Julius Chapiro Mark Lessne, MD Jay Mathews MD, MS, FACC, FSCAI Bao Tran, MD Venkat Tummala MD Kumar Madassery Sabeen Dhand Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett drcostantino Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Ahmed Kayssi Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Line Monkey MD I’m curious to know what the complications were specifically. I have found it to be very reliable, especially when used in patients where I can do the closure with ultrasound. There’s only 3 steps. I am concerned about the focal atheroma that Jay Mathews MD, MS, FACC, FSCAI mentioned.

Mark Lessne, MD Jay Mathews MD, MS, FACC, FSCAI Bao Tran, MD Venkat Tummala MD Kumar Madassery Sabeen Dhand Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett drcostantino Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Ahmed Kayssi Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Pankit Parikh Line Monkey MD We tried it and within the first 3 months our section saw more complications than within 10 plus years of AngioSeal. Absolutely do not understand why one would opt to use it. Just not worth it. Too many steps. Too little benefit.

Dan Brown Venkat Tummala MD drcostantino Kumar Madassery Sabeen Dhand Mark Lessne, MD Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett Jay Mathews MD, MS, FACC, FSCAI Zola N'Dandu August Ysa Fadi Saab Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Ahmed Kayssi Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Pankit Parikh Line Monkey MD We have use Angioseal for years without any major issues. But most of our cases are retrograde puncture ( much easier with high BMI) converted to ante and at the end redirected to retro and closure. Almost zero complication even with large sheath used for aspiration

Venkat Tummala MD drcostantino Kumar Madassery Sabeen Dhand Mark Lessne, MD Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett Jay Mathews MD, MS, FACC, FSCAI Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Ahmed Kayssi Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Pankit Parikh Line Monkey MD many, many years ago (junior faculty), I went to SIR and came back using Angioseal while one of my senior partners chose Starclose. I asked our fellows what they preferred and every one said Angioseal.

Bao Tran, MD Venkat Tummala MD Kumar Madassery Sabeen Dhand Mark Lessne, MD Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett drcostantino Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Ahmed Kayssi Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Pankit Parikh Line Monkey MD Celt is great for secure SFA puncture. I'm seeing a bunch come back with focal atheroma in the CFA. May need a drug coated Celt or bioresorbable Celt.

Venkat Tummala MD Kumar Madassery Sabeen Dhand Mark Lessne, MD Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett drcostantino Jay Mathews MD, MS, FACC, FSCAI Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Ahmed Kayssi Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Pankit Parikh Line Monkey MD Closure devices work well with no significant plaque burden in CFA .Consider a completion study when in doubt,Involve your vascular surgery colleagues early . Pictures from removal of an inadvertent closure device in CFA . Device failed here due to dissection of a calcific plaque

Venkat Tummala MD Kumar Madassery Sabeen Dhand Mark Lessne, MD Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett drcostantino Jay Mathews MD, MS, FACC, FSCAI Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional Peder E. Horner, MD Interventional Physician Goke Akinwande Srini Tummala MD FSIR FSVM Omar Solana MD NFT M. Larone Campbell Sid Rao Bret Wiechmann Pankit Parikh Line Monkey MD Prostyle if proximal 10cm of SFA is clear. I’ll also do an on-table ultrasound to make sure no pseudo or occlusion post deployment. Have recently had to reconstruct CFA for Prostyle CFA occlusion of and another case where the tip broke (see below). These devices aren’t perfect.

What’s your go to femoral antegrade closure device of choice? Why?
#CLTI

Kumar Madassery Sabeen Dhand Mark Lessne, MD Mike Watts Oleksandra Kutsenko, MD 🇺🇦 Lorenzo Patrone Varshana Gurusamy Keith Pereira MD, #VIrad Don Garbett drcostantino Jay Mathews MD, MS, FACC, FSCAI Zola N'Dandu August Ysa Fadi Saab BAO BUI Joseph L. Mills MD BackTable Vascular and Interventional

Venkat Tummala MD Mert Prof Ramesh K Tripathi Lorenzo Patrone Oleksandra Kutsenko, MD 🇺🇦 SIR RFS Srini Tummala MD FSIR FSVM Eric Secemsky MD MSc Hady Lichaa, MD, FACC, FSCAI, FSVM, RPVI Rx of iliac lesion for emboli, size>3.5cm, symptoms-pain

Venkat Tummala MD Mert Prof Ramesh K Tripathi Lorenzo Patrone Oleksandra Kutsenko, MD 🇺🇦 SIR RFS Srini Tummala MD FSIR FSVM Eric Secemsky MD MSc Hady Lichaa, MD, FACC, FSCAI, FSVM, RPVI Current guidelines recommend treatment of all SMA aneurysms.

Equally important if not more,

What are indications to treat (whatever this finding is ) in these anatomical locations? What morphology if any would expedite intervention?
Greg Hayes Prof Ramesh K Tripathi Lorenzo Patrone Oleksandra Kutsenko, MD 🇺🇦 SIR RFS Srini Tummala MD FSIR FSVM Eric Secemsky MD MSc Hady Lichaa, MD, FACC, FSCAI, FSVM, RPVI

Venkat Tummala MD Patrick Geraghty Dr. Bowser, MD, FACS 🔥 👊🏾👍🏾BT Fisher Sr., MD Prof Ramesh K Tripathi Leigh Ann O'Banion Jim Melton Mark Lessne, MD Mohammad Arabi Jay Mathews MD, MS, FACC, FSCAI Kumar Madassery Mike Watts Sabeen Dhand Peder E. Horner, MD Interventional Physician Saher Sabri Keith Pereira MD, #VIrad Austin Bourgeois Dr Shariq Shamim Michael Cellini Joseph L. Mills MD ᗰIGᑌEᒪ ᗰOᑎTEᖇO-ᗷᗩKEᖇ Line Monkey MD That term “dissecting aneurysm”, is very ambiguous, it should not be used. It is frequently confused with a ruptured AAA. A better term would be “dissection with aneurysmal dilation”, which does does not infer a rupture.

Let’s settle this ( hopefully)!

What’s the right terminology to describe these angiographic findings?
2 patients, Iliac & SMA
Patrick Geraghty Dr. Bowser, MD, FACS 🔥
👊🏾👍🏾BT Fisher Sr., MD Prof Ramesh K Tripathi Leigh Ann O'Banion Jim Melton Greg Hayes Mark Lessne, MD Mohammad Arabi Jay Mathews MD, MS, FACC, FSCAI Kumar Madassery Mike Watts

Venkat Tummala MD Saher Sabri Keith Pereira MD, #VIrad Line Monkey MD Varshana Gurusamy M. Larone Campbell Fakhir Elmasri Beautiful result! I especially like how you”cheated”the stent graft just a little cephalad to prevent type 1A leak. Not the cheapest solution but a very efficacious,safe, and durable one! #IRad

Weighed in various viable options that were mentioned.
Successful exclusion using appropriately sized stent graft. Anti platelet therapy was initiated.

Saher Sabri Keith Pereira MD, #VIrad Line Monkey MD Varshana Gurusamy M. Larone Campbell Fakhir Elmasri

Venkat Tummala MD Patrick Geraghty Keith Pereira MD, #VIrad 👊🏾👍🏾BT Fisher Sr., MD Mark Lessne, MD Kumar Madassery Sabeen Dhand Robert Ryu Don Garbett Oleksandra Kutsenko, MD 🇺🇦 Peder E. Horner, MD Interventional Physician Saher Sabri M. Larone Campbell Shamit Desai MD 𝙍𝙖𝙠𝙚𝙨𝙝 𝙎. 𝘼𝙝𝙪𝙟𝙖, 𝙈𝘿 Michael Cellini Sandeep Bagla MD Venkat Tummala MD I love these cases. This reminds me of a several years ago when you hit Twitter with wild vascular cases every day. I learn a lot every time. I’d put a covered stent in, particularly given age and course. Keep things simple.

Venkat Tummala MD Patrick Geraghty Keith Pereira MD, #VIrad 👊🏾👍🏾BT Fisher Sr., MD Mark Lessne, MD Kumar Madassery Sabeen Dhand Robert Ryu Don Garbett Oleksandra Kutsenko, MD 🇺🇦 Peder E. Horner, MD Interventional Physician Saher Sabri M. Larone Campbell Line Monkey MD Shamit Desai MD 𝙍𝙖𝙠𝙚𝙨𝙝 𝙎. 𝘼𝙝𝙪𝙟𝙖, 𝙈𝘿 Michael Cellini Sandeep Bagla MD Based on age, history and SFA location >>Stent graft 1 mm oversized will deal with both problems. Typical injury post bedside Temp dialysis catheter!!

Venkat Tummala MD Patrick Geraghty Keith Pereira MD, #VIrad 👊🏾👍🏾BT Fisher Sr., MD Mark Lessne, MD Kumar Madassery Robert Ryu Don Garbett Oleksandra Kutsenko, MD 🇺🇦 Peder E. Horner, MD Interventional Physician Saher Sabri M. Larone Campbell Line Monkey MD Shamit Desai MD 𝙍𝙖𝙠𝙚𝙨𝙝 𝙎. 𝘼𝙝𝙪𝙟𝙖, 𝙈𝘿 Michael Cellini Sandeep Bagla MD Stent graft for me 👍🏽

Venkat Tummala MD Patrick Geraghty Keith Pereira MD, #VIrad 👊🏾👍🏾BT Fisher Sr., MD Mark Lessne, MD Kumar Madassery Sabeen Dhand Robert Ryu Don Garbett Oleksandra Kutsenko, MD 🇺🇦 Peder E. Horner, MD Interventional Physician Saher Sabri M. Larone Campbell Line Monkey MD Shamit Desai MD 𝙍𝙖𝙠𝙚𝙨𝙝 𝙎. 𝘼𝙝𝙪𝙟𝙖, 𝙈𝘿 Michael Cellini Sandeep Bagla MD Small covered stent will take care of this. No need for coils.

Venkat Tummala MD Patrick Geraghty Keith Pereira MD, #VIrad 👊🏾👍🏾BT Fisher Sr., MD Mark Lessne, MD Kumar Madassery Sabeen Dhand Robert Ryu Don Garbett Oleksandra Kutsenko, MD 🇺🇦 Peder E. Horner, MD Interventional Physician M. Larone Campbell Line Monkey MD Shamit Desai MD 𝙍𝙖𝙠𝙚𝙨𝙝 𝙎. 𝘼𝙝𝙪𝙟𝙖, 𝙈𝘿 Michael Cellini Sandeep Bagla MD Need selective catheterization and high frame rate DSA. Then based on size of parent artery, either coil the artery across the fistula or stent graft it. Coiling fistulas or PSA rarely solves the issue.