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Related Concept Videos

Blood Flow01:29

Blood Flow

Blood is pumped by the heart into the aorta, the largest artery in the body, and then into increasingly smaller arteries, arterioles, and capillaries. The velocity of blood flow decreases with increased cross-sectional blood vessel area. As blood returns to the heart through venules and veins, its velocity increases. The movement of blood is encouraged by smooth muscle in the vessel walls, the movement of skeletal muscle surrounding the vessels, and one-way valves that prevent backflow.
Overview of Blood Vessels01:14

Overview of Blood Vessels

The human cardiovascular system comprises five primary types of blood vessels: arteries, arterioles, veins, venules, and capillaries, each serving unique functions.
Arteries and Arterioles: Arteries are muscular and elastic vessels that primarily carry oxygenated blood from the heart to body tissues, except for the pulmonary artery, which carries deoxygenated blood. They have thick walls to withstand high pressure and contain a layer of muscle tissue, allowing them to expand or contract as...
Blood Studies I: ABG and VBG01:26

Blood Studies I: ABG and VBG

Blood studies are critical in the medical field, enabling healthcare professionals to assess a patient's health status accurately. This page will focus on two significant blood studies: Arterial Blood Gas (ABG) and Venous Blood Gas (VBG).
Arterial Blood Gas (ABG)
Arterial Blood Gas (ABG) studies are crucial for assessing the lungs' ability to supply oxygen and remove carbon dioxide, reflecting the patient's ventilation status. They also help understand the kidneys' capacity to reabsorb or...
Anatomy of Blood Vessels01:20

Anatomy of Blood Vessels

The vascular system, an integral part of the circulatory system, comprises various blood vessels that play crucial roles in maintaining the body's homeostasis. These blood vessels form a complex and efficient circulatory network. The three primary categories of blood vessels are the arteries, veins, and capillaries.
Arteries
Arteries circulate oxygenated blood from the heart, except the pulmonary artery, which transports deoxygenated blood to the lungs. Large arteries, such as the aorta, have...
Assessment of the Cardiovascular System III: Palpation01:27

Assessment of the Cardiovascular System III: Palpation

Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
Varicose Veins II: Diagnostic Studies and Interprofessional Care01:26

Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...

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A Rat Carotid Balloon Injury Model to Test Anti-vascular Remodeling Therapeutics
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Transcarotid Artery Revascularization Learning Curves Differ between Surgeon Experience Level.

Litton Whitaker1, Yana Etkin2, Pallavi Manvar-Singh2

  • 1Surgery Department, Nuvance Health, Danbury, CT.

Annals of Vascular Surgery
|September 28, 2024
PubMed
Summary

Surgeons performing transcarotid artery revascularization (TCAR) achieve significant technical proficiency, particularly reduced skin-to-skin and fluoroscopy times, after approximately 15 cases. This learning curve is independent of patient factors or anesthesia type.

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Surgical Education

Background:

  • Transcarotid artery revascularization (TCAR) is gaining traction due to its favorable perioperative outcomes.
  • Assessing the learning curve for TCAR is crucial for optimizing its adoption and ensuring patient safety.
  • Surgeon experience is a key factor in procedural efficiency and outcomes.

Purpose of the Study:

  • To determine the case number threshold for improved technical proficiency in TCAR.
  • To evaluate the impact of surgeon experience (≤10 vs. >10 years) on TCAR outcomes.
  • To analyze the relationship between case volume and procedural efficiency metrics.

Main Methods:

  • A retrospective analysis of 160 TCAR cases performed between 2017-2023 at four hospitals.
  • Technical proficiency was measured by skin-to-skin, fluoroscopy, and flow reversal times.
  • Linear mixed models analyzed outcomes, comparing surgeons with ≤10 and >10 years of experience at specific case milestones (1st, 5th, 10th, 15th).

Main Results:

  • Surgeons with less experience (≤10 years) frequently managed more complex cases, including those with hostile necks and contralateral occlusions.
  • While median outcome values did not differ significantly, linear mixed models revealed significant improvements for less experienced surgeons after the 15th case.
  • Junior surgeons demonstrated a 30% reduction in skin-to-skin time and a 51% reduction in fluoroscopy time compared to senior surgeons after 15 cases.

Conclusions:

  • Junior surgeons show significant improvement in TCAR efficiency after approximately 15 cases, matching or exceeding senior surgeon benchmarks.
  • This learning curve progression is not affected by patient complexity or anesthesia choices.
  • TCAR technical proficiency is attainable and improves with experience, supporting its wider implementation.