Interventional Radiology: From Idea to Device to Patient (original) (raw)
Related papers
2004
This study aimed to determine the relative roles of radiologists, cardiologists, vascular surgeons, and other physicians in performing percutaneous peripheral arterial interventions and how these roles have changed over a recent 5-year period. Methods and Materials: The authors reviewed the Medicare Part B fee-for-service databases between 1997 and 2002 for the Current Procedural Terminology (4th ed.) (CPT-4) surgical procedure codes for percutaneous transluminal angioplasty (PTA) of noncardiac peripheral arteries (six codes), the transcatheter placement of noncardiac intravascular stents (two codes), and endovascular aortic stent graft placement (six codes). Using the Medicare physician specialty codes, procedure volume in each CPT-4 code was determined for radiologists, cardiologists, vascular surgeons, and other physicians. Percentage changes from 1997 to 2002 were calculated for PTA and intravascular stent placement procedures. Results: Between 1997 and 2002, the total Medicare procedure volume in the eight procedure codes relating to PTA and stent placement increased by 95%. In 2002, radiologists performed 72,657 of these procedures, cardiologists 62,901, vascular surgeons 17,895, and other physicians 19,666. Over the 5-year interval, procedure volume among radiologists increased 29%, among cardiologists by 181%, among vascular surgeons by 398%, and among other physicians by 195%. Radiologists' share in the total pool of procedures in 2002 was 42.0% (down from 63.3% in 1997), cardiologists' 36.3% (up from 25.2% in 1997), vascular surgeons' 10.3% (up from 4.0% in 1997), and other physicians' 11.4% (up from 7.5% in 1997). Trend data were not available for endovascular aortic stent graft procedures. Conclusion: Between 1997 and 2002, procedure volume in percutaneous peripheral arterial interventions grew at faster rates among cardiologists, vascular surgeons, and other physicians than it did among radiologists. As a result, radiologists' share of this market declined during the interval. However, procedure volume among radiologists continued to grow over the 5 years, and in 2002, they still had the largest share among the four physician specialty groups. Thus, despite the erosion, interventional radiologists still maintain a strong position in this rapidly growing field.
Turf wars in radiology: The battle for peripheral vascular interventions
Journal of the American College of Radiology, 2005
Interventional radiologists in many hospitals are involved in confrontations with cardiologists and vascular surgeons over who should be allowed to perform percutaneous noncardiac peripheral vascular interventions. There are valid reasons why radiologists should be the ones doing these procedures: first, because in any given hospital, radiologists are generally the physicians with the best training and most experience, and second, because they are generally not in a position to self-refer and will therefore be able to help keep utilization under control. If cardiologists or vascular surgeons request vascular interventional privileges at your hospital, there are steps you can take to see if they are properly qualified. If they are granted privileges, there are other steps you can take to ensure that high standards of patient care are maintained. The authors also present some discussion of how interventional radiologists can position themselves to either compete with or collaborate with the other clinical services. Throughout any confrontations that might occur, radiologists should stress that patients undergoing these procedures deserve the best possible care, which means that they should be performed by those physicians on the hospital staff who are the most knowledgeable and the least likely to commit medical errors.
Interventional Radiology: The Invisible Part of the Iceberg
European Archives of Medical Research, 2021
T-Tube occlusion removal under fluoroscopy was introduced by Alexander R. Margulis in 1967 and the placement of vascular prosthesis by Dotter in 1969. Thereafter, rapid developments in minimally invasive treatment methods occurred in the field of "interventional radiology," including the dazzling developments in the vascular, non-vascular, and neurointerventional fields. Radiologists primarily receive diagnostic radiology training, thus they are very skillful in using these treatment methods. Routine procedures in most countries include biopsies, drains, angiographies, venous dialysis catheters, port placement for chemotherapy, ablative treatments, etc. Additionally, some treatment methods continue to become widespread such as temporary intracranial stents, flow-diverter stents, middle cerebral artery embolization for chronic subdural hematoma, thyroid ablation and embolization, cryoablation, chemosaturation, bariatric embolization, uterine fibroid embolization, fallopian tube recanalization, hemorrhoidal embolization, varicocele treatment, prostatic artery embolization, and geniculate artery embolization. Continuous developments in the field of new interventional radiological treatment have been improving since the writing of this review.
Management of Angioplasty Complications, Unsuccessful Procedures and Early and Late Failures
Annals of Surgery, 1984
Limb-salvage was the indication for 90% of 206 attempted PTAs in 175 patients between 1976 and 1982. Life-table patency rates at 4 years for the angiographically successful iliac PTA and femoropopliteal PTA were 78% and 50%, respectively. PTA of eight iliac, seven femoropopliteal, nine tibial, and two subclavian arteries and one autogenous saphenous vein graft (ASV) were unsuccessful. Of these, 17 subsequently underwent successful bypass grafts and five required below-knee amputations. Ten iliac, 37 femoropopliteal, four tibial, and two ASV graft PTAs failed. Of 20 repeat attempts at PTA, only two have achieved long-term patency. Appropriate surgery allowed limb salvage in 23 of 36 earlyfailures (<3 months) and 12 of 14 late failures (>3 months), and usually consisted of the same operation that would have been performed had PTA not been attempted. Fiftytwo complications were classified according to the method of treatment. Fourteen warranted surgery, but in 10 this was successfully achieved by the same operation that would have been required had PTA not been performed.