ general surgery. No one ever says ‘just’ pediatric or ‘just’ vascular surgery. General surgery seems to have an identity issue and it either needs to be legitimized or to disappear.

@DrJesseMorse Most likely thoracic outlet syndrome given his age and profession.

That’s a blood clot… How much you want to make a bet he received the COVID vaccine?

@ProleneQueen @farkomd @jmills1955 @canuc_57 @AmputationSuck 😮😮😮

@prolenepapi @farkomd @jmills1955 @canuc_57 @AmputationSuck Yup

Welp some of my colleagues are at it again! They are requesting hard data to support needing only a PFA to heal a BKA… help me out X peeps! @farkomd @jmills1955 @canuc_57 @AmputationSuck

@KprasMD @thesurgerylife @_backtable If you consider the lack of blasting yourself with radiation a positive and the back breaking of being under the imager, it negates cost, and is better for the interventionalist

@thesurgerylife @_backtable Super cool approach, will have to try and let you know how it goes!!!

@prolenepapi @_backtable I picked it up as an attending. Never had a clinically relevant embolization the key: - avoid forceful contrast injection adjacent to the arterial anastomosis prior to thrombectomy - start the venous thrombectomy first and leave arterial last with CAt12 fogarty is rarely needed

IMO most efficient way to do graft/fistula thrombectomy. I go IJ approach then 12F sheath and CAT 12 typically 1-2 passes and the fistula/graft is all open, single stick, no hands under fluoro, cleaner thrombectomy.. Anyone else doing this approach? #IR, #vascular ? @_backtable

@aridi_hanaa @farkomd The one situation I can think of that wasn’t mentioned on the thread, is presence of contralateral nerve injury with vocal cord dysfunction.

@farkomd Disclosure: I am still in training. But teaching is that patient’s at high surgical risk ( neck irradiation or dissection) would benefit from tcar as a minimally invasive option. For high lesions, why would i go to mandibular subluxation if i can simply place a stent if suitable

Let’s have a little debate. Please give me every anatomic risk factor for CEA. Then I’ll respond with appropriate data for each.

@thesurgerylife The best thing about this tweet is that it can reliably be reposted every 6 months and will still be relatable and accurate!! 😂😂

Accurate? 🤣

@AmputationSuck I think the real cost saving in ivus or any adjunct intervention/device is in longer patency and reduced re-interventions. I think the metric being hospital stay is why the cost saving was not in favor of ivus.

If there’s a lumen without a covered stent, IVUS makes sense 👊🏾👍🏾

@cfbechara @RushMedical Mabrouk! Hope it’s a year of prosperity and growth for you and the division under your leadership!!

Happy new year and happy new beginning @RushMedical for me as chief of vascular surgery. Day one was great, and back to white coat and blue scrubs! #letsgo