Hello and welcome back to ACRACT. I'm Jed Wolplaw and I am really excited. I've been wanting to do this episode for a while. I've been trying to track this fabulous guest down and finally got her to come on the show.

Hey folks, exciting quick announcement. We are going to have another live ACRACT episode at this year's American Society of Anesthesiologist Annual Meeting in San Francisco. It will be at 2 p.m. at Center Stage and I have two amazing guests.

Dr. Deb Colley will talk about post op to lyrium, what we know about it and what we can do to prevent it. And Dr. John Icon will talk about the future of patient safety monitoring. I'm really excited for these two amazing guests. I think it's going to be a great conversation and we will have lots of time for audience Q and A. So come take part. It's going to be a blast. We'd love to see you there in the audience. It will be 2 p.m. Pacific time in San Francisco at Center Stage at the ASA Annual Meeting. I hope to see you there. I have with me Dr. Mimi when Dr.

David Professor and the Vice Chair for Clinical Affairs in the Department of Anesthesiology at the University of Wisconsin-Madison and she is a world expert on anesthesia for thoracic surgery. And so we're going to talk today about that and specifically about anesthesia for thoracic abdominal aortic aneurysm repair. And I'm really excited to learn a lot from her. Dr. Win, thank you so much for coming on the show.

Well, thank you so much for inviting me. So let's start, but just tell the audience a little bit about you. How did you get interested in the specific area of clinical anesthesiology that you do and how did you get there to the to the party your career where you are now?

Well, that's kind of a long path after fellowship.

My husband who is a vascular surgeon was recruited to University of Wisconsin to start a complex aortic surgery program. And I was a cardiac am a cardiac anesthesiologist.

He had trained with Dr. Stanley Crawford in Houston who was really the first surgeon to do thoracic abdominal aortic surgery. And I had spent some time there when he was a fellow amazed by what they were doing.

However, that was the beginning of the surgery and the outcomes were not good in terms of spinal cord injury. So when we came back here initially, I was just doing cardiac anesthesia.

However, having had that experience, I was in a good position to take an interest in thoracic abdominal aortic surgery and anesthesia for that. And we quickly realized, and by quickly, I would say over the first year or so, that unless we improved the outcomes by reducing paralysis.

And we couldn't continue to do this because it was such a devastating complication. And I felt we lived with these patients forever until they died.

So we began to invest energy into that endeavor. And that's where it began.

I would say that over the years, I've done more cardiac at some time. It's more vascular at other times. I was fortunate to have an absolutely wonderful group of surgeons and anesthesiologists in the cardiac group to work with.

And also the vascular surgeons so that my own colleagues in anesthesiology became fast out with what we were doing as well. And I think we worked as a team to improve these outcomes over the next 20 years, really.

Oh, that's great. And so at your place, do you do cardiac anesthesiologists obviously do the cardiac cases? Do they also do all of the thoracic and vascular cases or are those kind of spread out?

No, we do almost all of the vascular and thoracic cases here. Our division is actually cardio thoracic and vascular.

We have people within the division that focus more on one thing than another. However, we try to standardize our management as much as possible because when you're dealing with very complex things that have a limited volume, it's helpful to improve outcomes by learning from what you've done.

So there has to be a certain amount of consistency.

Yeah, that makes sense. All right, well, let's start at the kind of very basic level. When we say a T triple A, what does that mean?

That means an aneurysm that begins in the descending thoracic aorta. So it's at the subclavian or distal arch and may extend down to below the renal arteries.

And these aneurysms are classified according to their extent. Some may end before the visceral segment, others may end after the renal arteries and then there are intermediate ones.

And obviously the risk of spinal cord injury is greater in the more extensive aneurysms.

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