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Preventive health: Getting rid of the middleman (uh-oh, that’s us!)
As physicians, we find that preventive health is, frankly, really difficult. It requires thinking about a changing list of recommendations unprompted by the symptoms for which patients present. Compounding that challenge is that, in doing preventive health well, we need…
Point/Counterpoint: Should FEVAR be used for a short neck?
FEVAR is generally the best option The advent of endovascular aortic aneurysm repair (EVAR) has steadily become the standard of care in the management of infrarenal abdominal aortic aneurysms (AAAs). In fact, it has now surpassed open surgical repair and…
CMS clinical trials raise cardiac mortality
Nearly 2 years ago I speculated in this column that health planners or health economists would attempt to manipulate the patterns of patient care to influence the cost and/or quality of clinical care. At that time I suggested that, in…
Carotid-axillary bypass for revascularization of the left subclavian artery in zone-2 TEVAR
Stent-graft coverage of the left subclavian artery (LSA) is often performed during TEVAR treatment of thoracic aortic pathologies and, consequently, debranching of the LSA is frequently performed in such settings. The carotid-subclavian bypass (CSB) is undoubtedly the cervical bypass option…
Tips and Tricks: Dealing with a troublesome peritoneal dialysis catheter
When faced with a poorly performing or nonfunctional peritoneal dialysis catheter, there is a very simple trick to make laparoscopic exploration easier. Prep the catheter into the field and take extra care to prep the cover of the catheter. It…
Tips and Tricks: Using a ‘Roman sandal’ after compartment syndrome treatment
Compartment syndrome is a common complication after revascularization for acute lower extremity ischemia. Treatment with four compartment fasciotomy can result in significant morbidity, with wounds that are challenging to manage for both the patient and practitioner. An alternative to wound…
Shinal v. Toms: It’s Now Harder to Get Informed Consent
Question: Which of the following statements regarding Shinal v. Toms, a recent landmark decision on informed consent, is correct?: A. The case was heard in the Pennsylvania Supreme Court and its decision is binding only in that state. B. It…
Letters to the Editor: ‘Endo hubris’ – We got letters
[Editor’s Note: Dr. Russell Samson’s June editorial, “Endo hubris,” discussed the balance between open and endovascular surgery. His article garnered the most reader comment we have yet received. The letters that follow carry on this important discussion with a variety…
Points/Counterpoint: Should surgeons operate on functional tricuspid regurgitation?
Yes, functional TR is worth repairing (David H. Adams, MD) Functional tricuspid regurgitation is a common finding in patients undergoing degenerative mitral valve repair. Severe tricuspid regurgitation is unusual, and clearly there is little debate on the merits of concomitant…
Mitigating Burnout – Part 3
It is easy to look at the changes required to mitigate burnout and improve compassionate care and see the burden being placed mainly on the physician. Many of the proposed modifications seem to require the one commodity surgeons lack most,…