Interventional Cards Scope of Practice Questions..........

[Lasofloxabuterol]

I am currently involved in some research on cardiac robotic catheterization technology with Siemens and am quite fascinated with interventional cardiology. That being said, I was wondering:

1. What is the scope of practice of an interventional cardiologist, can they do femoral cut-downs, ECMO cannulations, etc...?

2. Is there an integrated program without the need to complete an IM residency now or in the near future?

3. Will robotically assisted catheterization be the standard of care in the future?

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[TraumaLlamaMD]

You’ll likely have more luck if you have this thread moved over to the Cardiology subforum in the Internal Medicine forum - not sure how many interventional cardiologists read our Surgery forum but I don’t recall ever seeing one post here.

 

[NDcienporciento100]

I am currently involved in some research on cardiac robotic catheterization technology with Siemens and am quite fascinated with interventional cardiology. That being said, I was wondering:

1. What is the scope of practice of an interventional cardiologist, can they do femoral cut-downs, ECMO cannulations, etc...?

2. Is there an integrated program without the need to complete an IM residency now or in the near future?

3. Will robotically assisted catheterization be the standard of care in the future?

But to be short the answer is no to every question.

 

[Winged Scapula]

Moving to IM forum

 

[epicandprivate]

1. Almost never
2. No
3. Probably not

 

[IMreshopeful]

I am currently involved in some research on cardiac robotic catheterization technology with Siemens and am quite fascinated with interventional cardiology. That being said, I was wondering:

1. What is the scope of practice of an interventional cardiologist, can they do femoral cut-downs, ECMO cannulations, etc...?

2. Is there an integrated program without the need to complete an IM residency now or in the near future?

3. Will robotically assisted catheterization be the standard of care in the future?

1. cut downs are not commonly done by IC docs. ECMO cannulations sometimes
2. No
3. No

 

[deleted709825]

I'm curious why you guys don't think robots will be used in the cath lab.

 

[NDcienporciento100]

I'm curious why you guys don't think robots will be used in the cath lab.

Not trying to sound like a jerk but have you ever seen a percutaneous across? It goes something like this needle, wire catheter, dilator, dilator dilator an Ecmo catheter. Why do you need a robot to do that?

 

[Lasofloxabuterol]

Y

Not trying to sound like a jerk but have you ever seen a percutaneous across? It goes something like this needle, wire catheter, dilator, dilator dilator an Ecmo catheter. Why do you need a robot to do that?

Your right, a robot probably does not need to be used to do something like an ECMO cannulation. I was really asking about more complex tasks such as congenital heart defects, complex coronary lesions, TAVR, TMVR... that could probably be done more accurately by a robot of course under the guidance of a MD/DO.

 

[NDcienporciento100]

Y

Your right, a robot probably does not need to be used to do something like an ECMO cannulation. I was really asking about more complex tasks such as congenital heart defects, complex coronary lesions, TAVR, TMVR... that could probably be done more accurately by a robot of course under the guidance of a MD/DO.

Why has the Robot made advances in fields like urology, ob gyn, complex hernia repair?

 

[Lasofloxabuterol]

Why has the Robot made advances in fields like urology, ob gyn, complex hernia repair?

im not sure

 

[NDcienporciento100]

im not sure

Because the robot can make complex movements 360 turns with the needle etc and hold it there, things that would be impossible laparoscopic. But it can do those things by being inside the body I just don’t see how that would cross over at this point in time. Maybe I’m wrong

 

[Lasofloxabuterol]

At Siemens they are working on cures for HLHS and other congenital heart defects with totally endovascular autonomous robots. Cool stuff.

 

[NDcienporciento100]

At Siemens they are working on cures for HLHS and other congenital heart defects with totally endovascular autonomous robots. Cool stuff.

Hey I’m just a simple IR Resident, what do I know? I’m all for curing the world through endovascular technology, and I think it’s about time cards invents there own procedures. Go Cards!

 

[aafisahar]

Hey I’m just a simple IR Resident, what do I know? I’m all for curing the world through endovascular technology, and I think it’s about time cards invents there own procedures. Go Cards!

IR is one of the most butt hurt specialties regarding catheter based therapies. IC has invented dozens of procedures (eg hemodynamic monitoring, complex PCI, CTOs, TAVRs, TMVR, balloon valvoplasty, PFOs) but because the first angioplasty was done by an IR doc, there's this feeling of betrayal/theft coming from IR circles.

 

[kjamess]

IR is one of the most butt hurt specialties regarding catheter based therapies. IC has invented dozens of procedures (eg hemodynamic monitoring, complex PCI, CTOs, TAVRs, TMVR, balloon valvoplasty, PFOs) but because the first angioplasty was done by an IR doc, there's this feeling of betrayal/theft coming from IR circles.

not to mention that the first coronary angioplasty was done by a cardiologist, where the stakes were much higher in a moving target, or the fact that IR borrows from the above techniques for their procedures as well.

 

[NDcienporciento100]

not to mention that the first coronary angioplasty was done by a cardiologist, where the stakes were much higher in a moving target, or the fact that IR borrows from the above techniques for their procedures as well.

IR invented seldinger technique, IR invented, angioplasty, IR invented the stent- take those three things away and Interventional cards would not even exist! Moving on, catheter directed lyses, aneurysm coiling, embolizations, ablations all pioneered by IR. Look beyond Interventional cards at cardiology imaging fellowships developed by Radiologist. You think that interventional cards are better interventionist it’s laughable, IR gets dished the craziest interventional complication in the hospital hands down things that cardiologist won’t touch, anecdotally I see a couple pseudoaneurisms a week, almost all of them caused by interventional cardiologists it’s literally a running joke between myself and my colleagues, “oh pseudoaneurism which cardiologists did it”. Field of cards would be a shadow of its modern self without Radiology.

 

[aafisahar]

IR invented seldinger technique, IR invented, angioplasty, IR invented the stent- take those three things away and Interventional cards would not even exist! Moving on, catheter directed lyses, aneurysm coiling, embolizations, ablations all pioneered by IR. Look beyond Interventional cards at cardiology imaging fellowships developed by Radiologist. You think that interventional cards are better interventionist it’s laughable, IR gets dished the craziest interventional complication in the hospital hands down things that cardiologist won’t touch, anecdotally I see a couple pseudoaneurisms a week, almost all of them caused by interventional cardiologists it’s literally a running joke between myself and my colleagues, “oh pseudoaneurism which cardiologists did it”. Field of cards would be a shadow of its modern self without Radiology.

Waah Waah my butt hurts

 

[NYknicks44]

IR invented seldinger technique, IR invented, angioplasty, IR invented the stent- take those three things away and Interventional cards would not even exist! Moving on, catheter directed lyses, aneurysm coiling, embolizations, ablations all pioneered by IR. Look beyond Interventional cards at cardiology imaging fellowships developed by Radiologist. You think that interventional cards are better interventionist it’s laughable, IR gets dished the craziest interventional complication in the hospital hands down things that cardiologist won’t touch, anecdotally I see a couple pseudoaneurisms a week, almost all of them caused by interventional cardiologists it’s literally a running joke between myself and my colleagues, “oh pseudoaneurism which cardiologists did it”. Field of cards would be a shadow of its modern self without Radiology.

U mad bro? Lol

 

[Gastrapathy]

Cardiology has the patients. If they can do it themselves, they will. Any service that is dependent on another procedural service for referrals will always be second fiddle. It’s not complicated.

 

[gutonc]

You guys are ridiculous. There's a naive pre-med here to feast on and we're attacking each other.

Weak...sauce.

 

[NDcienporciento100]

I am currently involved in some research on cardiac robotic catheterization technology with Siemens and am quite fascinated with interventional cardiology. That being said, I was wondering:

1. What is the scope of practice of an interventional cardiologist, can they do femoral cut-downs, ECMO cannulations, etc...?

2. Is there an integrated program without the need to complete an IM residency now or in the near future?

3. Will robotically assisted catheterization be the standard of care in the future?

Just do CT surgery.

 

[francisco84]

IR invented seldinger technique, IR invented, angioplasty, IR invented the stent- take those three things away and Interventional cards would not even exist! Moving on, catheter directed lyses, aneurysm coiling, embolizations, ablations all pioneered by IR. Look beyond Interventional cards at cardiology imaging fellowships developed by Radiologist. You think that interventional cards are better interventionist it’s laughable, IR gets dished the craziest interventional complication in the hospital hands down things that cardiologist won’t touch, anecdotally I see a couple pseudoaneurisms a week, almost all of them caused by interventional cardiologists it’s literally a running joke between myself and my colleagues, “oh pseudoaneurism which cardiologists did it”. Field of cards would be a shadow of its modern self without Radiology.

And apparently your $#!& doesn't stink either.

You also lose all credibility when you can't spell the word aneurysm properly

Regarding the initial questions:
1. No cut downs but sometimes ECMO
2. No integration in the near future, and the best interventionalist is a good cardiologist and the best cardiologist is a good internist
3. Not anytime soon

 

[Lasofloxabuterol]

Thanks for the replies. From what I've seen so far I can say I am definitely a "procedurally oriented" person and am fond of cardiac physiology/pathophysiology. Open surgical cardiothorathic interventions are amazing but I am interested in being able to treat the majority of cardiac illness through the wrist or groin in a hybridized fashion using nanorobotics and the like to facilitate closure of asd's, tavr, arch replacement s, ect. Probably not in the near future, but it is nice to think of ways to treat these patients without having to open them up...

 

[TheNextLevel]

1. What is the scope of practice of an interventional cardiologist, can they do femoral cut-downs, ECMO cannulations, etc...? This is the realm of cardiothoracic surgery.

2. Is there an integrated program without the need to complete an IM residency now or in the near future? No. IC is not a specialty for folks who want to be technicians. You will have the broad training of a general internist and general cardiologist to draw upon. Similarly, if you want to be a cardiothoracic surgeon you will need to learn general surgery first. Training is broad and long for a reason.

3. Will robotically assisted catheterization be the standard of care in the future? As someone who has seen robotic PCI performed, the technology is not even close.

IR invented seldinger technique, IR invented, angioplasty, IR invented the stent- take those three things away and Interventional cards would not even exist! Moving on, catheter directed lyses, aneurysm coiling, embolizations, ablations all pioneered by IR. Look beyond Interventional cards at cardiology imaging fellowships developed by Radiologist. You think that interventional cards are better interventionist it’s laughable, IR gets dished the craziest interventional complication in the hospital hands down things that cardiologist won’t touch, anecdotally I see a couple pseudoaneurisms a week, almost all of them caused by interventional cardiologists it’s literally a running joke between myself and my colleagues, “oh pseudoaneurism which cardiologists did it”. Field of cards would be a shadow of its modern self without Radiology.

And yet demand for interventional cardiology is booming while IR demand is waning. It pays to be more than a technician. Enjoy your role as a hospital-based utility service and don't bite the hand that feeds. Don't tell me about crazy procedures - we all see the boring stuff you guys do on a daily basis.
You better hope nephrologists don't develop an interest in learning to place a tunneled catheter BTW- you can keep the pseudo aneurysm cases!

 

[Dr G Oogle]

Why has the Robot made advances in fields like urology, ob gyn, complex hernia repair?

I’m a Urogynecologist
was just perusing this forum and saw this question. Short answer is because the marketing department at intuitive surgical is very good. If you’re a very good laparoscopic surgeon you don’t need the robot; if you are not and the option is robot or laparotomy robot is a better option. In urology things like prostates don’t have a conventional laparoscopic option, so robot is good option. Lap nephrecromy can be difficult and robot has come to dominate. In gynecology I personally think there is no role for robotics. I did a lot of robotic surgery in fellowship which requires fine presacral dissection and lots of suturing and have recently switched to a laparoscopic approach which is shorter. There are also many RCTs in gyn and urogyn in particular that have not shown any superiority of robotics compared to laparoscopy. The only benefits any RCT in any field has shown is when the only other option is an open surgery, and you have to balance that against the cost of purchasing and maintaining the robot plus the almost double the time it takes to complete each surgery. The reason some general surgeons have used it is that a robot has been purchased and admin wants to maximize use by asking people to use this more cumbersome approach. The height of this nonsense was when I had to wait 4 hours for a (generally efficient general surgeon) to finish a 3 hour robotic umbilical hernia repair. Not familiar with many of the CT surgeries but they are using robotics already. Endovascular does not need to add robotics since it’s about as minimally invasive as it gets. If something like a valve repair etc can be done robotically I imagine it would stay in the house of surgery

 

[NDcienporciento100]

And apparently your $#!& doesn't stink either.

You also lose all credibility when you can't spell the word aneurysm properly

Regarding the initial questions:
1. No cut downs but sometimes ECMO
2. No integration in the near future, and the best interventionalist is a good cardiologist and the best cardiologist is a good internist
3. Not anytime soon

I’m a Urogynecologist
was just perusing this forum and saw this question. Short answer is because the marketing department at intuitive surgical is very good. If you’re a very good laparoscopic surgeon you don’t need the robot; if you are not and the option is robot or laparotomy robot is a better option. In urology things like prostates don’t have a conventional laparoscopic option, so robot is good option. Lap nephrecromy can be difficult and robot has come to dominate. In gynecology I personally think there is no role for robotics. I did a lot of robotic surgery in fellowship which requires fine presacral dissection and lots of suturing and have recently switched to a laparoscopic approach which is shorter. There are also many RCTs in gyn and urogyn in particular that have not shown any superiority of robotics compared to laparoscopy. The only benefits any RCT in any field has shown is when the only other option is an open surgery, and you have to balance that against the cost of purchasing and maintaining the robot plus the almost double the time it takes to complete each surgery. The reason some general surgeons have used it is that a robot has been purchased and admin wants to maximize use by asking people to use this more cumbersome approach. The height of this nonsense was when I had to wait 4 hours for a (generally efficient general surgeon) to finish a 3 hour robotic umbilical hernia repair. Not familiar with many of the CT surgeries but they are using robotics already. Endovascular does not need to add robotics since it’s about as minimally invasive as it gets. If something like a valve repair etc can be done robotically I imagine it would stay in the house of surgery

You sound like a smart guy great urologist etc, your comments on hernia repairs are wrong? Complex hernia repair that used to be only possible open are being done with robot.

 

[kjamess]

IR invented seldinger technique, IR invented, angioplasty, IR invented the stent- take those three things away and Interventional cards would not even exist! Moving on, catheter directed lyses, aneurysm coiling, embolizations, ablations all pioneered by IR. Look beyond Interventional cards at cardiology imaging fellowships developed by Radiologist. You think that interventional cards are better interventionist it’s laughable, IR gets dished the craziest interventional complication in the hospital hands down things that cardiologist won’t touch, anecdotally I see a couple pseudoaneurisms a week, almost all of them caused by interventional cardiologists it’s literally a running joke between myself and my colleagues, “oh pseudoaneurism which cardiologists did it”. Field of cards would be a shadow of its modern self without Radiology.

Hahahaha thats a pretty big chip to have on your shoulder for someone barely half way into intern year. Do yourself a favor and put down the cheerleader koolaid that your PD is dishing out. Most of what you wrote doesnt even apply to cardiology since there is limited overlap between the two fields (chiefly PAD work). And PA rates after diagnostic cath are ~0.05%, so either lots of volume or suspect proceduralists (or both). When we hear a fake code being called overhead in the cath suite, guess which specialty it almost always is? But hey, being a skilled technician is cool! rah rah IR!

 

[Dr G Oogle]

You sound like a smart guy great urologist etc, your comments on hernia repairs are wrong? Complex hernia repair that used to be only possible open are being done with robot.

I stand corrected; certainly not an expert on anything outside the pelvis. just quoting my GS colleagues who none of them seemed happy using the robot.

 

[NYknicks44]

The topic of robotics in interventional cardiology is an interesting one.

I think there is a possibility that robotics could have a role. But the role isn't to make the procedure faster or safer. I think it will be to offer the procedure to patients in remote places. One area where I think it could be important is performing emergent PCI (for stemi or high nstemi) in remote areas where person on location gets access and an operator performs PCI remotely via robotics. What happens now is that patients get lytics and get shipped to PCI centers but robotics could offer a way for people to get PCI remotely if all the kinks in the system could be worked out.

 

[Egghead34]

The topic of robotics in interventional cardiology is an interesting one.

I think there is a possibility that robotics could have a role. But the role isn't to make the procedure faster or safer. I think it will be to offer the procedure to patients in remote places. One area where I think it could be important is performing emergent PCI (for stemi or high nstemi) in remote areas where person on location gets access and an operator performs PCI remotely via robotics. What happens now is that patients get lytics and get shipped to PCI centers but robotics could offer a way for people to get PCI remotely if all the kinks in the system could be worked out.

I feel like getting an IC is much cheaper/easier than getting a robot, keeping up maintenance, training operators. Unless you Mean in 20 years when costs drop low enough to make that feasible.

 

[NYknicks44]

I feel like getting an IC is much cheaper/easier than getting a robot, keeping up maintenance, training operators. Unless you Mean in 20 years when costs drop low enough to make that feasible.

Fair point. I definitely agree. Nothing happens in medicine unless it makes sense financially.

 

[deleted950463]

The poster in this thread is really bringing down the field of IR. For the record, we are definitely moving away from the technician model of training And almost all academic programs are implementing clinics. I have no issue with my cards colleagues and they dont have any issue with me.