Traditionally, there are three different working areas for radiologists, cardiologists and vascular surgeons. Radiologist activities typically take place in an angiography suite; cardiologists perform their interventions in the cardiac catheterization laboratory; vascular surgeons make use of a mobile C-arm within a regular OR setting. Today, where it has not already occurred, this tradition should end.
The vascular centre, which is run by vascular surgeons, installed a catheterization laboratory imaging system into a regular surgical suite. This setting is now known as the Vascular Intervention Unit at AZ Saint Blasius in Dendermonde, Belgium. At this centre, vascular surgeons are aided by one of the newest procedural imaging systems currently on the market, General Electrics’ Innova 4100. This system combines flat panel vascular imaging, a linked workstation, post-processing and storage. This fully integrated imaging system exceeds all clinical needs for interventional and diagnostic angiography by providing high-grade image quality, ease of positioning, and low radiation doses. This arrangement, 1) optimizes endovascular treatment with state of the art imaging modalities, 2) allows immediate verification of classic open surgical results and 3) provides an optimal venue for hybrid open-endovascular procedures. Treatment of peripheral artery disease is enhanced due to the advantages of the Unit’s design in terms of effectiveness and efficiency.
“The increased effectiveness of the Unit’s arrangement should be intuitive to the vascular surgeon. Hybrid interventions clearly benefit from our Unit’s combined imaging and operating room environment. The obvious synergy of simultaneous application of classical surgical and endovascular treatment modalities was the rationale that drove the design and implementation of this unit,” said Dr Marc Bosiers. The Unit’s utility, however, extends beyond hybrid procedures. Routine endovascular and open surgical practice both clearly gain from performance in this dual capability working environment. For example, classic open bypass creation is immediately controlled on-table. When improvement of inflow or outflow (not anticipated from preoperative non-invasive imaging) becomes necessary, additional stent placement or balloon dilation can be rapidly performed without dramatically prolonging procedure time and without relocating equipment or personnel from another area.
Efficiency improvement for vascular procedures – whether they are surgical, endovascular or a combination of both – is to be expected. Ready access to high-quality imaging and easy conversion from endovascular to classical treatment or vice versa, shortens the average procedure time. Furthermore, with a dedicated, seperate team, it takes less time to get a new patient prepared for operation or intervention than in a normal O.R.-setting. Consequently, more procedures can be done in the same room by the existing staff without increasing the strain on the Unit’s team.
Another important consideration is the training of the next generation of vascular surgeons. Fellows should learn endovascular surgery in a seamlessly integrated fashion, within a vascular intervention unit, and under the supervision of an accomplished endovascular surgeon. Endovascular surgery will continue be applicable to more and more of the problems seen by vascular surgeons. In the near future, endovascular techniques will be the dominant mode by which nearly all peripheral arterial and venous pathology is treated. Can aiming to train young peripheral vascular surgeons to be primarily open operative surgeons, to be clinicians who identify and manage patients for other endovascular specialists and to serve as access surgeons for other specialists’ interventions any longer be justified? The obvious answer is that it cannot. Towards this end, vascular fellows must see an interventional unit as a primary workplace for them, where they are as or more at home than in the traditional operating room. A combined Unit allows simultaneous maturation of open surgical and endovascular skills for trainees and ought to be an absolute requirement of any program which proposes to offer vascular surgery training to young surgeons in the present era.
“It is important that the VIU, with its state-of-the-art imaging combined with highest-standard surgical facilities in the same working environment, is run by vascular surgeons. Patients get the most benefit if they are diagnosed, treated and followed-up by a specialist who is trained in the pathology, natural history, surgical options, peri-procedural complications and medical management, in addition to imaging based therapy, for their specific disease state,” concluded Bosiers