Panos Kougias MD MSc
@KougiasP
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Chair, Dept of Surgery @SUNYDownstate | Vascular & Endovascular Surgery | Clinical Trials | PI #Top_Trial | co-PI #IMPROVE -AD trial
Brooklyn, NY
Joined November 2017
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The saddest week of
@DownstateSurg
in recent memory has come to a close. Our PGY2
@ErfanFarid
passed away peacefully after sudden cardiac arrest. His legacy of dedication, altruism, and excellence shines as a radiant beacon.
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CABG is superior to PCI in patients with 3 vessel CAD.
Interesting to see that a world renowned medical journal uses an obscure, double negative statement in the reporting of the key finding of the study.
In this trial, patients with three-vessel coronary artery disease, PCI guided by assessment of fractional flow reserve was not noninferior to CABG with respect to the composite end point of death, myocardial infarction, stroke, or repeat revascularization.
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His memory will live forever within
@DownstateSurg
to inspire, guide, motivate, and empower.
Rest in peace, Erfan. We are blessed to have known you. We will miss you.
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Patients undergoing major surgery within 8 weeks after a COVID (+) test have higher 90-day mortality than COVID (-), CPT-matched controls, regardless of presenting symptoms. We are currently investigating the relative impact of vaccination on outcomes.
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1/2: The Dept of Surgery at SUNY Downstate Health Sciences University is looking to hire a Program Director for our Gen Surg Program. We boast a vibrant, diverse residency, one of the largest in NYC!
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We are inviting categorical surgery residents with interest in high quality clinical or health services research to join our group for a mentored, fully funded 2-year research fellowship.
The SUNY Downstate Department of Surgery is pleased to invite applications for a 2-year research fellowship starting July 2024. Categorical residents
@ACGME
accredited general surgery programs interested in clinical outcomes & health services research are welcome to apply.
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It was a true privilege having the amazing
@pturnermd
for Grand Rounds
@DownstateSurg
. We learned a lot about the priorities and vision of
@AmCollSurgeons
. Thank you for spending time with our residents and faculty. The House of Surgery is in great hands!
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An outstandanding match for
@DownstateSurg
, from the top of our rank list. Looking forward to working with all of you for the years to come. Very grateful to all residents and faculty who participated in the interview process and made it possible.
With absolute joy and pride, we introduce our incoming general surgery residents
@sunydownstate
! They are truly a remarkable cohort & we couldn't be more excited to work with them. Welcome to the family!!
#DownstateStrong
#GenSurgMatch2022
#MatchDay
#MedTwitter
#SurgTwitter
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Very happy the patient feels better. Great images.
There are several options on how to treat this type of occlusive disease in a 57-year old patient. All of them include restoring blood flow to the profunda.
@jmills1955
@monteromiguel
@NealBarshes
@VascularSVS
An axillo femoral bypass offered to a 57 year old female pastor following failed fem fem and prior failed angio. Patient reached out to
@WayToMy_Heart
. We sent to another CLI Fighter who used Rotarex in iliacs, CFA, SFA, DCB, 2 covered stents, 1 self expanding. Beautiful flow.
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#IMPROVE_AD
, a proposed RCT of patients with uncomplicated type B aortic dissection received favorable score on first NHLBI review. The trial will randomize uTBAD patients to TEVAR vs. optimal medical therapy.
@AorticDissectUS
@UnTBAD
#AorticDissection
@VascularSVS
A0 (new app) IMPROVE-AD impact score: 28 RCT for upfront TEVAR VS. OMT in uTBAD. Now pray for world peace and more $$$ to NHLBI!
@ImperialVasc
@RLDalmanMD
@VascularSVS
@MichaelSConteMD
@manesh_patelMD
@KougiasP
@DCRINews
@keaglemd
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Very important trial highlighting the reality that a restrictive transfusion strategy after acute MI needs to be practiced cautiously.
Original Article: Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia (MINT trial)
#AHA23
@AHAScience
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Congrats to our chief residents who matched to outstanding fellowships, all from their top spot of their rank lists! Very proud they continue this legacy of excellence.
🚨 We’re so incredibly proud to present our chiefs’ matches in
#trauma
#SCC
:
1.
@monika_lay
to
@Ryder_Trauma
@JacksonHealth
2.
@zhang8682
to
@WCMTrauma
@WCMSurgery
3. Devin Hosein to
@TTUHSCEP
4.
@JoeBoachie
to
@UMichSurgery
@UMichACS
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We are looking forward to meeting with the minds that will shape the future of surgery!
#gensurgmatch2023
🔔
#GenSurgMatch2023
we’re excited to meet you! Please join us on Tuesday, Sep 6th @ 7:30 pm EST to learn about our great program, hear from some of our rockstar residents & what life is like in
#NYC
(slight bias, but best city in the world)
@FutureGenSurg
@Inside_TheMatch
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It will be a great session. Come to discuss how to make this long-due randomized trial a reality!
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Outstanding paper from
@MarcScherm
and other distinguished authors. In medically fit patients with large AAA open surgical repair has several distinct long-term advantages.
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Humbled to participate in this very important work. High quality evidence is needed on the use of early TEVAR in patients with uncomplicated type B aortic dissection
@VascularSVS
@UnTBAD
@manesh_patelMD
This study found that initial thoracic endovascular aortic repair for acute uncomplicated type B aortic dissection is not associated with reduced aortic rupture, aneurysmal degeneration, or mortality.
#Research
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An outstanding piece on the long term, insidious effects of Medicare cuts on access and quality of surgical care.
@ErfanFarid
makes
@DownstateSurg
residency program very proud!
A reflection on the potential ramifications of
@CMSGov
proposed
#Medicare
cuts to surgical care. Now, more than ever, we need to insure patients’ access to quality surgical services throughout the country
@SurgeonsVoice
@RASACS
@AmCollSurgeons
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The current fragmented approach in the COVID-19 crisis is the equivalent of trying to fix a ruptured AAA with a series of band aids. It will NOT work. Only a decisive lockdown will give us a fighting chance.
Exponential growth - why "only a 100 cases is no big deal" is just plain WRONG. Please don't wait and do it stepwise; a piecemeal approach will not work
@GovAbbott
@CDCgov
@VP
#StayHomeSaveLives
#StayAtHome
#WhereIsFauci
#Shutdown
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A long-awaited study, IMPROVE-AD will address the question of TEVAR vs. medical management in uncomplicated type B Aortic Dissection. Looking forward to getting started!
@UnTBAD
@VascularSVS
@manesh_patelMD
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So richly deserved ,
@LillianKao1
! An amazing role model, mentor and surgeon.
Congratulations,
@LillianKao1
on your new position as the Vice Chair of the
@AmCollSurgeons
Board of Governors!
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Many thanks to the amazing
@ShereneSharath
for pulling together data sources and conducting a methodologically very challenging analysis!
@DownstateSurg
@sunydownstate
@ErfanFarid
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Amazing work from an outstanding group of investigators. In patients with CLTI those assigned to bypass surgery vs. endovascular therapy as an initial treatment had fewer adverse limb events or all-cause death at a median of 2.7 years.
#AHA22
BEST CLI landmark trial presented today at AHA by Drs Alik Farber and Matt Menard establishes evidence based care for CLTI
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#top_trial
is a randomized study of transfusion triggers (nadir Hgb 7 vs. 10 g/dL) in high cardiac risk patients who undergo major vascular or general surgery operations (). Primary endpoint is a composite of 90 day mortality or major ischemic events.
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Time for high quality evidence on the management of uncomplicated type B aortic dissection. Thank you
@VascularSVS
and numerous others who helped push this funding effort through the finish line.
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Completely agree with
@AWBeckMD
. Taking on research time should be motivated by an inner desire to make a difference, not money.
The skillset acquired via structured research training is priceless, and may one day impact the lives of millions of people.
@DownstateSurg
Interesting 🧵 Life is about experiences and learning, not money. And you don’t know whether you’ll have a passion for research until you immerse yourself in it. I did 2 years of dedicated research in residency and would do it again. I have not suffered financially bc of it.
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@jmills1955
@FutureVascSurgn
@BCM_Surgery
@HansrajNatasha
@IlitisM
@RamyarGilaniMD
@TCCACS
@DrRosengart
@NealBarshes
@Jayer_Chung
@monteromiguel
@VascularSVS
What an amazing group! The present and future of vascular
@BCM_Surgery
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2/3: Amazing job from highly engaged trial teams that have made this possible:
@ClevelandVAMC
@gilles_pinault
@UF
@TampaVA
@USFvascular
@BCM_Surgery
@JCChoiMD
@NealBarshes
@HansrajNatasha
@VHALITPAO
@VANorthTexas
@UTSouthwestern
@VANFSG
@drrmthomas
@VAWesternNY
@dosluoglu
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#IMPROVE_AD
will follow the patients for 5 years to assess mortality and other clinically important outcomes.
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Could not agree more. Although the applicability of research findings depends on the study design, even small, hypothesis-generating studies can become drivers of innovative thinking that one day will radically change practice.
@ReaganACollins
@DownstateSurg
Humbling reminder that all research - whether it’s a case report or RCT - can make an impact and improve patient care which is all we can ever hope for 🤗 (shared with permission)
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@VikKashyapMD
Good old ABF with suprarenal clamp and anastomosis flush to the renal arteries. Case closed :-)
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A great study that reinforces what surgeons have always supported with passion, but without data-:) We finally have the data now.
Does anesthesiologist staffing ratio influence surgical patient morbidity and mortality? This cohort study uses EHR data from multiple centers to answer that question.
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@ErbenYoung
@RKTvascular
@jmills1955
@mhumphriesmd
@farkomd
@ColemanDM_vasc
@JudithLin4
@Dr_Bowser
Currently available infrarenal devices are not made for conical necks. FEVAR should be best option provided that there is suprarenal parallel aortic wall
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Truly amazing presentation and a very well deserving award.
@BCM_Surgery
@SamirSAwad1
@jmills1955
@DrRosengart
#AVAS2019
Congratulations to Dr. Zamani
@BCM_Surgery
@VAHouston
who won the BEST overall abstract award
@VAsurgeons
annual meeting
#VASurgeons2019
#AVAS2019
@p_kougias
@DrRosengart
@BgscottScott
@scottlemaire
@bwtrautner
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An excellent paper that highlights how life experiences and mentorship affect career choices and access to care.
Survey of graduating US medical students found fewer females intending to pursue surgery and racial and ethnic minority students and those with community/global health experience were more likely to report intention to practice surgery in underserved areas
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@jmills1955
@BCM_Surgery
@JaySayCa
@VascularSVS
@NealBarshes
@zpall11
@RamyarGilaniMD
@arvindsrinivasa
Seems like yesterday when they were timid interns :) Look at them now. Could not be more proud!
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Outstanding paper! The outcome is not surprising. Expanding the access outside the VHA system adversely affects VHA’s vertical integration capabilities that have served as the backbone for the outstanding short and mid- term VHA outcomes.
@ShereneSharath
Expanding access to healthcare outside of the Veterans Health Administration system changed the location of procedures but did not impact surgical outcomes.
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@Sharon_Kiang_MD
@benstarnesmd
@limbsalvagedr
@DrJCJimenez
@Roger_Tomihama
@adardik
@mhumphriesmd
@GustavoOderich
@WeiZhou74370988
@jmills1955
Seems like an easy FEVAR. If I am not mistaken there is also an aortocaval fistula, which augments the coolness factor of the case -:)
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Nothing makes a mentor prouder than seeing her/his mentees succeeding.
Soon, it will be your turn to offer the gift of opportunity.
When this time comes, be generous.
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2/2: Surgeons with a background in Critical Care and those interested in building a career in clinical research with emphasis in clinical trials are particularly encouraged to apply. Please, DM me if interested or you know of someone who may be a good fit for this opportunity.
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@jmills1955
Perhaps change it to “Endoflow”? It retains the all too familiar greek “endo” root, which is appropriate in this setting from a linguistic and contextual point of view :)
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An outstanding group of surgeons, leaders, educators. The vascular community owes you a lot!
Honored to join Past Presidents of VESS for dinner. Friendship. Different paths. Common goals.
#VESS22
#VESurgery
@RuthLBush
@WDarrinClouse
Jason Lee, Chip Sternbergh
@TomMaldonadoMD
Jon Eliason,
@MCorriereMD
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Important paper with thoughtful design. Smoking cessation three weeks prior to a major operative intervention is a clinically significant predictor of reduced mortality
New in Annals‼️🫁
Assessment of duration of smoking cessation prior to surgery for NSCLC
…
@BrendanHeiden
,
@SuhsinChang
,
@mwschoen
@lishiunchen
, Varun Puri
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Amazing perspective on the history of aortic surgery
@BCM_Surgery
from a living surgeon-giant, and the most gifted surgeon I ever had the privilege of working with.
Happy World Heart Day!
Did you know... that cardiovascular diseases are among the leading cause of death globally?
Many of the techniques directed towards the heart and aorta were pioneered right here at our institutions.
#WorldHeartDay
#UseHeart
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Very elegant. Aortobiprofunda bypass will stay open for a long, long time. Simplifying by performing a definitive operation is an outstanding choice.
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Congrats, Vik! Good luck with the new role.
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@jdimick1
@SAGES_Updates
Dunning-Kruger effect, a fancy way to describe overconfidence/arrogance
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It gets better over time. I was so excited after I completed (PGY 2) an entire proximal aortic anastomosis that I could not sleep that night :-)
Keep this passion and spirit up. It will carry you through the good and tough times of a surgeon's life.
Update: I’m now a 4-month old intern and was recently given the opportunity to sow on the proximal AND distal portions of an aortobifem. Vascular surgery is still amazing and I’m still grateful 😭
@usfvascularsur1
@FutureVascSurgn
#vascularsurgery
#MedTwitter
#match2022
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Richly deserved! Congratulations
@TL_Forbes
Welcome Dr. Tom Forbes (
@TL_Forbes
)! Our new Surgeon-in-Chief has a passion for staff wellness, and innovation in patient care.
#IAmSprott
#TeamUHN
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@prn19
@jmills1955
@UCDavisVascular
@mhumphriesmd
@VascularSVS
@UCDavisSurgery
@UCDavisHealth
@KempeKelly
@OUVascular
@BCM_Surgery
Very well deserved, congrats!
@mhumphriesmd
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@jsbrinkmd
Tough one. Open with the approach ( either trans- or retro-peritoneal) you are the most familiar with. Large balloon for proximal control during the initial dissection, just in case. A cigar after the case -:)
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It is a Cooperative Studies Program randomized trial (CSP 599) that initiated recruitment in February 2018 and is deployed in 15 Veterans Affairs Medical Centers. Anticipated study completion time is in late 2022.
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Great opportunity!
Amazing opportunity for surgical residents to become Assistant Editor in our journal 💥👨🏫⤵️👁🌎! Link: !
#SoMe4Surgery
@herbchen
@pferrada1
@PipeCabreraV
@cirbosque
@SWexner
@juliomayol
@MISIRG1
@TopKniFe_B
@TomVargheseJr
@LiangRhea
@sminaev2015
@CAHarrisMD
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@jmills1955
@BCM_Surgery
@FutureVascSurgn
@VascularSVS
@DrRosengart
@Jayer_Chung
@NealBarshes
@HansrajNatasha
@monteromiguel
@OPreventzaMD
@bwtrautner
@scottlemaire
@JCoselli_MD
Very proud and honored that he chose to stay with us.
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Preoperative intravenous iron supplementation does not reduce transfusion requirements after cardiac surgery.
Not surprising.
Measures to reduce blood loss intraoperatively should be more effective in this regard.
Effect of Perioperative Intravenous iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements: A Randomized, Double-Blinded Placebo-Controlled Trial
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@docmrjaff
@YannGoueffic
@VIVAPhysicians
These KM curves are very intriguing. After a lackluster performance for 360 days, it appears that suddenly at the one year mark Eluvia gains a decisive advantage.
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Excellent way to present a complex, convoluted decision making.
Differential Diagnoses in Acute Abdomen
#SoMe4Surgery
#MISIRGlobalSurgery
@SWexner
@SAGES_Updates
@Some4SurgeryIT1
@DrThawaba
@drdevirgilio
@arghavan_salles
@rupert_pearse
@rebgross
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Very thoughtful advice from
@herbchen
. I always ask surgery applicants what is one thing not included in their CV that they would like me to know about them. This one thing - and more - should be captured in the letters of recommendation.
If one element of your application replaces in-person interviews, it's probably Letters of Recommendation. Choose letter writers who know you and can highlight your strengths.
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@ErfanFarid
@NIH_LRP
@nih_nhlbi
@ferrag02
@ColumbiaSurgery
@ShereneSharath
@DownstateSurg
Very well deserved!
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