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Vascular Disease Blogs
A RCA CTO Treated with the CrossBoss™ Catheter
*NOTE: Click on the image above to view a video clip of the CrossBoss
JM is a 70 year-old gentleman who has had coronary disease for 20 years. He presented with angina pectoris and inferior ischemia on stress Myoview. He has had previous bypass surgery with a patent internal mammary to the ramus intermedius and a patent left anterior descending artery (LAD) bypass saphenous vein graft. His right coronary artery (RCA) has been occluded for at least 5 years and his left ventricular function is fair, with an ejection fraction of 50% with mild hypokinesis of the inferior wall
Where Are the SFA Data?
Continuing on the theme of evidence-based medicine and an open dialogue, I want to further discuss the current state of lower extremity revascularization for patients with claudication and critical limb ischemia and focus on the treatment of the superficial femoral artery (SFA) for claudicative diseases.
The discussion was not very robust last month despite what I thought would be provocative statements. For this month, I want to ask a simple question: Where are the SFA data? Do we really think that any trial using a lesion length of 6–10 cm is one that would translate to the gen
The Value of Interdisciplinary Collaboration
The ability to learn from other disciplines is significant and we should not let these opportunities pass us by. I once read a caption which said "the mind is like a parachute, it works best when open!" Likewise, if we embrace a disease process and collaborate with other disciplines, we can learn a lot and advance patient care. One such example that I would like to open for discussion is whether patients who have undergone lower extremity endovascular interventions should be followed with non-invasive vascular studies. If a restenosis is found, then one can "prophylactically" intervene — eve
Early U.S. Use of the Mo.Ma® Device in a Woman with Coronary Artery Disease
The Mo.Ma® device, developed by Invatec (Italy) received FDA approval on October 22, 2009. This was approved by the FDA for use in high-risk patients undergoing carotid artery stenting (CAS).
Case Presentation
RS is a 58-year-old patient with transient ischemic attacks. She had previous bilateral carotid endarterectomy and severe chronic obstructive pulmonary disease which required oxygen. The patient also has significant ischemic cardiomyopathy with an ejection fraction of 30%.
The patient tolerated the occlusion of her common carotid artery during stent
Collaboration: A Good Thing!
Vascular surgeons have developed clinical and technical skills that allow us to care for many of our patients on our own. In light of this, I think many of us have forgotten that there is a benefit to our patients to have more than one opinion regarding their most optimal care. As mentioned in my last blog, I recently moved to a new medical center. One of the biggest transitions in my professional life is a setting in which I work side by side in the Heart and Vascular Center with other specialists, including neurologists and cardiologists.
I have taken care of several patients in a short p
Going into Zone 2: When should the left subclavian artery be revascularized during TEVAR?
I presented this topic during the recent ISET event (Figure 1), and I thought that further exposure and discussion were warranted, given the continuing relevance of the subject. While it is true that further clarity has been injected over the last few years, the matter remains largely unresolved. We could relatively easily find a number of international experts willing to defend the two extremes of the spectrum: on the one hand, there are those who maintain that the left subclavian artery (LSA) should be preserved essentially in all cases — all elective cases that is; on the other, there is
Embracing New Technology — Cautiously
As a vascular surgeon, I am constantly evaluating advances that help us care for our patients. I think this is especially true with the rapidly changing medical device technologies. I think we generally fall into three categories when considering new techniques: “the immediate-users, the wait-and-seers, and the complete naysayers.”
I have usually taken the “wait-and-see” approach. This is especially true for EVAR performed in a percutaneous manner. I have spoken to colleagues, heard about the training courses, and have seen some data in the literature. I have always said th
Novel Method of Ventricular Closure Following Transapical Access
BACKGROUND
Left ventricular direct access and sheath placement through a mini-thoracotomy has been utilized to allow minimally invasive valvular surgery. One potential problem encountered is the closure of the ventricular puncture incision in a beating heart. Our aim was to develop a sutureless closure technique which does not leave behind a foreign body exposed on the endocardial surface.
METHOD
We sought to evaluate this concept in-vivo in the porcine model. Thoractomy was performed with exposure of the beating heart. Six-French sheaths were placed in t
Welcome to the New Vascular Disease Management!
Just as the treatment and understanding of vascular diseases is ever changing, so are things at Vascular Disease Management. We are launching an entirely new way to communicate about vascular disease — this is the first blog, and we welcome your input and direction. This blog can include hot topics, questions regarding management of a patient or disease, or bring forth new ideas for all of us to share. We welcome your input and look forward to this new phase of Vascular Disease Management. Happy New Year!
Robert S. Dieter, MD RVT
Aravinda Nanjundappa, MD RVT
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Vascular Disease Blogs
- Robert S. Dieter, MD, RVT and Aravinda Nanjundappa, MD, RVT
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