HMSBeagle

10+ Year Member
Dec 27, 2007
137
0
Status
Resident [Any Field]
Hi. After reading the posts here it is obvious that my hospital does things a little different. Here we have the cardiac surgeons basically also doing the majority of the vascular surgeries (AAA,carotids, lower extremities bypass, etc..) but they don't do any endovascular stuff. Therefore here the CT guys do cardiac, chest and vascular. Is this how many hospitals work or not?
 

Winged Scapula

Cougariffic!
Staff member
Administrator
Lifetime Donor
15+ Year Member
Apr 9, 2000
39,438
27,982
forums.studentdoctor.net
Status
Attending Physician
Hi. After reading the posts here it is obvious that my hospital does things a little different. Here we have the cardiac surgeons basically also doing the majority of the vascular surgeries (AAA,carotids, lower extremities bypass, etc..) but they don't do any endovascular stuff. Therefore here the CT guys do cardiac, chest and vascular. Is this how many hospitals work or not?
Not in my experience (which is colored by having trained in the NE...haven't seen enough out here in Az to get a feel for local practices yet).

In all the hospitals I've worked in, Vascular surgeons do AAAs (open and endovascular), carotids (some done by Nsgy as well), upper and lower extremitie bypasses, etc.

CT sticks to the heart, lungs and occasional goose (shared with Surg Onc).
 

Castro Viejo

Papa Clot Buster
10+ Year Member
15+ Year Member
Jun 3, 1999
3,733
5
Status
Attending Physician
It certainly depends on where in the country you are and the area's supply of physicians and surgeons. In the Northeast you'll almost never see any peripheral vascular stuff being done by anyone other than a trained Vascular Surgeon.

The situation you describe sounds a lot like what one of my Chiefs describes is the case in Florida. There's sort of a short supply of surgeons there, nevermind Vascular Surgeons, and so a lot of the peripheral work is done by General and Cardiothoracic guys.

Also realize that as the caseload for Cardiac goes I into the toilet, these guys need to make a buck or two somehow. So why not do Peripheral Vascular stuff?
 

Castro Viejo

Papa Clot Buster
10+ Year Member
15+ Year Member
Jun 3, 1999
3,733
5
Status
Attending Physician
Oops... It posted before I was done.

Anyway without an independent board in Vascular Surgery any General Surgeon, and by extension, any Cardiothoracic Surgeon, could do peripheral vascular stuff because they were trained to do so at some point.

But what are they truly offering? Is it really the best option for the patient?

There are plenty of things that vascular surgeons can do today for peripheral vascular disease without cutting that General and Cardiac guys can't do. I bring up the example, again, of my old Chief who's in PP in Florida. He described a TASC A lesion that he did an aortofemoral bypass on when the lesion is more than adequately treated with a wire in today's modern world.

But what gave him the right to do that was the nonexistence of an independent Board of Vascular Surgery.

An aortofemoral bypass can be a fairly morbid operation when compared to putting in a groin sheath for your wire work, no?

Anyway, you'll see from time to time Cardiac and General people taking on peripheral vascular surgery.
 
B

Blade28

That doesn't happen here either. Only thoracic aortas get handled by CT...AAAs, carotids, peripheral bypasses (e.g. fem-distals), etc. all get handled by Vascular.
 

njbmd

Guest
Moderator Emeritus
5+ Year Member
15+ Year Member
May 30, 2001
9,050
145
Gone Walkabout!
Visit site
Status
Attending Physician
Hi. After reading the posts here it is obvious that my hospital does things a little different. Here we have the cardiac surgeons basically also doing the majority of the vascular surgeries (AAA,carotids, lower extremities bypass, etc..) but they don't do any endovascular stuff. Therefore here the CT guys do cardiac, chest and vascular. Is this how many hospitals work or not?
Before vascular surgery split into its own fellowship, it was a branch of CT surgery. Many of the folks who trained in the fellowships that were Cardiovascular Surgery will perform vascular procedures. A couple of the CT surgeons at my old residency location did perform some vascular because they liked the procedures.
 

ESU_MD

Old School
15+ Year Member
Nov 17, 2001
773
6
Big Leagues
Visit site
Status
Attending Physician
Alot of the true "oldtimers" pride themselves as cardiovascular, CV surgeons.

These guys were pretty good, but the CT training is different now, One cannot find a true CV fellowship without doing CT and Vascular seperately.

If any 2 specialties are well suited for crossover it is CT/Vasc, both need expert technical skills, and attention to detail. With all the endo stuff needed to be a rounded vascular surgeon in modern times, it is unlikely that a single combined 2 yr fellowship would train for both,