The podium presentations at the 2016 SCVS Annual Symposium were filled with valuable clinical advice and considerations, especially for fellows and residents. Here are some of our top takeaways from the presentations:
- Be prepared for emergencies as a fellow. Dr. Brant Ullery shared the top five emergencies that a fellow could be faced with, and the importance of being prepared to treat them: acute limb ischemia, ruptured AAA, neck hematoma/carotid injury, acute mesenteric ischemia and bleeding AVF.
- Infections can be serious. In cases with infected stent grafts, Dr. Keith Calligaro recommended removing the graft rather than attempting to preserve it. He also warned that there is an increased risk of infection when the case is emergent rather than elective.
- Consider TEVAR for TAIs. Dr. Klaas Ultee explained that TEVAR has broadened the eligibility for surgical repair of traumatic aortic injury in his practice, and is now a dominant method of treatment.
- Collaborate with other specialties. Dr. Matthew Eagleton stressed the importance of a cross-disciplinary approach to treating aortic disease. “Aortic disease is ideal for collaboration due to the complex problems we see. Each collaborator brings a unique skill set and knowledge.”
- Use algorithms with caution. Dr. Patrick Thompson emphasized that currently published clinical decision algorithms should be used with caution when selecting treatment for a rupture case.
- Performing concomitant procedures is not risk free. Dr. Klaas Ultee recommended careful consideration of the operative risks associated with concomitant procedures during EVAR. He also emphasized the importance of adequate anticoagulation measures and prevention of arterial injury.
- Be mindful of C-arm positions. Dr. David Timaran shared that a right anterior oblique projection can be associated with higher doses of radiation for surgeons and fellows.
- Have a protocol ready for ruptures. Dr. Hence Verhagen recommended an EVAR-first strategy for ruptures, because it could result in a shorter ICU stay and earlier discharge.
- Be fair and visible, and lead by example. Dr. Thomas Bower gave this advice to fellows: “It is one thing to technically perform, but another to take command of a situation and make decisions with your best judgment. If you want to be of value in your career, expect change and be adaptable.”
Dr. Matthew Eagleton is a paid consultant of Cook Medical. All other physicians mentioned are not.