Mona Ranade

PE Compass app available now at the Apple app store ! #medtech #pulmonaryembolism

@FarajAlkassMD @roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS Patient was considered non operable due to prior Ca history by both Vascular and GI surgery. Our advanced Gi said nothing to do. I didn’t know if stent grafts would develop a biofilm of the poly-microbes and continue to be a nidus for infection long term.

@msran124 @roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS Of course, the Venus bypass from from lower to upper body will be DC after deploying the stent. The reason for venous bypass is to gain time to get the aortic tube or transfer the patient to tertiary hospital. Just clarification for the few DM messages🤷‍♂️

Septic thrombophlebitis of IVC post aspiration thrombectomy with recurrent IVC Thrombus… Diagnosis ??? What would you do if you saw this ???@roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS

@mms62786 @roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS Yeah. I thought about stent grafts but not a candidate for explants and I don’t know the data on whether anyone can truly clear the infection.

@msran124 @roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS Oof..no good solution.

@CHICKVIR @roblookstein @TheRealDoctorOs @SDhandMD @SIRRFS Any surgery was considered not possible for this patient. I want to know if those that have used stent grafts ever get rid of the infection with long term abx?

@msran124 @roblookstein @TheRealDoctorOs @SDhandMD @SIRRFS Challenging situation, but very thoughtfully managed. I have treated similar cases with parallel, side-by-side stent-grafts, which achieved moderate-term success; however, eventual explantation was ultimately required.

@TheRealDoctorOs @roblookstein @SDhandMD @CHICKVIR @SIRRFS This was growing multiple Microbes- Candida and many other bacteria. I consulted surgery but they didn’t think explant was ever a possibility.

@msran124 @roblookstein @SDhandMD @CHICKVIR @SIRRFS Can you cover stent graft the whole thing - screw the renals and hope for no infection long term 🤕

@smbracewell @roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS Unfortunately not long enough of a tract that would hold a plug so I tried glue which held for about 24 hours. Then the patient rethrombosed. Surgery weighed in as non operable.

@msran124 @roblookstein @TheRealDoctorOs @SDhandMD @CHICKVIR @SIRRFS Prolly place a plug to temporize the bowel leak the get surgery involved

Wysdom Radio™ | Venous Stents: How Much Inflow is Enough? share.transistor.fm/s/1087eea9

PE Compass app available now at the Apple app store ! #medtech #pulmonaryembolism

PE Compass is in the app store ! If you haven’t had a chance to check it out yet ! Please do !!! Your feedback can help make it better (please ignore my amateur capcut skills)!!! apps.apple.com/us/app/pe-comp… @SIRspecialists @SIRRFS @CritCareMed @CardioNerds @VenousNews

@CHICKVIR @KECKSchool_USC @InariMedical @UWRadiology @drochohan @AustinBourgeois @MinaMakaryMD @IR_Doctor @NDiazLorenzo @SriniTummala @t_intheleadcoat @DaveJohnsonMD @IR_Ethics 😳 how did that fracture? In my experience fractures in catheters happen at transition points in the catheter and especially when crossing occlusions or stent interstices.

History of extensive right lower extremity deep vein thrombosis complicated by a fractured Lightning Bolt 7 catheter fragment with successful thrombus removal and foreign body retrieval using the ClotTriever Thrombectomy System. @KECKSchool_USC @InariMedical @UWRadiology

Check out this great podcast from CardioNerds/PERT Trainee Council collab! The Golden Age of Pulmonary Embolism Randomized Controlled Trials with Dr. Jay Giri cardionerds.com/458-the-golden…

@FarajAlkassMD @CHICKVIR @TheRealDoctorOs @SIRspecialists Perhaps I was overthinking it with Angiovac being more aggressive in circulating the microscopic polymicrobial elements. In terms of cost and set up here seemed easier to do the ECMO-less circuit but that’s precisely why i put this case up on X to get other opinions!

@msran124 @CHICKVIR @TheRealDoctorOs @SIRspecialists 💯any hardware is contraindicated in septemia and bacteremia . However,in certain situations like your patient and every critical patient going south, IFU can be modified or is off the table. Like my patient, it’s contraindicated to use AngioVac without full anticoagulation.🤷‍♂️

Septic (Candida) IVC thrombus extending into RA managed with MT, IVUS & ONO Vascular embolic protection to prevent distal embolization during thrombectomy. Any experience or thoughts on embolic protection in these challenging cases? @CHICKVIR @TheRealDoctorOs @SIRspecialists

@JayMathewsMD @keithppereira @CHICKVIR @TheRealDoctorOs @SIRspecialists I know 😂 🤦‍♀️

@msran124 @keithppereira @CHICKVIR @TheRealDoctorOs @SIRspecialists ONO's price is also OH NO!! 😂 💰💰💰

@FarajAlkassMD @CHICKVIR @TheRealDoctorOs @SIRspecialists Angiovac was thought to be contraindicated in this patient with septic PE, with Polymicrobial bloodstream infection - Persistent candidemia (Candida kefyr) & S. odontolyticus - both grew out in the extracted thrombus.

@msran124 @CHICKVIR @TheRealDoctorOs @SIRspecialists AngioVac is a good option coming from the jugular vein. Had pt similar presentation, thrombus up to RA. Young female ovarian CA with brain mets. satisfactory result despite the fact, no anticoagulation during procedure. Despite poor prognosis, pt &family wanted evrything be done.

Congrats to our graduating Stanford IR trainees! 🎉 Your hard work, dedication, commitment to patient care have been inspiring to witness. Wishing each of you continued success & fulfillment as you begin the next chapter of your careers @Stanford_IR @robertochavezmd

@keithppereira @CHICKVIR @TheRealDoctorOs @SIRspecialists ONO is advertised for intra cardiac retrievals of foreign bodies, but obviously given its safety and structure I could use it off-label as embolic protection by viewing the thrombus within the device under IVUS as I was performing aspiration.

@msran124 @CHICKVIR @TheRealDoctorOs @SIRspecialists Nicely done Mona......i have heard of this device, never used it. Is the funnel large enough? We use the Protrieve device

Congrats @akhileshsistaMD and team!