sreek19413

Canadian MD
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Feb 1, 2016
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As more PERT (Pulmonary Embolism response teams) are forming around the country, there is little to no Vascular Surgery involvement in most of the institutions with these initiatives. Vascular surgeons, in general, do not treat PE's here in Canada based on the practice patterns I've seen. It's mainly IC and IR, they also make the majority of the PERT members in the US.

I was curious as to why there is only little representation of VS in wire-based PE treatments? Is it cause of a general lack of interest/ too many arterial cases already or political reasons? The procedures seem like something well within the specialty's skillset and "territory". It also seems like it would make rewarding cases with cool new tech (Flowtriever). Paging @Jolie South @TypeADissection @LucidSplash

The above is an article by Dr Ross written in 2017 briefly discussing the issue.
 

TypeADissection

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Jan 23, 2016
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I think a lot of it falls along political lines and interest. Where I did my residency, IR/IC/VS rotated taking PERT call and so I did a fair number of PE lysis cases +/- EKOS catheters. Where I am currently for fellowship, we play no role in the PERT team and mostly because we are so busy as it is with everything else that feeds into our institution from the entire state. Next year in practice the PERT call is split between IR and IC, and to be honest, I don't have a huge interest to insert myself into that call pool. It's not that the cases are technically challenging per se, for me it's more about how much I want to do when I get out into the real world. I would love to hear what others who are in practice think about this though. Cheers.
 

LucidSplash

Bloody Plumber
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I think regional referral patterns vary widely. Where I trained for fellowship, we had no involvement, IR handled it all. Volume there was such that no one really cared about missing those cases. Where I am now, ED calls vascular for these cases, but there is a PERT that encompasses IC and IR and pulm as well. My partner has put in lysis catheters for PE before but so have IR and IC. I have yet to but will if necessary and have been familiarizing myself with the data and recommendations (such as they are but not great all around) accordingly since I didn’t really pay attention to it in training. I’m happy to help out but also would be fine if IR and IC and pulm managed it all.
 
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LucidSplash

Bloody Plumber
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Also Flowtriever/Clotriever is pretty neat but currently the price point on the device is a bit too high IMHO to use it except in cases where other therapy has failed and the risk/benefit ratio meets a certain minimum.
 

Jolie South

is invoking Domo. . .
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As more PERT (Pulmonary Embolism response teams) are forming around the country, there is little to no Vascular Surgery involvement in most of the institutions with these initiatives. Vascular surgeons, in general, do not treat PE's here in Canada based on the practice patterns I've seen. It's mainly IC and IR, they also make the majority of the PERT members in the US.

I was curious as to why there is only little representation of VS in wire-based PE treatments? Is it cause of a general lack of interest/ too many arterial cases already or political reasons? The procedures seem like something well within the specialty's skillset and "territory". It also seems like it would make rewarding cases with cool new tech (Flowtriever). Paging @Jolie South @TypeADissection @LucidSplash

The above is an article by Dr Ross written in 2017 briefly discussing the issue.
We did not do lysis very much at all in fellowship because we had so much other volume on call. Not that we couldn’t do it, but it just requires a time commitment that logistically is easier for IR to manage than vascular surgery. I actually really like lysis cases. But say surgeon A has a million elective cases in hybrid 1 and cardiology doing TAVRs in hybrid 2, it would cause a huge delay in care for surgeon B to do the call lysis case after waiting for everyone else to be done. Then, when you have to bring the patient back the next day, it’s the same scenario again to find the time.

I do think flowtriever has advantages in that you are not having to bring the patient back multiple days, keep them in the ICU, and you don’t expose them to bleeding risk. If we did lysis in fellowship, we always did flowtriever or angiojet bc of the time constraints on my private practice attendings.
 
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