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Curious if anyone thought of doing vascular surgery rather than IR, and why you chose the route you did.
Vascular surgery
- Thread starter nick_carraway
- Start date
I thought about vascular surgery and interventional cardiology as options as well. I ultimately decided on IR, because I wanted to do more than just vascular and I really had little or no desire to do open surgeries.
I wanted to do IR, because it is truly minimally invasive and most of my patients go home the same day or the next day. The recovery period is very short as well.
Though I enjoy treating patients with various vascular conditions. I also truly enjoy some of the general IR and interventional oncology.
I got to do an antegrade nephroureteral stent and do a liver rfa on one of my patients with hepatocellular carcinoma yesterday. My colleague did a lung cryoablation yesterday. We get to see some interesting problems from head to toe.
The newer breed of IR have become more clinical and that is what is propelling the field forward. There is also an expansion of research and innovation with increasing level 1 evidence.
I wanted to do IR, because it is truly minimally invasive and most of my patients go home the same day or the next day. The recovery period is very short as well.
Though I enjoy treating patients with various vascular conditions. I also truly enjoy some of the general IR and interventional oncology.
I got to do an antegrade nephroureteral stent and do a liver rfa on one of my patients with hepatocellular carcinoma yesterday. My colleague did a lung cryoablation yesterday. We get to see some interesting problems from head to toe.
The newer breed of IR have become more clinical and that is what is propelling the field forward. There is also an expansion of research and innovation with increasing level 1 evidence.
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I honestly never seriously considered vascular surgery. I too had interest in interventional oncology and little interest in marathon open vascular surgery. I like the imaging, the diverse problems we treat and the amazing tools we have at our disposal. If you are primarily interested in vascular I would still strongly consider IR. Practices with both interventionalists and vascular surgeons are becoming more common, and with IR training you would have similar endovascular cases plus the ability to do additional procedures. Furthermore, I understand there are programs that are considering training fellows in carotid stents and endarterectomies.
That is pretty sweet. I haven't heard talk of IR fellowships including carotid endarterectomies but that would be cool.
Nevertheless, as a previous general surgery resident who switched to radiology specifically to do IR, I have to concur with what was said. When I was in surgery, I was considering trauma, critical care, or vascular. I realized very quickly though that I wanted more. More knowledge, more education, more tools at my disposal, more of a chance to help my patients. Maybe it was just my experience at an academic medical center. Nevertheless, IR has completely and utterly fit the bill. The broad scope of practice in IR is phenomenal. I truly have an impact on patients in multiple clinical specialties. From endovascular procedures to inteventional oncology to fibroid embolization, I feel on a daily basis like I am making a difference. I could never go back.
Nevertheless, as a previous general surgery resident who switched to radiology specifically to do IR, I have to concur with what was said. When I was in surgery, I was considering trauma, critical care, or vascular. I realized very quickly though that I wanted more. More knowledge, more education, more tools at my disposal, more of a chance to help my patients. Maybe it was just my experience at an academic medical center. Nevertheless, IR has completely and utterly fit the bill. The broad scope of practice in IR is phenomenal. I truly have an impact on patients in multiple clinical specialties. From endovascular procedures to inteventional oncology to fibroid embolization, I feel on a daily basis like I am making a difference. I could never go back.
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Am I free to ask where this talk is taking place? I'm all for being a gung-ho cowboy IR type, but endarterectomy, or anything that requires a hand sewn vascular anastomosis with castros, seems outside the scope of practice. Do you mean minimally invasive endarterectomies? I haven't heard of those being done in the carotids.
Though I have heard of IR doing femoral cutdowns, I have not heard of endarterectomy.
As far as carotid disease. I am on he fence with stenting. I do think that the SAPPHIRE showed that it is non-inferior for high risk for surgery patients (ie physiologic or anatomic) and they used a outcome of MACE (major adverse cardiovascular events).
Then, came the SPACE and EV3S trials which both were negative trials showing a high stroke rate in the interventional limb (European RCTs)
Then, the major trial the CREST came out huge numbers RCT showing a fairly equivalent result using dstal protection.
We are basing endarterectomy has a benefit based on NASCET and ACAS the trials were pre plavix and statin therapy. So, I wonder how beneficial medical therapy may truly be in the age of statins, ace, and plavix.
I think that flow reversal systems such as the PARODI, MOMA etc may hve a benefit.
But caroid endartectomy is a fairly safe and effective therapy. Certainly in a high carotid bifurcation, tandem lesions, radiated neck, restenosis post endarterectomy stenting is favourable.
I think if the anatomy is not favourable for stenting (ie type 3 arches) toruous distal cervical ICA, one should consider just going to endarterectomy.
As far as carotid disease. I am on he fence with stenting. I do think that the SAPPHIRE showed that it is non-inferior for high risk for surgery patients (ie physiologic or anatomic) and they used a outcome of MACE (major adverse cardiovascular events).
Then, came the SPACE and EV3S trials which both were negative trials showing a high stroke rate in the interventional limb (European RCTs)
Then, the major trial the CREST came out huge numbers RCT showing a fairly equivalent result using dstal protection.
We are basing endarterectomy has a benefit based on NASCET and ACAS the trials were pre plavix and statin therapy. So, I wonder how beneficial medical therapy may truly be in the age of statins, ace, and plavix.
I think that flow reversal systems such as the PARODI, MOMA etc may hve a benefit.
But caroid endartectomy is a fairly safe and effective therapy. Certainly in a high carotid bifurcation, tandem lesions, radiated neck, restenosis post endarterectomy stenting is favourable.
I think if the anatomy is not favourable for stenting (ie type 3 arches) toruous distal cervical ICA, one should consider just going to endarterectomy.
