JAPACVS

Journal of the Association of PAs in Cardiothoracic and Vascular Surgery

Editor-in-Chief

Aaron R. Morton, DMSc, MMSc, PA-C, ATC, FAPACVS Emory University, Atlanta, GA

Associate Editor—International Vicky Vink PA Switzerland

Associate Editor Writer Development

Edward A. Ranzenbach, PA-C, MPAS, CAQ-CVTS, FAPACVS, DFAAPA Forest Ranch, CA

Editorial Board

Matthew Vercauteren MPAS, PA-C, FAPACVS Thoracic Section Editor

Daniel Geersen MPAP, PA-C Vascular Section Editor

Hantz B. Fontaine PA-C

Editorial Member at Large

EDITORIAL MISSION:

The JAPACVS is the official clinical journal of the Association of PAs in Cardiothoracic and Vascular Surgery. The mission of the JAPACVS is to improve Cardiac, Vascular and Thoracic Surgical and CVT Critical Care patient care by publishing the most innovative, timely, practice-proven educational information available for the physician assistant profession.

PUBLISHED CONTENT IN THE JAPACVS: Statements and opinions expressed in the articles and communications herein are those of the authors and not necessarily those of the Publisher or the Association of PAS in Cardiothoracic and Vascular Surgery (APACVS). The Publisher and the APACVS disclaim any responsibility or liability for such material, including but not limited to any losses or other damage incurred by readers in reliance on such content. Neither Publisher nor APACVS verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damage incurred by readers in reliance on thereon. Neither Publisher nor APACVS guarantees, warrants, or endorses any product or service advertised in this publication, nor do they guaranty any claim made by the manufacturer of such product or service.

SALES OFFICE

APACVS 1208 Victoria Crossing Festus, MO 63028 Phone (502) 321-6155 admin@apacvs.org

Publisher

David E. Lizotte, Jr. MPAS, PA-C, FAPACVS Executive Director APACVS Fenton, MO

JAPACVS/Journal of the Association of PAs in Cardiothoracic and Vascular Surgery is published quarterly (4 issues per volume, one volume per year) by APACVS 1208 Victoria Crossing, Festus, MO 63028. Volume 5, Number 1, Winter 2023. One year subscription rates: $40 in the United States and Possessions. Single copies (prepaid only): $10 in the United States

© 2023 APACVS, INC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including by photocopy, recording, or information storage and retrieval system, without permission in writing from the publisher.

Editorial

4 From the Editor’s Desk

Aaron R. Morton, DMSc, MMSc, PA-C, ATC, FAPACVS Editor -In-Chief

5 In Memoriam: Doug Condit, RPA-C, DFAAPA, USN (ret.)

David J. Bunnell, MSHS, PA-C, DFAAPA

6 Tribute to Douglas Condit, RPA-C

John Lee, PA-C, Robert Sammartano, PA-C, Dana Gray, PA-C

Peer Reviewed Content

10 The Application of Transcarotid Artery Revascularization for Treatment of Carotid Artery Stenosis

Matthew Scherschel, DMSc, MPAS, MHA, RRT, PA-C

Peer Reviewed Content

20 Assessment of Malperfusion Syndrome in Aortic Dissection: Defining an Aortic Dissection Lab Panel

Edward Ranzenbach, DMSc, PA-C, CAQ-CVTS, FAPACVS, DFAAPA

APACVS is the only association representing Cardiac, Thoracic and Vascular Surgery and CTV Critical Care PAs. By PAs, For PAs!

From the Editor's Desk

We recently lost a champion and a pioneer for Physician Assistants in Cardiothoracic Surgery, in PA Publishing and for our journal. Our own Editor-Emeritus and charter member Mr. Douglas Condit. I will devote my usual space for tributes to Doug with invited content in memorial to a giant in our community.

In honor of Doug, -AM

In memoriam: Doug Condit, RPA-C, DFAAPA, USN (ret.)

by David J. Bunnell, MSHS, PA

-C,

DFAAPA

“I have fought the good fight, I have finished the race, I have kept the faith.”

2 Timothy 7

Doug Condit was the rare individual who was relevant to our profession from the moment he stepped on stage to the moment he died. APACVS Executive Director David Lizotte, MS, PA-C, FAPACVS described him as the prototype for our profession. Former APACVS President Michael Doll, MS, PA-C, FAPACVS, DFAAPA and past Board Member Genie Ball, MS, PA-C, FAPACVS agreed on the precise description in response to my online remembrance“iconic.”

PA Condit was iconic because you can learn the history of our profession by knowing his story. He volunteered to serve in the Vietnam war and became a Navy Corpsman deployed with the Marine Corps where he earned three bronze stars. He had the opportunity to leave Vietnam early, he chose to remain on the battlefield. He declined a seat offered to him at Duke University PA Program to finish his Navy service. He was invited to interview for the University of Alabama Birmingham surgical PA program where he was accepted and introduced to our specialty. During the HIV/AIDs crisis he engaged in scholarship through writing and being the first PA to speak at the Society of Thoracic Surgeons meeting about surgeon’s attitudes about providing care to HIV patients. He educated generations of PA surgical residents at Montefiore Medical Center in Bronx, New York. He was the editor of Surgical PA, CardioVISION, and Editor Emeritus for JAPACVS. He was working in New York during the 2001 terrorist attacks. He was still working when New York City was at the center of the Covid-19 Pandemic in 2020. However, while I admired Doug for his meaningful career, I loved him because he was my friend. We shared a heart for scholarship, a sense of history, and love for patient care. We became close when I started writing with him for CardioVISION which was the predecessor of JAPACVS. We shared emails, phone calls, and frequent social media contact. When I became the Editor of JAPACVS he gave me advice on editorial vision and the challenge of creating and maintaining a scholarly journal. About ten years ago he started sending me emails on anything that made him laugh and it continued until late in 2022. There were so many of these messages that I could not read them all in real time. It gives me comfort to go back and make sure I read every one. partment of PA Medicine and Director at Large for the American Academy of Physician Associates. He is a former JAPACVS Editor in Chief.

Doug was full of contradictions. He could be mistaken for someone who was a relic of the past, but he was always engaged with what was happening now. As the song says “he was quick with a joke or a light if you smoke” but he was also a private person. While his direct involvement with American and PA history is significant and he loved to tell the stories, the stories were told without ego or self-aggrandizement. While many of us knew him to be hilarious and down to earth, he was a deeply spiritual man who often spoke with me about our shared Christian faith.

Tribute to Douglas Condit, RPA-C

John Lee, PA-C, Robert Sammartano, PA-C, Dana Gray, PA-C

The Physician Assistant/ Associate (PA) profession, particularly the surgical PA community, has sadly lost a pioneer, leader, and surgical PA advocate. He will remain an everlasting surgical PA icon. Doug ‘s national impact on the PA profession was substantial and the honors he had earned do not measure his zeal and determination in effecting recognition for surgical PAs and all PA disciplines through the years.

After graduating from Colorado State University in 1966 and toying around with the idea of law school, he joined the US Navy instead, served in Viet Nam and was honorably discharged as a Hospitalman, receiving several citations for his outstanding military service. Doug’s military career set the tone for his PA life. Doug graduated from University of Alabama’s PA Program in 1970 and subsequently graduated from Montefiore’s Surgical PA Residency Program in 1972 in Montefiore’s first graduating class. Further details of his extensive biography can be accessed at the weblink, https://pahx.org/assistants/condit-doug/.

As a pioneer, he was fearless in overcoming challenges, undeterred by negativity, achieving multiple firsts in his illustrious career. He became the first PA to work in cardiothoracic surgery at Montefiore and was the first PA to present at the Society of Thoracic Surgeon’s national conference. Following a ski trip to the USSR (now Russia), Doug was the first PA to publish the similar roles of Soviet/ Russian “feldshers” to primary care PA’ s.

As a visionary leader, he was a charter member of the Association of PA’s in Cardiothoracic and Vascular Surgery (APACVS) and the American Association of Surgeon’s Assistance (AASA), precursor to the current American Associations of Surgical PA’s (AASPA). He was a prolific writer with over 200 publications. As Editor-in-Chief of Surgical Physician Assistant, along with Susan Lusty (publisher), they were instrumental in uniting the distinctive surgical PA subspecialty organizations. Doug’s spearheading of surgical PA advocacy within the American Academy of Physician Assistants/ Associates (AAPA), AAPA’s Surgical Congress (as Chair), AAPA’s House of Delegates, New York State Society of PA’s (NYSSPA), APACVS, AASA/ AASPA, markedly progressed the influence of surgical PA’s. Never forgetting his military roots, he was a charter member of the AAPA Veteran’s Caucus.

As a mentor, he instilled a passion to learn, teach and proliferate. He personalized Montefiore’s adopted military motto of “be all that you can be” to “you can do it”.

He approached life with humor and out-of-the-box thinking. His quirkiness made him unique and memorable. He remained open-minded exemplified by challenging to the status quo and non-traditional forms of meditation and medical treatments.

We are honored to have known Doug and am grateful for all he’s done for the profession and for each of us professionally. As a steadfast friend, he exuded compassion, support, and sagely advice. In Doug’s words, his hello was typically “ yo’ dude” and he typically ended our joint Christmas cards to hospital staff with “Peace, Love”. Doug, we wish you eternal peace and love.