How much "area" can a Thoracic (Cardiac) surgeon cover?

[superior_vena_cana]

I've always been drawn to surgery as well as the entire cardiovascular system. I was wondering just how much a cardiothoracic surgeon (who focuses on cardiac procedures) can do:

1. Outside of the heart. In certain areas I have heard of CT guys doing vascular work like AAA, peripheral vascular disease, dialysis fistulas, maybe some fem-pop on the side.

2. Interventional Procedures. How does a CT find a way into the cath lab with the IC guys? Can they opt for a IC fellowship like this guy did:
Isaac George, MD | Columbia University Department of Surgery
Or are these skills becoming built into CT residency/fellowships more now?

Also heard about this fellowship that seems to incorporate all of it, but I would not dream of sniffing a program like this as a DO Vascular Surgery Residency Program | ahn.org

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[Medstart108]

It does happen in the community but cardiac surgery is not the surgical specialty to go into if you want to operate on all parts of the body. It's one of the least diverse surgical specialties out there. The vast majority of surgeries start with the same incision, median sternotomy. In fact, 85-90% of surgeries or so are either CABG or Valve surgeries.

Many of the cardiac surgeons you may hear about doing AAAs, PVD, Fistulas aka vascular work are part of an older generation that trained in general/vascular as well. Surgery is becoming more and more specialized and it is even becoming more rare to see a new grad do both cardiac and thoracic work.

There are a few cardiac surgeons who do interventional only or both, but these surgeons are not the majority. This area is likely to become bigger in the future. Being a cardiac surgeon who does interventional procedures is doable, but it is unlikely you will be doing the full breadth of interventional procedures i.e. PCI, coronary angiograms etc. and open heart surgery. The one person I know of who does this no longer does open surgeries. It is much more common for young cardiac surgeons to be doing open heart surgery and TAVR or mitraclip.

If you are interested in doing a wide variety of surgeries, definitely consider vascular, or gen+vasc if you feel you aren't competitive for the 0+5. Vascular operates on nearly everything in the body except the brain and heart. Also tends to have a better lifestyle. More difficult patients though.

 

[LucidSplash]

Would you mind elaborating a little more about what you mean by better lifestyle/more difficult patients in vascular? Not to hijack the thread.. I'm interested in both these fields.

The patients are generally the sickest in the hospital. They are fragile with multiple comorbidities. I have plenty of patients that I operate on that CTS says aren’t candidate for CABG.

I have no idea what he means by better lifestyle. Vascular is known for one of the worst lifestyles with the most emergencies. I mean I love it, but I’m not going to kid you about it. Transplant is probably worse, and In vascular things can be a little more chill at a non-tertiary center hospital. But overall it’s still a lot of sick patients who tend to be non-compliant and don’t come to the ED until things are really dire.

 

[Medstart108]

Maybe its just where I work, but vascular tends to have less work to do, and has more residents. They definitely get a lot of emergencies compared to cardiac, the hours are less predictable. One of the other "benefits" i guess of vascular, is more of the work you do is less scrutinized.

 

[SociableJimmy]

Can anyone shed some light on what general thoracic work is like in a large academic center? I train at a Level 1 communiversity program that’s busy in pretty much every specialty but thoracic. Our two surgeons do a few wedges and lobes each week, an occasional goose or thymectomy, but that’s pretty much it.

 

[deleted50541]

Can anyone shed some light on what general thoracic work is like in a large academic center? I train at a Level 1 communiversity program that’s busy in pretty much every specialty but thoracic. Our two surgeons do a few wedges and lobes each week, an occasional goose or thymectomy, but that’s pretty much it.

The work varies but the majority of my practice is lung and pleural pathology, followed by esophagus, mediastinal, and diaphragm to a lesser extent. Lots of lobectomies and segmentectomies. Plenty of spontaneous pneumos, decorts, and malignant effusions. It's rare that we're putting in chest tubes in people outside of the OR these days with the help of IR. Lots of consults to manage other people's chest tubes though. We also work closely with other surgical specialties in the OR quite often.

Mediastinal procedures seem to come in waves. I do a fair bit of mediastinoscopies (often after EBUS fails to provide a diagnosis from another provider). My partner and I tag team on esophagectomies and do about 2-3 a month (approach varies by pathology, but usually 3-field).

Tracheal surgery is more frequently done in larger referral centers, but I do the occasional tracheal resection for strictures or repairs after traumatic injuries.

Emergency surgery is much less common than with cardiac. Esophageal perforations and massive hemothorax are the main surgical emergencies in thoracic. Many of those can be managed in a minimally invasive fashion with VATS and stents. But I have no hesitation to do a thoracotomy if I think it's necessary.

Overall, the work is steady and life is pretty good. I'm rarely in the OR past 5 and I almost never operate overnight or on weekends anymore.

 

[CyrusHabs7695]

The work varies but the majority of my practice is lung and pleural pathology, followed by esophagus, mediastinal, and diaphragm to a lesser extent. Lots of lobectomies and segmentectomies. Plenty of spontaneous pneumos, decorts, and malignant effusions. It's rare that we're putting in chest tubes in people outside of the OR these days with the help of IR. Lots of consults to manage other people's chest tubes though. We also work closely with other surgical specialties in the OR quite often.

Mediastinal procedures seem to come in waves. I do a fair bit of mediastinoscopies (often after EBUS fails to provide a diagnosis from another provider). My partner and I tag team on esophagectomies and do about 2-3 a month (approach varies by pathology, but usually 3-field).

Tracheal surgery is more frequently done in larger referral centers, but I do the occasional tracheal resection for strictures or repairs after traumatic injuries.

Emergency surgery is much less common than with cardiac. Esophageal perforations and massive hemothorax are the main surgical emergencies in thoracic. Many of those can be managed in a minimally invasive fashion with VATS and stents. But I have no hesitation to do a thoracotomy if I think it's necessary.

Overall, the work is steady and life is pretty good. I'm rarely in the OR past 5 and I almost never operate overnight or on weekends anymore.

Whats the job market like for general thoracic? Is it pretty easy to find jobs in any area of the country you want?

 

[deleted50541]

Whats the job market like for general thoracic? Is it pretty easy to find jobs in any area of the country you want?

The need for thoracic surgeons is definitely there. But it's not easy to find a job in just any part of the country, especially as a new grad. I eventually found a great job in a location close to family in the western U.S., which has far fewer job opportunities compared to the East Coast. Like many desirable positions, the job you may want is often not advertised and comes through word-of-mouth/who you know.

 

[deleted745951]

From my humble viewpoint, medicine is becoming more and more subspecialised as time passes. Cardiac surgery is mainly cardiac surgery, though there are some that do additional training to get wire skills or do vascular fellowships, the vast majority doesn't. For example, exposing and operating on the abdominal aorta (RP/TP) is very different from the proximal part. If you're not used to doing it day in and day out, there's going to be a huge learning curve.

With the rapidly evolving literature expanding options for peripheral/cerebrovascular and aortic surgery, it's prudent to be seeing/treating the pathology often and having a complete skillset (open/endo/hybrid) for correct decision making. I would strongly argue that you would need formal vascular surgery training to treat this. Especially so in the future seeing where things are moving. You can do this by pursuing a 5+2/3 like the program you've mentioned in your post but many other cardiac programs are up for grabs too (vascular followed by cardiac or vice versa)

Maybe this will change, with FET and TAVI. There has been more push by Cardiac giants to include endo into cardiac training but how feasible is this? Would it significantly increase the time frame of training in an already long residency program to become independently competent in aortic/valve intervention?

 

[deleted50541]

From my humble viewpoint, medicine is becoming more and more subspecialised as time passes. Cardiac surgery is mainly cardiac surgery, though there are some that do additional training to get wire skills or do vascular fellowships, the vast majority doesn't. For example, exposing and operating on the abdominal aorta (RP/TP) is very different from the proximal part. If you're not used to doing it day in and day out, there's going to be a huge learning curve.

Maybe this will change, with FET and TAVI. There has been more push by Cardiac giants to include endo into cardiac training but how feasible is this? Would it significantly increase the time frame of training in an already long residency program to become independently competent in aortic/valve intervention?

That's certainly been the trend for many years now. My CT training was two years and if I was going the cardiac route, I may have considered a third year for further endovascular training. Endovascular experience only became a requirement for the cardiac path the year after I started fellowship, but our program was pretty focused on us being in the OR. TAVR was done almost every day in the cath lab, so the opportunity was there if you wanted. I anticipate fellows from my program having more dedicated time in the cath lab rather then extending the length of training.

On the thoracic side, my colleagues and I have talked about where the future of our specialty is going and the technologies we need to embrace now. For example, immunotherapy has been a game changer in lung cancer. While it's not a curative treatment, these drugs combined with emerging endobronchial therapies and SBRT have the potential to limit the pool of patients we see for surgery in the near future. I'm not opposed to less folks needing my knife if the long-term results suggest non-surgical therapies offer equivalent survival. However, in our practice we're trying to have a seat at the table through active involvement in endobronchial procedures that would otherwise be dominated by the interventional pulmonologists.

 

[CyrusHabs7695]

That's certainly been the trend for many years now. My CT training was two years and if I was going the cardiac route, I may have considered a third year for further endovascular training. Endovascular experience only became a requirement for the cardiac path the year after I started fellowship, but our program was pretty focused on us being in the OR. TAVR was done almost every day in the cath lab, so the opportunity was there if you wanted. I anticipate fellows from my program having more dedicated time in the cath lab rather then extending the length of training.

On the thoracic side, my colleagues and I have talked about where the future of our specialty is going and the technologies we need to embrace now. For example, immunotherapy has been a game changer in lung cancer. While it's not a curative treatment, these drugs combined with emerging endobronchial therapies and SBRT have the potential to limit the pool of patients we see for surgery in the near future. I'm not opposed to less folks needing my knife if the long-term results suggest non-surgical therapies offer equivalent survival. However, in our practice we're trying to have a seat at the table through active involvement in endobronchial procedures that would otherwise be dominated by the interventional pulmonologists.

If someone is purely interested in the general thoracic, do you recommend the general surgery route or the i6 route? Or no difference from what you've seen

 

[superior_vena_cana]

From my humble viewpoint, medicine is becoming more and more subspecialised as time passes. Cardiac surgery is mainly cardiac surgery, though there are some that do additional training to get wire skills or do vascular fellowships, the vast majority doesn't. For example, exposing and operating on the abdominal aorta (RP/TP) is very different from the proximal part. If you're not used to doing it day in and day out, there's going to be a huge learning curve.

With the rapidly evolving literature expanding options for peripheral/cerebrovascular and aortic surgery, it's prudent to be seeing/treating the pathology often and having a complete skillset (open/endo/hybrid) for correct decision making. I would strongly argue that you would need formal vascular surgery training to treat this. Especially so in the future seeing where things are moving. You can do this by pursuing a 5+2/3 like the program you've mentioned in your post but many other cardiac programs are up for grabs too (vascular followed by cardiac or vice versa)

Maybe this will change, with FET and TAVI. There has been more push by Cardiac giants to include endo into cardiac training but how feasible is this? Would it significantly increase the time frame of training in an already long residency program to become independently competent in aortic/valve intervention?

From my humble viewpoint, medicine is becoming more and more subspecialised as time passes. Cardiac surgery is mainly cardiac surgery, though there are some that do additional training to get wire skills or do vascular fellowships, the vast majority doesn't. For example, exposing and operating on the abdominal aorta (RP/TP) is very different from the proximal part. If you're not used to doing it day in and day out, there's going to be a huge learning curve.

With the rapidly evolving literature expanding options for peripheral/cerebrovascular and aortic surgery, it's prudent to be seeing/treating the pathology often and having a complete skillset (open/endo/hybrid) for correct decision making. I would strongly argue that you would need formal vascular surgery training to treat this. Especially so in the future seeing where things are moving. You can do this by pursuing a 5+2/3 like the program you've mentioned in your post but many other cardiac programs are up for grabs too (vascular followed by cardiac or vice versa)

Maybe this will change, with FET and TAVI. There has been more push by Cardiac giants to include endo into cardiac training but how feasible is this? Would it significantly increase the time frame of training in an already long residency program to become independently competent in aortic/valve intervention?

It does happen in the community but cardiac surgery is not the surgical specialty to go into if you want to operate on all parts of the body. It's one of the least diverse surgical specialties out there. The vast majority of surgeries start with the same incision, median sternotomy. In fact, 85-90% of surgeries or so are either CABG or Valve surgeries.

Many of the cardiac surgeons you may hear about doing AAAs, PVD, Fistulas aka vascular work are part of an older generation that trained in general/vascular as well. Surgery is becoming more and more specialized and it is even becoming more rare to see a new grad do both cardiac and thoracic work.

There are a few cardiac surgeons who do interventional only or both, but these surgeons are not the majority. This area is likely to become bigger in the future. Being a cardiac surgeon who does interventional procedures is doable, but it is unlikely you will be doing the full breadth of interventional procedures i.e. PCI, coronary angiograms etc. and open heart surgery. The one person I know of who does this no longer does open surgeries. It is much more common for young cardiac surgeons to be doing open heart surgery and TAVR or mitraclip.

If you are interested in doing a wide variety of surgeries, definitely consider vascular, or gen+vasc if you feel you aren't competitive for the 0+5. Vascular operates on nearly everything in the body except the brain and heart. Also tends to have a better lifestyle. More difficult patients though.

Do the 3 year CT fellowships offer the additional vascular and hybrid interventional skills? Or is it something you would have to pursue via a traditional vascular fellowship after CT??

 

[deleted745951]

As of status quo, I don’t think it includes it in the 3 year curriculum or at least sufficient amounts of it. but there are many informal short-term fellowships in TAVI, endo aorta.

In Canada, I’ve heard of cardiac surgeons pursuing a vascular fellowship, I don’t know if this happens in the US. I have heard of vascular going into cardiac though and in my very biased opinion that would be your best bet.

 

[deleted745951]

Ultimately, you do have to decide if you want to pursue cardiac surgery, you have to accept and be happy with the idea that you’re pretty much only going to be doing mainly CABG/ valves ( this is an oversimplification but this will be your bread and butter).

 

[superior_vena_cana]

As of status quo, I don’t think it includes it in the 3 year curriculum or at least sufficient amounts of it. but there are many informal short-term fellowships in TAVI, endo aorta.

In Canada, I’ve heard of cardiac surgeons pursuing a vascular fellowship, I don’t know if this happens in the US. I have heard of vascular going into cardiac though and in my very biased opinion that would be your best bet.

Ultimately, you do have to decide if you want to pursue cardiac surgery, you have to accept and be happy with the idea that you’re pretty much only going to be doing mainly CABG/ valves ( this is an oversimplification but this will be your bread and butter).

I think I'm drawn to the idea that I can do "mostly" everything regarding the heart. I would hate the idea that I'm stuck doing only a handful of procedures via CT surgery but know that if I went the IC route I wouldn't forgive myself for not pursuing surgery

 

[SociableJimmy]

Can anyone comment on what sort of TAVR volume in training is required to be 1. Technically proficient and 2. Marketable as a graduating fellow?

 

[Medstart108]

Can anyone comment on what sort of TAVR volume in training is required to be 1. Technically proficient and 2. Marketable as a graduating fellow?

Most cardiologists say you need a 1 year fellowship to be competent enough in TAVR to do TAVR independently and be a full member of the heart team.

Some surgeons suggest a 3-6 month rotation would be enough to learn TAVR, but I have my doubts that cardiologists will welcome you as a full member of the team without 1 year where you can truly understand TAVR, workup and do these cases from start to finish. Most of the time, when a surgeon does an endovascular fellowship, they continue to do 1-2 days in the OR to maintain their surgical skills.

 

[Medstart108]

I think I'm drawn to the idea that I can do "mostly" everything regarding the heart. I would hate the idea that I'm stuck doing only a handful of procedures via CT surgery but know that if I went the IC route I wouldn't forgive myself for not pursuing surgery

You need to decide if you want to do heart or peripheral stuff. I think this is the big distinguishing factor. Vascular and cardiac have their differences. Sure, both do blood vessels, but the case mix, the complexity, the style of work are going to be different. Vascular definitely has the edge when it comes to smaller cases, less scrutiny, and breadth. Cardiac has the big complex surgeries, but comes with more scrutiny, heavier emphasis on research and a longer training time.

If you really can't decide, do general surgery, but I do think all these fields are different in their own way so there is a way to distinguish them all.

 

[CyrusHabs7695]

You need to decide if you want to do heart or peripheral stuff. I think this is the big distinguishing factor. Vascular and cardiac have their differences. Sure, both do blood vessels, but the case mix, the complexity, the style of work are going to be different. Vascular definitely has the edge when it comes to smaller cases, less scrutiny, and breadth. Cardiac has the big complex surgeries, but comes with more scrutiny, heavier emphasis on research and a longer training time.

If you really can't decide, do general surgery, but I do think all these fields are different in their own way so there is a way to distinguish them all.

Aren't both 5 years gen sure + 2 years fellow?

 

[deleted745951]

I’d echo most of what the above post says. I’m just a lowly R1 but I would comment that research is heavily emphasized in vascular especially when it comes to databases and outcomes and there’s a massive avenue for creativity with innovation in techniques and devices.

Maybe it’s just the center I’m in, but we do crazy things like thoracos, ruptures, trauma and open aortas via multiple approaches quite regularly and it’s pretty complex, even the complex endo, dialysis access and limb salvage can be no joke. We routinely help other surgeons and health providers deal with their bleeding mishaps. There is totally the option to do veins and fistula for a living or you can be the complex aortic surgeon. In cardiac however IMO, every surgery is a complex one.

As outlined in many different posts, they are different specialties and the best thing to do is to get a feel of each, see the emergencies and late night consult to make a decision as to what you want to pursue.

 

[Medstart108]

Aren't both 5 years gen sure + 2 years fellow?

If you take the general surgery pathway yes it is technically the same, but the effective training time is more likely to be longer. You are more likely to do a fellowship in cardiac and more likely to do research years.

For cardiac it is more common to do a 5+2+2 aka 2 years of research during gen surg and some do 5+3 as well or do a superfellowship after a 5+2.

In I-6 programs its common to do 6+2, especially in more academic focused programs and again its encouraged now to do a fellowship on top of that.

Vascular's 0+5 programs are also a year shorter than the I-6.

There are definitely people who do research in vascular and do fellowships in vascular but it isn't as common, partially also because more of vascular's case load is community based compared with cardiac.

 

[ed*26]

In I-6 programs its common to do 6+2, especially in more academic focused programs and again its encouraged now to do a fellowship on top of that.

Has anyone seen if the I6 programs are better at training grads in endovascular techniques? I can see it being difficult to squeeze into a 2-3 year fellowship, but surely it could be worked into a six-year program...

 

[superior_vena_cana]

If you take the general surgery pathway yes it is technically the same, but the effective training time is more likely to be longer. You are more likely to do a fellowship in cardiac and more likely to do research years.

For cardiac it is more common to do a 5+2+2 aka 2 years of research during gen surg and some do 5+3 as well or do a superfellowship after a 5+2.

In I-6 programs its common to do 6+2, especially in more academic focused programs and again its encouraged now to do a fellowship on top of that.

Vascular's 0+5 programs are also a year shorter than the I-6.

There are definitely people who do research in vascular and do fellowships in vascular but it isn't as common, partially also because more of vascular's case load is community based compared with cardiac.

Did you take the I6 path or CT Fellowship path? Any advice? I have no plan on doing anything integrated seeing as I'm a DO student and average to begin with.

 

[Medstart108]

Did you take the I6 path or CT Fellowship path? Any advice? I have no plan on doing anything integrated seeing as I'm a DO student and average to begin with.

I'm donig I6. You have time, just do general surgery and find your passion. It's a big field and you will definitely know what you want once you are in residency.

 

[ThorSv]

The work varies but the majority of my practice is lung and pleural pathology, followed by esophagus, mediastinal, and diaphragm to a lesser extent. Lots of lobectomies and segmentectomies. Plenty of spontaneous pneumos, decorts, and malignant effusions. It's rare that we're putting in chest tubes in people outside of the OR these days with the help of IR. Lots of consults to manage other people's chest tubes though. We also work closely with other surgical specialties in the OR quite often.

Mediastinal procedures seem to come in waves. I do a fair bit of mediastinoscopies (often after EBUS fails to provide a diagnosis from another provider). My partner and I tag team on esophagectomies and do about 2-3 a month (approach varies by pathology, but usually 3-field).

Tracheal surgery is more frequently done in larger referral centers, but I do the occasional tracheal resection for strictures or repairs after traumatic injuries.

Emergency surgery is much less common than with cardiac. Esophageal perforations and massive hemothorax are the main surgical emergencies in thoracic. Many of those can be managed in a minimally invasive fashion with VATS and stents. But I have no hesitation to do a thoracotomy if I think it's necessary.

Overall, the work is steady and life is pretty good. I'm rarely in the OR past 5 and I almost never operate overnight or on weekends anymore.

How much benign esophageal work do you do? And as you mentioned earlier, how successful have you been in trying to get in with doing endobronchial work, or even more advanced esophageal endoscopy work?

 

[deleted50541]

How much benign esophageal work do you do? And as you mentioned earlier, how successful have you been in trying to get in with doing endobronchial work, or even more advanced esophageal endoscopy work?

I don't do much benign esophageal work, but my partner does. MIS dominated the benign esophageal surgeries at my training institution and we mostly got the re-do hiatal hernias that they didn't want to touch. I'm perfectly comfortable doing cases like diverticulectomies and leiomyoma enucleations when they come around. Similarly, advanced endobronchial and endoscopy were not part of my training, but I know plenty of programs that do offer that. Our IP folks do the majority of the endobronchial work now and as busy as we are, we appreciate the load they've taken off us.

My endoscopy is limited to diagnostic procedures, stenting for perforations, and occasional stricture dilations of our esophagectomies. We are looking into adding POEM though in the coming year to our available procedures.

 

[dodolol21]

Hey @superior_vena_cana, we seem to have common interests! PM me if you don't mind. Also thanks @Medstart108, your comments are insightful as usual. Glad we still have an i6 resident hanging out around here

 

[HighPriest]

Depends on his stride, speed, and how much time you give him.

 

[dienekes88]

I've always been drawn to surgery as well as the entire cardiovascular system. I was wondering just how much a cardiothoracic surgeon (who focuses on cardiac procedures) can do:

1. Outside of the heart. In certain areas I have heard of CT guys doing vascular work like AAA, peripheral vascular disease, dialysis fistulas, maybe some fem-pop on the side.

2. Interventional Procedures. How does a CT find a way into the cath lab with the IC guys? Can they opt for a IC fellowship like this guy did:
Isaac George, MD | Columbia University Department of Surgery
Or are these skills becoming built into CT residency/fellowships more now?

Also heard about this fellowship that seems to incorporate all of it, but I would not dream of sniffing a program like this as a DO Vascular Surgery Residency Program | ahn.org

It's increasingly rare for CT surgeons to do peripheral vascular work given how specialized vascular surgery is becoming. Can you really expect someone who is trying to keep up with the endovascular encroachment in cardiac surgery to also be at the cutting edge of peripheral endovascular techniques?

Interventional. Exceedingly rare for a cardiac surgeon to be doing diagnostic caths or PCI. Pretty common for cardiac surgeons to do perc ECMO, TEVAR, and TAVR. You do need to be able to do some basic peripheral vascular surgery to be an active participant in the cutting edge of these 3 procedures. Axillary access for TAVR, femoral reconstruction after perc ECMO. Carotid subclavian for TEVAR with Zone 2 deployment.

If someone is purely interested in the general thoracic, do you recommend the general surgery route or the i6 route? Or no difference from what you've seen

For esophagus and foregut, I suspect general surgery may be a better route. For lung, thoracic vascular, and lung transplant (a lot of programs have thoracic surgeons do lung transplant), I suspect I6 may be better.

Can anyone comment on what sort of TAVR volume in training is required to be 1. Technically proficient and 2. Marketable as a graduating fellow?

I'd suspect that if you did 40 or 50 TAVRs, you'd feel pretty good. You have to remember that experience with TEVAR will definitely help.

Most cardiologists say you need a 1 year fellowship to be competent enough in TAVR to do TAVR independently and be a full member of the heart team.

Some surgeons suggest a 3-6 month rotation would be enough to learn TAVR, but I have my doubts that cardiologists will welcome you as a full member of the team without 1 year where you can truly understand TAVR, workup and do these cases from start to finish. Most of the time, when a surgeon does an endovascular fellowship, they continue to do 1-2 days in the OR to maintain their surgical skills.

I don't think you need 6 months. With a broad endovascular experience on a vascular rotation and 50 TAVRs, I think you'd be good.

 

[deleted745951]

To further touch on aortic surgery. There is also ample opportunity for cross collaboration with the new mushrooming of multidisciplinary Aortic Centers treating complex and acute aortic pathologies. It’s crucial for Vascular, Cardiac and cardiology to work well and learn from each other to establish a successful center.

In the institution I’m in we double scrub for things like aortic arch (FETs) and though a majority of TEVARs are done by VS, cardiac scrubs and learn if they want to or if it’s primarily their patient.

Building a Multidisciplinary Aortic Center - Endovascular Today

Five key components to providing comprehensive care for patients with aortic dissections.

evtoday.com