Joseph Sabat MD, PhD

@monteromiguel @limbsalvagedr @academicaorta Exactly. Months of wound care before sending them to the ER for “vascular evaluation” after the foot is no longer salvageable.

@limbsalvagedr @academicaorta My thought too. Systemic overhaul.

Regarding CLTI. In your opinion, what’s draining the system financially most? #medtwitter

@farkomd Did they shockwave the endpoint on an endart which also oh by the way had a pseudo?

Congrats on being first in #Canada but you’d be better off doing the right operation. IVL works well, it just doesn’t work on pseudoaneurysms

Proud of our former scribe and now second year medical student @im_danielnguyen for his 3rd publication @TweetPimaHeart #comprehensivevascularcare sciencedirect.com/science/articl…

@raimcsantos @farkomd @AWBeckMD @cfbechara @jmills1955 @RKTvascular @walter_boim @OckeReis White vein anybody?

📌73 yo, ♂, R. #popliteal #artery #aneurysm with 3 cm in diameter. High exit of the anterior #tibial artery. What would you do? 1 - OS 2 - ES #MedTwitter #AortaEd #VascularEd #Vascular #Surgery @farkomd @AWBeckMD @cfbechara @jmills1955 @RKTvascular @walter_boim @OckeReis

@Mancvascular @farkomd Some people still do completions :)

Non contract carotid stenting to protect kidneys. I’ll pick my brain over my kidneys. Disliked as much as carotid conduits. When did carotid disease become so difficult?

@farkomd I haven’t used any new GE units. Between the Siemens and Philips azurion I like the azurion a lot. Great imaging and easy to use, intuitive controls and fully customizable settings that are easy to use when you don’t have a dedicated radiology staff to run the machine

Your going to purchase a new fixed imaging system. Which would you pick? Comments appreciated

@BillBeckerman @farkomd Unfortunately I have heard of that happening. Didn’t go well.

@farkomd Just be happy they didn’t use CO2 for this angio. 🤦‍♂️

@farkomd Did he just use a super long stent to make sure he landed it?

@farkomd If you’re going with stenting- I average only about 3 -10 mls of total contrast on tcar, tops. Plus if that patient in the tweet had tolerated a cta I’m sure a few more ml’s of contrast wasn’t going to hurt.

@farkomd Does anybody routinely get cta of the head to look for aberrant circle of Willis anatomy?

Look Mom! No shunt, no flow reversal, no stent. Just an endarterectomy of a carotid soon to be patched

For everyone doing CEA and CAS, this CMS National Coverage Determination (NCD 20.7) is an important topic, and you should consider weighing in. This proposal: -Will expand CMS coverage to patients previously only eligible for tf-CAS in a clinical trial. -Will expand coverage to standard surgical risk individuals -Will remove facility standards and approval requirements -Provides no requirement for registry participation or reporting of outcomes A few important points to consider before we open the proverbial flood gates for tf-CAS: -Currently, there is no level 1 evidence that supports the use of tf-CAS over CEA or TCAR or medical management in standard surgical risk patients as this would allow. -The preponderance of existing literature demonstrates a higher 30-day stroke risk of tf-CAS over CEA (nice relatively recent review here: ejves.com/article/S1078-…) -There is an ongoing NIH funded clinical trial (CREST-2; clinicaltrials.gov/study/NCT02089…) that would provide Level 1 evidence towards this question. Why are we making this decision before this multi-million dollar trial is complete? -This proposal provides no requirement of ongoing monitoring of outcomes. -There is a significant learning curve for CAS (journals.sagepub.com/doi/10.1111/j.… among others), highlighting the importance of proper credentialing and following outcomes (especially for low-volume operators) -Ultimately, there is a significant risk of increased stroke in CMS beneficiaries with this change, with no method to capture the additional potential harm to our Medicare beneficiaries. At the very least, registry participation and reporting (as has been done very successfully with TCAR) should be required so that we can follow outcomes and change course in the future, if necessary. -We are currently learning lessons related to unfettered use of percutaneous procedures in outpatient settings. This seems to be begging for a repeat of that history, only in the world of CAS: propublica.org/article/maryla… nytimes.com/2023/07/15/hea… Submit your comments to CMS here: cms.gov/medicare-cover…

@ArjunMahadevan So if we put up with her EMR, we stand for it?

What if I told you there is a billionaire who controls your medical records. She started Epic Systems in a Wisconsin basement in 1979. And now she's the richest woman you've never heard of. 10 matter-of-fact messages from the Midwest billionaire, Judy Faulkner: 1. “If you see a snake, kill it; don’t form a committee on snakes.” 2. “What you put up with is what you stand for.” 3. "One of the things that made Epic strong when I wrote the original code was that it never occurred to me to do anything other than put the patient at the center. I developed a clinical system at a time when the health care world had pretty much only billing and lab systems available." 4. “I have never had any personal desire to live lavishly.  I’m probably among the billionaires who are indifferent to the lifestyle that great wealth can buy.  There is no apartment in New York or Paris.  There is no ranch in Aspen.  There are no private or even corporate jets.” 5. “I was a programmer, I thought it was fun.  I’m not sure in the beginning I felt that I’m here to save lives.  Why do you come to work?  For the paycheck?  For something interesting to do?  For customers?  For the competition?  For the mission?  If I had to circle one reason, it’s for my customers.” 6. “Programming is a mix of language, math and art, and I remain a software developer at heart.  And I have no plans to retire or even slow down.” 7. “[On living in Wisconsin] The first thing you’ve got to like is the people.  It’s the Midwest work ethic, the Midwest nice.  I was just in an area with gated communities.  I do like the Midwest where there is much more a feeling of… we trust each other.” 8. “I think it’s very interesting, the difference between ‘thank you’ and ‘congratulations.’  To me, ‘thank you’ makes it a personal thing, like you did it for me, and I don’t like to take that from a person unless it was something they did for me.  So, I prefer to congratulate them on a job well done if that was something they did themselves.” 9. “Many years ago I asked my young children what two things they needed from their parents.  They said ‘food and money.’  I told them ‘roots and wings.’  My goal in pledging 99% of my assets to philanthropy is to help others with roots – food, warmth, shelter, health care, education – so they too can have wings.” 10. “I took the route of higher education and took a risk starting a business.  My success didn’t happen overnight, but over time with steady improvement.” *** Remember: It's never too late to turn your dream idea into your dream business. *** That's a wrap. Hope you enjoyed these matter-of-fact messages from Judy. If you did: 1. Follow me @arjunmahadevan for more like this (and for more on how to turn your dream idea into your dream US business with @doolaHQ) 2. RT this, if you can, to share these messages with a friend

@farkomd @jmills1955 @thesurgerylife @mhumphriesmd I can’t remember the last time I turned someone down for tcar for a short runway. Very unusual.

@jmills1955 @thesurgerylife @mhumphriesmd If you have an over 5% stroke rate for a carotid intervention, even if symptomatic, it’s time to stop doing carotids

IMO The question that is more pressing than the conduit would be the over 5% stroke in the regular TCAR group (4 out of 77)

@MoridzadehMD @Philips @DanielMilesMD @SallySchonefeld @ChrisShanley5 @VascularSurgCS Was there a difference in size on ct v ivus here?

Young girl #MVA transferred urgently from outside outside hospital with blunt aortic injury. @Philips #IVUS invaluable for sizing. Pts often hypotensive at time of CT- aorta appears smaller 👉🏼 under sizing graft. @DanielMilesMD @SallySchonefeld @ChrisShanley5 @VascularSurgCS

#FightOnForever, Vin Scully. The voice of our city.

I finally became that stereotype surgeon playing late Friday afternoon golf. And I love it.

Very proud of our growing clinical research program now housed in its own center at Prince and Campbell here in Tucson pimaheartandvascular.com/for-patients/c… @TweetPimaHeart @joevascular @BaldermanMD “We don’t just follow the standards, we help set them”

@farkomd Had to watch it a second time to find the psoas 🧐

Follow the aorta, #AortaEd. Positive blood cultures, ++ staph. How would you treat. Based on CTA, what is nutritional status. Age in 50s.

@ErbenYoung @VascularSVS @LandisMD @SammySiada @Angela_Kokkosis Data from VQI is compelling in matched cohorts. And less CN injury is major benefit in anatomically appropriate patients @VascularSVS @joevascular @BaldermanMD

@VanessaKade @EddySabat Sounds like Eddy, quality human being