Matthew Smith

Grateful for the opportunity to present our @UWVascsurg @MattSmithVascMD experience with aTOS at @SeattleSurgical

@wasse_m @robshahverdyan @nick_inston @jimbog_76 @JeremyCraneMD @ASDINNews @VASAMD Have had good results with aneurysmoraphy. Ellipse skin out favoring one side. Mobilize aneurysm and reconstruct over 8mm balloon or 5ml syringe with quarter turn rotation to same side to move vascular suture line out of puncture zone.

🗣️ Vascular access surgeons: 12 yr old left brachial-basilic AVF. No stenosis on angio, but dialysis unit states ‘limited cannulation sites d/t aneurysms’. Do you: • Do aneurysmectomy (technique?) • Convert to a BB-AVG • Leave it alone

Excellent and timely article @katie_thomas, @anniewaldman, @andrewfordnews and @ikeswetlizt, thank you. If I were a patient with #PAD, this would scare the hell out of me, and probably should. A few important takeaways from this if you're a patient: -Doctors do get paid for procedures, so they are inherently conflicted in some ways. -In some settings, doctors can make tremendous amounts of money doing certain procedures, and this can be intoxicating and lead to overtreatment and nefarious business practices -Despite this, most doctors want to help you. But you should advocate for yourself and always consider a second opinion when you are offered a procedure. -All #PAD does not need a procedure! -Patients with claudication (pain in the legs when walking due to poor blood flow) most often don't need a procedure. -If you are a claudicant, you are very unlikely to lose your leg. And plaques/atherosclerosis/hardening of the arteries/peripheral arterial disease/peripheral vascular disease (all terms to describe the same thing) in your legs do not cause strokes or heart attacks (but are a marker of you being high risk for those problems) -If a doctor tells you that they think you should NOT have a procedure, listen! They are a good doctor. -If you can quit smoking(!!!), get on a statin medication (if you are able...even if your cholesterol isn't high), take an antiplatelet medication like aspirin, and walk, walk, and WALK some more, you will lower your risk of amputation and will improve your symptoms without a procedure -Nothing can MAKE you quit smoking, but your doctor can help you. -Sometimes atherosclerosis can be severe and become what is called Chronic Limb Threatening Ischemia (CLTI for short), manifested as pain at rest or leg wounds due to very poor blood flow, and this may require a procedure to save your leg. -Sometimes this can be done with wires, catheters, balloons and even atherectomy (little data, long story). Sometimes surgery ("bypass") is better! This is a complicated decision process and depends on the severity of ischemia, the extent of your blockages, and your overall health -Not all legs can be saved unfortunately, and sometimes amputation is the only treatment option. Your doctor can help you get through this, rehabilitate and it is possible to walk again afterwards. -Make sure to ask your doctor if they participate in quality registries such as the Society for Vascular Surgery Vascular Quality Initiative (SVS VQI) and the National Cardiovascular Data Registry (NCDR). Doctors that follow their outcomes are simply better doctors. @CaitlinWHicks @nichosbo @VascularSVS @ACCinTouch

@farkomd I don’t even consider that a choice but switch up the poll. Patients 80. Or 50 and only occluded to AKP. Or 50 and occluded to AKP with stenotic proximal SFA.

Young patient, 50, gangrenous toe, excellent saphenous vein. SFA and pop occluded below the knee. Three vessel runoff to foot. For vascular reconstruction which do you choose?

@cfbechara @doctormaxw How long do you wait before coming back for the endo? And is this just setting up for possible future intervention or are you using as alternate to bypass?

Endo changed the way we do open surgery. “Think forward”Even If sfa is occluded don’t give up on it, do patch into sfa/PFA or in this case eversion endart, this was done 5 years ago and my partner recently recanalized the sfa for cli, and stent into clean sfa away from PFA

From less than 50ft to almost symptom free. Sometimes it’s just as gratifying to “treat” claudication with education. Patient step calculator since initial visit 3 months ago (shared with pt permission)

The originators of the @AudibleBleeding podcast, reunited at #PNEC @Kniery_Bird and @MattSmithVascMD

@jmills1955 @Emaperidol wellness is being home with my family, cooking in my kitchen, and relaxing...not watching wellness modules...#foodforthought

#MTBM is back with Dr. Niten Singh, Associate Chief of @UWVascsurg and Program Chair of the upcoming @PNECSeattle!

@limbsalvagedr @jmills1955 @jmills1955 @limbsalvagedr Likewise what are your thoughts on treatment of the same patient who was treated with an equivilant SFA/pop stenting for CLTI who now has critical stenosis of these stents and new claudication?

#VASCtwitter How would u classify a pt w/a fem-pop for CLTI & tissue loss years ago, now presents with disabling IC and hemodynamically threatened bypass? is a pt with CLTI always a CLTI pt in remission or are they now IC with requirement of angio to maintain patency? @jmills1955

@benstarnesmd Incredible!

So amazed by my daughter Jessie’s Two Track at Berklee that aired tonight. Two of her original songs. Check it out… you won’t be disappointed. youtube.com/watch?v=HpJ1Ez… 

@westleyohman @JVascSurgCIT @randydemartino @JFreischlag @mhumphriesmd @G_Velazquez_R @WakeVascular @JHHVascular What are your thoughts on how much is high volume for this condition and you think it matters neurogenic versus venous or you’re talking primarily the operation?

@JVascSurgCIT @randydemartino @JFreischlag @mhumphriesmd @G_Velazquez_R @WakeVascular @JHHVascular Well, if the last one didn't break the internet, this one will... Outcomes matter, and why would we expect TOS would be one surgery where outcomes aren't reflected in high volume centers?

Q4: Should TOS mgmt, particularly 1st rib resection, be performed in "centers of excellence" or is this a basic procedure all vascular surgeons should master? #JVSCITTweetChat @randydemartino @JFreischlag @mhumphriesmd @G_Velazquez_R @westleyohman @WakeVascular @JHHVascular