IR doing their own cut downs?

[badasshairday]

For endovascular procedures, I have seen a general surgeon do the exposure for the femoral artery before IR takes over and does the procedure. As IR changes to a more clinically based specialty, and more rads residents with their eyes on IR are doing surgical internships, are any IR's doing their own cut downs?

I was talking to my surgery intern, and he told me his roommate going into Rads with the ultimate goal of IR is doing a surgical intern year. He believes new IR docs that are more surgical will not always need help of a surgeon to do cut downs. However, after seeing a cut down during my general surgery rotation, I could see these things get really hairy, at a rapid rate while opening or closing.

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[7summits]

I've heard of certain IRs doing their own cut downs, but haven't worked with one who does. What I'm hearing more of is IRs starting to use endografts that don't require cut downs and can be placed percutaneously. It seems likely that there will be a movement more towards this approach in general so that you get rid of the risks/negatives that come with using cut downs for access.

As an aside, I'm interviewing for Rads residencies now and also surgical prelims, and I've had several attendings/PDs in surg interviews tell me that they'll teach me how to do cut downs if I go to their program. I didn't bring it up, either- they offered. Not saying I would end up doing my own cut downs (or feel qualified to do so), but it would be neat to have some experience with it and at least have done it before.

 

[Gvataken]

lately we have been deploying alot of these endografts without a cutdown and just doing these percutaneously.

I will use 2 proglide sutures and then preclose the arteriotomy and at the end tie the knots. Patients can ambulate in 6 to 8 hours even with up to 20 french sheaths.

People have done this with up to 24 french sheaths.

The key is to make sure the femoral artery is not too heavily calcified and that it is a reasonable diameter. I puncture under ultrasound and make sure I dissect well down to the arteriotomy. The key is to make sure you review the CT angiography closely. I think that the benefits is less postoperative pain than a groin cutdown. Patients seem to prefer it.