Az rsebszeti gyakorlat vltozsa osztlyunkon Dr. Palsthy Zsolt, Dr. - PowerPoint PPT Presentation

Az érsebészeti gyakorlat változása osztályunkon Dr. Palásthy Zsolt, Dr. Sipka Róbert, Dr. Mihalovits Gábor, Dr. Takács Tibor, Dr. Leindler László, Dr. Hódi Zoltán,Dr. Váradi Rita, Dr. Nyilas Áron, *Dr.Nagy Endre, Szegedi Tudományegyetem, Érsebészet *Szegedi Tudományegyetem, Radiológiai Klinika

In 1954, DeBakey collaborated with Professor Thomas Edman, a Philadelphia textile engineer, to build a new knitting machine to make seamless Dacron grafts of all sizes, shapes, and configurations In 1964 Charles Dotter had a crazy idea: to open blocked arteries from the inside out. No cutting, suturing, or stitching. Less trauma, lower morbidity, quicker recovery. He was a radiologist in Portland, Oregon

- 2008-tól kezdtük meg az endovasculáris technika alapjainak elsajátítását. - A „learning curve”-et követőn osztályunkon 2012 óta végzünk nagyobb számban endovasculáris beavatkozásokat. - 2015-ben a finanszírozás megteremtése, az eszközpark fejlesztése (Philips Pulsera, - Siemens Cios Alpha) - 2016-ra elértük azt, hogy Szegeden a periférián történő intervenciók 59% - többnyire hybrid műtét részeként - már érsebész végezte. -Kompromisszumok nélkül terjeszthetjük ki a kezelés határait, melynek révén elérhető előnyösebb haemodynamika jobb klinikai eredményekhez vezethet.

(213%) (460%) ( 33%) (114%) (3,9%) (19,7%)

170% 132% -18%

-Műér beültetések számának csökkentése (endo /TEA /rVSM/artériás folt) -Zselatin impregnált helyett kollagénnel (1,2%) impregnált vagy PTFE protézisek (3,9%) használata -Klaudikáló betegek preop. bakteriológiai szűrővizsgálata -Homograft program beindítása -33% -„Költözés”- a kubatúra válozása

Financiálisan rentábilis Minimálinvazív Szakmailag korszerű

� Open cases accounted for 26%–49% of the caseload for about one-third of those surveyed and 50% of the caseload for 21% of VS. However, 22% and 37.8% of respondents stated that endovascular cases account for 50% and 51%– 75% of their personal operative caseload, respectively . � Between 1995-2009 there was a 124% increase in applicants reporting to have performed endovascular repairs . � In order to prepare VS for these changes, the SVS would need to develop more educational meetings and training courses nationwide. 2230 active VS members of the SVS in February 2011, followed by a second request for responses in March 2011. International, honorary, senior, associate, affiliate, candidate, and retired members were excluded from the survey. Over 3 months, responses were collected from 207 members (10.7% response rate)

� Nowadays, experience in endovascular techniques is required of all vascular surgeons working in western countries Percentage share of the various departments Percentage share of the various departments of the total volume of percutaneous arterial of the total volume of hybrid procedures interventions Nowadays, experience in endovascular techniques is required of all vascular surgeons working in western countries

The 10 proceduresmost frequentlyreported byUS vascularsurgeons applyingforrecertificationexaminationin1995 vs. 2009 Rank 1995 2009 1 Leg bypass (all) Arteriogram 2 CEA Varicose vein 3 AV graft PTA 4 AAA (open) Stent 5 Thrombectomy Leg bypass (all) 6 Varicose vein AV fistula 7 Digit amputation CEA 8 Below-knee amputation Venogram 9 AV fistula IVC filter 10 IVC filter EVAR Eidt JF, et al.. Comparison of surgical operative experience of trainees and practicing vascular surgeons: a report from the Vascular Surgery Board of the American Board of Surgery. J Vasc Surg. 2011;53:1130–1139. doi: 10.1016/j.jvs.2010.09.023. [PubMed]

Peter A. Schneider, MD Division of Vascular Therapy, Kaiser Foundation Hospital, Honolulu, Hawaii What is vascular surgery in the 21st century , the Information Age? I describe vascular surgery in this way . Full-spectrum care and long-term relationships constructed to make a difference in our patients' lives. The goals are practical, and the dilemmas are intellectually stimulating. The procedures include multiple techniques, are anatomically based, aesthetically pleasing, and technically challenging, with opportunities for innovation . There is a beautiful simplicity to vascular work. If some part of the body has no blood supply, it is blue and cold and painful. When perfusion is returned, it is warm and pink and happy. Vascular surgeons work hard, take on seemingly impossible cases at times, have incredible persistence, and are strong patient advocates. May 2015, Volume 61, Issue 5, Pages 1357–1365

Vasculáris Centrum Érsebészet - Intervenciós radiológia - Angiológia (Vasculáris-team)