#vascular surgery

[bouncyalex]

Progress! I’m not giving up🫡

[docresa]

Bye bye, core surgical training…

As of today, I completed PGY-2, and therefore the core training part of my residency!

It has been absolutely wild. I am so thankful that I get to learn and grow and practice medicine every single day. The fact that people people put their lives in my hands is still absolutely mind-blowing to me. It’s a huge priviledge.

Is it still hard? Hell yeah! I think in some regards, PGY-2 was even harder for me than PGY-1. I didn‘t exactly have the best time during my ICU rotation, which took up most of the year. While I had great colleagues, I did miss surgery a lot, and the „better“ work-life-balance gave me a lot of time to deal with some personal issues that I had been successfully repressing before. I experienced my first major complication on a procedure that I did, and I took that very hard. But, and I guess that’s what counts, I came back stronger.

Coming home to surgery in December, I now feel so much more confident in my clinical decision making. I am much more self-accountable, within the limits of my training stage of course. And with being back in surgery, and finishing up my core training, of course one question, which people had been asking me way before my ICU rotation, resurfaced: where to go from here?

Choosing a subspecialty has been a very anxiety-inducing topic for me for quite a while. While I applied to my residency with the goal of becoming an abdominal surgeon, there has been some pressure quite early on to focus on a specific field within abdominal surgery from the respective attendings. And as our department includes not only abdominal surgery, but also thoracic and vascular surgery, those were no exception as well. Now being the good old people pleaser that I am, I spend all of PGY-1 trying to build good relationships with everyone and so during PGY-2 I became an absolute master in not committing to anything in order to not step on anybodies toes. Meanwhile though, I slowly figured out, in many long talks, on many long on-calls, and in many exciting surgeries, that there in fact is a subspecialty that I am more drawn to than all the others. One that I came to love because of the creativity and the delicacy of the surgeries, its acute nature, and the fact that there were not one, but two attendings who always motivated and encouraged me, not only professionally, but personally as well. That subspecialty though was not the one I initially applied for. So for a long time, I thought far too much about what others might think and who I might disappoint, instead of what’s best for me.

But, two weeks ago, I finally came up with the courage to talk to my program director, and, unsurprisingly to everyone but me, it wasn’t a big deal whatsoever. So, starting tomorrow, I will continue my specialty training as a vascular surgery resident.

Was it a popular decision? Nope! Most of the abdominal surgeons seem to think I’m some kind of alien. But those I care about most have been supportive. And, most importantly, the whole vascular team so far has been even more welcoming and motivated to train me than I could have dreamed of. Every day that goes by I feel more confident in my decision, and I am so excited for everything to come.

So yeah… cheers to PGY-3!

[bpod-bpod]

Revealing Vessel Variance

Anatomical study of the incidence of variants in arteries of the adult hand provides detail that will aid orthopaedic, microvascular and reconstructive surgery

Read the published research paper here

Image from work by Marko Simić and colleagues

University of Belgrade, Belgrade, Serbia

Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)

Published in Scientific Reports, January 2024

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[heardatmedschool]

“... and that’s why we call it ‘Cementeric Ischemia’.”

About Mesenteric Ischemia.

I’d say “badum tss”, but an up to 80% mortality rate is a bit too grim.

[studyornotblog-blog]

first post since starting my internship in dubai ☺️

revising some vascular surgery notes before my rotation starts

[mddiaries]

The Vascular Surgery Dream Team. Saving the world... one leg at a time.

[scriptmedic]

Hi! I need a semi-plausible way to repair a severed artery without sutures. Can I use superglue? I've got a humanoid alien with high density tissues, so the needles won't pierce it. I am thinking: ligate both ends (it's a clean cut), clean and try to glue back. Could that ever work?

Hey there!

So this is a non-human thatI’m going to treat as human because otherwise I’m just going to shrug andgo “sure? If you want it to?”. Though if you’ve got high density aliens, maybethey have high density metals…?

Anyway. Here’s the problem with superglue. Yes, it’seffective at holding things together, but it’s not particularly choosy about what it holds together. So if you’re phenomenally good at what you’re doingand you’ve superglued hundreds ofalien arteries back together… fine.

But more than likely your medic-character is going to getglue on the interior surface of the artery, where it’s not supposed to go, andocclude the artery. This is what we in the industry refer to as bad, although perhaps not as bad as youmight think.  

The not-so-bad thing is simple: arteries usually havebackups (in humans). For example,hold up your non-dominant hand. With your dominant hand, push down over thepulse point on the thumb side of the wrist (radial artery) and on the pinky side of your wrist (ulnar artery). Open and closeyour non-dominant hand a few times – see how white it gets? Now release only the pinky side of the wrist. Watchit get its color back. Kind of miraculous, right? Since you’re still holdingpressure over the “primary” artery that feeds that area?

What you’ve just done is called an Allan test. It checksperipheral circulation. It’s how we medfolk know if we can stick an IV in yourartery (technically now an IA line).  

So some arteriesyou can get away with losing (it’s never great, but there are a few you could sacrifice).Many you can’t.

I normally advise against it, but I might actually suggestcauterization for this instead. If the artery “melts” together properly itcould alleviate a world of complications. But again, you’re not going to have a100% success rate. It takes a really good surgeon to repair arteries, especiallytransected ones.

Hope this was useful!

xoxo, Aunt Scripty

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[misboxiemd]

Vascular surgery (end of feb) 

I have to be away on the last day of my Vascular Surgery rotation in May, so i had to make it up with a subgroup from the other main group. 100% attendance can be a pain. I was only able to make it up because Diabetology ended on the thursday instead of the friday as scheduled, leaving the morning rotation free for me. 

One of the surgeries on this day was for a patient who was suspected of having a ruptured abdominal aortic aneurysm because they really couldn’t tell where the bleeding was coming from. When/As they cut him open, so much blood came gushing out. It turned out to be a ruptured spleen probably injured during a surgery the day before and his spleen was taken out.I have never seen so much blood. there were huge blood clots everywhere the blood spilled. He lost almost 2L of blood. Due to his situation, they didnt close him up fully, instead they used some machined called a Vac and put some “packing”(i guess) in between to create low pressure in his abdomen. They were scared of possible intestinal necrosis. His prognosis seemed very poor. I hope he made it :(