Training standards for physicians performing peripheral angioplasty: new developments

Article Abstract:

Angioplasty, surgical dilation of blood vessels, is routinely performed by doctors from a number of different medical specialties. Controversy exists over what qualifications a doctor should possess to perform this procedure. The doctor's area of specialty is not as important as specific training and experience in the procedure itself. A number of groups from the various specialties have proposed standards for doctors who perform angioplasty, but no intergroup proposal has been made thus far. The most recent attempt at setting such standards comes from the Society of Cardiac Angiography and Interventions (SCAI). Their proposal is important to radiologists because it tries to set rigid standards for physicians from all specialties. The proposal requires minimally that the physician either be board certified or eligible in cardiovascular disease or radiology or have a special certification in vascular surgery or vascular medicine. The physician should have had a minimal level of fellowship training involving general arterial and venous catheterization and angioplasty procedures with others before doing so independently. Physicians may then qualify for temporary privileges to perform the procedure once they meet one of two sets of requirements. The physician would also then apply for percutaneous transluminal angioplasty (PTA) privileges and be required to perform the procedure 10 times under supervision. If these are performed satisfactorily, then 15 more are performed. The physician may then apply for full privileges if the 25 procedures meet a minimal standard. It is also recommended that proficiency in simpler procedures be gained before going on to do more complex procedures. The standards set by SCAI are rigorous, but the demands of peripheral angioplasty require such standards for all physicians who plan to perform such procedures. The radiology community should study and consider this proposal carefully, as well as make comments and proposals of its own. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Physicians, Medical professions, Training

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Pull-through approach to percutaneous angioplasty of totally occluded common iliac arteries

Article Abstract:

A new method has been developed to pass a balloon catheter through dense areas of atherosclerotic (hardening of the arteries) material to open the main artery of the leg. A balloon catheter is a small tube that is pushed through a needle-like inserter into the main artery of the leg. When it reaches the area of the atherosclerotic plaque it expands to open the cavity (lumen) of the vessel. In some cases the material is so thick and dense that the catheter can not be directly pushed through the affected area. Therefore, a guide wire may first be inserted and pushed through the dense plaque. This paper reports on a method of pulling the catheter across the atherosclerotic area by snaking the guide wire in from the artery on the opposite side and down (retrograde) into the artery which is being operated upon. The balloon catheter is then attached to the guide and it is literally pulled into position. The procedure has been used on 10 hospitalized patients with an average age of 59 years. All patients were severely restricted by their reduced leg arterial blood flow (claudication). The first five attempts to push the guide wire failed, and the pull-through method was then used. The final group of patients had the pull-through method used as the primary means of inserting the balloon catheter. In carefully selected cases the pull-through technique can be used to treat more severe atherosclerotic vessel disease by percutaneous (through the skin) technique than was previously possible. The method is not without risks, and the procedure is not as durable as a surgical graft of the blocked area.

Methods, Arteriosclerosis, Atherosclerosis, Transluminal angioplasty, Balloon angioplasty, Arterial occlusions, Arterial occlusive diseases, Iliac artery

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The role of radiologists in the American Heart Association: getting the message out

Article Abstract:

The field of radiology has successfully expanded awareness of its importance and scope to the media and the general population. However, it has lagged behind in showing the rest of the medical and scientific community the depth and quality of scientific research being produced. Many radiologists have not joined nor presented research to organizations outside the field such as the American Heart Association (AHA). The AHA is a large medical organization that has interests covering all the medical specialties relating to cardiovascular disease; it is also a very influential organization. The AHA has research interests closely related to those of many radiologists. Cardiovascular magnetic resonance imaging, angioplasty, and vascular ultrasound are just a few of these shared interests. Unfortunately, many radiologists only present their research to groups of other radiologists. This prevents the rest of the medical and scientific community from realizing the quality and depth of research being performed in the field. A previous explanation for this problem could have been that the major organization for radiologists, the Radiological Society of North America (RSNA), would not accept previously presented research. This is no longer true. It is in the best interests of both the radiologist and the field of radiology that radiologists become more involved with professionals and research in other medical disciplines. Joining the AHA and its Council on Cardiovascular Radiology is one possible way to address this problem. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Practice, Science and technology policy, American Heart Association, Radiologists, Radiology

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