Commentary

I am often asked how I acquired my catheter-based endovascular skills, not because I am such a skilled operator, but primarily because my background training was as a classically trained cardiothoracic and vascular surgeon, who almost two decades ago began to treat his patients with catheter-based technology. The answer is quite simple in that probably greater than 90% of my training came “on the job,” primarily directed by skilled cath lab technologists and professionals. This is why I have a soft spot in my heart for cath lab techs, CLD and the Society of Invasive Cardiovascular Professionals (SICP) and Alliance of Cardiovascular Professionals (ACVP). Understand I did not have those 3-4 years of catheter-based training that all interventional cardiologists and interventional radiologists went through at that time. As a matter of fact, even today, those who work with me in the cath lab on a regular basis are almost daily reminded of my “lack of basic catheter and imaging training.” Regardless, I did acquire those skills over the last two decades by working closely with cath lab technologists who had acquired advanced skills. Therefore, I believe I am qualified first-hand to give my thoughts and support on the creation of a new advanced cardiovascular imaging technology society, which will hopefully lead to a specialty certification. For many years, surgeons have used advanced help in the OR in the form of physician assistants (PA), specially trained OR techs as first assistants, residents and fellows to facilitate the operative procedure and in many ways act independently during the case, performing such complex maneuvers as radial artery harvest, saphenous vein harvesting, cannulation of the heart during coronary artery bypass graft surgery (CABG), and opening-closing of the patient. These specialty skills were developed over time and incorporated into these surgical “physician extenders.” Similarly, this evolution is now occurring in the cath lab and endovascular suite. There has now been over two decades of endovascular experience accumulated by a large number of cath lab and imaging technologists. I believe it is time these professionals are organized in a fashion that would be analogous to what has occurred in the operating room over the last 3-4 decades. The development of this society is very important today for multiple reasons. First, there is no question that there is an overall shortage of cardiovascular interventionalists to handle the growing interventional needs of our expanding elderly patient population. Second, there are simply not enough interventional cardiology or endovascular fellows to “go around,” and our CIS group is a perfect example of a large high-volume practice that has never benefited from a certified cardiology or vascular surgery fellowship. I personally have never had the luxury, or catastrophe, to work with an interventional fellow. Therefore, we have had to create our own “fellow equivalents” and the majority of practicing cardiovascular interventionalists in the U.S. in the “real world” also have limited or no access to interventional cardiology or vascular fellows. I firmly believe that the creation of an advanced medical imaging society and certification would greatly benefit the majority of interventionalists nationwide. Third, with just the explosion of new cardiovascular imaging, especially CTA, it would be a great asset to have cardiovascular imaging specialists who are facile in the cath lab with fluoroscopy and endovascular procedures, and in the office or radiology suites wherever CTA, MR and/or nuclear imaging occurs. In our practice, many of our cath lab professionals are and have been acquiring experience and skills in all aspects of cardiovascular imaging; therefore adding benefits to the hospital, the cath lab and to their physicians. Fourth, who is going to help train all the growing number of OR endovascular suites and CT surgical suites, if not talented and skilled cath lab technologists as “training extenders”? In today’s medical environment, with increasing clinical cases and interventional needs occurring at the same time of decreasing availability of cardiovascular-interventional resources, the need for specialty cardiovascular imaging physician extenders is great. Simultaneously, our decreasing reimbursement structure and healthcare economic crisis demands much more out of physicians, hospital and all healthcare providers. I can easily envision that the creation of a cardiovascular imaging specialty group would benefit many aspects of our healthcare needs. It seems to me that the economics alone make a great deal of sense, and I can tell you now that I would rather have several of our own trained skilled cath lab technologists around than several cardiology or surgical partners. Over the last 12 years, my esteemed colleague and friend, Dr. Craig M. Walker, MD, Medical Director of CIS, and I have trained over 2,000 interventionalists, cath lab techs, and industry representatives during their frequent visits to our CIS cath labs in Lafayette, Houma and Opelousas, Louisiana. The attendees are always appreciative of the interventional training provided by Dr. Walker and myself, but the single thing most of them are impressed by after their visit is the skill and expertise of our CIS cath lab staff. Our staff, under the direction of Gary Chaisson, RT(R), RCVT/RCIS and Chris Hebert, RT(R), RCIS, routinely perform, with the physicians, very advanced maneuvers during cases that greatly facilitate the performance of the case. They are, therefore, functioning as advanced physician extenders. This not only helps us as physicians, but I firmly believe facilitates flow through the lab and hospital, decreases fluoro and contrast exposure, and I feel greatly improves our patients’ clinical outcomes, especially those high-risk patients with advanced peripheral vascular disease (PVD) and critical limb ischemia (CLI). I would like to applaud the work of Chuck Williams, BS, RPA, RT(R)(CV)(CI), CPFT, CCT, FSICP and his burgeoning staff as he steadily moves forward to create what I believe to be his dream and passion in creating and international society of advanced cardiovascular imaging. Both Dr. Morton Kern, myself and other leading physicians have added their input and resources to this project. In that spirit, I personally am working with Mr. Williams and the society in an effort to further its organization and potentially organize an inaugural educational conference in 2009. In that spirit, we at the “New Cardiovascular Horizons” (NCVH) will host the first organizing committee meeting for the society’s board of directors and any interested party on Friday, September 12, 2008 in New Orleans within our 9th annual 4-day NCVH conference, to be held at the Sheraton Hotel, September 10-13, 2008. NCVH would waive any registration fee for anyone interested in attending this society’s organizational meeting during the conference. NCVH was attended by greater than 3,500 participants in 2007, and this year we will have a faculty of 175+, 150+ exhibits and will have a multidisciplinary agenda appropriate for all healthcare providers and cath lab professionals that will even include a 3-day SICP review course, ACVP Mini-CV MBA program and 30+ CME-CEUs. NCVH will have 3 days of complex, live PVD cases transmitted from the cath labs at CIS, with a focus on CLI and limb salvage cases. NCVH will end on Saturday with the Horizons Cath Lab Professional Symposium, which will have a renowned faculty with the theme of “Be the Best Team You Can BE!” I would invite all interested parties to join us in New Orleans this fall and especially those cath lab professionals interested in becoming a part of the development and organization of the International Society of Advanced Level Medical Imaging Physician Specialists. It is high time we organize this very important group of CV physician extenders. I hope to see all CLD readers soon in New Orleans.

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