Learning PAD in program without a lot of it

[MouseChair]

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IR at my institution does zero PAD work. We do get a couple of months of Vascular Surg experience but the experience can be variable and we are often 3rd/4th scrub (behind attending, fellow, resident and maybe even a Sub I medical student).

I’m interested in learning more about PAD. What are solutions to get more exposure as an attending?

And to specify, not interested in doing an “advanced fellowship” for the exposure

 

[SeisK]

The difficulty with PAD is not the wire and catheter skills. Visceral Angio is significantly more technically difficult than aortoiliac or femoropopliteal stenosis maneuvering which is the most difficult part. Subintimal or sharp recanalization is a fancier technique but not super difficult to learn, and if you’re in a practice that does PAD you’ll be able to help with the simpler cases and get quickly up to speed on the below knee and recanalization cases.

If you want to learn, Cook offers courses that cycle around in location. There are other courses offered by various other device manufacturers, who will often pay for all of it as it benefits them through marketing to you. It’s open to fellows and attendings alike.

 

[NDcienporciento100]

The difficulty with PAD is not the wire and catheter skills. Visceral Angio is significantly more technically difficult than aortoiliac or femoropopliteal stenosis maneuvering which is the most difficult part. Subintimal or sharp recanalization is a fancier technique but not super difficult to learn, and if you’re in a practice that does PAD you’ll be able to help with the simpler cases and get quickly up to speed on the below knee and recanalization cases.

If you want to learn, Cook offers courses that cycle around in location. There are other courses offered by various other device manufacturers, who will often pay for all of it as it benefits them through marketing to you. It’s open to fellows and attendings alike.

I used to think viceral work was harder as well. Having done a lot of both now I strongly disagree. In visceral work a prograte and a Fathom wire will get the job done 95% of the time. In PAD you need to know lots of different wires, crossing catheters, crossing balloons, atherectomy devices, lithotripsy, covered stents, bare stents Supera vs Eluvia, cardiac stents. Access can be challenging in PAD. Need to know antegrade Fem sticks, retrograde PT and AT sticks, popliteal and DP sticks. Very fast changing field with DVA just becoming a big thing. Almost none of these things does visceral work prepare you for.

 

[irwarrior]

Agree visceral catheter and embolization have their unique challenges but 95 pct plus these patients have healthier vessels than PAD patients that can have calcified occlusive disease and even access can be tricky. They often have CAD and CKD and are often on the verge of coding due to their comorbid conditions. Long segment calcified CTOs can be a challenge to cross, vessel prep and avoid distal embolization. There are a myriad of devices that you need to know as mentioned above (Embolic protection devices, rotaterex, pounce, laser, csi orbital atherectomy, shockwave, focused force balloons etc).

How to get the training is becoming more and more of a challenge, perhaps go to an OBL or outside facility where the VIR do vascular etc.