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AAMS Journal Club: Acute Mesenteric Ischemia and Article Review - Shared screen with speaker view
EQ
24:16
hi everyone
EQ
24:28
again… feel free to ask questions on this chat
EQ
25:33
i hope this JC to be as interactive as possible
EQ
28:05
i mentioned last time heparin being my favorite drug, well…SMA is my favorite blood vessel
Philip Caushaj
29:06
I love removing intestines!!! Just saying!
EQ
30:20
the only time dr. caushaj when im jealous about gen surg colleagues is mesenteric ischemia cases…bowel is removed and they all leave
EQ
31:17
Also…wanna add to this slide median arcuate ligament syndrome and spontaneous SMA dissection
EQ
31:26
not included on this article
Ergen Muso
31:37
HI guys, didn’t get a chance to introduce. Im a Gastroenterologist in NH so its nice to see all different specialties here.. I like to consult IR and surgery haha.
EQ
32:08
Dr. Muso, i respect tremendously what you do…IR has no role in my opinion.
Arbenita Dervisholli
32:45
Is inferior mesenteric artery ischemia common and if so is prognosis better for inferior mesenteric ischemia compared to superior d/t the ability to better resect hindgut and the three arteries perfusing the rectum.
Lorenc Malellari
33:14
Our vascular surgery colleagues trump IR any day
Ergen Muso
33:25
I don’t disagree!
EQ
33:38
IMA has little role in mesenteric ischemia (unless it is dominant vessel with chronically occluded SMA)
Arbenita Dervisholli
33:48
Thank you
Philip Caushaj
34:02
I can honestly say Erion and his vascular colleagues at my hospital are a real blessing
EQ
34:07
rectum sigmoid is well collateralized (hypogastric and SMA collaterals )
Ira
34:16
Hi All, I am Ira Male, probably the only PhD here. But very quickly I have a PhD in cell and molecular biology and currently work in a multi-stage investment company (hedgefund, venture capital) where I do work from building start-ups from an idea to doing diligence on public companies. I was introduced to AAMS by Dr. Coku when AAMS was in its infancy. Glad to be here and nice to virtually meet everyone.
EQ
34:20
ie i cover IMA all the time i do an EVAR
EQ
34:37
welcome IRA
Lorenc Malellari
35:14
IMA occlusion can cause sigmoid colon ischemia, but its's very rare. Not usually an emergency and it doesn't effect the rectum as Dr. Qaja said.
Arbenita Dervisholli
36:44
Great thank you
Lorenc Malellari
36:52
Those pt would show up to the hospital with sigmoid colon inflammation and they're usually diagnosed as diverticulitis or colitis.
Lorenc Malellari
38:45
Welcome IRA, glad you could join us
Erion Qaja
39:43
i always like to give analogies
Erion Qaja
40:37
mesenteric ischemia is the equivalent of myocardial infarction (except what dies the intestine not the myocardium )
Erion Qaja
40:57
pain out of proportions = elephant sitting on your chest
Ira
43:44
These were studies conducted in Spain. How do they translate to what we see here in the US?
Erion Qaja
46:49
pretty similar in tertiary care centers her in the US in terms of mortality
Ira
46:58
Are there any tests that we can do to catch this disease earlier?
Ira
47:13
As it sounds like there is a huge unmet need to diagnose these pts on time
Erion Qaja
47:36
short answer =nope
Erion Qaja
47:49
it takes a good clinician to diagnose it
Erion Qaja
48:06
and and even better to order the appropriate diagnostic test ie CTA
Erion Qaja
48:46
we sort of rely on physicians who have first contact with these patients
Philip Caushaj
49:10
Klevi excellent presentation
Arber Shehu
50:03
Klevi, great job!
Klevi Golloshi
50:05
Thank you very much!
Ira
50:06
What is the prevalence in US and world wide for this disease?
Arber Shehu
51:05
Is there any study so far which shows the correlation between Covid pts and AMI?
Erion Qaja
51:28
Arber; not to my knowledge
Lorenc Malellari
52:00
Ira...thankfully rare. Dr. Qaja I'm sure has more details.
Erion Qaja
52:08
Ira
Erion Qaja
52:11
had to look it up
Philip Caushaj
52:26
Covid and Mesenteric ischemia has been seen in. Rare cases with hypercoagulable state
Erion Qaja
52:34
17 % > 65 have critical stenosis of t least one mesenteric vessel
Erion Qaja
52:57
AMI prevalence 6.7-9.6 /100000 admissions
Erion Qaja
53:25
chronic mesenteric ischemia 1/100000 admission
Erion Qaja
53:31
hope this helps
Arber Shehu
53:32
I am wondering how much effective covid vaccines would be in this category of disease. Thanks
Philip Caushaj
53:51
Not sure relevant to stopping
Erion Qaja
54:17
OKAY
Sara Kryeziu
54:20
Just as a side note, we are planning on discussing COVID related gastrointestinal complications next month. Maybe we can answer these questions in more detail then.
Erion Qaja
54:29
absite question
Ira
54:44
Thanks @EQ . Just curious as if we had a test that we could catch AMI sooner - we could save society quite a bit
Erion Qaja
55:00
which portion of the bowel is preserved in MI due to embolus vs acute on chronic (another name in situ thrombosis)
Erion Qaja
57:16
thrombosis are the patients who have had one or two carotid endarterectomies performed, maybe a fem-distal bypass, heavy smokers, with non palpable pedal pulses
Erion Qaja
58:48
Elmira answered first question
Erion Qaja
01:01:30
I had a patient who i did open BRACHIAL embolectomy
Erion Qaja
01:02:29
all well and good, patient goes in pacu only to get a phone call from radiology (usually its the other way around) that patient also had SMA embolus
Erion Qaja
01:02:54
once you get a blood clot in one arterial bed make sure you check that would kill the patient sooner ie SMA embolus
Sara Kryeziu
01:03:31
what imaging did you have on this patient?
Erion Qaja
01:03:41
CTA chest upper extremity
Erion Qaja
01:03:48
CTA chest barely caught the SM A
Erion Qaja
01:04:38
FYI- i could be wrong by saying this, if i were to do emergent vascular intervention in this day and age i would get a CTA 100% of the time
Erion Qaja
01:05:01
Elmira is well prepared
Erion Qaja
01:05:18
my absolute favorite question on this topic is :
Ergen Muso
01:05:30
I feel like I can do surgery now after this lecture
Erion Qaja
01:05:36
1-what kind of incision would you make and WHY?!
Sara Kryeziu
01:05:45
transverse
Erion Qaja
01:05:55
answer to this question tells me how much you know on the topic
Erion Qaja
01:06:17
transverse if its embolic in origin
Erion Qaja
01:06:33
so you can close it with interrupted 6.0 praline
Erion Qaja
01:06:40
prolene*
Erion Qaja
01:06:48
what if the SMA is less than 6 mm
Sara Kryeziu
01:06:58
that’s a fellow level question
Erion Qaja
01:07:02
you’ll have to do longitudinal and close it with the patch
Erion Qaja
01:07:11
patch is NOT bovine
Erion Qaja
01:07:15
usually GSV
Erion Qaja
01:07:28
never such a thing of fellow level questions :)
Erion Qaja
01:08:02
if you were to do a bypass than longitudinal for an end to side anastomosis
Ylli Zhubi
01:08:57
I agree with you Erion that that question is not a fellow level question. It is fair on oral boards and I was prepared to answer that question on my boards two years ago.
Erion Qaja
01:11:22
PTFE vs GSV
Erion Qaja
01:11:29
historical question
Erion Qaja
01:11:34
with a very simple answer
Erion Qaja
01:11:40
how sick is the patient ?!
Erion Qaja
01:13:20
on pressors, acidotic than reach for PTFE
Erion Qaja
01:13:26
if you have a partner in the room
Erion Qaja
01:13:32
with a “stable” patient
Erion Qaja
01:13:37
than go dig out GSV
Erion Qaja
01:13:50
real life ;
Erion Qaja
01:14:03
all alone in the middle of the night (regardless of the patient status )
Erion Qaja
01:14:07
reach for PTFE
Erion Qaja
01:14:14
i did a few months ago
Philip Caushaj
01:14:17
Change your diaper as well
Ergen Muso
01:15:04
That’s why I chose GI, lol, surgeon life sucks
Lorenc Malellari
01:15:12
That is quite the procedure...
Philip Caushaj
01:15:27
Sometimes better to die quietly
Erion Qaja
01:15:58
lifestyle is relative
Lorenc Malellari
01:17:20
I almost did GI, but then I did my surgery rotation...haha, no contest.
Ergen Muso
01:18:05
Haha.
Erion Qaja
01:18:57
these are the types of consults when we all go “why did you call me , patient is dying"
Erion Qaja
01:19:44
Ergen
Erion Qaja
01:19:56
maybe you’re right-these are the patients i would call IR :)
Ergen Muso
01:19:56
Very true—consult for GIB today, pt post STEMI, intubated 2 pressers, impalla ….lol
Philip Caushaj
01:19:57
Exactly often difficult ti diagnose
Nora Gashi
01:20:19
Do we use anticoagulation for NOMI?
Erion Qaja
01:20:28
question stem for those absite enthusiasts
Ergen Muso
01:20:31
Guess what, ischemic colitis haha
Erion Qaja
01:20:45
“inability to tolerate tube feeds, with bloody diarrhea"
Erion Qaja
01:21:22
mesenteric venous thrombosis is not etiology treated by vascular surgeons
Arbenita Dervisholli
01:24:03
Great presentation
Arber Shehu
01:25:25
Thank you Elmira! Brilliant
Erion Qaja
01:35:17
looking forward to next JC Dr. Zhubi
Ylli Zhubi
01:35:51
Looking forward to it as well. This is a great platform.