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Audible Bleeding
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Audible Bleeding is a resource for trainees and practicing vascular surgeons, focusing on interviews with leaders in the field, board preparation, and dissemination of best clinical practices and high impact innovations in vascular surgery.
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Holding Pressure - TransCarotid Artery Revascularization (TCAR)
1w ago00:33:49Tap to summarizeCORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease: https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/ OUTLINE: CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition. Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma. Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke. 2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging. Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction. 3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis. In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors. These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass. Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis. Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery. Classification of stenosis: Mild: Moderate: 50-69% narrowing Severe: ≥70% narrowing TRANSCAROTID ARTERY REVASCULARIZATION (TCAR) 5. Relevant Trials ROADSTER-1 trial: prospective, multicenter, single-arm study evaluating TCAR with dynamic flow reversal in patients at high risk for carotid endarterectomy (CEA), including both symptomatic (≥50% stenosis) and asymptomatic (≥80% stenosis) patients. 30-day stroke rate of 1.4% and a combined stroke/death/MI rate of 3.5%, with technical success in 99% of cases At 1 year, the ipsilateral stroke rate was 0.6%, indicating excellent durability in a high-risk population Limitations: highly controlled environment with a select group of experienced operators, which raised concerns about the generalizability, especially among physicians new to TCAR. Additionally, ROADSTER-1 was a single-arm study without a comparison group. ROADSTER-2: prospective, multicent...
Transcribe →Landmark Paper Series: Asymptomatic Carotid Artery Stenosis
May 3100:34:29Tap to summarizeWelcome back to the Audible Bleeding series: Landmark Papers in Vascular Surgery. In this episode, co-hosts John and Dr. Jesse Columbo are joined by our guest, Dr. Caitlin Hicks, to discuss one of the most studied—and most debated—topics in vascular surgery: asymptomatic carotid stenosis. In this episode, we'll trace that evolution through three pivotal trials: ACAS and ACST-1, which established carotid endarterectomy as the standard of care; and the newly published CREST-2, which challenges us to reconsider everything we thought we knew. Along the way, we'll explore how advances in statin therapy, blood pressure control, and antiplatelet agents have fundamentally changed the natural history of this disease—and what that means for our patients today." Links to Landmark Papers: (ACAS) Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACST-1) 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis: a multicentre randomised trial (CREST-2) Medical Management and Revascularization for Asymptomatic Carotid Stenosis Guests: Dr. Caitlin Hicks, MD (@CaitlinWHicks); Associate Fellowship Program Director, Vascular Surgery & Endovascular Therapy at Johns Hopkins and Director of Research Hosts: John Culhane, MD (@JohnCulhaneMD); General Surgery Resident, Abrazo Health Dr. Jesse Columbo, MD; Assistant Professor of The Dartmouth Institute, Geisel School of Medicine, Dartmouth Follow us @audiblebleeding, Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →SVS Leadership and Advocacy Summit
May 2600:47:02Tap to summarizeAudible Bleeding editors Falen Demsas, an integrated vascular surgery resident at Massachusetts General Hospital, and Sasank Kalipatnapu (@ksasank), a fifth-year general surgery resident at UMass Chan Medical School, are joined by Megan Tracci (@MeganTracci), James Black (@JamesHBlackMD), and Lauren West-Livingston (LWestLivingston) for a discussion following the inaugural SVS Leadership and Advocacy Summit. In this episode, the group reflects on the importance of surgeon advocacy, highlights key takeaways from the Summit, and discusses how vascular surgeons throughout training and practice can engage in policy, leadership, and organized medicine at local and national levels. The conversation explores the evolving role of advocacy within the Society for Vascular Surgery, including the work of the SVS Advocacy Council and its collaboration across Government Relations, Coding, VA advocacy, and quality and policy initiatives. Dr. Tracci shares insights from her leadership roles within SVS advocacy efforts and her work as ACS Medical Director for Surgeon Engagement. Dr. Black discusses his longstanding advocacy work on behalf of patients and physicians, including numerous trips to Capitol Hill over the course of his career. Dr. West-Livingston reflects on her experience attending the recent Advocacy & Leadership Conference as a trainee and the importance of resident involvement in advocacy work. Show Guests Megan Tracci Leader within the SVS Advocacy Council, which includes Government Relations, Coding, VA advocacy, and quality and policy collaboration efforts. She also serves as the ACS Medical Director for Surgeon Engagement. James Black Chief of Vascular Surgery and Endovascular Therapy at Johns Hopkins University and longtime advocate who has made countless trips to Capitol Hill to advocate for patients and physicians. Lauren West-Livingston Integrated vascular surgery resident at Duke University and member of the SVS Government Relations Committee who attended the recent Advocacy & Leadership Conference. Notable Mentions The inaugural SVS Leadership and Advocacy Summit Advocacy efforts within the Society for Vascular Surgery, including Government Relations, Coding, VA advocacy, and quality and policy collaboration. Learn more here SVS Advocacy Council Opportunities for vascular surgeons to engage in advocacy throughout all stages of training and practice. Sign up for updates Follow us @audiblebleeding Learn more about us at Audible Bleeding and provide us with your feedback through our listener survey. Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →Crossing Borders: International Fellowships in Vascular Surgery
May 2300:47:43Tap to summarizeAudible Bleeding editor Wen (@WenKawaji) discusses international vascular surgery fellowships with Dr. Judith Lin (@JudithLin4), Dr. Adam Johnson, and Dr. Robbie Aru (@AruRobbie). Together, they reflect on what drove them abroad, what the experience actually looked like on the ground, and the professional, financial, and personal challenges that came with it. Whether you're a resident exploring your options or simply curious about roads less traveled in surgical training, this conversation offers a candid and practical look at what international fellowships in vascular surgery really entail. A must-listen for anyone considering fellowship training outside the U.S. Articles: A contemporary guide to an international aortic super-fellowship for surgical trainees and surgeons in the United States Show Guests Dr. Judith Lin: professor and chief of vascular surgery in the Department of Surgery at Michigan State University's College of Human Medicine Dr. Adam Johnson: assistant professor of surgery and assistant professor in population health science at Duke university school of medicine Dr. Robbie Aru: assistant professor of surgery at Thomas Jefferson university medical college Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →JVS CIT Editorials and Abstracts - April 2026
May 1000:53:35Tap to summarizeIn this episode, we spotlight editorials and abstracts from the Journal of Vascular Surgery Cases, Innovations, and Techniques (JVS-CIT). Editorials and Abstracts are read by Authors as well as members of the SVS Social Media Ambassadors. Guests: Isabel Banks, MS4, SLU Selected publications regarding lower extremity chronic ischemia and the diabetic foot from the Journal of Vascular Surgery: Cases and Innovative Reports 2025, Volume 11 Best of 2025—abdominal aortic and iliac aneurysm Double anonymous peer review in JVSCIT—lessons from our pilot trial and next steps Endovascular stapling with Aortoseal as an adjunct for the hostile neck The transcaval approach may be the new route vascular surgeons need in their arsenal Intraoperative positioning system-guided antegrade in situ laser fenestration in an aortic model Single-center experience using Endologix anatomically fixated endograft device for treatment of aortoiliac occlusive disease Short-term analysis of botulinum toxin A for functional popliteal artery entrapment syndrome Comparing neurological complications between endovascular and open surgical repair of the descending thoracic aorta Hosts: John Culhane (@JohnCulhaneMD) Follow us @audiblebleeding, @JVS-CIT Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →JVS Author Spotlight - Weaver, Repella, Sridharan and Anan
May 300:44:05Tap to summarizeAudible Bleeding editor Wen Kawaji (@WenKawaji) is joined by integrated vascular surgery resident Falen Demsas, 5th-year general surgery resident Sasank Kalipatnapu (@ksasank), JVS editor Dr. Duncan (@ADuncanVasc), and JVS-VL editor Dr. Ruth Bush to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Weaver, student doctor Finn, Dr. Sridharan, and Dr. Anan. Articles: Evaluating the Vascular Quality Initiative's role in advancing minority health and health disparities research―a scoping review Catheter-directed interventions versus surgical embolectomy in massive pulmonary embolism Show Guests Dr. Weaver: assistant professor of surgery and associate program director of the vascular surgery fellowship at the University of Utah. She is also the director of clinical operations efficiency at the University of Utah. Finn Repella: rising 4th medical student at the University of Virginia Dr. Sridharan: associate professor at the University of Pittsburgh Medical Center (UPMC). Site Chief of vascular surgery at UPMC Mercy. Dr. Anan: research fellow in the division of vascular surgery at the University of Pittsburgh Medical Center (UPMC). She earned her MD from the American University of Beirut. Notable mentions: From Bench to Bill: How a Transplant Nuance Became 1 of Only 57 Laws Passed in 2013 Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →JVS Author Spotlight - Shetty, Reitz, Alsiraj & Cassis
Apr 1500:50:58Tap to summarizeAudible Bleeding Editor and vascular surgery fellow Richa Kalsi (@KalsiMD) is joined by 5th year general surgery resident Amol Kamat, JVS editor Dr. Audra Duncan (@ADuncanVasc), and JVS-VS editor Dr. John Curci (@CurciAAA) to discuss two great articles in the JVS family of journals. This episode hosts medical student Neha Shetty (LinkedIn), Dr. Katherine Reitz (@MollReitz), Dr. Yasir Alsiraj, and Dr. Linda Cassis. Articles: Part 1: Prioritizing high-volume repair hospitals with ruptured abdominal aortic aneurysms, for rural and nonrural patients (Shetty & Reitz) Part 2: Role of adipocyte angiotensinogen or angiotensin type 1a receptors in the development of diet-induced atherosclerosis or angiotensin II-induced abdominal aortic aneurysms (Alsiraj & Cassis) Show Guests Neha Shetty is currently a medical student within the University of Pittsburgh School of Medicine's Class of 2027 Dr. Katherine Reitz is an Associate Professor of Surgery at the University of Pittsburgh School of Medicine. Dr. Yasir Alsiraj is an Assistant Professor of Pharmacology and Nutritional Sciences, Pediatrics, at the Saha Aortic Center at the University of Kentucky. Dr. Cassis is the Vice President of Research at the University of Kentucky College of Medicine. Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →The Vascular Voice - Inside the Editorial "A Call for Pay"
Apr 100:26:11Tap to summarizeJacob Soucy (@JacobWSoucy) hosts an inside look at a timely and thought-provoking editorial published in The Vascular Specialist, the official news magazine of the Society for Vascular Surgery. In this episode, we explore the evolving conversation around surgical call and compensation through the lens of the editorial "A Call for Call Pay." The discussion challenges the traditional framing of call as simply part of the job and instead examines it as a measurable burden of availability that carries legal, financial, and personal implications. This conversation highlights why the valuation of call may represent one of the defining structural issues in modern vascular surgery practice. Jacob speaks with Dr. Malachi G. Sheahan III about the motivation behind the piece, how hospital systems value call, what the true cost of call coverage is, and what the future may hold if the current model remains unchanged. Show Guest Dr. Malachi G. Sheahan III is Professor and Chair of Surgery at Louisiana State University Health Sciences Center and Chief of the Division of Vascular Surgery. He previously served as Program Director for both the fellowship and integrated residency in vascular surgery at LSU. Nationally, Dr. Sheahan serves as Secretary of the Society for Vascular Surgery and as Chief Medical Editor of The Vascular Specialist. With more than two decades in academic surgery, he is a recognized leader in vascular education, workforce policy, and advocacy within the specialty. Resources and Social Media X (Twitter): @lsuvascular Read the editorial: "A Call for Call Pay" – The Vascular Specialist Special thanks to Dr. Malachi G. Sheahan III for sharing his time and insight and for his ongoing contributions to vascular surgery. Follow us @audiblebleeding for updates on upcoming episodes and new research features. Learn more about us at audiblebleeding/about and share your feedback through our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →Decoding the SVS MIPS Value Pathway (MVP)
Mar 1500:31:16Tap to summarizeAudible Bleeding editor Wen Kawaji (@WenKawaji) and 5th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School host SVS QPMC leadership Dr. Shutze, Dr. Hicks and Carrie McGraw to take a deep dive into the Vascular Surgery–specific Merit Based Incentive Payment System Value Pathway or MVP. Show Guests Dr. William Shutze: Associate Professor at Texas A&M College of Medicine at Texas A&M Health Science Center in Dallas Texas. He is a managing partner at Texas Vascular Associates. He is the co-chair for the SVS Vascular Center Verification and Quality Improvement program, vice chair for the SVS QPMC committee Dr. Caitlin Hicks: Associate professor at Johns Hopkins University school of medicine, vice chair of research in the department of surgery. Chair for the SVS QPMC committee Carrie McGraw: SVS manager of Quality Improvement and Practice Important resources 2026 Vascular MVP PDF: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3100/Vascular-Surgery-MVP-Candidate.pdf SVS Quality improvement contact email: SvsQuality@vascular.org Vascular Specialist article: https://vascularspecialistonline.com/introducing-the-vascular-surgery-mips-value-pathway-a-new-era-for-meaningful-specialty-driven-quality-reporting/ Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →JVS Author Spotlight - Ullery, Bath, Lee, and Satam
Mar 800:53:32Tap to summarizeAudible Bleeding editor Wen Kawaji (@WenKawaji) is joined by Dr. Danielle Garcia, Dr. James Martinson, JVS editor Dr. Duncan (@ADuncanVasc), JVS-CIT editor Dr. Smeds (@MattSmeds) to discuss some of our favorite articles in the JVS family of journals. This episode hosts Dr. Ullery, Dr. Bath, Dr. Lee, and Dr. Satam. Articles: Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry A novel approach to thoracic endovascular aortic repair using "zone 1.5" deployment of the Gore thoracic branched endoprosthesis device Show Guests Dr. Ullery has served as the medical director of vascular and endovascular surgery at the Providence heart and vascular institute since 2017 and is the co-founder of the Laser In-Situ Fenestration of Aortic Endografts (LIFE) Registry Dr. Bath is a practicing Vascular Surgeon at the University Hospital of the University of Missouri Dr. Lee is the chief of vascular surgery at Stanford Medicine Dr. Satam is a current vascular surgery resident in her PGY3 year at Stanford Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey. *Gore is a financial sponsor of this podcast, which has been independently developed by the presenters and does not constitute medical advice from Gore. Always consult the Instructions for Use (IFU) prior to using any medical device.
Transcribe →