The power of surgical drawings
This presentation aims to highlight the usefulness of surgical drawing in practice. It sums up experiences, planning and real cases of the past 5 years of practice in vascular surgery. As I got tremendous positive feedback from patients, colleagues, GP’s, relatives and artists, I decided to share this experience with the vascular community.
The chronic mesenteric ischemia
Age: 69 years old
Comorbidity: Arterial hypertension, Dyslipidemia, coronary heart disease (DES deployment 2 years ago)
Symptoms: Postprandial pain
Previous abdominal operations: None
DUS: Occlusion of the superior mesenteric artery
The AV access salvage procedure
Age: 75 years old
Comorbidity: End-Stage Renal Disease, Diabetes, Arterial hypertension, Dyslipidemia, on hemodialysis in the last 5 years
Symptoms: Acute occlusion of a surgically created left-sided brachial cephalic AV fistula
The radiation exposure
Since January 2018, employers in the U.K and Europe have had to comply with their duties under the Ionising Radiations Regulations 2017, IRR17. Previous to this most health trusts working with ionising radiation followed IRR99.
The main changes since the last edition (IRR99) that affect the operator:
- The dose limit for exposure to the lens of the eye has been reduced from 150 mSv to 20 mSv in a year. This is usually assessed using forehead monitoring bands.
It is the duty of the operator to control methods for restricting exposure to ionising radiation by use of distance and shielding etc.
Vascular Education 2030: One Year Vascupedia
The femoropopliteal In-Stent-Restenosis
Age: 79 years old
Comorbidity: Arterial hypertension, Dyslipidemia,
Implantation of a bare metal stent right SFA 4 years ago, Debulking and DCB angioplasty for ISR 2 years ago
Symptoms: Calf claudication after 50 meters
DUS: SFA stent Occlusion
The Type II Endoleak
Age: 68 years old
Comorbidity: Arterial hypertension, active smoker
Underwent EVAR 2 years ago
DUS/CT A: Aneurysm sac growth > 7mm compared to last CT scan with evidence of type II Endoleak (Inferior mesenteric artery)
Choice of antiplatelet therapy around complex revascularisation
A 79-year-old diabetic male patient with no history of coronary disease is referred to you to undergo angioplasty for tissue loss on the tips of the hallux and second toe. He is taking Aspirin 75mg. From preoperative imaging he needs a 20cm SFA occlusion stopping before the adductor hiatus recanalizing as well as multilevel tibial disease which appears to be a combination of short occlusions and stenoses. The dorsal pedal is seen in the foot and is in continuity with the arch. The PT artery appears occluded through it’s whole length.