interventional procedures done by fellows

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[P Diddy]

M3 here, planning on applying to IM and Cards down the road.

Question: do cards fellows participate in interventional procedures before an interventional sub-fellowship (i.e., a month or two in the cath lab)?

Diagnostic caths are not considered to be interventional procedures. Interventional procedures include angioplasty and stenting of coronary arteries, carotid arteries and femoral arteries; intravascular ultrasound of coronary arteries (IVUS), fractional flow reserve (FFR), PFO closure, alcohol septal ablation, Intra-aortic balloon placement and probably some other procedures I am forgetting (like pericardiocentesis). Typically these procedures are perfected and performed during an interventional fellowship (except for pericardiocentesis and perhaps IABP).

A general cardiology fellow spends a variable amount of time in the cath lab (4-8 months over 2 years) performing right heart caths and diagnostic caths. depending on the program, you do get some interventional experience. I have put in a couple IABPs, done FFR and IVUS and a few stents but this experience has been sporadic at best. we get more interventional experience our second year.

p diddy

 

[Teejay]

Diagnostic caths are not considered to be interventional procedures. Interventional procedures include angioplasty and stenting of coronary arteries, carotid arteries and femoral arteries; intravascular ultrasound of coronary arteries (IVUS), fractional flow reserve (FFR), PFO closure, alcohol septal ablation, Intra-aortic balloon placement and probably some other procedures I am forgetting (like pericardiocentesis). Typically these procedures are perfected and performed during an interventional fellowship (except for pericardiocentesis and perhaps IABP).

A general cardiology fellow spends a variable amount of time in the cath lab (4-8 months over 2 years) performing right heart caths and diagnostic caths. depending on the program, you do get some interventional experience. I have put in a couple IABPs, done FFR and IVUS and a few stents but this experience has been sporadic at best. we get more interventional experience our second year.

p diddy

So interventional cadiologist also do femoral and renal stenting. Interventional Rads won't be too happy with this for sure. One of my lecturers, who is a radiologist disliked me a little bit the day i told him i have plans of going into Interventional cardiolgy. So much anger from the other side and i can't exactly explain why. Atleast, the field and opportunities for Interventional cardiologists are expanding. Hope IC's will invade pulmonary stenting too someday.

 

[Naked Ned]

So interventional cadiologist also do femoral and renal stenting. Interventional Rads won't be too happy with this for sure. One of my lecturers, who is a radiologist disliked me a little bit the day i told him i have plans of going into Interventional cardiolgy. So much anger from the other side and i can't exactly explain why. Atleast, the field and opportunities for Interventional cardiologists are expanding. Hope IC's will invade pulmonary stenting too someday.

Here's a couple of reasons:
1) That IR doc got probably 12 months of fluoroscopy and angio or fluoro-guided procedures and another 4 months of interventional radiology during residency, before he ever set foot in the angio suite as a fellow. As a fellow, that was all he did. In practice, that is all he does. In my experience, nobody can beat a good IR guy with a catheter.

2) Every groin hematoma I've ever been called to deal with came from the cards department. They are the only ones who use femstops. Ever heard of holding pressure? They also don't seem to know how to localize their puncture site with fluoro and end up with retroperitoneal hematomas. Moral of the story: localize your puncture site before you stick, hold pressure for 10-15 minutes (or as long as it takes) with every patient, and don't use a femstop.

3) Cards outside the heart are dilettantes. It's a fairly common thing to hear a cardiologist mention that he stented the renal arter(ies) "on the way out." It's a flippant attitude that comes from lack of formal training and leads to unconsented procedures and unexpected complications. Same goes for carotid stenting -- how many cards are trained in neurointervental techniques to deal with the common complications of stenting the carotids? Not many. The problem is, you don't know what you don't know, and unless you've done IR training it is well below the standard of care to be screwing around outside the heart.

 

[TransFatsRgood]

Here's a couple of reasons:
It's a flippant attitude that comes from lack of formal training and leads to ......

.
Hmmm, last I checked the fellowship was a cardioVASCULAR fellowship. Maybe they should include medical terminology in radiology training. I think it is amazing that a radiologist actually has the nerve to mention lack of formal training. Unless you've done IR training.... what a joke

 

[Naked Ned]

Come on. I know you have a bone to pick with cardiology, but you make the most ridiculous generalizations. There is a great deal of variability in certain practices from hospital to hospital, so you really can't say that because certain things are done at your institution that they apply to cardiology everywhere. For example, we don't use femstops. Most of our closures are manual; some are Angioseal or Perclose.

And I'm guessing you're in radiology - why are you being called to deal with cardiology groin hematomas?

I honestly haven't had a lot of experience with what the interventional radiologists here do regarding access/closure, except for one experience where I happened to be walking down the hall in the echo lab and an echo tech called for help with a patient who was bleeding from their access site from an IR procedure. I was not otherwise involved in the patient's care, but I held pressure and had them call the resident who had done the procedure, who acted like "why would you bother me with that?" I wasn't impressed with that attitude. Apparently it wasn't their problem once the patient was out of the angio suite. If we had done a case with an access complication, you'd better believe we would take responsibility for managing it. But that was one person - I wouldn't even generalize that to all rads residents here let alone an entire specialty.



More generalizations. Peripheral training is now being included formally in interventional cardiology programs. As another poster mentioned - it's a cardioVASCULAR fellowship.

Who do you think vascular surgery calls after cardiology asks them for help with the expanding groin hematoma that has been expanding for 6 hours with nothing but a poorly placed femstop?

 

[salmonella]

There are lots of bitter radiologists on this board who feel inadequate and inferior when they compare themselves to the clinical colleagues who are running codes, seeing patients, prescribing meds, performing surgery, directly saving lives everyday. For those radiologists, interventional radiology is the last and the only way for them to ever come close to being a "real doctor." Obviously it upsets them when other specialists (cardiology, neurology, vascular surgery, neurosurgery, interventional nephrology) are trying to invade what rads consider their most precious territory.

It's really not healthy to carry this inferiority complex around everyday. Problem with self-esteem eventually leads to low job satisfaction, depression and psychiatric issues.

 

[TransFatsRgood]

Damn, don't you guys feel like ordering some extra unnecessary Xrays to give these radiologists something to do? They must be pretty short of work nowadays. I think we should also make them go back to real films also and take away PACs.

 

[MedStudent2007]

you're right, the radiologists are just bitter that everyone is taking over their field. this just makes them threaten the rest of the world with "i'll go to court against you" and "i'm smarter than you". yes, you're smarter than us, prettier than us and gosh darn it, you like yourself! good for you.

 

[joti]

M3 here, planning on applying to IM and Cards down the road.

Question: do cards fellows participate in interventional procedures before an interventional sub-fellowship (i.e., a month or two in the cath lab)?

See this post Rads. They think all the people going to IM just land up there. It is not the fact. Med students do plan for this and excited about this. Ofcourse few louzy people end up in IM, as there are huge no of IM positions. But none of them end up in Cards.

 

[kito]

Results for the COURAGE trial is out.

http://content.nejm.org/cgi/content/short/NEJMoa070829