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Have you ever tried to manipulate a 0.014 wire with a 0.035 torque device and get 😖?
Sometimes, if you happen to have a yellow V8 torque, you can kind of get it to work, but even then it doesn’t work… PLUS, opening 1 just for the torque is $$
INSTEAD, use two 0.035!
Cheap+
Unexpected honor to present at the @ACCinTouch’s Ohio chapter to talk about asymptomatic carotid stenosis.
It’s an amazing time to be a vascular surgeon given the nuanced evolution of carotid intervention since 1953!
Medical management has become a powerful ally to prevent CV events, coupled with judicious choice of an arsenal of great interventions
Guillermo Escobar🩸 retweeted
#Carotid Opinion:
Patient with asymptomatic carotid disease. PSV of left ICA 260 cm/s and CTA read as 60-70% LICA stenosis. Debating opinions by IC and vascular.
Vascular: CEA (no angio needed)
IC: angio then decide stent vs CEA
I find it odd not consider angio for confirmation. Vascular states it’s a slam dunk CEA case.
I understand the debate with stent vs CEA (anatomical considerations) but shouldn’t we delineate the anatomy with angio or can you just rely on a CTA?
Would you do a carotid angio here first and then decide?
Guillermo Escobar🩸 retweeted
Video explaining the truncated V18 wire as an easy and affordable way to re-enter back to true lumen. Explained by @DrPatGeraghty himself.
@VIVAPhysicians @WashUVascular
Guillermo Escobar🩸 retweeted
Bleeding question for the American healthcare system 🏥
Imagine you walk into a restaurant.
You ask for a menu.
The waiter smiles: "There are no prices. Eat first."
You finish eating. You ask for the bill.
The waiter says: "We cannot tell you. Go home."
Three months later, an envelope arrives in your mailbox:
- Bread basket: $480.00
- Water glass rental fee: $210.00
- Out-of-network chef who walked past your table for four seconds: $1,650.00
TOTAL DUE: $2,340.00.
This sounds like a dystopian comedy sketch.
Except it is literally how going to the hospital works in the United States.
You can ask five different doctors, "How much will this cost?", and all five will look at you with genuine mystery, like you just asked them the location of Atlantis.
Nobody knows! The hospital does not know! The insurance company does not know!
The price is decided by a magical dice roll three months after you leave.
Why is healthcare the only industry in the free world where you buy a product with zero idea of the price tag? 🎲💸
Guillermo Escobar🩸 retweeted
At a coffee shop, the glass jar said: *TIPS APPRECIATED.*
I wrote on a paper napkin: *"Do not draw unless you intend to strike. Rest your horse after hills."*
I folded it and dropped it into the jar.
The barista found it at closing.
She taped it directly onto the espresso machine.
Next week, the chalkboard menu had a new header: *NOBU'S DAILY TIP.*
My coffee is free on Mondays now.
Guillermo Escobar🩸 retweeted
Dr Marcelo Gomes: STOP checking for MTHFR mutations…these are very common and DO NOT increase risk of VTE. I second that….this lab test drives me crazy and makes patients unnecessarily anxious! #VSS2026
Such a pleasure to see Dr James Stanley again as our Visiting Professor as the Jerry Goldstone Professorship lecture.
Dr Stanley was a superb technical surgeon and teacher, leader and remains an enthralling lecturer.
We all learned something as he covered renal artery interventions from the discovery of renin, to appropriate case selection, atherosclerotic, FMD and pediatric diseases. Loved the lecture!
A baby girl was noted to have swelling and cyanosis of the left arm, shoulder, and chest after birth. An MRI showed two fibrous bands penetrating the deep fascia.
Read the full case details in the Images in Clinical Medicine article “Congenital Amniotic Band Sequence”: nej.md/4drTsWs

ALT Two medical images from the Images in Clinical Medicine article "Congenital Amniotic Band Sequence." Panel A: A photo showing two areas of constriction at the level of the wrist and proximal forearm. Panel B: Magnetic resonance imaging of the arm showed two fibrous bands penetrating the deep fascia. Panel C: A photo of the left arm at the 5-month follow-up.
Guillermo Escobar🩸 retweeted
Replying to @JCoselli_MD
@JCoselli_MD is this year’s Wilfred Bigelow Lecturer and one of our invited speakers! A world-renowned cardiothoracic surgeon and leading authority on complex aortic surgery, he will be sharing ‘Lessons from a Lifetime in Aortic Surgery’. Register today! #CCC26 #CCCongress
Guillermo Escobar🩸 retweeted
From our @HarringtonHVI FMD program led by @cwru student Karen Ji: 10% of patients with multifocal #FMD imaged had aortic involvement, most commonly thoracic aneurysm/ectasia or arch anomalies. Need to image the chest!
Free download: openheart.bmj.com/content/13…
Guillermo Escobar🩸 retweeted
Gold handles on surgical instruments are not decoration. They signal tungsten carbide working surfaces, one of the hardest alloys in the OR.
Sharper cuts, better needle grip, longer service life. Black handles mean something different - the color code explained.
HUGE news for vascular trainees!
Fundamentals of Vascular Surgery will soon be a requirement of the American Board of Surgery for Vascular surgery trainees. APDVS Curriculum Chair Dr. Paul DiMusto here at @MWVSSociety 2026 evaluating trainees. For more information check out: vascular.org/apdvs/program-d…
Guillermo Escobar🩸 retweeted
Fundamentals of Vascular Surgery will soon be a requirement of the American Board of Surgery for Vascular surgery trainees. APDVS Curriculum Chair Dr. Paul DiMusto here at @MWVSSociety 2026 evaluating trainees. For more information check out: vascular.org/apdvs/program-d…
Guillermo Escobar🩸 retweeted
7/ I’ve been thinking about it ever since.
In medicine, so many days feel ordinary.
See the patient.
Solve the problem.
Write the orders.
Make the call.
Fight with insurance.
Find a way.
Then move on to the next person who needs you.






























