This a topic near and dear to me - thanks for having me. Congratulations to the authors on a beautiful result. I think these discussions about this topic are great to have. #VisceralEd

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 UR in the house - Genesee Brewery

JVS-Cases Innovations and Techniques Michael Nooromid University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Michael Stoner Great JVS paper by Elizabeth Andraska , UPMC Vascular Surgery on ROMS vs conventional bypass. jvascsurg.org/article/S0741-… ROMS with decreased operative time (189 vs 302 minutes), and no significant difference in primary patency of surviving individuals or all-cause mortality at two years.

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Michael Stoner You also have to consider your systems. Real talk - At my institution, I have yet to be in a situation where I could do ROMS more rapidly than I could do a retrograde bypass. This is just the reality of staffing, supplies and x ray where I am. #VisceralEd

JVS-Cases Innovations and Techniques Dr. Bowser, MD, FACS 🔥 Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Ugh. Bad news bears. Vein h-graft to SMA.

Michael Nooromid JVS-Cases Innovations and Techniques Brandon Creisher University of Missouri Vascular Surgery Michael Stoner EJVES American College of Radiology I think it is institution dependent and dependent on all the factors we have brought up. On top of that you must have excellent communication and physicians taking ownership of the whole patient to be able to quickly shift to laparotomy if needed.

Michael Nooromid Matthew Smeds JVS-Cases Innovations and Techniques Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Michael Stoner Distal Embolization can happen but if care is taken to go through the thrombus with constant suction, not very likely. I have seen it once only as a transfer….

Q3: In your practice, how is dead bowel handled after revascularization?  Is the general/acute care surgeon involved in the management of patients with acute mesenteric ischemia in your practice? Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Michael Stoner #JVSCITxChat

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Simple one segment resection by vascular. More complex done by EGS

JVS-Cases Innovations and Techniques Michael Nooromid University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Michael Stoner There is significant rate of need for bowel resection and negative radiographic findings does not mean these patients are always out of the woods. Our ACS team is always on hand for a diagnostic laparoscopy or laparotomy and performs bowel resection or a second look #JVSCITxChat

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Michael Stoner Yeah but you need their buy in. Back in the day people were less afraid of a negative ex lap. Dx lap is more palatable. #visceraled

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Michael Stoner I want the women and men who handle bowel every day take it out. I’m board certified general surgeon but acute care surgeons in house will have better outcomes, I almost guarantee it. #jvscitXchat

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher Dr. Bowser, MD, FACS 🔥 Michael Stoner #jvscitxchat The issue for me is not whether I CAN do it - but whether I WANT to take the patient back; open abdomen, VAC change, washout, attempted closure if too tight, diuresis, complex closure etc. Then if there is a leak...well...

University of Missouri Vascular Surgery JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher Dr. Bowser, MD, FACS 🔥 Totally. We don’t always have “block time” to support this endeavor.

JVS-Cases Innovations and Techniques FutureVascSurgeons Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 All open surgery translates. ABF duodenal mobilization translates. Get your trainees on foregut cancer services to maximize exposure and comfort.

JVS-Cases Innovations and Techniques FutureVascSurgeons Michael Nooromid Brandon Creisher Dr. Bowser, MD, FACS 🔥 Michael Stoner #jvscitxchat We still do perhaps 5-6 open elective bypasses a year - adequate exposure - perhaps. ROMS provides most of the SMA exposure skills for the AMI cases. I do think that performing a mesenteric bypass is a bit of a dying art though - sadly

JVS-Cases Innovations and Techniques FutureVascSurgeons Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Dr. Bowser, MD, FACS 🔥 Michael Stoner Find mesenteric vessels (at least by pulse) in all open aortic cases so they are familiar to its course. Oh, and send your trainees to #APEX24 Lightly embalmed cadaver exposure course. (Shameless plug)

JVS-Cases Innovations and Techniques FutureVascSurgeons Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Michael Stoner Open surgery is still happening in Delaware. If there’s an interest in rotating residents - something we can explore. Already have UPenn Ct integrated residents for half the year.

JVS-Cases Innovations and Techniques Michael Nooromid Brandon Creisher University of Missouri Vascular Surgery Michael Stoner Great case - love the Jefferson group. Keep up with the great work!

Luke!!!!!!! Luke Meredith, MD another Jefferson Thoracic superstar in the pipeline. A Robotic Minimally Invasive Technique for Resecting a Retro-Oesophage... sciencedirect.com/science/articl…