actually I have a quick question for you so we had a similar case last week at UVA and was a 32 year old female and she had connective tissue disorder and she had had an eighth inning repair five years ago and she subsequently developed
a type V dissection okay and this type B dissection they have been just basically monitoring for a couple years and so now we have this or chronic dissection flap and I actually made drop to dr. Kasia because we were
planning on doing an T bar and propping open the true limit but my concern is because that's the technologists are always thinking like if this doesn't work what am I gonna have available in the room and so I was thinking if we
prop up in this true lumen and we collapse the false lumen which was feeding a good bit of the viscera how am I going to successfully finish straight open this this chronic dissection flap and I don't have any experience with
laser we usually use the colon to needle we use that kind of approach and so my question is do you guys routinely use this in both chronic and okay well we don't use doing a B arcade typically but this was something new that we did dr.
Koch oh yeah so this is something new right you've never done a laser fenestration before yep bigger voice [Music] the laser septum II is something that we thought of I think which was a new thing
we also are kind of planning new ways to do that I think the main point that Sam mentioned is you want to create a total a single lumen that gets a full seal so you don't have persistent retrograde perfusion and I know from Y training at
UVA that we used to do the used to do T bars and hope that that overtime remodels but you still get a lot of retrograde flow and then you can get false lumen degeneration and then aneurysmal formation and by doing it
this way you don't get that anymore from anybody else this is open and back and forth no hard questions just joking I got I got my backup I got dr. Kajal I got Rudy and Anthony and magnetized okay
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