Thoracic Aortic Aneurysm

[Cacaman]

I'd like to know if thoracic aortic aneurysms can be repaired using endovascular techniques like abdominal aortic aneurysms. If so, who performs this procedure, is it a CT surgeon, a vascular surgeon , or an interventional cardiologist?
Do interventional cardiologists receive this training or can they do this if they receive adequate training?

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[Celiac Plexus]

I'd like to know if thoracic aortic aneurysms can be repaired using endovascular techniques like abdominal aortic aneurysms. If so, who performs this procedure, is it a CT surgeon, a vascular surgeon , or an interventional cardiologist?
Do interventional cardiologists receive this training or can they do this if they receive adequate training?

Yes. Vascular surgeons typically, although I have seen CT surgeons "assisting" vascular surgeons in order to learn how to do this. Interventional cardiologists do not perform this endovascular operation at this time.

I do not see why interventional cardiologists will not at some future point perform this operation (or at least try). It is essentially a "catheter jockey" type of operation that requires no open surgical skills. Even the femoral cutdown can be avoided with newer percutaneous vascular access devices.

 

[Blade28]

Wow, just the thought of Cards operating on the aorta (especially an aneurysmic one) is scary...though I guess it's possible.

 

[johnny_blaze]

I'd like to know if thoracic aortic aneurysms can be repaired using endovascular techniques like abdominal aortic aneurysms. If so, who performs this procedure, is it a CT surgeon, a vascular surgeon , or an interventional cardiologist?
Do interventional cardiologists receive this training or can they do this if they receive adequate training?

It depends on the aneurysm. No two thoracic aneurysms are exactly alike so various specialties (CT, vascular, IR) may be involved in the decision making process. Generally, aneurysms involving the aortic root and/or arch are CT domain. Aneurysms involving the descending thoracic aorta may involve CT, vascular surgery, and IR depending on if the aneurysm is stentable or not and if it involves the abdominal aorta. There are different methods of operating on these types of aneurysm, some requiring CPB to achieve hypothermic circulatory arrest and adequate cerebral perfusion. CT are usually involved in these cases. This topic is very complicated and doesn’t really have a simple answer. This is one of the reasons I find thoracic aortic surgery to be one of the most fascinating aspects of medicine.

 

[Castro Viejo]

I'd like to know if thoracic aortic aneurysms can be repaired using endovascular techniques like abdominal aortic aneurysms. If so, who performs this procedure, is it a CT surgeon, a vascular surgeon , or an interventional cardiologist?
Do interventional cardiologists receive this training or can they do this if they receive adequate training?

It usually involves a vascular surgeon and a cardiothoracic surgeon.

As was already mentioned, it's a complicated operation that doesn't always have a simple endovascular fix.

Who actually does it kind of depends on the politics of the situation. More and more CT surgeons are getting training in using TAG grafts, so they may take those over in the future. I doubt vascular surgeons would just sit by and watch them do that, but I think there may be enough justification to keep interventional cardiologists and radiologists out of doing TAGs in the future (although IR is doing EVARs for abdominal aneurysms now).

 

[Arch Guillotti]

Who actually does it kind of depends on the politics of the situation. More and more CT surgeons are getting training in using TAG grafts.

None of our CT guys do TAG procedures (yet). Only a couple of the vascular guys do them.

What happened to the turtle?

 

[Castro Viejo]

What happened to the turtle?

Haven't used that user account for a while, wow, that brings back memories... I changed my user name to be a bit freer in my postings.

It doesn't seem to have worked as some people have seen my post where I ask to have my user name changed.

 

[Winged Scapula]

Haven't used that user account for a while, wow, that brings back memories... I changed my user name to be a bit freer in my postings.

It doesn't seem to have worked as some people have seen my post where I ask to have my user name changed.

If you became a donor you could delete that post so your "air pf mystery" would be maintained!

 

[Arch Guillotti]

Haven't used that user account for a while, wow, that brings back memories...

Yes, the good times bashing Gonzaga on MEM...

 

[turtleboard]

Yes, the good times bashing Gonzaga on MEM...

You know you can say you've lived a full life when you witness Gonzaga College become Gonzaga University and something of an NCAA Division I powerhouse. Obviously, they did it in deference to my snide comments about how they're a sucky school.

Ahh... Back to hibernating.

 

[blotto geltaco]

Ahh... Back to hibernating.

The turtle has spoken. Let's please have a moment of silence.

 

[Winged Scapula]

What's up with all these old timers?

Did the gates of Hell suddenly open up and you guys came crawling back toward the sunlight that is SDN?

 

[Castro Viejo]

What's up with all these old timers?

Did the gates of Hell suddenly open up and you guys came crawling back toward the sunlight that is SDN?

Seriously, I thought I was the only old timer who had voluntarily taken a back seat and became a bi-weekly reader rather than poster.

Viva la old timers! Cheers!

Hope being a doctor has turned out to be everything you'd hope it'd be...

Anyone else becoming a vascular surgeon, or am I the only masochist?

 

[Winged Scapula]

Anyone else becoming a vascular surgeon, or am I the only masochist?

You're not the ONLY masochist...there are a few others around here.

 

[tussy]

Did someone say "oldtimer"? there are a few of us around, although i was never a prolific poster.

 

[blotto geltaco]

Before SDN existed, the main source for pre-med/health type info was on the old usenet group misc.education.medical. Castro was a pretty prolific poster in response to a lot of stuff, which seemed to be comprised in large part of "What are my chances?" type threads. Besides Castro the only other poster that I remeber was NJBMD. Ah, the old days.

 

[Castro Viejo]

Correct me if I'm wrong, but did MEM combine with osteopathic.net and medical student lounge to form SDN? I seem to remember it went that way somehow, but in my old age my memory fails quite a bit.

Other old-timers that I don't see around anymore...

Dave Russo
Paul W.

Interestingly enough they're both physiatrists and at least one of them is practicing in the Scottsdale/Phoenix, AZ area.

 

[blotto geltaco]

Correct me if I'm wrong, but did MEM combine with osteopathic.net and medical student lounge to form SDN? I seem to remember it went that way somehow, but in my old age my memory fails quite a bit.

Other old-timers that I don't see around anymore...

Dave Russo
Paul W.

Interestingly enough they're both physiatrists and at least one of them is practicing in the Scottsdale/Phoenix, AZ area.

As I remember it, the original website for SDN was osteopathic.com. MEM is still a usenet group but last time I visited it there was little traffic. I remember drusso from there as well.

 

[ESU_MD]

Some interventional cards guys do TAG's- (in texas)
IR guys do EVAR's

this could all stop if the general surgeons would stand up and refuse to do the cutdowns. there is not a current device on the market (yet)that you can deploy without at least one cutdown (to my knowledge)

the problem is that there is always "that guy", who will do any case for the money. every hospital has its bottom feeder who will sell out


As a CT oriented type of guy, i dont have much problem with vascular doing TAG's. but will fight to keep IC/IR out.

 

[LGMD]

Some interventional cards guys do TAG's- (in texas)
IR guys do EVAR's

As a CT oriented type of guy, i dont have much problem with vascular doing TAG's. but will fight to keep IC/IR out.

Why do you have this attitude towards IC or IR? If they can perform the procedure with the help of someone to do the cutdown why not have them do it? The are the ones with the best catheter skill, even better than vascular. Will there be a device that wouldn't need a cutdown in the future ?