MCW Vascular and Endovascular Surgery @MCWVascSurg Twitter profile

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

This is actually all from one aorta. Better out than in. Type Ia perigrqft flow. Out with the old, in with the older… #inthebucket #aortaed #aorta

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

There is no GOOD place to be stabbed. Right through the renal arteries is a pretty bad spot.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 months

Before, during and after - have you ever seen barnacles on an endograft? #inthebucket #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

#notgood #aortaed Now what? Relatively fit sexagenarian….

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Always nice to find a little elephant trunk to sew to when you open the aorta! #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Lots of endoanchors in this one; didn’t work. Don’t be afraid of open AAA repair, especially with angulated necks. One good operation is better than five suboptimal ones. #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

8 cm femoral false aneurysm 30 years after aortofemoral bypass and fem-pop bypass - both grafts primarily patent! Repaired with rifampin soaked Dacron interposition grafts and sartorius myoplasty.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

6 months

Before, during and after the ruptured extent 3. Intrathoracic control first, iliacs next, then diaphragm down with a stapler and full exposure. Full set of branched grafts on the shelf makes all the difference for these cases where time is of the essence. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 months

Sometimes you just need to replace the parachute pants with some high-waisted bell bottoms. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Today was the official last day of a legend. As Gary Seabrook retires, having been at MCW since coming as an intern in 1982, we wish him many bright sunny days in the garden, and a wonderful time making new memories and traveling with Nancy. We will miss him every day!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Welcome to Dr. Yulia Kostenko, who will be joining our team as the incoming vascular fellow in 2024! We couldn’t be more pleased!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

This aneurysm ruptured on Thanksgiving...9 years ago. No surgery. Went home on hospice. Still alive 9 years later and came to the office for claudication. 86 years old. We are starting an exercise program. Just goes to show you never know. #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Extent II TAAA with left sided IVC. A challenge for cannulation for CPB/DHCA. #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

One of my favorite operations, and one of my least favorite operations, all rolled into one. #Aorta #AortaEd

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

Aortic rupture in 2020 after EVAR elsewhere in 2014. Demonstration of the need for life-long follow up.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 months

At this rate we will take out more endografts than we put in this year. Anyone else noticing a similar trend? Is the pendulum swinging? This one for a type Ia endoleak 5 years after EVAR for rAAA. #inthebucket #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

60s pt RAAA in 2019 rx with EVAR at 5.6 cm. Now up to 8.5 cm with no endoleak on imaging. Foul odor on opening sac with no endoleak! Always think infection with sac enlargement and no EL - #teamorange graft and vancomycin powder. Graft did its job! #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Perfectly done resection of leiomyosarcoma of renal vein-IVC confluence by our fantastic colleague ⁦ @DrCNClarke ⁩ with prosthetic reconstruction (with one of our great fellows ⁦ @simonfraser75 ⁩) - an uncommon problem in a rare location.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

This new rounding mug should be a real time saver. Thanks @sb_white1 !!! @MCW_VIR

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 months

30 yrs s/p Crawford extent 3 repair by…well…Dr. Crawford. 9cm visceral patch aneurysm tx with redo extent 3 repair. And a little TEVAR #inthebucket for good measure. Great job ⁦ @mitchelldyermd ⁩ , Drs. Mace and Plambeck and the whole aortic team - #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

7 months

This would have been a good-sized aortic aneurysm. Except it was in the arm…

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

A nice little contralateral femoral vein for a disrupted infected common femoral false aneurysm. Balloon inflow occlusion is key to avoid a flank incision when BMI is 45

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

To quote ⁦ @farkomd ⁩ , time for heparin

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Alto and Palmaz stent #inthebucket #aorta #aortaed . The polymer rings are not conducive to the 20 cc syringe trick previously described so we cut the suprarenal stent (which is actually supraceliac) and left it there.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 months

Symptomatic innominate occlusive disease is well handled by open reconstruction especially when the vertebral origin is involved. Aorta-CCA interposition with R SCA interposition and vert reimplant to SCA bypass. 4 hour operation and fast recovery with ministernotomy. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

Medial visceral rotation for repair of juxtarenal AAA with infected (Pseudomonas bacteremia) Endurant, with bilateral common iliac aneurysms. More orange grafts.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Taking the diaphragm down with a stapler and vicryl/prolene strip reinforcement, then using that strip to put it back together, is my new favorite thing! #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Welcome Dr. Mohammad Rajei to our vascular fellowship! We are very excited to have him join us from the general surgery residency @UABSurgery @UABVascular - a great match this year!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Sometimes a picture is worth 1000 words. What’s wrong here? With ⁦ @MCW_VIR ⁩

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Not very often that faculty get to operate together, but when three rooms are running with complicated aortic dissections, it can happen! Drs. Brown and Seabrook with CCA-SCA bypass with TEVAR to follow!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

#inthebucket

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

Aorta broke, aorta fixed. Great multidisciplinary care of vascular trauma by Dr. Brian Lewis and Dr. Sarah White @sb_white1 - the exact approach to provide the maximum benefit to injured patients. It’s routine here. @MCW_VIR @AorticTrauma @MCWSurgery

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

When they called me in the OR about a transfer and said “it’s a thrombosed aortoenteric fistula”, I said “no, it’s not.” Turns out... #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

First comformable Excluder in SE Wisconsin! Thanks to Gore for great support as always. With ⁦ @MCW_VIR ⁩⁩ @MCWSurgery ⁩ ⁦ @MCWVascSurg ⁩ - a great partnership continues

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Not very often you get the phrenic nerve and recurrent laryngeal nerve exposed for the same operation. Nice multi-D approach to right subclavian transection at origin with our friends from MCW CT surgery. How collaboration for complex vascular injuries should work.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

We are very pleased to welcome Dr. Momodou “Momo” Jammeh to the @MCWVascSurg @MCWSurgery family this summer! He will be joining our faculty from the vascular residency program @WashUVascular - we are thrilled for him to return to his old stomping grounds in Wisconsin!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Some days we are sad that we are doing less CCA-SCA bypasses, and some days we are not - very large aortic false aneurysm in a pt with BMI of 45, this is a great option. #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

First commercial Gore TBE in Wisconsin yesterday - along with a fenestrated graft and aortic rupture done by our team all in about 8 hours. Collaborative aortic program running strong! ⁦ @MCW_VIR ⁩ ⁦ @MCWSurgery ⁩ #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Inflammatory juxtarenal AAA - loops on celiac, SMA and left renal. Terrible calcification of aortic bifurcation. Longer main body preserves endo options in future if needed. RP approach gives a lot of reconstruction options. Nicely done by our fellow Sheaffer Sorrells!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Weekend starting with a bang; one hour into call and here comes the first malperfused type B….

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

One ugly femoral true AND false aneurysm ten years after we did an infrarenal EVAR. With a bonus 5 cm popliteal aneurysm!… Lifelong surveillance for all EVAR is important! #aorta #aortaed #teamorange

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

5 years

It was a million-to-one shot, doc...

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

5 months

Lots of short necks around today - big posterior PAU below renals would compromise seal - open tube graft RP 9th rib to umbilicus. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

The best way to get hemostasis on an anastomosis to an AFX? Have the fellow hold pressure and walk away for 20 minutes. Works like a charm.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

5 years

Transection Wednesday. Four minutes of fluoro. Grade 4 injury with SBP in 50s, not a trial candidate. Good timing, walked out of the case to the other room where they are inducing the elective open AAA.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Weekend acute aortic occlusion and infected fem-fem = #teamorange graft! #aorta #aortaed FYI the part of the graft with the writing did NOT go in the patient!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Things you don’t want to remove from the pulmonary artery 2 weeks after repair of RAAA…despite uninterrupted DVT prophylaxis. Thanks to our outstanding cardiac surgery colleagues!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Bird-beaking and type Ia endoleak years after TEVAR for TBAD; solved with thoracic branch device for LSA. Surveillance is important! #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

Another day at the office...pulling out infected aortic grafts with Dr. Lewis. #badaorta Should probably add the hashtag #badduodenum as it was clearly misbehaving to cause this problem.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Before and after, juxtarenal with a terrible neck and 4 renal arteries - ⁦ @simonfraser75 ⁩ getting some good fellowship abdominal vascular surgery over the last week! #aorticaneurysm

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

After a 14 cm long femoral endarterectomy with profundaplasty for ischemic rest pain with an ABI of 0.2, the best call to get is that the patient is complaining that his foot is too hot.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

On his last day of morning Zoom sign out before joining the faculty next week, outgoing fellow Dr. Nathan Kugler is wearing the right hat for the operating room. Congrats Nate! You’re going to be a great addition to the group! ⁦ @MCWSurgery ⁩ ⁦ @MCW_VIR ⁩

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

The aneurysms keep coming in 2021... Extent 2 with DHCA and our great partners in cardiac surgery. Patient was considerate enough to have a chronically occluded celiac. #aorta

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Not seen in these images - the type Ia endoleak. 10 years after EVAR and multiple type II endoleak embolizations. Need for good surveillance is paramount - and we need better predictors of long-term failure. #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 months

That doesn’t belong there - great multi-D work with ⁦ @AllyIstl ⁩ ⁦ @mcwsurgonc ⁩ to remove this nugget and reconstruct IVC at renal confluence. Tomorrow back to #aortaed -

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

Two years after perc EVAR (under local) for rupture with hemodynamic collapse. He’s headed to Florida to golf for the winter. We have the greatest job in medicine.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

9 months

A beautiful start to the long call weekend!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

88 year old F, independent, 6 cm AAA enlarging (5 mm in 7 months) with bilateral R3 claudication, long segment R external iliac occlusion and focal left common iliac occlusion; excellent functional status. Neck length 8 mm and diameter 22 mm. What would you do? #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Very pleased to have matched Dr. Paul Dyrud (MCW) and Dr. Anna Gillio (Indiana University) as our incoming vascular fellows! Looking forward to having you both on the team in 2023!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

6 months

Request to any physician that doesn’t fix complex aneurysms - when confronted with a TAAA please refer EARLY, and don’t just say “we will watch until 6 cm.”’ Get them to a high-volume center so that THIS doesn’t happen. Successful open repair - images of that later. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

One of our favorite exposures, sternotomy for AI bypass - symptomatic, bulky, very calcified innominate lesion with near-bovine arch. Quick recovery in good-risk pt and didn’t put the left CCA at risk. With our colleague ⁦ @Djoyce4 ⁩ #aorta

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Challenging anatomy. How would you handle? Hypotensive, abdominal pain, can’t flex left thigh. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

For all of the problems we see in vascular surgery every day, sometimes we see something great - like these twin girls, Violet and Maple, born to our amazing nurse practitioner Laura Needler and her husband Jon! Everyone is home and doing well! Shared with permission ☺️

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Ever wonder where thoracic endografts come from? #aorta

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Just one of the interesting anatomic findings of the call weekend - in fact several in one scan! #aortaed #aorta

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

Dr. Kellie Brown @KellieB93264399 officially recommended to the Board of Trustees for tenure today! An amazing accomplishment for a deserving leader in vascular surgery!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 months

Have you ever wondered what the inside of a Carrel patch looks like after 30 years? Here it is. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Twas the night before Christmas, and all through the office, not a creature was stirring, except reviewer two.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

4 years

A fond, outdoor, socially-distanced, mask-wearing farewell as we launch Jacob Wood, our 40th vascular fellow, into the world. He is going to be a great addition to the faculty at the University of North Carolina; we will miss him and Val greatly around here! Congrats Jake!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Easy to see why this patient was symptomatic. Ulcerated, ruptured nasty plaque - barely 50% stenosis on CTA but degree of carotid stenosis doesn’t tell the whole story.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Sometime the elephant trunk comes out easy, and sometimes it’s plastered to the wall of the aorta and make things a little more exciting - why it’s important to do these operations with partial LHB, especially in larger patients. Another great OR collab with Dr. Lyle Joyce.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Congrats to this guy ⁦ @kosta_md ⁩ - working with you from the beginning of your first year in clinical apprenticeship, to your last day now starting vascular residency, has been a joy. Couldn’t be prouder, or happier for you and your family!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

@farkomd I was asked at a course once what my favorite device was for long-segment SFA occlusion and I said saphenous vein. They didn’t ask me back

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

6 months

Three “Mo”s (⁦ @MHRajaei ⁩ ⁦ @JammehML ⁩ ), two surgeons and one AAA - nice AFB for #AAA and #AIOD - great job by this crew including Dr. MOhammad Rajei, Dr. Momo Jammeh and the one and only Tequila! #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

First official weekend on call for @nwkugler - 1. Ruptured AAA? No, just a 6.8 cm intact AAA next to a 15 cm renal mass. 2. Oh, so you thought we were kidding? Now here’s an ACTUAL ruptured aneurysm. And it’s only 7pm. Glad to have the best partners at @MCWVascSurg !

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Congrats to Dr. Michael Malinowski on being included in the @AmCollSurgeons Academy of Master Surgeon Educators as an Associate Member!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Apparently I need to pay them more so they can afford socks - #VAM23

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

10 months

⁦ @JammehML ⁩ wrapping up his first operation on the faculty ⁦ @MCWSurgery ⁩ - fem-peroneal PTFE graft with femoral endarterectomy and distal vein patch! Well trained by ⁦ @DrPatGeraghty ⁩ ⁦ @westleyohman ⁩ and all at Wash U Vascular

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Just a simple operation with a simple orange graft

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

16 days

Before and after…first case for Saturday AM, 8cm right femoral false aneurysm from 20 yo degenerated Dacron graft. Maybe the shortest interposition graft ever

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 months

Organ transplantation step 1 #AorticOrgan #aortaed #inthebucket Still ambivalent about this whole “aorta as an organ” thing but I guess the concept is interesting.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

5 years

“We can do this the right way, the wrong way, or the vascular fellow way.” “What’s the vascular fellow way?” “It’s like the wrong way, but slower.”

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

TCAR, TEVAR, bilateral ax-fem bypass, AKA, axillary GSW, 2 outpatient angiograms in last 12 hours. And now....documentation. Just another day that ends in Y in vascular surgery.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

We are recruiting! Due to continued program growth, we need to add another surgeon starting August 2022. Upcoming graduates are welcome! Please DM me or email prossi @mcw .edu if interested in a dynamic, collaborative academic practice, and feel free to pass this along!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 months

With permission - our guy Ted and his wife Betty. Four years out from removal of an endograft with Psuedomonas infection, reconstructed as a pararenal repair with B renal grafts by #teamorange . Playing golf every day and enjoying life! Best job in the world. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

3 years

Modified vein boot to the distal posterior tibial artery for R5 CLTI. Not enough vein for a bypass but enough for this - hope to prevent problems down the road if the graft occludes. #failforward

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

A privilege to have Dr. Audra Duncan as our 14th annual Jonathan Towne Visiting Professor — it has been a great couple of days with her here!

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

5 years

Some days you just need to put in an orange graft. Makes everything look better.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

An uncommon, incidentally found problem….

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

2 years

Help for Ukrainian surgeons, please! Our Ukrainian vascular colleagues need our help. The letter below I just posted to the SVS Connect site a few minutes ago. We would like to collect supplies. DM me for more information. Pls amplify.

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

9 months

The Ps of acute limb ischemia are familiar. The Ps of hemostasis, not so much. “Plambeck” is one our outstanding cardiac anesthesia faculty - meaning work with anesthesia when someone is bleeding after an aortic operation. #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

1 year

Dacron grafts should not be green. Orange yes - #teamorange - but not green. Screen right is the sizeable hole in the duodenum. #aorta #aortaed

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MCW Vascular and Endovascular Surgery

@MCWVascSurg

10 months

F/U to the last case - RP juxtarenal aortic endarterectomy. Palpable pulses and hyperemic feet at the end. Endo possible but likely a lot more secondary interventions. Come one come all it’s a great specialty! #aortaed ⁦⁦ @FutureVascSurgn ⁩

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