PEOPLE WHO CHANGED MY LIFE FOR EVER-A TRIBUTE

I STILL REMEMBER THE DAY WHEN I JOINED NIZAM INSTITUTE OF MEDICAL SCIENCES HYDERABAD IN 2002 AS A VASCULAR TRAINEE UNDER PROF.RAMAKRISHNA PINJALA.I WAS AN AVERAGE GENERAL SURGEON TO SAY THE LEAST.WITH AN AVERAGE GENERAL SURGICAL TRAINING BEHIND ME I WAS JUST WONDERING WHAT WAS I UPTO INSPITE OF PUTTING IN 10 GOOD YEARS OF MY LIFE INTO MEDICAL PROFESSION AS A STUDENT.ALL I HAD WAS A BURNING PASSION TO DO SOMETHING GOOD IN LIFE.TO MAKE LONG STORY SHORT I WAS LOOKING FOR THE RIGHT DIRECTION IN MY SURGICAL CAREER.AND AS ALWAYS HAPPENS IN A TYPICAL MASALA INDIAN MOVIE THOUGH THIS TIME IN REAL LIFE(READ REAL AND NOT REEL)I CAME ACROSS DR PINJALA AS A MENTOR AND A TRUE GUIDE.HE NOT ONLY TAUGHT ME THE BASICS OF VASCULAR SURGERY BUT WENT A STEP FURTHER STATING THE GLOBAL PRESENCE OF THIS SPECIALITY AND WHAT EVERYONE OF US CAN DO TO MAKE OUR PRESENCE FELT IN THE VASCULAR COMMUNITY.IT WAS UNDER HIM THAT I FIRST CAUGHT UP WITH THE PHRASE"THINK GLOBAL ACT GLOBAL".

THIS PHRASE OF HIS LEFT AN INDELIBLE MARK AS IF SOMETHING GOT CHISELLED ON MY HEART.

AND THEN STARTED WHAT I CALL AS THE SECOND INNINGS OF MY VASCULAR SURGICAL CAREER WHEN I MET THIS GREAT MAN BY THE NAME PROF.WILHELM .SANDMANN WHO HEADS THE VASCULAR SURGERY DEPARTMENT IN HEINRICH HEINE UNIVERSITY DUSSELDORF GERMANY.I NEVER KNEW BY THEN THAT MY CAREER WAS TO CHANGE FOR EVER.HE IS AN INSTITUTION IN HIMSELF ,SOMEONE WHO HAS MASTERED THE ART OF VASCULAR SURGERY.NO DOUBT HE IS ONE OF THE MOST RESPECTED NAMES IN VASCULAR SURGERY IN EUROPE AND THE UNITED STATES.I STILL REMEMBER THE LETTER HE EMAILED ME WHEN I APPROACHED HIM THROUGH A COMMON FRIEND TO GET TRAINED UNDER HIM .HE ASKED ME THE KIND OF VASCULAR SURGERIES I WAS INTERESTED IN AND BELIEVE ME I WROTE PRACTICALLY EVERY POSSIBLE VASCULAR SURGERY THAT I COULD THINK OF AND CAN YOU IMAGINE WHAT THE REPLY WAS?HE EMAILED ME SAYING"WHAT ALL YOU DESIRE TO LEARN FROM US LIKE THORACO-ABDOMINAL ANEURYSMS ,ANEURYSMS AT ANY AND EVERY LEVEL,REDO AORTIC CASES ETC IS OUR DAILY ROUTINE AND YOU ARE WELCOME'.I BECAME AN INSTANT FAN OF HIS AND WOULD ALWAYS REVERE HIM IN THE LIST OF MY ALL TIME GREATS.ITS A PITY THAT HE RETIRES THIS OCTOBER BUT THEN ALL GOOD THINGS HAVE TO COME TO AN END.

CONTRAINDICATIONS TO CAROTID ARTERY STENTING

WITH EMERGING TRENDS AND A SCIENCE THAT KEEPS REINVENTING ITSELF ITS NO SURPRISE TO COME ACROSS DIFFERENT TREATMENT MODALITIES EVEN ON A ROUTINE BASIS.PROBABLY NO OTHER SUBJECT IN VASCULAR SURGERY HAS RECEIVED SO MUCH ATTENTION AS IS THE TREATMENT OF CAROTID ARTERY DISEASES.WE HUMANS ARE PRONE TO GET HOOKED INSTANTANEOUSLY TO THINGS THAT ARE TERMED" NEW ARRIVALS" IN THE MARKET.FIRST RESULTS OF EVA-3S STUDY ARE ALREADY OUT AND THE GAME IS LOST BY THE STENTS AS THIS STUDY CLEARLY STATES THAT THE STROKE AND DEATH IN SYMTOMATIC CAROTID STENOSIS POPULATION WERE LOWER WITH ENDARTRECTOMY THAN WITH STENTING AT 1 AND 6 MONTHS.THE NON INVASIVE CHARACTER OF THE STENTING IS USED AS THE PRIMARY ARGUEMENT AGAINST OPERATIVE TREATMENT.ADDED TO THIS PROBABLY IS THE HUMAN INCLINATION TO AVOID SURGICAL PROCEDURES FOR INNATE FEAR OF KNIFE AND STUFF.
CONTRAINDICATIONS TO CAROTID ARTERY STENTING ARE IN PLENTY WHICH UNFORTUNATELY MOST OF OUR MEDICAL FRATERNITY IS UNAWARE OF OR ELSE PRETENDS TO .I FEEL AT THE END OF THE DAY ITS THE PATIENT WHO SHOULD BE THE FINAL BENEFICIARY AND EVERYTHING ELSE IS SECONDARY.
CAROTID ENDARTRECTOMY(CEA)IS A SAFE 60 MINUTES SURGICAL PROCEDURE DONE ON A ROUTINE BASIS WORLDWIDE WITH GRATIFYING RESULTS .THE PATIENT IS USUALLY DISCHARGED FROM THE HOSPITAL IN A DAY OR TWO POST PROCEDURE.IF AT ALL ECONOMY HAS SOME ROLE TO PLAY ,ITS JUSTIFIED TO SAY THAT IN A COUNTRY LIKE INDIA CAROTID ENDARTRECTOMY IS A FAR CHEAPER OPTION THAN STENTING EVEN AFTER TAKING INTO ACCOUNT THE SAFETY OF BOTH THE PROCEDURES.
I AM STATING FEW CONTRAINDICATIONS TO CAROTID STENTING THAT HAVE EVOLVED OVER A PERIOD OF TIME AND HAVE BEEN PUBLISHED IN VARIOUS VASCULAR SURGERY BOOKS AND VASCULAR SURGERY JOURNALS.
1)HEAVILY CALCIFIED PLAQUE
2)SOFT PLAQUE
3)DIFFULELY DISEASED CAROTID VESSELS
4)SEVERELY TORTUOUS AND ATHEROMATOUS AORTIC ARCH AND ITS BRANCHES
5)TORTUOUS CAROTID VESSELS
6)STRING SIGN
7)FREE FLOATING AND PEDUNCULATED THROMBUS
9)RECENT STROKE
10)SEVERE RENAL IMPAIRMENT PRECLUDING SAVE USE OF CONTRASTS
11)PRESENCE OF CONTRAINDICATIONS TO ANTIPLATELET AGENTS
12)INTERNAL CAROTID ARTERY SIZE LESS THAN 3 MM.

NOTE:ITS NOT EASY TO REPLACE A PROCEDURE LABELLED TO BE A "GOLD STANDARD".CAROTID ARTERY ENDARTRECTOMY(CEA)IS STILL THE GOLD STANDARD .PROBABLY IN HIGHLY SELECTED CASES CAROTID STENTING DOES HAVE A ROLE TO PLAY LIKE REDO SURGERIES OF THE CAROTID VESSELS, UNFAVORABLE ANATOMY LIKE VERY HIGH CAROTID BIFURCATION & RADIATION ARTERITIS .PLEASE SEE THIS 3 MINUTES VIDEO RELEASED BY THE "SOCIETY FOR VASCULAR SURGERY"(SVS) IN AUGUST 2008 TO EDUCATE MEDICAL FRATERNITY AND PUBLIC ALIKE ABOUT THE HAZARDS OF CAROTID ARTERY STENTING.DO GO THROUGH THIS.