The clash between mission and revenue for not-for-profit, tax-exempt hospitals
Hospitals represent one of the largest industries in the U.S., with revenues greater than $1.4 trillion. The American Hospital Association reports that there are...
Invisible ties: The unique journey that landed one medical student on...
In the latest Corner Stitch column, medical student Bailey Richardson recounts the deeply personal life events that led to her unique journey into vascular...
Government Grand Rounds: A call to action for the 119th Congress
A foundational element for effective advocacy is understanding the profound impact that legislative decisions have on the practice of medicine and the health of...
Our patients need more Spanish-speaking vascular surgeons: An argument for medical...
Since there are more than 40 million Spanish speakers in the United States, training more bilingual physicians could potentially improve equitable care in Latino...
The good, the bad and the bloody: Reflections on the road...
As my third year of residency comes to a close, that little thing called The Match feels like a distant fever dream. The...
Corner Stitch: Navigating pregnancy as a vascular surgery trainee
As a vascular surgery resident, our training emphasizes anticipating and planning for complications. This mindset is undoubtably critical clinically but can be less beneficial...
Springtime in the world of vascular training
In places across the country, it's spring. March Madness is ending, flowers are sprouting, gardens are being planted, and trees are budding. In the...
The power of grassroots and grasstops advocacy
The progress in congress can seem overwhelmingly slow, especially considering the 118th Congress has only passed 27 pieces of legislation while holding over 700...
I’m just a bill: An overview of health-related committees on Capitol...
In the U.S., the legislative process is complex. Among the most important in this process are congressional committees, which play a pivotal role in...
Grit: The value of growth mindset and persistence as a vascular...
One of the biggest mental shifts I had to make during residency was my view on failure. I literally had to rebrand failure. As...
Budget neutrality and code valuation basics
So, what is budget neutrality and how does it affect physician payment? The Medicare Physician Fee Schedule (PFS) is a resource-based relative value scale...
‘Where are you from? Where are you really from?’
Vascular resident Saranya Sundaram, MD, shares a story of finding cultural understanding and community.
“It’s Sundaram, S-U-N…” I’m interrupted by a nurse asking me if...
Redemption through perseverance
In the late 1970s, a neurosurgeon at New York’s St. Luke’s Hospital operated on a beautiful, young, rising soprano who studied opera at a...
Beyond ‘do better’: New year reflections from a vascular surgery trainee
The new year is a time for reflection. It is also an opportunity to rededicate, or if needed, reinvent ourselves. Vascular surgery training is...
ESVS 2024 clinical practice guidelines on the management of abdominal aortoiliac...
The updated European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and...
Why should SVS members respond when they receive an invitation to...
The Society for Vascular Surgery (SVS) is an active participant in the American Medical Association (AMA)/ Specialty Society Relative Value Scale Update Committee (RUC)...
Government Grand Rounds: How SVS members can contribute to actively support...
While advocacy consistently maintains a top spot among the list of priorities for SVS members, there remains a degree of uncertainty among many in...
Corner Stitch: On the vascular trainee opportunities on the conference calendar
Christopher Audu, MD, surveys the 2024 meeting landscape, highlighting prime opportunities for trainees to showcase their research.
It is abstract submission, and this month I...
Carotid stenting rebuttal: Those who live in glass houses…
Christopher J. White, MD, responds to a recent editorial by Malachi Sheahan III, MD, that took a critical look at the decision by the...
Change: A driving force behind SVS advocacy initiatives
Change is a constant in life, and advocacy is no exception. The healthcare landscape is always evolving, and the SVS Advocacy Council is working...
The pulmonary arterial tree—it is time we branch out
Nicolas Mouawad, MD, chief of vascular surgery at McLaren Health System in Bay City, Michigan, urges vascular surgeons to “get out of their comfort...
On gratefulness as a vascular surgery trainee
I enjoy listening to podcasts. In addition to my usual rotation through Audible Bleeding and Behind the Knife, I’ve found insight in listening to...
The ‘modern’ VA has made great strides with patient outcomes and...
Data can be granular and clarifying. Conversely, data without appropriate context can lack nuance—like a paint-by-numbers portrait using only one crayon.
A recent article publivenshed...
Government Grand Rounds: Opportunity knocks as Congressional ‘busy season’ beckons
With the congressional “busy season” upon us, the SVS is gearing up for big tasks ahead on the legislative and regulatory fronts. Having stepped...
Corner Stich: Bridging knowledge gaps and meeting new demands of vascular...
This month in Corner Stitch, we highlight a trainee-centric study presented at the 2023 Midwestern Vascular Surgical Society (MVSS) annual meeting held in Minneapolis,...
Why CMS should still not extend reimbursement indications for carotid stenting...
This commentary—authored by Anne Abbott, PhD, MBBS, Lawrence Schott, MD, Lan Gao, MMed, PhD, Hrvoje Budincevic, MD, PhD, Rishad Faruqi, MD, Tatjana Rundek, MD,...
CMS: Proposed reduced conversion factor would cut vascular surgeon reimbursements
The Centers for Medicare & Medicaid Services (CMS) in mid-July released two payment-related proposed rules—the highly-anticipated calendar year (CY) 2024 Medicare Physician Fee Schedule...
Empowering vascular surgery to promote five pivotal healthcare bills before Congress
Welcome back to Government Grand Rounds, a campaign aimed at expanding vascular surgeons’ understanding of—and comfort with—the SVS’ many advocacy tools. In the dynamic...
Congress considers incremental steps towards Medicare payment reform
There is no doubt that the Medicare payment system needs reform. At this moment, the SVS is aiming to inspire reform through all facets...
Corner Stitch: Supplementing our formal learning as vascular trainees
As a vascular surgery trainee, there are multiple aspects of vascular surgery that I’ve had the opportunity to learn about. And to be honest,...
‘FDA’s mission to bring safe and effective vascular surgery devices to...
The Vascular and Endovascular Devices Team (VEDT) in the Food and Drug Administration (FDA) Office of Cardiovascular Devices appreciates the Vascular Specialist editorial board's...
Changing gears: A guide to cruising back to the operating room
For surgeons-in-training, professional development time (colloquially known as “the research years”) is a welcome break from the rigors of surgical residency. A time to...
Educational opportunities abound at VAM 2023
Ok, so day one has lived up to the hype. From hearing about amazing research endeavors to listening to lively discussions on the latest...
BASIL-2 and BEST-CLI: A tale of two limb trials
Optimal treatment of patients with chronic limb-threatening ischemia (CLTI) has been an ongoing debate within the vascular community, fueled by growing numbers of patients,...
Happiness, well-being and culture are key ingredients for seeking ‘eudaimonia’
Although researchers describe eudaimonia as the practice of virtues like courage, wisdom, good humor, moderation and kindness, some have translated the writings of Greek...
Corner Stitch: Navigating the technology landscape as a vascular trainee
I vividly recall sitting in the back of the conference room as a medical student and marvelling at the various approaches that could be...
Corner Stitch: Spotlight on VESS 2023
This month, Corner Stitch highlights one of the papers recently presented at the Vascular and Endovascular Surgery Society (VESS) 2023 winter meeting in Whistler,...
Letter to the editor: The virtue of a social media presence...
Dear editor,
I recently read an article in Vascular Specialist regarding the new age of the “vascular surgery influencer” that discussed how the world of...
Government Grand Rounds: Educating through advocacy
Since the initial launch of the Cancer Moonshot in 2016, the cancer community has made tangible progress towards ambitious goals, including accelerating scientific discovery...
Navigating the red tape: A case for hybrid ORs in the...
The United States military has access to the most cutting-edge equipment to perform its duties, so we should expect nothing less for its veterans....
Letter to the editor: The vascular influencer
Dear editor,
Reading “Likes, dislikes and reposts: The new age of the vascular surgery influencer,” by Drs. Jean Bismuth (@jeanbismuth) and Jonathan Cardella (@yalevascular), they...
From the SVS president: Supporting one another
The Society for Vascular Surgery (SVS) has a vision that is unwavering. We desire quality vascular care for all patients by providing our members...
Corner Stitch: What I wish I had known in vascular training
Welcome newly matched vascular surgery residents into the fold! I am just over six months into my first attending position after completing my residency...
More than a research project: The vascular trainee’s role in tackling...
One of my earliest clinical experiences with vascular disease was as a high school student shadowing at a busy urban hospital in Detroit. A...
Back to basics: All the things I love about vascular surgery
Recently, after completing a difficult open aortic operation with my attending, a bright M3 asked me, “Why vascular surgery?” The question didn’t catch me...
Learning culture, errors and Melinda French Gates
Workplace culture is fascinating to observe because it is nebulous and hard to measure. There is also often a perceived gap between the existing...
Corner Stitch: A reflection on 2022…
This month's column chronicles the exciting year we’ve had here at Corner Stitch. As the section editor, I’ve been most proud of the various...
Veterans Affairs: A call to surveillance
For many of those injured in combat, the transition in care from the Military Health System (MHS) to the Veterans Health Administration (VHA) can...
Bright future predicted for JVS internship program
This month on Corner Stitch, Christopher Audu, MD, profiles a new and innovative program offered by the Journal of Vascular Surgery (JVS). It’s called...
Signal-to-noise ratio: Thoughts on fine-tuning feedback during vascular surgery training
I recently took the Registered Physician in Vascular Interpretation (RPVI) exam. While studying for it, one of the concepts that stood out was the...
Corner Stitch: Audible Bleeding cuts down to vascular core
Many Corner Stitch readers subscribe to Audible Bleeding, the vascular surgery podcast for updates on all things vascular—from vascular knowledge, to reviewing key Journal...
A brilliant plan to increase vascular surgeons’ income—and decrease the incidence...
I have come up with a brilliant plan that will decrease the incidence of stroke nationwide, provide an excellent source of income for vascular...
DEI initiatives in vascular surgery: How are we doing?
The 2022 Vascular Annual Meeting (VAM) has been touted as the most diverse to date. As attendees ourselves, we can attest to the increased...
Innovation within the Veterans Health Administration
If one were to ask the average citizen where cutting-edge technology is developed, the most probable answer would be “private industry”; think Apple, Tesla,...
Patient-reported outcomes in vascular surgery are here to stay
In 2022, the Centers for Medicare and Medicaid Services (CMS) is again emphasizing the importance of patient-reported outcomes (PROs) through legislation regarding the Quality...
Confessions of a dual-trained, dual-practicing vascular-trauma surgeon
Like most of the other readers of Vascular Specialist, I look forward to perusing each release for not just useful information but also insightful...
Corner Stitch: A letter to new vascular interns
Every intern starting vascular surgery this year is incredibly talented, and soon to be a member of a tight-knit, supportive, and fiercely passionate group...
Mentorship: Why more vascular surgeons should consider mentoring young minds
Addressing challenges of diversity and inclusion within medical schools and the larger physician workforce should begin with a conversation about the intrinsic barriers to...
Getting the most out of meetings like VAM
It’s Friday at Vascular Annual Meeting (VAM) 2022 in Boston! Hopefully, many of us trainees are getting to mingle and meet leaders in the...
Discussing ERAS—Enhanced Recovery After Surgery
Enhanced Recovery After Surgery (ERAS) pathways have been beneficial for many surgical specialties and are now available to guide the perioperative care of patients...
From proposal to podium: Tips for getting your abstract accepted at...
Striving for excellence in research is one of the defining characteristics of an academic surgeon. But simply doing great research is not enough. The...
Moments suspended in time: Joining the vascular fold
Noon on March 19, 2021, marked the end of an unprecedented year in the world of resident recruiting. Months of virtual interviews, “away” rotations...
The pandemic has been a challenge, but perhaps it imposed some...
Years from now when we look back, will we measure time in terms of B.C. and A.C.—Before Covid and After Covid? It’s hard to...
Sex discordance and postoperative outcomes: We should be vigilant of a...
The recent JAMA Surgery publication “Association of surgeon-patient sex concordance with postoperative outcomes” is a population-based, retrospective cohort study of more than 1 million...
Diversity efforts while in training: Is it just another box to...
2020 was a herald year. It ushered in a global pandemic and a reckoning with issues of diversity, equity and inclusion (DEI) in our...
A balance is required with non-compete agreements in surgical practice
Unless prohibited by state law, most physicians employed by hospitals or physician groups are required to sign non-compete agreements (NCAs). A recent survey of...
Corner Stitch: From intentions to gratitude in 2022
A time of transition, like the dawn of a New Year, usually commences the mass drive for New Year’s resolutions and intentions. Many of...
VESS: A society primed for young vascular surgeons, trainees and medical...
Welcome to December where the calendar is filled with abstract and registration deadlines to various meetings through the summer of 2022. In this month‘s...
VSIGs increase early exposure to vascular surgery in med school
This month, we are focusing on medical student recruitment into vascular surgery. In many medical schools, students do not get any exposure to the...
‘Do not blame the legal system for the present state of...
I read with both interest and disappointment Dr. Andrew J. Meltzer’s guest editorial regarding medical malpractice published in the October issue of Vascular Specialist....
Journey of a trainee surgeon-scientist: Mentorship, passion and the importance of...
In August, University of Michigan general surgery resident W. James Melvin, MD, picked up the coveted Society for Vascular Surgery (SVS) Foundation Resident Research...
Prediabetes screening: ‘Target of reducing disparities should be geared towards advocacy’
On Aug. 24, the United States Preventive Services Task Force (USPSTF) published the newly updated recommendations regarding screening for prediabetes and type-2 diabetes mellitus.1,2...
Six top tips to help navigate interview season
Ahh October… The air is a bit cooler; pumpkin spice is in everything; and leaf colors are more dazzling. It’s interview season! If you’re...
‘Proceed cautiously in use of DCBs in CLTI patients with advanced...
The last several years have seen ongoing controversy and debate about the risks and benefits of paclitaxel-coated devices (PCDs) for patients with peripheral arterial...
PCBs: Panel of vascular surgeons review latest findings on paclitaxel-coated balloons
A recent meta-analysis by Konstantinos Katsanos, MD, of Patras University Hospital, Rion, Greece, and colleagues—“Risk of major amputation following application of paclitaxel-coated balloons ...
Corner Stitch: The art of surgery in the present moment
As a young surgeon-in-training, and a millennial, the concept of mindfulness and wellbeing perfuses my day-to-day life. Reminders of the importance of “being present”...
Corner Stitch: If you want to go far, go together
The COVID-19 pandemic left many of us missing social interaction and hungry for a change of scenery. As someone who had never been to...
Corner Stitch: Acing the final training years
In academia, the start of summer brings about new beginnings and a changing of the guard. Chief residents and senior fellows graduate and start...
Pearls of wisdom for interns
It’s June and, in less than a month, a swarm of new faces, and freshly minted MDs and DOs will descend upon most academic...
Being queer without proximal or distal control
“What do you mean your partner? Does that mean a man?” These were among the questions one of my mentors asked me when we...
A love for writing
Welcome to Corner Stitch, a brand new section by and for trainees. First up is outgoing Vascular Specialist residents and fellows editor Laura Marie...
SVS advocacy efforts help spark landmark change in research effort requirements
The recent decision from the National Heart, Lung and Blood Institute (NHLBI) to reduce the dedicated research effort from 75 to 50% for K...
Settled science: The indisputable link between EHR and burnout
The CEO of Epic, Judith Faulkner, recently made a statement questioning whether there was any evidence tying the EHR (electronic health record) to physician...
‘Latinx’: How to understand and use the term
Three members of the Society for Vascular Surgery (SVS) Diversity, Equity and Inclusion (DEI) Committee, chaired by Vincent M. Rowe, MD, explain use and...
OBL: In praise of the office-based interventional lab
Vascular surgery has undergone dramatic changes over the last 30 years. What was once a traditional open surgical discipline has now become a hybrid...
System outage alert: Cyberattack sends medicine back to paper age
On Oct. 28, 2020, the University of Vermont Health Network—consisting of six hospitals in Vermont and upstate New York, was hit by a cyberattack.1...
The benefits of an academic research career in the VA
Every year a number of graduating vascular trainees look for jobs in academic surgery to develop a career as a surgeon-scientist in basic, translational...
Flying lesson: King Air 559 Delta Whiskey
This article has little, yet everything to do with surgery. It is about decision-making under adverse circumstances. If you have not listened to the...
Professionalism: #Medbikini through the eyes of an aspiring medical student
The recent furor over the article published in the Journal of Vascular Surgery (JVS) about unprofessional behavior among recent vascular surgery trainees occasioned a...
Through the looking glass: Addressing bias in surgery
The #Medbikini campaign spread like wildfire following the publication of the journal article in question. Reading the manuscript seemed like we crossed the threshold...
Letter: ‘Women must not only have a seat at the table,...
Dear editor: Submitted with little fanfare to the Society for Clinical Vascular Surgery (SCVS) in July of 2019 and accepted later that year in...
Integrated vascular residency recruitment: Start pipeline earlier, engage more deeply
Our great specialty and the patients we serve face an impending critical shortage of vascular surgeons in the decade ahead. The Association of Program...
APDVS responds to #Medbikini, re-avows commitment to diverse workforce
Vascular surgery took the national stage during the last week of July as outraged medical professionals across the country responded to a visual abstract...
Vascular fellow: ‘Keeping your head down does not save you from...
Pain is often fully experienced in isolation. It’s these experiences that serve as some of the most defining moments in life. The history of...
‘I cannot remove my black skin’: Perspective of a vascular surgery...
For each of the past 10 days, I’ve woken up and asked myself the same questions: Do I matter? Does my life have as...
Virtual catch-up: Vascular surgery and coming around to telemedicine
Remote treatment of patients, so-called telemedicine, has been around since the 1940s, when it was first used for transmission of radiology images. In later...
To drain or not to drain? That is the question
Improvements in techniques of distal organ protection decreased the risk of spinal cord injuries (SCIs) from 30% to <5% with open repair of extent...
Embracing new definition of healthcare as digital age confronts holdouts
There is no doubt that the COVID-19 pandemic has challenged our healthcare system like nothing before. We have confronted other diseases like influenza, tuberculosis,...
Medical care in time of coronavirus: Handling patients without COVID-19
The patient was thin, pale and clearly frightened, although he tried not to show it. With poor English skills, he patiently sat on the...
SVS needs assessment survey: Evaluating impact of COVID-19 on vascular surgery
The COVID-19 pandemic has stressed the healthcare workforce with unprecedented challenges, the like of which has not been experienced in a century. In response,...
COVID-19: Socially distant yet never closer
We certainly live in interesting times—times in which social distancing has literally become the new normal. COVID-19 came to the United States quietly and...
Wellness: Of dreaming in blood and the ‘moral injury’ contained in...
Have you ever “dreamt in blood”? A vivid, waking nightmare that reminds you of exsanguinating hemorrhage that can’t be stopped? I have. An Iraqi...
Advocate or adversary? Perils baked into the relationship between physicians and...
Patients with complex illnesses may not be eligible for hospital admission unless their diagnoses meet InterQual Criteria or Milliman Care Guidelines—hurdles patients must first...
Letter from Seattle: Amid COVID-19 pandemic, time to act is long...
SEATTLE—We live in unprecedented times. On Jan. 19, patient zero arrived in the United States at Seattle-Tacoma International Airport after returning from a visit...
Early adaptation of SVS, STS TBAD joint document will drive robust...
The Society for Vascular Surgery (SVS) and the Society of Thoracic Surgeons (STS) recently published a joint document on reporting standards for type B...
How will coronavirus impact medical education?
The meeting, the seminar and the symposium: Collectively, this triumvirate of forum types forms one of the core elements of postgraduate medical education. These...
Deploying robust, detailed SVS VQI data to help better define role...
In December 2018, the Journal of the American Heart Association published “Risk of death following application of paclitaxel‐coated balloons and stents in the femoropopliteal...
Latest edition of USPSTF guidance produces essential reiteration, continuing to leave...
The United States Preventive Services Task Force (USPSTF) recently released an update to their 2014 abdominal aortic aneurysm (AAA) screening recommendations. The update is...
Global vascular guidelines for CLTI are gaining traction but work remains...
The application of new global vascular guidelines for chronic limb-threatening ischemia (CLTI) provides an opportune and worthwhile window to revisit the concept of critical...
PEARLS: A mnemonic to help handle adversity
There is accumulating evidence that adverse clinical outcomes have a negative impact on the clinician. As vascular surgeons, we are particularly vulnerable to feelings...
A call to address sexual harassment and gender discrimination in medicine
PART I
Reports of sexual harassment and gender discrimination have dominated news headlines, and the #MeToo movement has brought the scope and severity of discriminatory...
Legal duty to nonpatients: Driving accidents
Question: Driver D strikes a pedestrian after losing control of his vehicle from insulin-induced hypoglycemia. Both Driver D and pedestrian were seriously injured. Driver...
Who’s increasing health care costs? Not us!
Determining who is responsible for the increase in health care cost in the United States has seemingly limitless possibilities. There are enough culprits to...
The paclitaxel paradox
As medical editor of Vascular Specialist, it has always been my hope to use our excellent reporters and rapid production schedule to keep readers...
Patient, heal thyself!
Octavio has prostate cancer. His prostate growth is large but localized.
“What do your doctors suggest?” I asked him.
“They sent me to two specialists at...
Patients who want to make you retire, and how to cope
I was at a meeting in Orlando, sitting in the front row. The speaker was a former Disney executive who was telling us how...
Commentary: Should AVFs be ligated after kidney transplant?
Hemodynamic complications of arteriovenous (AV) access are uncommon but can be potentially life threatening. Fistulas and grafts can cause a decrease in systemic vascular...
Commentary: Bias rules
Bias can be defined as a prejudice or a preformed inclination. Bias is reflective of one’s inherent mind set about any thing, concept, ideology,...
Commentary: Physician burnout: It’s good to complain
Burnout among vascular surgeons and other physicians is a serious national epidemic that needs immediate attention by senior policy makers and health care leaders....
What I learned from Navy SEALs about resilience
In 2017, the National Academy of Medicine recognized the urgent need to address burnout, wellness, and resilience in physicians. A consortium was subsequently put...
Terminating an employee
I’ve written more than once about the private practitioner’s least favorite task. Most physicians find it so objectionable that they will tolerate marginal employees...
Understanding the terminology of gender identity
TRANSforming Gynecology is a column about the ways in which ob.gyns. can become leaders in addressing the needs of the transgender/gender-nonconforming population. We hope...
Medical ethics and economics
The balance between medical research and the pharmaceutical world has always been unsettling. The recent spate of articles in the press reporting the large...
Some patients leave a scar on you
Every surgeon has experienced the anguish of an adverse outcome. The elective aneurysm that dies on the table, the asymptomatic carotid patient that has...
Reflections on women in surgery
As I reflect upon the past year, 2018 has certainly made a mark for addressing burnout among medical professionals, enforcing wellness, and targeting implicit...
Burnout
Having taken the SVS “burnout” survey, I felt that it really never got into the “whys” of what was making individuals burn out. It...
The SVS is working for you on burnout
Following a series of Vascular Specialist pieces highlighting the crisis of surgeon burnout and the unique challenges that face vascular surgeons, the SVS Wellness...
Physician value thyself!
The Merriam-Webster dictionary defines value as “the regard that something is held to deserve; the importance, worth, or usefulness of something” and “relative worth,...
Continuous certification – Not just one more hoop to jump through
Maintenance of Certification (MOC) is an American Board of Medical Specialties (ABMS) requirement for their 24 member boards. The MOC process has received much...
Guest editorial: Best of both worlds
Within 3 minutes of the car engine rumbling to a roar in the morning air, cruise control is set, freshly ground coffee is in...
Should toe amputation be delayed in diabetic patients with osteomyelitis?
Amputation: Resistance is not futile!
What’s in a toe you may ask? Why worry about saving it? Just amputate and move on ...
Dr. Issam Koleilat
Not...
We need to reassess our primitive understanding of the venous system
If one includes the entire spectrum of venous disease, it is a more common pathology than peripheral arterial disease. The financial impact of venous...
Risking it all on the miracle of teamwork
On Feb. 4, 2018, with his team narrowly leading the New England Patriots in Super Bowl 52, Philadelphia Eagles head coach Doug Pederson made...
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...
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...
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...
Carotid-axillary bypass for revascularization of the left subclavian artery in zone-2...
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...
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...
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...
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...
Letters to the Editor: ‘Endo hubris’ – We got...
To the Editor:
Thank you for your article, “Endo Hubris.” Your observations raise many deeper issues in our specialty of vascular surgery. It appears we...
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...
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...
Special Report II: Tackling Burnout
Last month, we introduced the epidemic of burnout and the adverse consequences for both our vascular surgery patients and ourselves. Today we will outline...
Hard road disproving that statins make you dumb
The impact of lipid-lowering drugs on patients’ mental states was on the minds of many attendees at the American College of Cardiology’s annual meeting...
Taking a leap of faith
After a grueling first two years of surgical residency, I welcomed with open arms my surgical research years. Junior surgical residency was arguably the...
Upper arm loop grafts
Many forearm loop grafts have multiple outflow interventions before failure. These angioplasties and outflow stents create inflammation around the vein just above the antecubital...
Point/Counterpoint: Is endograft PAA repair durable?
Endovascular repair is durable
Endovascular repair of popliteal artery aneurysms is vastly superior to all other previous techniques of popliteal aneurysm repair. Half of all...
Open vs. endovascular for chronic mesenteric ischemia
Chronic mesenteric ischemia is best treated in an open operation.
Chronic mesenteric ischemia is a rare disorder accounting for about 1 out of 100,000 admissions.1...
The PERT Movement – Vascular surgeons must answer the call
Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States and remains the most common preventable cause of...
Point/Counterpoint: Is limb salvage always best in diabetes?
Salvage limbs at all costs
Aggressive limb salvage in people with diabetes leads to an overall reduction in cost not only economically, but also from...
SVS (Specialty of Vascular Surgery): Why, How, and When
The November 2016 issue of Annals of Vascular Surgery was devoted entirely to the history of the American Board of Vascular Surgery (ABVS) and...
Antibiotic resistance remains a challenge for hospitals
The Centers for Disease Control and Prevention just released a surveillance report describing national estimates of antimicrobial resistance among health care–associated infections (HAIs) in...
Idle intravenous catheters are associated with preventable complications
Intravenous catheters (ICs) are common and necessary for inpatient care. However, peripheral and especially central venous catheters (CVCs) are associated with increased risk for...
How to write a manuscript for publication
Writing should be fun! While some may view writing as painful (i.e., something you rather put off until all your household work, taxes, and...
Residency is like an IRONMAN
At the end of my junior surgical residency years, I was in a pretty bad physical and mental space. With resident coverage shortages, long...
Should clopidogrel be discontinued prior to open vascular procedures?
The continued use of perioperative clopidogrel is appropriate
Surgeons have always worried about bleeding risks for procedures we do. Complex vascular procedures are further complicated...
Commentary: INR instability in the NOAC era
Progress in the development of new oral anticoagulants (NOACs), as well as agents for their reversal, has lowered the threshold to use these therapeutics...
Commentary: Should board exams include a technical skill assessment? A European...
The incidence of vascular diseases is steadily increasing because of an aging population. Vascular surgery is the only specialty that can offer all modalities...
Tips for using EMRs effectively
All young physicians are adept at using electronic medical records. Do you agree? If so, you’d be wrong. It’s true that young, so-called “digital-native”...
A welcome addition
On behalf of the SVS Publications Committee I am delighted to announce the appointment of Malachi Sheahan, III, M.D., as Associate Medical Editor of...
Why be a vascular surgeon?
This edition of Vascular Specialist is being published early to coincide with the VAM. Since medical students will be attending the meeting I thought...
The end of polypill – statins for everyone
At a time when therapeutics is emphasizing personalized therapy, it is reassuring that someone is interested in the big picture. Treating a single patient...
General surgeons getting less vascular training
Vascular surgery fellow case logs reflect an increase in endovascular interventions, but general surgery residents may be missing out on training opportunities, according to...
Transitions
A few years ago I accepted an offer to work in a small community hospital. It was the only medical facility in a small...
Present vascular surgery challenges are magnified in our emergency rooms
The historical successes of emergent vascular care are known to many. The role vascular surgeons have played in providing experienced care in emergent situations...
Disappearing Act
By now you must be tired of my rants about other specialties making inroads into our “turf.” But a brochure came across my desk...
The ‘Silent Minority’
In May, Rebecca (Becky) Maron CAE, the first Executive Director of the Society for Vascular Surgery, is retiring. Becky played a pivotal role in...
Vascular Surgery Chronicles: Charles Lindbergh and Alexis Carrel: Strange Bedfellows
How does one of the smartest and most well-known men of his time become almost forgotten in history? Dr. Alexis Carrel’s contributions to medicine...
Elections?
The SVS is currently soliciting nominations for election to the positions of VP, Treasurer, and Secretary. Because this is an election year in the...
Law & Medicine: Which doctors get sued?
Question: Doctors are more prone to lawsuits if they:
A. Have been sued before.
B. Spend fewer dollars per hospitalized patient.
C. Show poor communication skills.
D. A...
Vascular surgery – it’s personal
Let’s get personal for a moment. The next time you walk past your local cancer center, pay attention to the signs, the branding, and...
Dealing with adversity in vascular surgery
Adversity is part of life and everyone must deal with it. How one manages adversity matters, separates the winners from the losers, and is...
Why you need a new SVS tie or scarf
Congratulations! You noticed that Vascular Specialist has a new look. And with your well-honed powers of observation you also noticed the inauguration of the...
Vascular: The Final Frontier – Pushing vascular science where no science...
Space is truly a magical place, enchanting philosophers, scientists, artists and dreamers. From ancient civilizations that found pantheons of gods among the stars, to...
Mischief Maker
There is a woman whose mischief is causing me a whole lot of problems. Now, I don’t want you to think that I’m a...
Analysis finds 28.8% prevalence of depression in residents
The estimated prevalence of depression or depressive symptoms was 28.8% among residents and interns worldwide in a meta-analysis of 54 studies of the issue,...
Brothers and sisters, unite!
In this month’s Vascular Specialist, there are two letters to the editor that seem to imply a division in the SVS membership. The letters...
I’m having an identity crisis
I’ve described my nightmares before. But they are becoming more frequent. Night after night I would see myself in an operating room or Endo...
The pros and cons of novel anticoagulants
Novel anticoagulants will likely replace need for vitamin K antagonists
BY MADHUKAR S. PATEL, M.D., AND ELLIOT L. CHAIKOF, M.D.
The discovery of oral...
Using a retrojugular approach to the carotid
Carotid endarterectomy is one of the most common operations for vascular surgeons. The standard approach, anteriorly, requires division of the facial vein, frequently additional...
From the Editor: The elephant in the operating room
Once again hospital administrators in their never-ending quest to reduce expenditures have placed vascular surgeons at a disadvantage. First they reduce the inventory of...
The six Ps of vascular surgery
Vascular Surgery has evolved to balance clinical medicine, open and minimally invasive surgical interventions, and innovation into a unique career where technological advancement is...
Witch hunts and hidden agendas
Witch hunt: An intensive effort to discover and expose disloyalty, subversion, dishonesty or the like, usually based on slight, doubtful or irrelevant evidence, and...
‘Medicar’– shared decision making? part III
Recently, my daughter asked my opinion of a salesperson’s suggestion that she spend extra for additional safety features on a new car she was...
From the Editor: Knights of the Rectangular Table
In my past editorials I have made it abundantly clear that I believe that vascular surgeons, like the Knights of the Round Table in...
From the Editor: What’s in a name? In the case of...
It is apparent from the many letters I have received as medical editor of Vascular Specialist that vascular surgeons are disappointed that our patients,...
Medicare at 50: Physicians brace for transition to value-based payment
As Medicare celebrates its 50th anniversary, federal officials are beginning one of the most significant shifts in the program’s history – paying physicians based...
Shared decision making? Part two
In a previous editorial I outlined the problem with performance measures that demand that we incorporate the patient into our decision-making process. From the...
From the editors
Editor’s Note: The associate editors of Vascular Specialist were asked to provide their perspectives on the stenting controversy. Here is a selection.
Dr. Frank J....
More on the PAD stenting issue
I suspect that most members of the SVS are aware of the recent New York Times article entitled “Medicare payments surge for stents to...
Private-academic surgeon salary gap raises concerns Lifestyle choice important Not just...
LAKE BUENA VISTA, FLA. – Academic surgeons earn an average of 10% or $1.3 million less in gross income across their lifetime than surgeons...
Letters to the Editor
Editors note: The following are a selection of responses from the SVS membership sent to Dr. Peter Lawrence based upon his article in a...
Using the gracilis muscle flap
Muscle flaps have come to play an invaluable role in the management of complex groin wounds (Figure 1). We have found that the gracilis...
The 10,000-hour rule
In 2002, the Accreditation Council for Graduate Medical Education, or ACGME, rocked traditional residency training paradigms by proposing a regulated residency call schedule.1 Revised...
From the editor: New column launches
This month we are introducing a new feature in Vascular Specialist – a column on medicolegal matters. After all there are few issues that...
Reducing radiation exposure
SCOTTSDALE, Ariz.– “It’s surprising to me today, when I go proctor or watch a case, how people don’t understand the impact of radiation,” Dr....
Shared decision making?
Recently I read a blog by Dr. Ira Nash at the blog site, KevinMD, where Dr. Nash suggests that it behooves physicians to fully...
Residents reluctant to recommend DNR to patients
BOSTON – Medical residents in the United States appear to understand that cardiopulmonary resuscitation or intubation is highly unlikely to benefit patients with advanced...
TLR – Target lesion recurrence
In November I attended the VEITHsymposium in New York. Almost 600 experts from around the world gave lectures on every aspect of vascular surgery....
Some things vascular surgeons should know that they don’t learn in...
All vascular surgeons want to be good doctors and to take the best possible care of their patients. They, therefore, train diligently and strive...
Reduced resident duty hours haven’t changed patient outcomes
Patient mortality and morbidity outcomes have not changed since the most recent round of reforms to medical residents’ duty hours in 2011, according to...
Last night I had a nightmare
In the dream I had an asymptomatic 5.7-cm juxtarenal abdominal aortic aneurysm. Like most of my patients I also had a 70% left internal...
EVAR vs. open repair for rAAAs
Although some vascular surgeons are convinced that endovascular aneurysm repair (EVAR) is superior to open repair for the treatment of ruptured abdominal aortic aneurysms...
Point/Counterpoint: Is TEVAR required for all Type B aortic dissections?
Yes, TEVAR is clearly indicated.
Aortic dissection is a devastating condition afflicting an estimated two to eight per 100,000 people annually and comprises a large...
Helping history come alive online in Vascular Specialist
Medical history is more than just the praise of great heroes and heroines and the nearly mythical stories of serendipitous discovery and invention. It...
Pioneer Heart Surgeon, Dr. Michael DeBakey
Dr. Michael Ellis DeBakey, pioneer heart surgeon and medical device innovator, died July 11, 2008 in Houston, about 2 months shy of his 100th...
Pioneers of Heparin
The ready availability of nearly unlimited quantities of biologically-based drugs such as heparin is something that is taken for granted nowadays, such that massive...
Alexis Carrel, the “Father of Anastomoses”
In the first years of the 20th century, Dr. Alexis Carrel (1873-1944) introduced three-point end-to-end vessel anastomosis, a technique that revolutionized vascular surgery. His...
Valentine Mott and the Innominate Artery
Well before the American Civil War, without benefit of anesthetics and without antiseptics, Dr. Valentine Mott performed some of the first successful operations on...
Five reasons physicians will use mobile health for patient care
Mobile health technologies will become a part of the health care landscape for all stakeholders at some point. Other sectors of society currently cannot...
Steps to incorporate business knowledge into the medical school curriculum
Declining reimbursements, health care law changes, and increased costs means the modern physician needs to have knowledge in business, law, and medicine. In today’s...
The ‘I’s have it: Ethics and the vascular community
Who in their right mind would organize the main event of a surgeons’ convention around the topic of unnecessary procedures? Surely this would almost...
IIb or not IIb?
I must admit that Shakespeare was not one of my favorite subjects at school. However, his words have relevance to some of my thoughts...
Crawford Forum: Are procedures overused?
BOSTON – This year’s F. Stanley Crawford Critical Issues Forum, titled "Appropriate Use of Vascular Surgery Procedures: Do We Have a Problem?," was a...
Just do it?
The typical American world view has always extolled the virtues of positive thinking. From the pilgrim fathers to the Western settlers, we pursued goals...
What would Charles Darwin say about collaborating with and training other...
Vascular surgery has evolved from a limited subspecialty of general and thoracic surgery into a complex and well-defined specialty. The introduction of endovascular treatments...
Residents, postop complications linked
BOSTON – Resident participation in emergency general surgery cases was independently associated with a host of complications – pulmonary embolism, surgical site infections, and...
COMMENTARY: How and why to perform research as a trainee
"Why do I need to do research if I'm going into private practice anyway?"
I have heard this question multiple times throughout my career...
‘Walk out the snot’
Balloon embolectomy revolutionized the treatment of acute thromboembolism involving peripheral arteries. However, an often overlooked method that actually may be more beneficial is to...
What happened to 5-year outcomes?
I recently returned from Professor Roger Greenhalgh's excellent Charing Cross meeting in London. A plethora of exciting new developments was presented to almost 4,000...
The USPSTF says ‘Don’t do it’
The United States Preventive Services Task Force (USPSTF) recently issued a draft document recommending against screening for carotid artery disease in asymptomatic patients.
The draft...
The ACA, the private practice of vascular surgery, and SVS: A...
As I view the implementation of the Patient Protection and Accountable Care Act (ACA), I am concerned that this bureaucratic, administrative, directive-driven apparatus will...
A band of brothers and sisters
In this online issue of Vascular Specialist, we mourn the passing of five pioneer vascular surgeons. One of these, Dr. James DeWeese, worked with...
Percutaneous closure
Editor’s Note: I urge readers unfamiliar with the Perclose Proglide® device to pay special attention to the instructions for use and to follow them...
Yes, give more patients statins
The question of whether or not to give more healthy patients statin drugs is one of considerable interest to the public and much debate...
Challenges in Training: Open repair in 2020
Since FDA approval of endovascular aneurysm repair in 1999, the management of abdominal aortic aneurysms has transformed. Only 5.2% of AAAs were repaired by...
‘Anti-Semantic’
I am ashamed to admit this, but I think I am becoming an "anti-semantic!" Surely it is scandalous that an editor is beginning to...
Invisible ink
Sometimes I feel like I am writing in invisible ink. I write these editorials but I have a feeling no one is actually reading...
How To Maximize a Minimal Incision
Mini-incision carotid surgery was first reported (not necessarily performed) by Ascher et al. in 2005. In light of this report and an ever-growing patient...
Welcome Our New Resident Editor
We are pleased to have Dr. Sapan S. Desai come on board as our Resident/Fellow Editor for the next year. Dr. Desai was selected...
Calling SOS — Save Our Saphenous!
For a specialty with less than 5,000 members in the United States, vascular surgery certainly has an abundance of societies – SVS, SAVS, ISVS,...
Veith’s Views: The Blacksnake Phenomenon
Two young men went camping in the wilderness. One of them went off to gather firewood. He returned an hour later, staggering, badly battered,...
‘That 5% Thing’
On a recent flight back from Europe I had a most unsettling but thought provoking experience when I watched the Oscar-winning foreign movie "Amour."
You...
Ten tips for chronic venous ulcers
The underlying pathophysiology of chronic venous insufficiency is complex and involves many factors. Studies have shown that average venous ulcers may need 6-12 months...
Democracy – best, but only if….
A stated goal of the United States is to support and promote democracy throughout the world. This seems reasonable, because democracy has often worked...
From the Editor: Let the ‘Sunset Act?’
The Physician Payment Sunshine Act is now in place, and I’m concerned that it may become the "Sunset Act" since it may be another...
Keep RUC in mind
In July, the Society for Vascular Surgery sent requests to its members to complete surveys regarding the work involved with creation, revision, and thrombectomy...
Stopping the ooze
Many of us will do anything or use any product available to stop oozing from suture needle holes. After all, waiting for bleeding to...
SVS Resident Research Prize given to AAA study
Dr. Nathan D. Airhart, Washington University School of Medicine, St. Louis, was the recipient of this year’s SVS Foundation Resident Research Prize Paper, which...
Forecast from your new editor
I am extremely thrilled to be named the new editor of Vascular Specialist. Uniquely unblemished by commercialism, Vascular Specialist has provided updated information with...
Veith’s Views: Second opinions are overrated
A middle aged man goes to his primary care physician for his annual check-up. Because of an abnormal physical finding or laboratory test, he...
Professional Courtesy
In an early Peanuts cartoon Charlie Brown asked Linus what he wanted to be when he grew up, and Linus replied that was going...
Kudos to our departing Medical Editor, Dr. George Andros
Dr. George Andros, departing Medical Editor of Vascular Specialist, was presented with a Presidential Citation Award by Dr. Peter Gloviczki in recognition of his...
Ancient Aneurysms
Before anesthetics, before antibiotics, before surgery had even become a scientific discipline, surgeons throughout history did not shy away from the treatment of aneurysms,...
Questions on OECs
Several months ago we asked our readers to respond to an eleven-part questionnaire dealing with outpatient endovascular centers (OECs). Forty-three of you took the...
The FREEDOM trial: Is it sui generis?
I have never understood how the cardiology community is able to organize so many excellent trials while vascular surgeons struggle to complete a small...
Veith’s Viewpoint: Good doctor, good medical care: priceless
Today all we hear about is the high cost of U.S. health care, and how for our country to survive economically, it must cut...
Vascular Chronicles: EVAR: 20 years in North America
The first endovascular treatment of an abdominal aortic aneurysm (EVAR) in North America was performed 20 years ago last November. Dr. Juan Parodi, Dr....
Endovascular Therapy First for All CLI?
The Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC I), published in January 2001, resulted from cooperation between fourteen medical, radiological...
Welcome to our Online Edition and a New Voice
This issue's editorial is a calling card by our newest editorial board member, Dr. Joseph Mills of the University of Arizona. Demography is destiny....
The Affordable Care Act: Oversight on Providing for Graduate Medical Education
For more than 50 years, the federal government has accepted the responsibility for financial support of graduate medical education. Legislation passed during the 1960s...
General Residents See Fewer Aortic Surgeries
MILWAUKEE – General surgery residents in a community-based residency program experienced a significant 49% decline in open aortic surgeries over the last decade, an...
Solving the Surgical Workforce Dilemma
"For every complex problem, there is an answer that is clear, simple, and wrong."
– H.L. Mencken
Every time I think about trying to solve the...
The Prince of Surgery: Sir Astley Cooper
Imagine ligating an arterial aneurysm in the early 1800s, when clipper ships were the fastest mode of transport. Thomas Jefferson was still President and...
Primary Care Physicians Don’t Get Patients Well
(Editor's Note: Read Dr. George Andros' introduction to this installment of Veith's Viewpoint.)
The Affordable Care Act (ACA) has the laudable goals of extending health...
Who Gains, Who Pays?
Once you’ve read this month’s Veith’s Viewpoint, you will see it doesn’t shy away from topical and highly controversial realities that will come into...
Outpatient Endovascular Suites: Are They Good for the Patient or the...
Vascular surgeons, as well as related specialists, have increasingly become involved in the ownership of outpatient endovascular suites as proprietors (individual or partnered with...
Welcome to the August Online Issue: Take the SVS Survey
When the Society for Vascular Surgery (SVS) was approached to become involved in assessing vascular out-patient centers (OEC) the Clinical Practices Committee (CPC) convened...
Rudolph Matas, M.D.
Rudolph Matas, M.D, is yet another of the famous surgeons of the past 2 centuries to whom the sobriquet "father of Vascular Surgery" has...
John Hunter and the Vasculature
"If Hunter were to return to life, nothing, I believe, would grieve him so much as the fact that tying the femoral artery where...
E. Stanley Crawford
Ernest Stanley Crawford (1922-1992) was an internationally renowned cardiovascular surgeon whose greatest technical work involved innovative surgical techniques in the treatment of complex aortic...
Michael E. DeBakey
Dr. Michael Ellis DeBakey, pioneer heart surgeon and medical device innovator, died July 11, 2008, in Houston, about 2 months shy of his 100th...
Applying Education Theory to Vascular Training
Citing a revolution in the way surgeons learn their craft, Dr. Erica L. Mitchell and Dr. Sonal Arora present an analysis of vascular training...
Veith’s Viewpoint: Vascular Surgery and Creativity
Vascular surgery is an exciting field. It also faces enormous challenges. These include a difficult economic climate and intense competition from other specialties, both...
Dealing With the Disruptive Surgeon
"Get this thing out of my operating room! The colon stapling device exploded into pieces when I hurled it against the operating room wall."
Most...
Veith’s Viewpoint: Extend and Fix the Sunshine Act, or End It
The Affordable Care Act (ACA) has the laudable goals of extending health care insurance coverage and reducing overall health care costs. However, hidden in...
Veith’s Viewpoint: The Vascular Disease Paradox
Vascular patients who most need treatment are often difficult and risky to treat by open operation or an endovascular intervention. In contrast, patients who...
February Fix-Up
Welcome to the February online edition of Vascular Specialist.
We all had hoped for more but had to settle for another temporary fix to the...
Einstein’s Aneurysm: Of Cellophane and Rudolph Nissen
In December 1948, Dr. Rudolph Nissen, later famed for his esophageal surgery technique called fundoplication, operated on Albert Einstein, at the Jewish Hospital in...
‘Our What’s In It For Me’ Society
These are hard times for the United States. Our economy is floundering. Unemployment is high. Bankers and financiers seem to be getting away with...
A Thoughtful December
Welcome to our December Online issue. I hope you all have a happy holiday season and as prosperous a new year as Congress will...
Editor’s Diary
A vascular surgeon friend from the Midwest recently stopped by my office here in Southern California. His visit gave me a chance to compare...
Can RCTs be misleading and biased?
Randomized controlled trials (RCTs) constitute level 1 evidence, which is widely considered the best data upon which to base medical practice. This is particularly...
Introducing Our New International Editors
If our readers have any doubt, all they need do is casually scan the program for the recent VAM in Chicago or examine the...
APDVS: Tapping the Minds of Vascular Trainees
CHICAGO – Vascular surgery trainees are increasingly turning to online texts for clinical information and seek more training on the business aspects of vascular...
Impact of Fellowship Programs on Residents’ Case Logs Examined
BOCA RATON, FLA. – Coexisting subspecialty fellowship programs have at most only minimal adverse impact on general surgery residency training operative volumes, according to...
Vascular Surgery Chronicles
Ernest Stanley Crawford (1922-1992) was an internationally renowned cardiovascular surgeon whose greatest technical work involved innovative surgical techniques in the treatment of complex aortic...
About The Residents’ Forum
With this issue, we begin a new column which we have chosen to call Residents' Forum. We hope that Vascular Residents, Fellows, and others...
Fear and Loathing on the Interview Trail
As we strive to provide the most advanced care possible to our patients with vascular disease, there is one area of our practice that...
Vascular Surgery Chronicles: Michael E. DeBakey
Dr. Michael Ellis DeBakey, pioneer heart surgeon and medical device innovator, died July 11, 2008, in Houston, about 2 months shy of his 100th...
