[HSF] Another Victory for the LAD Stent.....

[Hgrmd at aol.com]

Steve,
  It sounds like you are doing an exceptionally good job of coronary  
revascularization for your community.  Most of us should heed your example  of 
routinely using BIMA's and radials.  The fact that you aren't seeing too  many redos 
reminds me of an analogous situation in our practice.  When I  arrived in 
South Florida in 1990, I spent the next 8 years doing mainly CABG's  and 
peripheral vascular work.  Probably the most common vascular procedure  for us was 
revising a clotted Goretex AV fistula in dialysis patients.  In  1998, we hired a 
boarded peripheral vascular surgeon.  He essentially  stopped the use of 
Goretex for the AVF's and did only natural  fistulas. Within a couple of years, 
declotting dead fistulas nearly  disappeared, and the nephologists and their 
patients flocked to our new vascular  surgeon.  I think something very similar 
would happen if we made a  concerted effort to maximize the number of arterial 
anastomoses in coronary  revascularization.
 
Hal



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