Michael R. Go

Predicted shortage of Vascular Surgeons in the United States: Population and workload analysis

OBJECTIVE To estimate the size of the future workforce in vascular surgery (VS) and the added cost associated with addressing the projected shortage in the United States. METHODS The net supply (number of Vascular Surgeons [VSN] currently practicing, new graduates entering the workforce, and those retiring) for each decade was calculated. The projected population for each decade was determined by U.S. Census Bureau figures. Some assumptions of this model included: (1) In 2008, the population was 300,000,000; (2) There were 2783 board certified VSN in 2008; (3) VSN will practice 30 years from board certification to retirement; (4) There will be 105 board certifications and 93 retirements per year; (5) Vascular operations will remain at 284 per 100,000 population; (6) Salaries of trainees will be

Long-Term Complications in Two Patients After Aortoaortic Bypass for Midaortic Syndrome

50,000 with benefits of 30% and

Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese

15,000 of additional direct medical education costs. RESULTS Population and workload analysis suggests that there will be a shortage of 330 surgeons (9.8%) and 399 surgeons (11.6%) by 2030, respectively. The cost of training enough VSN (in a six-year program) by 2030 will be between

Mesenchymal tumour of the inferior vena cava

1,166,400,000 and

Cervical Rib Causing Occlusion of the Subclavian Artery and ThoracicOutlet Syndrome

1,199,520,000. CONCLUSIONS A conservative estimate by both population and workload analysis, disregarding aging of the population, lifestyle choices of future VSN, and increasing demand for services, indicates a shortage of VSN in the future. Unless the Balanced Budget Act of 1997 is revised by Congress, the cost to train the additional VS workforce remains a significant barrier.

Diagnosis and Rescue of a Kinked Pulmonary Artery Catheter

The midaortic syndrome (MAS) refers to descending thoracic and abdominal aortic coarctation, which is rare and most common in the pediatric population. Open surgical repair, often with aortoaortic bypass, remains a highly effective treatment and is traditionally thought to be definitive despite concerns over patient growth postoperatively. This article presents 2 cases of MAS treated with aortoaortic bypass who developed long-term complications, one related to patient growth and the other to graft-enteric fistula. Consideration must be given to patient growth at operation for MAS, and long-term follow-up is necessary to identify other complications.

Axillary–Femoral Bypass May Provide Inadequate Distal Perfusion Compared with In-Line Large Diameter Aortic Reconstruction

Introduction: Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. Methods: This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI < 35. Outcome was failed treatment resulting in residual pseudoaneurysm. Results: Our cohort consisted of 54 patients who underwent thrombin injection. There were 41 nonmorbidly obese and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures, of which 1 underwent successful repeat injection and 5 underwent open surgical repair. There was no statistically significant difference in failure between nonmorbidly obese and morbidly obese patients (9.8% vs 15.4%, P = .45). There were no embolic/thrombotic complications. Conclusion: Ultrasound-guided thrombin injection is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, UGTI should remain a standard therapy in the morbidly obese.

Endovascular Intervention for Pelvic Congestion Syndrome Is Justified for Chronic Pelvic Pain Relief and Patient Satisfaction

Abstract The aim of this work was to study the associations between weather conditions and the occurrence of type B acute aortic dissections (ABAD). This study was a retrospective review of all ABAD cases between January 1st, 2006 and December 31st, 2015. Using a time-series design and distributed lag non-linear models (DLNM), we estimated the relative risk (RR) of ABAD presentation associated with mean daily temperatures, including cumulative RR for a 28-day period, and RR for individual daily lags through 28 days. A total of 213 patients were admitted with ABAD. A significant association was found between the daily maximal temperature and the number of hospital admissions for ABAD. The lower the maximal temperature, the higher the incidence of ABAD (P = 0.044). Furthermore, the onset of ABAD was higher in winter than in summer and autumn (P = 0.009 and P = 0.001). Based on a time-series analysis, this study showed that the associations between mean daily temperature and ABAD presentation were not monotonic. Compared to the centered temperature at 8°C, the cumulative 28-day (lag 0 to lag 27) RR was significantly elevated at - 20 °C and - 19 °C for ABAD (RR = 1.39; 95%CI: 1.02, 1.98 and RR = 1.36; 95%CI: 1.02, 1.98). At the extreme low temperature (- 17.7 °C) in Shenyang, the cumulative 14-day (lag 0 to 13 day) and 21-day (lag 0 to 20 day) RR were remarkably increased for ABAD (RRlag14-day = 1.34; 95%CI: 1.08, 1.40 and RRlag21-day = 1.06; 95%CI: 1.06, 1.23). For the extreme high temperature, however, no particular finding was detected regarding acute and prolonged effects on ABAD. In general, low ambient temperature was significantly associated with ABAD presentations in comparison with high temperature. The effects of cold were delayed by two weeks and persisted for a few days.

Clinical evaluation of suspected deep vein thrombosis guides the decision to anticoagulate prophylactically but does not impact the decision to perform after hours duplex venous scanning or increase its yield

Purpose: To present an unusual case of a cervical rib as a cause of subclavian artery occlusion and thoracic outlet syndrome. Procedures: Case report Results: A 39-year-old female presented to the emergency room with a 2-day history of unilateral headache, facial tingling, and slurred speech, along with a 2-month history of left upper extremity weakness and coolness of the left hand. A stroke workup that included carotid duplex ultrasonography revealed findings suggestive of left subclavian occlusion, later confirmed on CT angiography. Neurologic workup suggested migraine, rather than ischemia, as the cause of headache; however, the subclavian occlusion prompted further investigation, including a chest radiograph that revealed bilateral cervical ribs. The patient was taken to surgery where her left cervical rib was excised and the chronically occluded left subclavian artery was found to have significant post-stenotic dilatation. Given that the chronic nature of her left upper extremity symptoms were not limiting, the decision was made to not undertake bypass. Recommendation was made to remove her right cervical rib prophylactically at a future date. Conclusions: Cervical ribs are a rare cause of vascular thoracic outlet syndrome, with compression leading to post-stenotic dilatation and symptoms of ischemia in the involved extremity.

Diversity in membership and leadership positions in a regional vascular society

Invasive hemodynamic monitoring with a pulmonary catheter has been relatively routine in cardiovascular and complex surgical operations as well as in the management of critical illnesses. However, due to multiple potential complications and its invasive nature, its use has decreased over the years and less invasive methods such as transesophageal echocardiography and hemodynamic sensors have gained widespread favor. Unlike these less invasive forms of hemodynamic monitoring, pulmonary artery catheters require an advanced understanding of cardiopulmonary physiology, anatomy, and the potential for complications in order to properly place, manage, and interpret the device. We describe a case wherein significant resistance was encountered during multiple unsuccessful attempts at removing a patients catheter secondary to kinking and twisting of the catheter tip. These attempts to remove the catheter serve to demonstrate potential rescue options for such a situation. Ultimately, successful removal of the catheter was accomplished by simultaneous catheter retraction and sheath advancement while gently pulling both objects from the cannulation site. In addition to being skilled in catheter placement, it is imperative that providers comprehend the risks and complications of this invasive monitoring tool.