Greg Hayes
@canuc_57
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Chief of Vascular Surgery @ProvSwedish . alum @UofTSurgery @UofTVascular 🇨🇦 @shocktrauma Triple Boarded #aorta #carotid #dissection #CLI #spineaccess
Seattle, WA
Joined May 2016
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#whipple
#pancreaticcancer
#oncovascularsurgery
#vascularsurgery
#surgicaloncology
resection portal vein-SMV with interposition tubularized bovine pericardium
@VascularSVS
@CanadianSVS
@docpark
@MaherSabalbal
@farkomd
@AWBeckMD
@mattsmeds
@JamesHBlackMD
@mhumphriesmd
@MJLenihan
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#vascularsurgery
Residents and fellows, what is the operation depicted here and what is it’s indication?
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@nickmmark
@VascularArtist
If the patient consented and it’s totally redacted, I typically wait at least a few weeks to post it
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0
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@joannagiddens
@nationalpost
A surgical saviour???? Since when do we refer to murderers as saviours of any kind?
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Received 2 calls from ER between 12:00-3:00 AM to discuss patients with claudication. ER doc wanted to admit for work up. Same response each time, “claudication is never an emergency”.
#claudication
#vascular
#PAD
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2
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@farkomd
I’ll call your fellow, and raise you my chief resident
@SwedishSurgRes
, she’s starting her vasc fellowship in 6 mos.
#CEA
# vascularsurgery
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#breastcancer
Surgeons who insert port-a-caths, please access the IJ preferentially. Complications from DVT/occlusion are much more frequent when the subclavian vein is accessed.
@SIRspecialists
@VascularSVS
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@VascularForum
“They” can try all they want, however no interventional procedure will ever match the outcome of a
#CEA
performed by a well trained experienced
#vascularsurgeon
.
#carotid
#carotid
stenosis
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@PipeCabreraV
@BBASS_skills
@rbarbosa91
@pferrada1
@David_ukan
@XavierBerardMD
@VasculonR
@docpark
@AWBeckMD
Don’t be afraid to sew forehand out-to-in on the aorta. It’s an old wives’ tale one has to see in-to-out.
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@farkomd
Wait wait! Claudication is claudication! Why does this pt even have an angio? 🚬 cessation, A1C<7, ASA, statin, exercise! No wires in tibials, no lasers,atherectomies, stents, , or balloons. “Frankly” keep catheters and wires out of this patient’s arteries Frank!
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Congratulations to
@ProvSwedish
incoming R1 class General Surgery 2024-2025. I’m wondering how many of these bright young minds I can recruit to 5+2 vascular surgeons?
#vascularsurgery
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My 6 yo daughter wants to be a surgeon, learning to pronate/supinate on a watermelon. It had to be “perfect”! Look out surgical world she’s coming…
@WomenSurgeons
@womensurgeonpwr
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@RKTvascular
@farkomd
When planned properly, a high carotid lesion can be effectively treated with CEA, without CN nerve injury. The gold standard remains CEA!
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@vascularIR
@VasculonR
@AngioPod
@FadiSaab17
@kmadass
@DonGarbettMD
@drcostantino1
@EricSecemskyMD
@SDhandMD
@docTPlive
@t_intheleadcoat
@Watts_IR
@monteromiguel
@bretwiechmann
@HadyLichaaMD
@AmputationSuck
@keithppereira
@ADiamantop
@a_saratzis
@K_Stavroulakis
@Vascupedia_com
@drochohan
@SriniTummala
@Kuldeep1926
@farkomd
@VascularSVS
Like this! Nice vein, P1 to PT BPG, rGSV, palpable PT pulse, 3 day LOS, foot healed.
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The best operation we do, every trial since NASCET the operative M&M has gone down. There are now multiple generations of superbly trained VSs performing safe CEA everyday. Transfemoral CAS will never match CEA for major M&M. TCAR has a role, however CEA is tough to beat!
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@docpark
@PipeCabreraV
@XavierBerardMD
@BBASS_skills
@rbarbosa91
@pferrada1
@David_ukan
@VasculonR
@AWBeckMD
The late great K Wayne Johnston used to say “the aorta doesn’t know which way you’re sewing”. “In-out” or “out-in”, whatever is technically easier.
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@saherssabri
@jmills1955
@drcostantino1
@ReneLizola
@farkomd
@AmputationSuck
@BEST_CLI
@MichaelSConteMD
@UCSFvascular
@VASCevidence
@BCM_Surgery
I know I’m pontificating, however every graduate from a vascular surgery program today should be adept at tibial/pedal bypass. This skill should be available at all medium to large vascular centres across Canada and US
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That’s Dr. John Harlock
@MacVascular
giving the presidential address at
@CanadianSVS
annual meeting. Thank you for your leadership John.
@VascularSVS
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@CaitlinWHicks
@jbsgreenberg
@nytimes
@VascularSVS
@JudithLin4
I am so pleased to see this issue being addressed on a large scale. We
@VascularSVS
need to be more vocal and active protecting our patients from these harmful procedures.
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Just walked out of a rAAA, 3 urgent messages regarding same patient , from PCP, clinic nurse, patient. “Type II endoleak, should he go to ED?” We really need to change the term or the classification.
#AortaEd
@VascularSVS
#endoleak
#EVAR
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Say hello to my best friends. Medium double/double and honey dip donut!
Back in the home country 🇨🇦, always my first stop.
@TimHortons
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@GAEscobarMD
@AmputationSuck
@UnTBAD
I’ll just add this note, I’ve recruited 4 young fellowship trained (5+2) vascular surgeons in the last 10 years, and everyone of them can do a distal bypass to a 2 mm vessel.
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@thingcreator
@nickmmark
@VascularArtist
Nonsense, with few exceptions we all have colleagues to go over cases with, and if one doesn’t then call a mentor or another colleague you respect.
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@cfbechara
Come on people, within 24 hrs? Really? That goes to the OR right away, or you’re going to have a dead patient. Infected? Of course it’s infected.! Either autogrnous repair or ligation.
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@farkomd
@cfbechara
@thesurgerylife
No interventional procedure will match the outcomes of CEA performed by an experienced surgeon with appropriate track record.
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@cfbechara
The “intern’s popliteal pulse”
If the intern feels a popliteal pulse get an US, it’s probably aneurysmal.
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Back in the homeland 🇨🇦 again. Medium double/double and
#Timbits
!
I could get used to this
@farkomd
@TimHortons
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This tells it all!
@MichaelSConteMD
has hit the ball out of the park! It’s a grand slam. Tibial interventions for IC are criminal! Been to meetings where it’s discussed, and even observed in live cases. It’s OBL driven, and prominently IC/IR. Sad, but true
#VEITH23
:
@MichaelSConteMD
speaks on the increase in tibial vascular interventions for claudication
@VEITHsymposium
, asking what's behind it. "It's not the evidence," he says.
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Happy 97th birthday dad, we love you. Yours is the greatest generation! 1945-19yo, 2023-97yo
#WW2
#Veteran
#VeteransDay2023
#RememberanceDay
#Birthday
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@FotehMazinMD
@CMSGov
@farkomd
@AWBeckMD
@scarolinavasc
@VascularSVS
@Dr_Bowser
@AmputationSuck
@drseanlyden
Mazin, how about this beauty for a TFCAS….?
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@farkomd
@dratiehammar
That looks very familiar.
No stents, no conduits.
Like I said, the “high carotid lesion”seems to be getting “lower and lower”
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@IRKhalsa
@VascularSVS
I’ll say it till the I’m blue in the face. The problem described in NYT is about patient care! It’s not specialty- centric. This egregious care implicates VS/IR/IC by a few bad apples. We all need to band together to stop it, not bicker with each other.
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@LeonardoRandial
@GAEscobarMD
@jmills1955
@DevinZarkowsky
@limbsalvagedr
@monteromiguel
@PipeCabreraV
@Cirbosque
@VesaliusCX
@docpark
@mricardomd
@AmputationSuck
Very nice, I am concerned that the collateral fills faster than the bypass….comment?
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@jmills1955
@mattsmeds
@LeonardoRandial
@GAEscobarMD
@farkomd
@docpark
@limbsalvagedr
Joe, I had a similar experience as a PGY-3 at Toronto General.
@UofTSurgery
Chairman, the late Dr. Bernard Langer used to say “you learn to be a surgeon at 2:00 in the morning, not 2:00 in the afternoon”. All those nights taking care of sick patients remains invaluable.
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Yesterday was my father’s 96 bday. Survived COVID critical illness. Lives independently, married 72 yrs and counting.(mom’s 92) Proud of you dad!
#WWII
#VeteransDay
#Veterans
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@ProleneQueen
@jmills1955
@limbsalvagedr
@mattsmeds
@DejahJudelson
@nnainej
@RuthLBush
@farkomd
@jfhemingway
@AmputationSuck
Believe it or not, elective AAA with horseshoe kidney, 7 renal arteries. Asked for a little handholding from the chief, the late Dr. Ray Alexander
@UFJacksonville
.
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WWYD? 76 yo M, DM, SLE, pulmonary fibrosis, arch aneurysm 4.8 to 5.6 in 6 mos with chest pain. What questions do you have?
@farkomd
@RKTvascular
@XavierBerardMD
@docpark
@AWBeckMD
@westleyohman
@ShereneShalhub
@DrPatGeraghty
@ErbenYoung
@MaherSabalbal
@FotehMazinMD
#AortaEd
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@RKTvascular
Well it almost seems taboo to suggest it, how about a small RP incision and repair directly? Especially if he’s got normal EF and good lungs. Then it’s done, fixed! Preserve IIA. After all we are vascular surgeons! Let’s use our skills. Out of the hospital in 2 days.
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So happy to see that
@ESVSmembership
has doubled down on
@VascularSVS
guidelines for Rx
#claudication
: don’t intervene on tibial disease for claudication!
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@limbsalvagedr
@jmills1955
@saherssabri
@drcostantino1
@ReneLizola
@farkomd
@AmputationSuck
@BEST_CLI
@MichaelSConteMD
@UCSFvascular
@VASCevidence
@BCM_Surgery
@UMassVascSurg
@BIDMCVascular
@UABVascular
@usc_vascular
@UvaVascular
@VascularMD
@BAulivolaMD
@TL_Forbes
@UofTVascular
@NealBarshes
@VEITHsymposium
@DHMCVascular
@UWVascsurg
@WashUVascular
Endo will never beat a well performed tibial/pedal bypass in appropriately selected patients.
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A very useful technique outlined by
@SDhandMD
Important tip for crossing CTOs:
Vary the wire tip weight by changing tip length from support cath, keep straight & gently test wire after cap. Increase your crossing chances & keep luminal!
@kmadass
@LessneVIR
@DanHan
@Watts_IR
@monteromiguel
@AlexCVIR
@bretwiechmann
@rkryu
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@AortophilicMD
Bravo! Keep posting Cassra, we need to saturate social with these cases and end the “full metal jackets” in patients who are good op candidates and have adequate vein!
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@CaitlinWHicks
@mattsmeds
@KatDiLosa
@thesurgerylife
@malas_mahmoud
@JVascSurgCIT
@VascularMaximus
@RMotaganahalli
@drpillado
@limbsalvagedr
@JVascSurg
@VascularSVS
@FutureVascSurgn
@farkomd
There is no reason not to test for Plavix resistance, it may save a few strokes. If they are resistant, we switch to Brilinta
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@drochohan
@kmadass
@iRadRock
@AmputationSuck
@kush_r_desai
@keithppereira
@CHICKVIR
@KaremHarthMD
@SriniTummala
@DrJayMohan
@HadyLichaaMD
Totally agree, sometimes it’s just another individual trying
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@kmadass
@farkomd
@SIRRFS
@monteromiguel
@vascularIR
@LessneVIR
@Watts_IR
@SIRspecialists
@dandu_n
@SDhandMD
@jmills1955
@drochohan
Anytime I see that scenario I start thinking thrombophilia
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@doctorORbust
@AmputationSuck
I would agree, each and every residency has its stressors. We need to be kind and care for one another. There were “several” cases of self harm when I was a resident/fellow. Look for the signs and reach out to your colleagues in need.
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@DanielCarradice
@farkomd
@AfifiRana
@Dr_Bowser
@limbsalvagedr
@ColemanDM_vasc
@DrLizGenovese
@trisharoymd
@VascularGirl212
That aorta is over 3 times the size of the native aorta. Guidelines are exactly that, “guidelines”. Each patient should be treated as an individual, not as a “guideline”, there is no question in my mind I would treat that aneurysm.
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@GAEscobarMD
@limbsalvagedr
@henriqueSBBr
@LeonardoRandial
@jmills1955
@martincont91
@ManuelHosma
@farkomd
@docpark
@DevinZarkowsky
@CarlosAHinojosa
@mricardomd
@IR_Doctor
@vascularIR
@monteromiguel
I now look at a long SFA occlusion I’m confident I can cross, and think “good vein, good op candidate, bypass is a better option” This is an option only vascular surgeons have!
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@farkomd
@DrPatGeraghty
“The profunda is the lifeline of the leg”
The late Ronald J. Baird MD, Toronto General Hospital
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@ReneLizola
Transabdominal, juxtarenal, can sew at the level of renals. Supra-renal clamp, looks like you can clamp if downward traction on sac, if not supraceliac clamp, decompress sac, move clamp down. Aorto-bi-iliac graft. Would like to see coronal. My record 18 cm dia.
#AortaEd
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@mattsmeds
@DukeVascular
@VESurgery
Having fellowship training in both trauma and vascular, I find myself wondering why this is a debate? Trauma training does not provide the experience required to competently repair complex vascular injuries IMHO. Isn’t the goal to provide the patient the best care?
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@docpark
@VascularForum
Excellent, whether eversion or more traditional CEA, do it frequently and do it well. Carotid stenting will never match
#CEA
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@farkomd
@drdevirgilio
@UCSDsurgery
@PCSAsurg
@jmills1955
@PipeCabreraV
@limbsalvagedr
@Brig13Smith1
@malas_mahmoud
Throughout my career I have done both GA and regional, do them all under GA now. Transfusion indications are very heterogeneous, ie- was restrictive transfusion policy in effect?
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@mattsmeds
@VascularMaximus
@JVascSurgCIT
@KatDiLosa
@RMotaganahalli
@CaitlinWHicks
@malas_mahmoud
@farkomd
@VascularSVS
@JVascSurg
@mimmieMD
My belief is asymptomatic carotid surgery will be of historical significance only following CREST 2
5
3
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@dratiehammar
@farkomd
@VarenyamVasc
@mattsmeds
@ReneLizola
@CincyVascSurg
@XavierBerardMD
@RKTvascular
Not a fan of sacrificing both IIA, even if staged. Concerned about spinal cord/bowel, perineal necrosis. Need to make every effort to preserve at least 1 IIA. Have used hybrid technique with Viabahn to distal IIA and jump graft off biiliac limb. As described by
@hawkeyeBJP
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@KhashiRahmani
If that patient can tolerate an operation, open repair. Don’t be afraid to operate! Most patients can tolerate an open repair.
1
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@monteromiguel
Absolutely 💯, could not agree more. I have been critical of several posts on this account. Including tibial interventions for claudication. However in some cases I have gone farther to be disparaging of the physicians
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0
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@Dr_Sudi
@farkomd
@VascSurgMD
@VascularSVS
@_backtable
@AmputationSuck
@VascularMD
I don’t consider another test unless they’ve displayed a significant increase in velocities on aggressive medical therapy, or their EDV>125. Far too many asymptomatic carotids are intervened on in my humble opinion.
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@michaelcsiah
Who on God’s green earth is doing this stuff? Please please please honour the profunda
“Lifeline of the leg”
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@DrPatGeraghty
@farkomd
@MaherSabalbal
@ahmedkayssi
@VascularSVS
I’ll add another penny. CEA under local/block has never been shown to reduce complications. Personally I think it’s cruel and unusual punishment, I recognize that is my dogmatic opinion. However patients should not be told it’s “safer”.
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This is the most accurate technique for end to side anastomosis.
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@ReneLizola
@farkomd
@monteromiguel
@KaremHarthMD
@UkVenous
@JVSVL
Great demonstration of examining the thrombus removed, important in both arterial and venous thrombectomy. A point stressed by Fogarty himself in a talk he gave.
Esmarch is a valuable tool in venous trauma, ie-popliteal venous injury for clearing distal venous system.
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@t_intheleadcoat
@AmputationSuck
@farkomd
@JimGMelton
@DrPatGeraghty
@NickMouawadMD
@RKTvascular
@limbsalvagedr
@jmills1955
@Kuldeep1926
Not so fast on the congratulations. The profunda is the “lifeline of the leg”, it’s now occluded. When that intervention goes down, and it eventually will, that leg is going to crash hard, One cannot overstate the value of the profunda in PAD. I’d get that profunda open!
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@LeonardoRandial
@XavierBerardMD
@farkomd
@jmills1955
@DevinZarkowsky
@docpark
@GAEscobarMD
I doubt that’s an aortopathy, suprarenal clamp, fenestrate the flap, aortobiiliac graft. By fenestrating the flap don’t have to worry about bypassing the renal.
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@vascularIR
@AmputationSuck
@YsaAugust
@FadiSaab17
@kmadass
@JillSommerset
@drcostantino1
@a_saratzis
@drochohan
@EricSecemskyMD
@IR_juniors
@ADiamantop
@dandu_n
@monteromiguel
@SriniTummala
@trisharoymd
@t_intheleadcoat
I could not agree more, tendency is to undersize especially in the BTK vessels….
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@jbsgreenberg
@katie_thomas
@gebeloffnyt
@virginiahughes
@davidenrich
The
@VascularSVS
is making great efforts to educate the public about these issues. Unfortunately patients are being told many untruths regarding the management of there vascular disease by a few bad apples.
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@LeonardoRandial
@jmills1955
@monteromiguel
@limbsalvagedr
@JillSommerset
@docpark
@ManuelHosma
@mricardomd
@FelipetobJorge
Absolutely not a lost art, every vascular surgeon completing vascular surgery today should be capable of pedal bypass. It should not be thought of as an advanced skill
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@thingcreator
@nickmmark
@VascularArtist
Get serious, “some tiny group of doctors”? I think your comments speak for themselves. We physicians all have mentors and colleagues who we communicate with all the time, and did so for years prior to the growth of social media. Physicians do not offer advice on social media.
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@raimcsantos
@cfbechara
@ThinkAorta
@AortaSurg
@farkomd
@AWBeckMD
@RKTvascular
@OckeReis
@walter_boim
@dr_sincos
@ErbenYoung
@ShereneShalhub
How can we create a software program like that, for our radiologists that automatically places arrows pointing at the pathology?😂
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Back in the Great White North 🇨🇦
First stop
@TimHortons
! The original “donut holes”. they’re called TIMBITS and a medium double/double.
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@DGArmstrong
@VascularNews
Basil-2 is underpowered and poorly designed.David Sackett would be appalled! I challenge anyone to make the argument it is a “better” study than
@BEST
-CLI. The majority of those touting the virtues of BASIL-2 only have 1 tool in the shed, and it’s not a scalpel.
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@UofLHealth
@docpark
This could not have been expressed better! This needs to be sent to every politician in every state and DC! Well said Dr. Smith, I applaud your frank expression of the state of violence in the USA. Please please listen to him.
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@LeonardoRandial
@jmills1955
@GAEscobarMD
@farkomd
@docpark
@limbsalvagedr
@mattsmeds
I realize I’m a veteran at this VS stuff, however I think GS is the perfect place to learn how to take care of sick patients that will be invaluable throughout your career. Learning about shock, infections, wound healing, nutrition, fluid & electrolytes, etc. Just my take 5+2
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@MayoAZVascSurg
@VascularSVS
@JVascSurg
Tibial interventions for claudication reveal a very very disturbing trend!
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@AmputationSuck
@mattsmeds
Need more info, age, health history? Can we see coronal and sagittal images. There r an awful lot of asymptomatic patients carrying on normal lives with an iliac occlusion. It’s hard to make an asymptomatic patient better, it’s easier to make them worse.
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@DrKimberlyMalka
Kimberly, get your well deserved rest. I have been shouting this from the tree tops for 25 years!
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@FadiSaab17
@michaelcsiah
@shamitsdesai
@saherssabri
@ACCinTouch
@SCAI
@SIRRFS
@CLI_Global
@EricSecemskyMD
@bretwiechmann
@BobTahara
@RafaMalgor
Fadi 💯 agree, this is not about specialty, it’s all about good medicine
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@docpark
@AWBeckMD
@RKTvascular
@jsmhoughton
@farkomd
@AmputationSuck
@westleyohman
@AorticCenter
@bevis_paul
This is my greatest concern! Because of that inability to do anything complex, the patient then becomes subject to an endovascular procedure outside of IFU, and exposed to all the inherent risks associated with that….
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@malas_mahmoud
@JVascSurgCIT
@VascularMaximus
@KatDiLosa
@RMotaganahalli
@CaitlinWHicks
@farkomd
@VascularSVS
@JVascSurg
@mimmieMD
An awful lot of asymptomatic 230/50 cm/s are gonna get stents
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@sbellmunt
@a_saratzis
@Matt_J_Bown
@EndovascularU
@ninsalsaadi
@uk_surgeon
Perfection leads to dissection Try to make it look like you know what you’re doing
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