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Medical Editor Malachi Sheahan III, MD Associate Medical Editors Bernadette Aulivola, MD | O. William Brown, MD | Elliot L. Chaikof, MD, PhD | Carlo Dall’Olmo, MD | Alan M. Dietzek MD, RPVI, FACS | Professor HansHenning Eckstein, MD | John F. Eidt, MD | Robert Fitridge, MD | Dennis R. Gable, MD | Linda Harris, MD | Krishna Jain, MD | Larry Kraiss, MD | Joann Lohr, MD | James McKinsey, MD | Joseph Mills, MD | Erica L. Mitchell, MD, MEd, FACS | Leila Mureebe, MD | Frank Pomposelli, MD | David Rigberg, MD | Clifford Sales, MD | Bhagwan Satiani, MD | Larry Scher, MD | Marc Schermerhorn, MD | Murray L. Shames, MD | Niten Singh, MD | Frank J. Veith, MD | Robert Eugene Zierler, MD Resident/Fellow Editor Christopher Audu, MD Executive Director SVS Kenneth M. Slaw, PhD Director of Membership Marketing and Communications Tara J. Spiess, CAE Managing Editor SVS Beth Bales Marketing & Membership Specialist Amber Dunlop Assistant Marketing & Social Media Manager Kristin Crowe
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Vascular Specialist is the official newspaper of the Society for Vascular Surgery and provides the vascular specialist with timely and relevant news and commentary about clinical developments and about the impact of healthcare policy. Content for Vascular Specialist is provided by BIBA Publishing. Content for the News From SVS is provided by the Society for Vascular Surgery. | The ideas and opinions expressed in Vascular Specialist do not necessarily reflect those of the Society or the Publisher. The Society for Vascular Surgery and BIBA Publishing will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services, or the quality or endorsement of advertised products or services, mentioned herein. | The Society for Vascular Surgery headquarters is located at 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | POSTMASTER: Send changes of address (with old mailing label) to Vascular Specialist, Subscription Services, 9400 W. Higgins Road, Suite 315, Rosemont, IL 60018. | RECIPIENT: To change your address, e-mail subscriptions@bibamedical.com | For missing issue claims, e-mail subscriptions@bibamedical. com. | Vascular Specialist (ISSN 1558-0148) is published monthly for the Society for Vascular Surgery by BIBA Publishing. | Printed by Vomela Commercial Group | ©Copyright 2022 by the Society for Vascular Surgery
Vascular Specialist | May/June 2022
FROM THE EDITOR A modest proposal: Let’s eat the trauma surgeons By Malachi Sheahan III, MD
W
ell folks, after more than two years of the pandemic, racial injustice, and medical misinformation, I have decided it is time to return to writing about what I truly love: fake feuds with other specialties. Remember the heady days of 2019 when surgeons took on the Association of periOperative Registered Nurses (AORN) in the Bouffant War? All it took was a global plague and international shortages of personal protective equipment (PPE) to prove that AORN’s 47 evidence-free recommendations for surgical attire might not be addressing the most pressing needs in modern medicine. Today, we are free to put on our skullcaps and bask in our victory, earlobes and napes of our necks exposed like the day our mamas made us. Now we are being pulled into a new, ridiculous feud. I think the millennials would describe it like this: No one: Absolutely no one: Trauma surgeons: Hey, I don’t think we need vascular surgeons anymore! The first salvo came in 2020 with the Annals of Surgery perspective article “Beyond the crossroads: Who will be the caretakers of vascular injury management?” The authors of this piece made several salient points detailing the lack of adequate training in vascular injuries for trauma and acute care surgeons. Our esteemed profession, however, endured several cheap shots in the process. “As vascular practitioners become more focused on elective endovascular procedures, they often develop ‘lesion vision,’ similar to ‘tunnel vision,’ focusing on obtaining gratifying before/after images, whereas failing to use the patient’s other injuries or physiology in the decision making of how the vascular injury should be managed.” Lesion vision? That’s not even catchy. I mean come on, “stenosis psychosis” is right there. Besides, who has lesion vision? Vascular surgeons, or the people calling us at 4 a.m. because they think they see a 5mm blush near the superficial femoral artery on an 18-year-old with palpable pulses? Elsewhere in the article, the authors declare without evidence that “Patients with injuries that may be best treated by open surgery receive endovascular care because that is what the local vascular surgeon knows.”
Other random grievances are aired. Vascular surgeons are apparently so afflicted with Lesion VisionTM that we fail “to fully prepare and drape the trunk and extremities to allow for rapid default for open proximal control or a later fasciotomy…” A remarkably specious accusation to cast at a specialty who routinely prep their endovascular aneurysm repairs (EVARs) from nipples to groins despite last performing an open conversion before the iPad was invented. I was fortunate to contribute to the response to this article organized by Drs. Brigitte Smith and Erica Mitchell. The resulting perspective was thoughtful and measured (despite my best efforts). The answer, we maintained, was collaboration between vascular surgeons and trauma surgeons. It certainly says something about our commitment to patients that we are so willing to battle over the management of vascular trauma. These cases live in that godless patch of night starting around 3 a.m., where you leave the comfort of your bed with the terrible knowledge that your day has now begun, and an Odyssean journey separates your return. Masochistically, I run the dispiriting math on the way to the hospital. Let’s see, I can finish this trauma by 7, get to my clinic at 8, grab a fast lunch, make war with the Trojans, three quick cath lab cases, then sail home to Penelope. Hopefully, there won’t be traffic on the Aegean. The back and forth in Annals of Surgery should have been the end of it, but, ladies and gentlemen, I regret to inform you that the trauma surgeons are back on their bullstuff. In the recently published study “Trauma surgeon-performed peripheral arterial repairs are associated with equivalent outcomes when compared with vascular surgeons,” the trauma surgeons from the Medical College of Wisconsin purport that their brachial and femoral artery repairs had the same shortterm outcomes as those performed by their institution’s vascular surgeons. In an unfortunate blow to the scientific validity of this conclusion, the femoral injuries treated by the vascular surgeons were significantly more complex and more likely to be associated with
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MALACHI SHEAHAN III is the Claude C. Craighead Jr. professor and chair in the division of vascular and endovascular surgery at Louisiana State University Health Sciences Center in New Orleans.
Welcome to your new-look SVS newspaper THIS MONTH, VASCULAR SPECIALIST, YOUR OFFICIAL monthly newspaper from the Society for Vascular Surgery (SVS), re-launches with a new look. Our masthead has been freshened up and the layout has undergone a revamp. We hope you enjoy this new, modern look. The edition is a double issue covering the months of May and June, and also includes a 20-page section devoted to the upcoming Vascular Annual Meeting (VAM) in Boston. Included in the regular pages of the newspaper are interviews with Vascular Surgery Board Chairman Thomas Huber, MD, a vascular surgeon-led commentary from the frontlines of the war in Ukraine, and a peek behind the curtain of the most recent issue of Seminars in Vascular Surgery with Editor-in-Chief Caitlin Hicks, MD, and Sherene Shalhub, MD, who was guest editor for a focused look at aortic dissection and the Aortic Dissection Collaborative. The VAM preview section—and the cover of this May/June special issue—features an interview with Michael Dalsing, MD, on the Crawford Forum he has put together, a
chat with Christopher Audu, MD, the winner of this year’s SVS Foundation Resident Research Award (also our own resident/fellow editor), along with reports on presentations from across various plenary, focused and special sessions. The preview section’s name, Vascular Specialist@ VAM, will also be the new name of the VAM daily newspaper starting this year, replacing Vascular Connections. Meanwhile, all of our regular features take up their usual spots in the paper, including Corner Stitch, our monthly column written by and for trainees and medical students. Thank you, as always, to our readership, and we look forward to more of your contributions to the rebooted Vascular Specialist in the months and years ahead. Yours,
