Real-World Decision Making
There are many ways to learn in medicine. We read articles, attend lectures, listen to webinars, and talk with our peers. Most importantly, we learn from our patients. They are often our greatest teachers, selflessly giving us priceless knowledge that makes us better at what we do. In this issue of Endovascular Today, 11 contributing moderators have prepared challenging patient scenarios that will capture your interest, stimulate your thinking, and hopefully inform your practice.
Most issues of Endovascular Today are focused on a singular theme—a disease, procedure, anatomic region, or health care issue—however, this month is different. This issue acknowledges one of the great ironies of current medicine: although evidence should be the basis of practice, we often face patients who don’t quite fit into the evidence-based algorithms, guidelines, consensus statements, or recommendations. As we all experience, it is impossible to capture the full complexity and nuance of the choices that must be made when caring for real patients.
The 11 moderators included in this issue have done a fantastic job of presenting cases that do not have clear answers, assembling a total of 37 discussants and moderating the ensuing discussion. Each case begins with the question, “What would you do?” In total, 48 experts representing six different specialties provide their opinions, rationales, and recommendations. The topic areas span a wide range, including endovascular aneurysm repair (EVAR), thoracic endovascular aortic repair (TEVAR), stroke, superficial femoral artery (SFA) intervention, critical limb ischemia (CLI), visceral aneurysms, venous insufficiency, chronic deep vein thrombosis (DVT), acute pulmonary embolism (PE), oncologic intervention, and uterine embolization. All readers of Endovascular Today should find something that will catch their interest.
To start, Guilherme Dabus, MD, focuses on stroke with panelists Donald Frei, MD; Ansaar T. Rai, MD; and Sudhakar R. Satti, MD. Then, Ali Azizzadeh, MD, directs Benjamin Jackson, MD; Joseph Bavaria, MD; Kristofer M. Charlton-Ouw, MD; Anthony L. Estrera, MD; Michael Fischbein, MD; Michael D. Dake, MD; and Jason T. Lee, MD, as they wrestle with the next frontier in TEVAR: acute type A dissection.
Keith M. Sterling, MD, oversees a discussion on a difficult presentation of PE by James F. Benenati, MD; Noah J. Jones, MD; and Akhilesh K. Sista, MD. Tara Mastracci, MD, leads a discussion with Jean-Paul P.M. de Vries, MD; Brant W. Ullery, MD; Nuno Dias, MD; Tim Resch, MD; and Björn Sonesson, MD, about EVAR in a patient with thrombus-lined proximal neck. Robert J. Lewandowski, MD, then puts Daniel B. Brown, MD; Riad Salem, MD; and Fred T. Lee Jr, MD, through their paces with a complex case of hepatocellular carcinoma. Parag J. Patel, MD, walks through the management of a renal artery aneurysm with Maureen P. Kohi, MD; Rahul S. Patel, MD; and Saher Sabri, MD.
Next, Janice Newsome, MD, confronts Jason Levy, MD; Michael Miller Jr, MD; and Alex Powell, MD, with a pregnant patient requiring uterine artery embolization. Kathleen Gibson, MD, takes on extreme venous insufficiency with Ellen D. Dillavou, MD; Raudel Garcia, MD; Antonios P. Gasparis, MD; and Raghu Kolluri, MD. Brooke Spencer, MD, presents a very challenging case of chronic DVT to Lawrence “Rusty” Hofmann, MD; Mark J. Garcia, MD; and Brent T. Steadman, MD.
Moderator John H. Rundback, MD, and panelists Michael Miller Jr, MD; Miguel Montero-Baker, MD; and Vincent Varghese, DO, tackle a case of calcified chronic total occlusion in the SFA. Lastly, Lawrence A. Garcia, MD, brings together Tony S. Das, MD; Robert A. Lookstein, MD; and Peter A. Schneider, MD, to discuss CLI intervention in the setting of gangrene.
We all learn from challenging cases, both our own and those of others. For that reason, this issue of Endovascular Today is dedicated to those who teach us the most—our patients.
John A. Kaufman, MD
Guest Chief Medical Editor