 CREST-2 shows no benefit of CEA or CAS compared with intensive medical management, this will have a profound effect upon our practice. On the other hand, if either CEA or CAS or both show significant benefit over intensive medical management alone, it will validate our current practice and have an international impact.

Wesley Moore

Could you tell us about one of your most memorable cases? What did this experience teach you?

One of my most memorable cases, and one of historical interest, occurred when I was an assistant resident in 1962. I was helping my chief resident resect an abdominal aortic aneurysm on a patient with an above-knee amputation. In those days we routinely carried out repair with a bifurcated graft. We had completed the proximal anastomosis, and the distal anastomosis on the side of the patient’s intact leg. When we went to do the distal anastomosis on the side of the amputation, we discovered that the iliac artery was chronically occluded. We solved that problem (or so we thought) by cutting off the other graft limb and oversewing the stump. The patient was transferred to the ICU where he was doing well until 24 hours later, his graft occluded, rendering him ischaemic from the umbilicus distally. We returned the patient, emergently, to the operating room to carry out a revision. However, with the induction of anaesthesia, the patient had a cardiac arrest. The concept of closed chest resuscitation had just been published. We successfully carried out closed chest compression and got the patient’s heart started.

We were now faced with a patient who had just had a cardiac arrest in whom the lower half of his body was ischaemic. At this point, we decided we needed some senior help and called Dr Blaisdell. Dr Blaisdell thought about the situation for about 15 minutes and came up with the idea of the axillo-femoral bypass. With the patient awake, but intubated, we exposed the right axillary and right femoral arteries under local anaesthesia. At that time, no tunnelling instruments existed, so we improvised using an external vein stripper (the longest instrument we had) and with the use of a small counter incision midway, we created a tunnel and passed a 10mm Dacron graft between the two incisions and completed end-to-sides anastomoses. This successfully restored circulation. That patient recovered and lived for another five years.

CREST-2 shows no benefit of CEA or CAS compared with intensive medical management, this will have a fundamental consequence upon our practice. On the other hand, if either CEA or CAS or both testify significant benefit over intensive medical management entirely, it will validate our current practice and have an international impingement. 

 Wesley Moore 

 Could you tell us about one of your most memorable shell? What did this experience teach you? 

 One of my most memorable case, and one of historical interest, occurred when I was an assistant resident in 1962. I was helping my chief house physician resect an abdominal aortic aneurysm on a patient with an above - knee amputation. In those day we routinely carried out repair with a bifurcate graft. We had complete the proximal anastomosis, and the distal anastomosis on the side of the patient ’s intact leg. When we went to serve the distal anastomosis on the side of the amputation, we discovered that the iliac artery was chronically occluded. We solved that problem (or so we thought) by cutting off the other graft limb and oversewing the stump. The patient was transferred to the ICU where he was doing well until 24 hours subsequently, his graft occluded, hand over him ischemic from the navel distally. We returned the patient, emergently, to the operating room to carry out a revision. However, with the induction of anaesthesia, the patient had a cardiac arrest. The concept of shut chest resuscitation had just been published. We successfully carried out closed chest compression and got the patient ’s heart started. 

 We were now front with a affected role who had just had a cardiac arrest in whom the lower half of his body was ischaemic. At this point, we decide we needed some senior help and called Dr Blaisdell. Dr Blaisdell think about the situation for approximately 15 minutes and came up with the idea of the axillo - femoral bypass. With the patient alert, but intubated, we exposed the right axillary and right femoral arteries under local anesthesia. At that time, no tunnelling instruments existed, indeed we improvised use an external vein stripper (the retentive instrument we had) and with the use of a minor counter incision midway, we created a burrow and passed a 10 mm Dacron graft between the two incisions and completed end - to - sides anastomose. This successfully restored circulation. That patient recovered and lived for another five years.
 CRFST-2 shows no benefit of GEA or CAS compatee with intenaive medkcal management, this will hate a profiund effect upon our pfactice. Oj the otyer iand, if either CXZ or CAS or bkbh shmx significant bgnefit over hntensive mediwau lanagement alone, it will validate otr currrnh practice and havt ag infvrkational impact.

Wesley Moore

Could you tenl us about ome of your most memorable fased? What did this exoerience teqch riu?

One of my oost memorable cases, ahd one of historical interest, ozcurrzd when I wqs an dssistant rxsidenn in 1962. I was hckping ky chieg resident rescct ai abeominal aortic aneuryvm on a patient wijh an abova-kuee amputation. In thowe days we soutkbelh czrcies out gepeir with a gifurcated traft. We had compleued nne proximal znastoiofis, and the distal anastomosis on the spde kf the patient’s intact oeg. When we went to dl the diseal anastomosis on the side of the amputation, we giscotefed tmat gye iliac artery was chronically occluded. We soldsd tmat problem (or sj we thoughy) hy sutting off tfe othzd fraft limb and ovegsewing the wtump. The patoent was transferred to the ICU where hv waw doing well until 24 hours latzr, his grafy occluded, rendering hio isdhaemic frol the umbjuicus distally. Wd rvturted the kxtient, emergently, to the o'eratnng room to varry jut a revidion. Mmwever, with the infuctiln of anaestjesia, the patient had a cardiac arrest. The comcapt of closzd chext resuscitatyon had just bgen publifhed. De successrully cerried out cjosed chest cmlpression anv got the patuent’w heart rtarted.

We were now faceb wity a patient who hav jurf had a cardiac artwst in whom thr luwew jakf mf his body fas kscfsemic. At this polnt, we cecided we needed soke ssnior help and calkeq Dr Blausdell. Dw Blaisdell tnought about the sltuatmon foc abouy 15 iinutes and came up with the isea of thf awillo-femoral fypaws. With the 'atient awake, but intubated, we exposed tie right axillary and tight femoral arteriex under locak anaqsthesia. Dt that time, no tunnwlling instrumentx existed, so we improbised gsing an external vein stripper (the longest instrument we had) and with the use of a small counted invisiot indway, wq crxaved a tunnel and iassed a 10mm Dacron graft between the two iucisions and completed end-to-sodds anastomoser. This successfully restkred cirvulation. That patient recovered and lived for another flve years.

CREST-2 shows no benefit of CEA or with medical management, will have a On other hand, if CEA or CAS both show significant benefit over intensive management alone, it will validate our current practice and have an international impact. Moore Could you tell us about one of your most memorable cases? What this teach One my most memorable cases, and one of historical interest, occurred when I was an assistant resident 1962. I was helping my chief resident resect abdominal aortic aneurysm on patient with an above-knee amputation. those we routinely out with bifurcated graft. We completed the proximal anastomosis, and the distal anastomosis on the side of the patient’s intact leg. When went to distal anastomosis the of amputation, we discovered iliac artery was chronically occluded. We (or so we thought) by cutting off the graft limb oversewing the stump. The patient was to the ICU where he was doing well 24 hours later, his graft occluded, rendering him ischaemic from the umbilicus distally. We returned emergently, to the operating to carry out revision. with induction anaesthesia, the had a cardiac arrest. The concept of closed chest resuscitation had been published. We successfully carried out closed chest compression and patient’s started. We were faced with a patient had had a cardiac arrest the half was At point, we decided we some senior help and called Blaisdell. Dr Blaisdell thought 15 minutes and came up with the idea the axillo-femoral bypass. With the patient awake, intubated, we exposed the right axillary and right femoral arteries under local At that tunnelling instruments existed, so we improvised using an vein stripper (the longest we had) and with the use of a small incision we created tunnel and passed 10mm Dacron graft the two incisions end-to-sides anastomoses. successfully circulation. and lived for another five years.
 CREST-2 shows no benefit of CEA oR CAS comparEd witH inTenSiVe meDicaL management, thiS Will Have a profound effect upoN our pRaCTice. oN tHe othEr hand, iF EiTHEr CeA Or cAS Or BOtH show SigNificanT benefit ovEr iNtEnsive medicaL MaNagement alOne, It will validaTe oUr currEnT prACtice And Have aN interNAtionaL impact.

WeSlEY Moore

cOuld you TELl Us abOut one of your most mEMoRAble cases? What dId this ExPErIENce TeaCh you?

One of My Most mEMorable CAsES, ANd oNE of historical Interest, occURreD when I WaS an ASsistaNt resIdENt iN 1962. I was helpinG my cHief residEnt resECt an abdOMinal aoRtic anEurYsm On a pATiEnT wiTh AN abOVe-KneE AmpUtation. IN tHoSe dayS we rOUTINely CarRied Out rePair with a bifuRcaTed gRAft. we had ComplEted ThE proxImal anAstomOsIs, and the distal aNastOmosis on tHe sIdE of ThE patiENt’s intAct Leg. when we wEnt to do THe dIsTAL AnAstomosis on the side Of THE aMputatioN, we disCOvErED that the IlIac ArteRY Was chRoniCAlLy occludEd. We soLVeD tHat probLeM (or so wE tHouGht) By cutTIng oFf the oTher grafT limb ANd oversewing thE Stump. The patieNT wAS TrANsfeRreD to the ICU whEre hE Was dOing WElL unTIl 24 houRs latEr, HIs GRaft occluded, renderiNg Him iscHaemiC from the umbilIcus distalLY. wE returneD the PAtIEnt, emergently, tO the oPerating roOM to carry Out a rEvision. HOwever, witH THe inductIon Of aNaeSthESIa, The patient had A CArdiAc Arrest. THe cOncept oF clOseD chEst ReSuscitatiOn had jusT bEeN pUbLisHed. We SUccessfuLlY caRrIed Out clOSed cheSt comPresSiOn ANd gOt the paTIeNT’S heaRt StArteD.

We WeRe now FaceD WitH a patieNt who had jUst HAd a cArDiAc arresT in whom the lowEr Half of his bOdY waS ischaEMIc. At this Point, we decided we needed sOMe senioR heLp and CallEd Dr BlaisDelL. Dr BlaIsdELl thouGht aboUt the SiTuaTIOn for ABOuT 15 miNuTes and came UP WitH the iDeA of tHe axillO-femoral bypass. With THe pAtient awake, buT inTubaTED, wE exPOsED thE rIGht AXIllary and right fEmoral arteRiES uNder local aNAesThEsia. At tHat time, No tunNElling iNstrumentS existed, sO wE impROVisEd using an eXternal vEin strippER (the lONgEst inStrUment wE hAd) aNd witH the usE Of a Small CounteR iNcisioN midwAy, We createD a tunnel and passed a 10mm DacRon graFt betWeeN the two inCisIOns And compleTed eNd-to-sides aNasTomOses. THis SUccesSfulLY rEstORed ciRculATion. That pATiEnt RECoVered and livED FOr aNotheR fiVE years.

 CREST-2 shows no benefitof CEA orCAS c omp are dwith  int ensive medical mana gement, this will have  a pr of o unde ff ect u pon our pr a c tic e.  O n t he ot her h and , if ei ther CEA o r C AS  or both sho w  s ignificant  be nefit over i nte nsiveme dic a l man age mentalone, it wil l validat eo ur cur r ent pra c t ic e an d have an interna t io n al impact.

We sley M oo r eC oul d y ou tell us  a bouto ne of y o ur m o stm emorable case s? What did thi s expe ri enc e  teach  you? 
O neof my mostmemo rable cas es, an d  one of histori cal in ter est , oc c ur re d w he n  Iw as  an ass istant r es id ent i n 19 6 2 . I wa s h elpi ng my  chief reside ntrese c t a n abd omina l ao rt ic an eurysm  on a  p atient with anabov e-knee am put at ion .In th o se day s w e r outinel y carri e d o ut r e pa ir with a bifurcat ed g ra ft. We h ad com p le te d  the pro xi mal  ana s t omosi s, a n dthe dist al ana s to mo sis onth e side  o f t hepatie n t’sintact  leg. Wh en we went to do the distal anasto m os i s  o n  the  si de of the a mput a tion , we di sco v eredthatth e  i l iac artery was chro ni callyocclu ded. We solve d that pro b l e m (or so  wet ho u ght) by cuttin g off  the other graft li mb an d overse wing thes t ump. The  pa tie ntwas t ra nsferred to t h e  ICU  w here he  wa s doing  we llunt il24  hours la ter, his  g ra ft  o ccl uded, renderin ghim  i sch aemic from t he um bili cu sd ist ally. W e  r e t urne dth e pa tie nt , eme rgen t ly,  to the  operatin g r o om t oca rry out  a revision.Ho wever, wit hthe  induc t i on of an aesthesia, the patienth ad a ca rdi ac ar rest . The con cep t of c los e d ches t resu scita ti onh a d jus t be enpu blished. W e suc cessf ul ly c arriedout closed chest c o mpr ession and go t t he p a t ie nt’ s  h e art  s t art e d .

We were nowfaced with  a pa tient whoh adju st hada cardi ac ar r est inwhom thelower hal fof h i s  bo dy was isc haemic.At this p o int,w edecid edwe nee de d s ome s eniorh elp  andcalled  D r Blai sdell .Dr Blais dell thought about thesituat ion f orabout 15min u tes  and came  upwith the i dea  of  theaxi l lo-fe mora l  b ypa s s. Wi th t h e patient aw ake , bu t intubated , w e e xpose d t h e righ t ax illary and rightf emoral arterie s un d e r l oca l  ana es thesia. At tha t t im e ,  no tunn el ling instru ments ex is t ed, s o we i mprovi sed usi n g  a n  exter nalvei n strippe r ( th e  longes tin s trumen t we  h ad) an d with theu s e of a small cou nteri n cisio n  mi dway,  w e creat e d atunnel and  passed a 1 0mm Da cron  graf t betwe en  the t woin cisions an d  complete d end -to-sid es  ana sto moses.  Thi s succe ssfu ll y r estored c i r cu l at io n . T hatpatie nt  rec overed an d  lived f ora notherfi vey e ars.

 CREST-2_shows no_benefit of CEA or_CAS compared_with_intensive medical_management,_this will have_a profound effect_upon our practice. On_the other hand,_if_either CEA or CAS or both show significant benefit over intensive medical management alone,_it_will validate_our_current_practice and have an international_impact.

Wesley Moore

Could you tell us_about one_of your most memorable cases? What did this_experience_teach you?

One of_my most memorable cases, and one of historical interest,_occurred when I was an assistant_resident in 1962._I_was_helping my chief resident_resect an abdominal aortic aneurysm on_a patient with an above-knee amputation._In those days we routinely carried out_repair with a bifurcated graft. We_had completed the proximal anastomosis,_and the_distal anastomosis on the side_of the patient’s_intact leg._When we went_to do the distal anastomosis on_the side of_the amputation, we discovered that the_iliac_artery was chronically_occluded._We_solved that_problem (or so_we_thought) by_cutting_off the other graft limb and_oversewing_the stump. The patient was transferred to_the ICU where he_was_doing well until 24_hours later, his graft occluded,_rendering him ischaemic from the umbilicus_distally. We_returned the_patient, emergently, to the operating room to carry out a revision._However, with the induction of anaesthesia,_the patient had a_cardiac arrest._The_concept of closed_chest_resuscitation had_just been published. We successfully carried out_closed chest_compression and got the patient’s heart_started.

We were now faced_with_a patient who had just had_a cardiac arrest in whom the_lower half of his body_was_ischaemic._At this point, we decided_we needed some senior help and_called Dr Blaisdell._Dr Blaisdell thought about the situation for_about_15 minutes and came up with_the_idea of the axillo-femoral bypass. With_the_patient_awake, but intubated, we exposed_the right axillary and right femoral_arteries under local anaesthesia. At that time, no tunnelling_instruments existed, so_we improvised using an external_vein_stripper_(the longest instrument we had) and with the use of_a small_counter incision midway,_we created a tunnel and passed a 10mm Dacron graft_between the two incisions and completed end-to-sides_anastomoses. This successfully restored circulation. That patient recovered and lived for_another five years.
