More Endovascular Specialists Needed
Amidst turf wars, endovascular specialists seek to better define the necessary skill sets.
"As we continue to fight amongst ourselves over who is the best endovascular interventionist, the public has a totally different perception,” said Michael R. Jaff, DO, Assistant Professor of Medicine at Harvard Medical School and Director of Vascular Medicine at Massachusetts General Hospital in Boston.
“We continue to fight, the public continues to be confused about what we’re doing, and the government gets to decide who gets what,” Jaff said in a plenary session yesterday. “We shouldn’t need a randomized trial to tell us who should care for these patients.”
Jaff discussed the need for endovascular specialists and the training that they should receive. These individuals should be knowledgeable about pathophysiology and additional options for therapy.
“And the specialist should have no axe to grind,” Jaff said. “The goal is to provide the best care.”
Defining a specialist
Ideally the specialist should have expertise in vascular medicine. The field has been dominated by three specialties: vascular surgeons, interventional radiologists and cardiologists/vascular medicine specialists.
Each of these specialties is adjusting its training to account for this emerging field. For instance, vascular surgery training now mandates that residents and fellows recieve training in endovascular techniques, Jaff said.
Many interventional radiology programs are trying to teach radiologists how to follow patient progress in outpatient clinics and offices. Most cardiology programs mandate some formal didactic training in vascular medicine as part of an adult cardiovascular training program.
Vascular surgeons
A 2005 article in the Journal of
Vascular Surgery indicated that vascular surgeons have functioned as the principal care providers for patients with peripheral vascular disease for the past 50 years, Jaff said. The article reported that, among the three subspecialties, vascular surgeons have the most advanced clinical knowledge of peripheral vascular disease.
The article indicated that for cardiologists, a “reapplication to peripheral vascular procedures is questionable, and many cardiologists seem to be burdened by a compulsion to treat every peripheral vascular lesion.”
That was “hardly a collaborative statement,” Jaff said.
In the Journal of Interventional
Cardiology, Gray and colleagues said that endovascular interventional care is evolving into a multidisciplinary specialty. The researchers cited several reasons for this evolution: advances in equipment and therapeutic options, shifting specialty representation and ongoing evolution in the management algorithms.
Comprehensive knowledge
Optimally, Jaff said, the best endovascular specialists will possess a comprehensive knowledge of noncardiac vascular disorders, including arterial, venous, and lymphatic disorders
hypercoagulability; vasospastic disorders; wound care; and environmental vascular diseases, Jaff said.
They should have surgical and endovascular treatment expertise for vascular diseases, whether they perform this care themselves or understand when a patient should be referred elsewhere. They also must have the ability and the desire to follow patients longitudinally for vascular disease, including offering risk factor intervention for atherosclerosis, long-term anticoagulation and other conditions.